Despite this, far too few people are able to access the drug. Since bedaquiline was approved for use in 2012, just over 37,000 people have ever received it. This is a paltry figure considering that an estimated 80 percent of the 484,000 people who develop DR-TB annually should be treated with this drug, according to the World Health Organization's 2019 Global Tuberculosis Report. Rapid rollout of better-tolerated treatment containing bedaquiline will happen only if J&J makes it widely available in an affordable way, including by allowing other TB drug manufacturers to make generic versions.

Bedaquiline was developed with considerable taxpayer, non-profit and philanthropic support. Much of the critical work to inform the use of the drug and demonstrate its therapeutic value was conducted by the TB research community, health ministries, and treatment providers including MSF, and was financed by taxpayers and other donors. J&J should therefore not be the sole decision maker regarding who has access to the drug.

J&J currently charges double the price that MSF is asking: J&J has priced bedaquiline at $400 for a six-month treatment course for countries eligible to buy the drug through the Global Drug Facility, an organization run by the Stop TB Partnership that supplies TB drugs to low- and middle-income countries. J&J charges far more in other countries. Additionally, some people require up to 20 months of the drug, raising the price of bedaquiline alone to $1,200. However, researchers from the University of Liverpool have calculated that the drug could be produced and sold at a profit for much less—as little as 25 cents per day if at least 108,000 treatment courses were sold per year.

MSF is the largest nongovernmental provider of TB treatment worldwide and has been involved in TB care for 30 years, often working alongside national health authorities to treat people in a wide variety of settings including chronic conflict zones, urban slums, prisons, refugee camps, and rural areas. As of September 2019, across MSF projects in 14 countries, more than 2,000 people have been treated with the newer drugs, including 874 with delamanid, 1,946 with bedaquiline, and a subset of 429 people who were treated with a combination of both medicines.