Only one new antituberculosis drug has come to the market in the last 28 years despite nearly 2 million deaths from the disease occurring each year. A new report from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) - Incentives and Disincentives for New Antituberculosis Drug Development - looks at the reasons for the lack of interest in antituberculosis drugs by the pharmaceutical industry and how to stimulate research and development of new drugs. The report contains a brief description of the current situation and major findings of the evaluation. Lack of interest by pharmaceutical companies is attributed to:

• The cost of drug development: which varies between US $300 to 500 million, and company concern that the commercial return would be insufficient from patients in developing countries.

• Risk of patent violations.

• The perception that new drugs would not be responding to an unmet medical need given the cost-effectiveness of the directly-observed short-course treatment (DOTS) regimen for TB which is currently available. This would also tend to force down the price of any new drugs.

In conclusion, the report proposes broad recommendations which include the need for public sector efforts to build relationships with industry and other stakeholders, provide discussion and drive forward the process of antituberculosis drug development by helping to build, define and protect markets for new drugs. Governments should also be encouraged to strengthen their health infrastructure, lower the barriers to development and build financing mechanisms for the private sector.

Incentives and Disincentives for New Antituberculosis Drug Development. World Health Organization, Geneva, WHO/TDR/PRD/TB/00.1 (2000) or http://www.who.tdr/publications/antituberculosis.htm