Indian civil society pushes for ‘Government Use’ compulsory license on MDR-TB Drugs


Survivors of drug resistant tuberculosis, health organisations and the TB community in India and across the globe have appealed to the Prime Minister of India to issue a government use compulsory license for two of the essential drugs for Drug-Resistant Tuberculosis (DR-TB) treatment- Bedaquiline and Delamanid to encourage generic competition. 

Bedaquiline and Delamanid adult formulations were added to the WHO Essential Medicines List (EML) for TB in 2015, and Delamanid was added to the WHO EML for children in 2017.

The Patents Act provides for a special provision that empowers the Central Government to notify a compulsory license for public non-commercial use. The government use license for Bedaquiline and Delamanid thus issued will encourage generic production and supply to India’s TB Control Program and reserving them for public health use.

Drug-resistant TB is a major public health problem across the globe. Out of the ten million people who fell ill with tuberculosis (TB) in 2016 alone, over half a million are estimated to have resistance to the most effective drugs used to treat TB, rifampicin and isoniazid. These new TB drugs offer fresh hope to those at high risk of treatment failure; notably, people living with HIV co-infected with DR-TB, children with DR-TB, extensively and pre-extensively drug resistant (XDR/pre-XDR) TB patients and those with drug intolerance.

With about 1.3 lakh annual incident of MDR-TB in India, the Indian TB Control Program is in the process of introducing these new drugs through donations and will have to pay INR 1 lakh for a six-month Delamanid course and bedaquiline INR 58,000 for a six-month course in the coming years.  Prices of these drugs could be reduced 95% through generic competition.   

Lawyers Collective along with 59 other civil society organisations (India and international) and 31 individuals have written to the Prime Minister of India seeking a government-use compulsory license on Multi-Drug Resistance TB drugs called Bedaquiline and Delamanid.

Read the full text of the letter below: 


Mr. Narendra Modi,

Honourable Prime Minister of India,

Prime Minister’s Office,

South Block, Raisina Hill,

New Delhi 110011


March 12, 2018

SUBJECT: Appeal to issue ‘government use license for new TB medicines’ for securing access to affordable DR-TB treatments across the developing world


Dear Prime Minister Modi,

Representing people affected by DR-TB, various health organizations, people living with HIV and the TB community in India and across the world, we are writing to appeal to the Indian government to continue to play its crucial role in global health by addressing the urgent treatment needs for drug-resistant tuberculosis (DR-TB).


Although tuberculosis is gradually declining worldwide, nearly half a million people acquire DR-TB each year, which poses a serious public health challenge. In India alone, an estimated 1,30,000 multi-drug resistant TB patients emerge annually (Central TB Division, Annual Status Report, 2017).


After a gap of 50 years, the new antibiotics, bedaquiline and delamanid, together with re-purposed drugs, now provide opportunities to countries with a high burden of TB to improve the safety and efficacy of its DR-TB treatment regimens and thus, prevent further infections, resistance and deaths.


As a response to the ‘high unmet medical need’  for new treatment options for multidrug-resistant tuberculosis, bedaquiline and delamanid adult formulations were added to the WHO Essential Medicines List (EML) for TB in 2015 while delamanid was added to the WHO EML for children in 2017.


These new TB drugs offer fresh hope to those at high risk of treatment failure; notably, people living with HIV co-infected with DR-TB, children with DR-TB, extensively and pre-extensively drug resistant (XDR/pre-XDR) TB patients and those with drug intolerance.


Subsequent to India’s adoption of the product patent regime for pharmaceuticals in 2005 (the WTO TRIPS deadline), bedaquiline and delamanid were two of the first TB drugs to be patented. The compound patents numbers for bedaquiline and delamanid are IN236811 and IN250365, which expire in July and October 2023, respectively.


Currently, access to the new, patented TB drugs is solely dependent on ‘mere imports’ that Johnson and Johnson (J&J)/United States Agency For International Development (USAID) and Otsuka donate to the TB programme in India. Not just in India, access to these critical drugs remains limited in other high burden countries in the developing world.


Once the USAID/J&J donation concludes in April 2019, the price for a six-month course of bedaquiline in India will be USD 900 and even higher in other middle-income countries. Additionally, the Japanese pharmaceutical corporation, Otsuka, charges an exorbitant USD 1700 for a six-month delamanid course, the price of which is not expected to decrease substantially.


According to a study published in the Journal of Antimicrobial Chemotherapy, the target generic price for a six-month course of bedaquiline and delamanid is between USD 48 to 102 and USD 36 to 96, respectively. Thus, prices could fall by up to 95% through the generic production of these life-saving medicines.[i]


However, in the absence of government support and awaiting patent expiries in 2023, a number of Indian manufacturers are hesitating to move forward with any plans for the production of these drugs.

Since it can take up to two years to develop and file a registration dossier with the Central Drugs Standard Control Organization (CDSCO) and the WHO prequalification programme, plans for the scale up and generic supply of these antibiotics to the TB programme needs to be put in place now.


As affirmed in the Doha Declaration on the TRIPS Agreement and Public Health and even more recently, by the United Nations High-Level Panel on Access to Medicines (UNHLP), international trade rules allow countries to issue licences when pharmaceutical companies fail to make patented medicines available and affordable to patients and governments.

Time and again, multiple countries have made use of this provision. Most recently, the Malaysian government affirmed its commitment to help the more than 400,000 people living with hepatitis C and scale up access to affordable treatment in the public health system throughout the country by issuing a ‘government use’ licence that enables its Ministry of Health to procure generic sofosbuvir at the lowest possible price.

