Illustration of someone sitting at a lemonade stand with a sign advertising tuberculosis tests.
Design by Hailey Kim

Last week, activists and patients won a breakthrough in the fight against the world’s deadliest infectious disease: tuberculosis. Cepheid, a medical equipment manufacturer owned by the multinational conglomerate Danaher, agreed to slash the price of their multi-drug resistant tuberculosis tests after lobbying from organizations such as Doctors Without Borders and Partners In Health — and the novelist-philanthropist-YouTuber duo Hank and John Green.

Adding to an increasingly large body of work spreading awareness about tuberculosis, John Green’s video compares Cepheid’s business model to those of printer, razor and coffee-pod companies: sell an effective base device at a relatively accessible price, but offer the essential and replaceable component at a high mark-up.

Cepheid’s equivalent of the printer is the GeneXpert, a machine which can test a sample for genetic markers of countless infections and their variations — including COVID-19, HIV, influenza and, of course, tuberculosis. The machine is game-changing for diagnosing tuberculosis, which is still most commonly done through the 130-year-old process of microscopy. Scientists and doctors manually scanning a sputum sample for tuberculosis bacteria under a microscope miss more than half of all cases and cannot determine if a bacterium is drug-resistant. 

Multidrug- and extensively drug-resistant tuberculosis infections — MDR and XDR tuberculosis, respectively — require specialized, incredibly rigorous treatment plans, involving a cocktail of two to four drugs (or more) taken on a strict schedule for six to nine months. If treatment is missed or delayed, the tuberculosis can develop a resistance to one or more drugs and, catastrophically, stop responding to treatment.

Thankfully, the GeneXpert is able to quickly and accurately scan samples for tuberculosis and determine if the bacteria is drug resistant. This minimal turnaround is critical for a timely response and has the potential to save hundreds of thousands of lives around the world, especially in the low-income and middle-income countries where tuberculosis is most commonly transmitted. However, the printer needs its ink: The GeneXpert uses test cartridges, which now range from about $8 for one MDR tuberculosis test to $15 for an XDR test.

Cepheid had sold the MDR cartridge for $9.98, a price which Doctors Without Borders estimated was a 20% markup. In a press release, Danaher officials reported that Cepheid would sell their MDR tests at the cost of manufacture, $7.97, and forgo profits on the product. This is still $3 more than organizations like Doctors Without Borders had hoped for, and XDR cartridges remain at their high price, but it is undoubtedly a step in the right direction.

A $2 difference between a marked-up and break-even cartridge might seem miniscule, but it’s crucial to consider the target demographic of tuberculosis tests. While tuberculosis is certainly still a problem in the United States and other wealthy countries, the highest risk falls on citizens of poorer countries. Clinics in South Asia, Southeast Asia and across Africa are often already spread thin, with minimal resources and higher incidence of infectious disease. Coinfection of tuberculosis and another major illness, such as HIV, is a major concern and can spell disaster for patient prognosis.

In an interview with The Michigan Daily, Denise Kirschner, professor of microbiology and immunology, said that tuberculosis doesn’t get enough attention simply because it doesn’t directly affect the developed world as much as a disease like COVID-19, which briefly overtook tuberculosis as the world’s deadliest infectious disease between 2020 and 2021.

“TB is a Brown disease,” Kirschner said, referencing a panel held by the World Health Organization on World Tuberculosis Day, March 24. “It is in countries that are predominantly people of Color and of low socioeconomic status.”

Kirschner also shared concerns about the increase in drug resistance as tuberculosis infections persist and lie dormant as latent infections. While we don’t know what the next pandemic will be, we can be assured that tuberculosis will play a role in the health outcomes of countless patients around the world.

In the wake of a modern pandemic, as COVID-19 settles as an endemic disease, the healthcare industry will have to consider its priorities. Are hand-over-fist profits worth the people inherently placed out of testing and treatment?

World governments have the ability to subsidize healthcare companies, especially in widespread emergencies. While government subsidies could threaten competition in the industry, competitive grants could still incentivize the development of effective tests and interventions at low-to-no cost to patients.

More than that, we as citizens, patients and people need to understand the threats to vulnerable communities around the world. With empathy comes compassion, and with it solidarity. Even beyond the threat of tuberculosis or other diseases spreading in the U.S., we should be worried about how people are experiencing those diseases now — and how they are being actively taken advantage of.

There are plenty of differences between the large-but-unequal health care system in the U.S. and the smaller (and also unequal) systems in poorer countries. The key, however, is giving voice to the people in the face of explicit corporate greed. Given a choice between patents and patients, there is no contest.

Nick Rubeck is an Opinion Columnist from Williamston, Mich. He writes about what our food, media and physical spaces can tell us about ourselves. He can be reached at nmrubeck@umich.edu.