What do an author, an online community of meme makers, and global healthcare all have in common? Well this week, they took up arms in an ongoing effort to persuade a global conglomerate to prioritise healthcare over greed in the fight against Tuberculosis.
- The author: Renowned young adult writer and Tuberculosis advocate, John Green, who you might know from his ‘The Fault in Our Stars’ fame.
- The online community: Nerdfighteria, a group of John Green fans who have combined research, web design and meme creation skills to fight for people over profits
- The health care partners: Médecins Sans Frontières (Doctors Without Borders), Partners in Health, Stop TB, alongside many more, and a longstanding effort called Time for 5.
And the business at the centre of this flurry of attention: Cepheid (the producer), and Danaher (the profiteer), of lifesaving Tuberculosis tests.
An unlikely combination of grassroots advocates, healthcare economics, creative memes and a sprinkling of celebrity notoriety, this campaign may just provide the much needed win in the ongoing and so often forgotten battle against tuberculosis.
But you may ask: Why should we care about tuberculosis in 2023? Hasn’t this ‘romantic’ disease of the past been eradicated already?
Well not exactly.
Tuberculosis (TB) is an airborne bacterial infection which remains the deadliest infectious disease and the 13th leading cause of death in the world. Historically considered a disease of poets and artists (spoilers if you’ve never seen Moulin Rouge!) a cure was discovered in the 20th century, with TB now preventable and curable with the aid of antibiotics.
And yet the disease is estimated by the World Health Organisation to have infected a quarter of the global population as of 2023, with 1.6 million people dying every year. That is 3 people every minute. And the primary barrier in this preventable disease? Diagnosis.
Caused by slow moving bacteria, but fast moving transmission, Tuberculosis is signaled by mild and often under-noticed symptoms such as a prolonged cough. Furthering difficulties is the evolution of multidrug-resistant TB, which requires extensive and expensive medicine to combat. As the World Health Organisation highlights “Multidrug-resistant TB remains a public health crisis and a health security threat”, with only 1 in 3 multidrug-resistant sufferers accessing treatment in 2021.
So, here exists a curable disease killing millions each year in a world that has been largely told that we have eradicated this disease of the past – in wealthy countries that is.
In 2021 India, Indonesia, China, The Philippines, Pakistan, Nigeria, Bangladesh and Democratic Republic of the Congo accounted for more than ⅔ of all global TB cases. So, while the West may not be burdened with this disease of the past, the rest of the world certainly is.
And that is where Danaher, Cepheid and their controversial biotech come in. With an ethical code to “support international efforts to promote and protect human rights”, this conglomerate provides a powerful product for good by diagnosing Tuberculosis via WHO approved Xpert MTB/RIF rapid tests called GeneXpert tests. Similar to COVID-19 lateral flow tests, these offer an accurate diagnosis within an hour, and can save hundreds of thousands of lives by expediting the path towards correct care. In fact, these GeneXpert tests can even be used to diagnosis Covid, HIV and other deadly epidemics.
Unlike our more familiar COVID-19 tests however, Danaher and Cepheid use a razor-blade model similar to printers. Meaning they sell an affordable machine but price gouge the subsequent cartridges for each test. One health care provider quoted by John Green said, “the machine is amazing, if only we could afford the tests.”
Global health professionals estimate test production costs sit at about $3 – $4.60 per test. However, Danaher charges $10 (USD) per TB test and up to $15 (USD) for other disease tests (despite the same cost price), creating at least a 200-500% markup.
Given that the median wage in high-burden TB stricken nations such as Sierra Leone is $10 a week – Danaher and Cepheid have made a public good that is simply inaccessible to much of its customer base.
So not only is Diagnosis easy and possible, but Tuberculosis is curable.
And the primary blockade in global efforts to fight TB are the very companies that produce and profit off modern medicines’ lifesaving diagnosis innovations.
Which is why various healthcare professionals have found the need to call in the reinforcements of John Green and his meme making, public-pressure-putting, injustice fighting Nerdfighteria.
Médecins Sans Frontières (Doctors without Borders), is one such organisation which has been fighting tuberculosis in impoverished communities for over 30 years. Since 2019, they have been calling on Cepheid and Danaher to lower their prices to $5, in a global coalition called ‘Time For $5’.
They believe that a blanket $5 price on GeneXpert tests would save lives and retain an acceptable profit margin for the companies, if only Cepheid and parent company Danaher would listen.
Enter John Green, an author hyper-focused on the unjust tuberculosis epidemic, and his army of online campaigners who have experience overwhelming big companies into listening to public pressure. In fact, the group even (unknowing) had a practice run in July, where they took a mere 4 days to convince pharmaceutical company Johnson & Johnson not to renew their expiring patent on the life saving TB drug Bedaquiline.
“A wondrous and terrifying force,” Green praised the group before the campaign began, “No one understands Nerdfighteria until they experience it.”
And the aim of this incoming onslaught of memes, playlists, emails, calls and vast online campaigning: to signify to Danaher, Cepheid and frankly all their stakeholders that this is unacceptable, people are paying attention and they will keep paying attention.
“In my opinion it is just unconscionable,” John Green announced in his first campaign video on Tuesday. “And so I am angry. [People] died because they couldn’t get an accurate test in time and I simply don’t believe that Danaher charging these profit margins is making it easier for anyone who needs the test to be able to access it.”
“You’ve built something amazing with the GeneXpert machine but building something is only valuable if the people who need it most can access it.”
“I am disappointed that Danaher is choosing profits over people, but I don’t think it’s inevitable. I think most people, most of the time want to do what is right, they just sometimes need polite and impassioned reminders of what is right.”
Thus begins a campaign of authors, healthcare experts, nerdfighters and yes, memes, working to offer ‘polite and impassioned reminders of what is right’.
That public good is only ‘good’ if it’s accessible to all. That limited funds should not mean limited treatment. That no one should die of TB in 2023 because they can’t afford diagnosis.
That it is time for $5 tests. That it is time to put People Over Profits.