India, too, supports the use of TRIPS flexibilities, the Doha Declaration and the UNHLP recommendations on access to medicines. Numerous health ministries rely on generic medicines from India, which have played a pivotal role in the scale up of HIV and HCV treatment across the developing world.


India’s role is thus critical and it needs to desist from endorsing secretive bilateral voluntary licensing deals between pharmaceutical companies for their own profits, and instead, operationalize generic supply through a government use license. The grant of a government use license on grounds of public non-commercial use (under section 92) would create competition, significantly reduce government expenditure, provide impetus to the scaling up of access to these new TB drugs globally and help kick start the generic supply of new TB drugs to the national TB programme by 2019.


So many lives depend on it.


Yours sincerely,


Bazo Kire, Kekhrie Foundation, Nagaland

Bobby Khumanthem, Health Activist, India

Daisy  Dharmaraj, M.D., Director TEST Foundation

Daisy David, Chennai

Dr Arne von Delft, living with presumed latent MDR-TB

Dr Ruvandhi Nathavitharana, Infectious diseases physician and TB researcher at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston

Dr. Dalene von Delft, occupational MDR-TB survivor

Dr. Helene-Mari van der Westhuizen, TB Activist

Dr. Mira Shiva, MD

Dr. Zolelwa Sifumba, occupational MDR-TB survivor

Edwina Pereira, Child First Foundation

Eldred Tellis, Sankalp Rehabilitation Trust, Mumbai

Ganesh Acharya, TB Activist and Survivor, Mumbai

Henry Zohmingrhanga, ex-MPLAS Secretary, Aizawl, Mizoram

Ingrid Schoeman,  occupational XDR-TB survivor

Jennifer Furin, MD., PhD., Harvard Medical School, Boston, MA, USA

Ketholelie Angami, Health Activist, India

Lorraine Misquith, Health Activist, India

Mutum Tilak Singh , TB survivor

Nandita Venkatesan, DT-TB survivor

Neil Jaitly Khongwir, Manbha Foundation

Paula Donovan, AIDS-Free World

Peter Angom, Health Activist, India

Phumeza Tisile

Prashant, TB Survivor

Raman Chawla, Independent Consultant, India

Anand Grover, Senior Advocate

Renbonthung Tongoe, ARK Foundation

Safiatou Simporé, Yolse, Santé Publique & Innovation, West Africa

Soubhagya Chakrabarty

Stephen Lewis, Director, AIDS-Free World

Suthirtha Dutta, Health Activist, India

AIDS Access Foundation, Bangkok

AIDS Access Foundation, Thailand

AIDS and Rights Alliance for Southern Africa (ARASA)

AIDS-Free World

All India Drug Action Network

All-Ukrainian Network of People Living with HIV

ARK Foundation, Nagaland

Brazilian Interdisciplinary AIDS Association

Care and Support Society, Nagaland

Citizen News Service (CNS)

Delhi Drug Users Forum

Delhi Network of Positive People (DNP+)

Dimapur Network of Positive People

Drug Study Group, Thailand

Drug System Monitoring and Development Program, Thailand

Drug-Resistant TB Scale Up Treatment Action Team

Empower India

European AIDS Treatment Group

Foundation for AIDS Rights, Thailand

Foundation for Consumers, Thailand

FTA Watch, Thailand

Global Coalition of TB Activists

Gramin Samaj Kalyan Vikas Manch, Jharkhand

Health GAP (Global Access Project)

Hep. Com

Hepatitis AIDS and Tuberculosis (HeAT NE Region)

Hopers Foundation, Chennai

Human Touch


Initiative for Health & Equity in Society

International Human Rights Clinic, Northwestern Pritzker School of Law 

ITPC, South Asia

Just Treatment

Kalinga Network for People Living with HIV/AIDS (KNP+), Odisha

KELIN, Kenya

Knowledge Ecology International

Lakshita Foundation of India

Lawyers Collective

Meghalaya Drug Users Network

Mizoram Drug Users Forum

Mizoram HCV Response Team (MiHReT)

Nirmaan Rehabilitation Facility

Northeast India TB Coalition

Pan-African Treatment Access Movement (PATAM)

People’s Health Systems Movement, Thailand

Positive Malaysian Treatment Access & Advocacy Group (MTAAG+)

Positive Women Network, India

Salud por Derecho – Spain

Section 27, Johannesburg

Social Awareness Service Organization

South Indian Harm Reduction Network

TB Proof

Thai Network of People Living with HIV/AIDS (TNP+)

The Global Network of People Living with HIV (GNP+), The Netherlands

The Sentinel Project on Pediatric Drug-Resistant Tuberculosis

Third World Network

Touched by TB- National Coalition of People affected by TB, India

Treatment Action Campaign

Treatment Action Group, USA

Western Harm Reduction Network, India


[i] Dzintars Gotham et al. “Estimated Generic Prices for Novel Treatments for Drug-resistant Tuberculosis,” Journal of Antimicrobial Chemotherapy 72, Issue 4 (2017): 1243–1252. Available:,




Shri Jagat Prakash Nadda, Minister of Health and Family Welfare (MOHFW)

Shri Suresh Prabhu, Minister of Commerce and Industry

Smt. Anupriya Patel, Minister of State, MOHFW

Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organisation

Ms. Preeti Sudan, Secretary, MOHFW

Ms. Rita A. Teaotia, Secretary, Department of Commerce

Shri Ramesh Abhishek, Secretary, Department Of Industrial Policy & Promotion

Dr. Vinod Paul, Member, NITI Aayog

Shri Manoj Jhalani, AS & MD, National Health Mission, MOHFW

Dr. R.K. Vats, AS & DG (CGHS), MOHFW




Comments are closed.