Sweet Hope to End Bitter Pills for Multidrug-Resistant Tuberculosis

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Rallying call to end TB by 2030. Credit: Busani Bafana/IPS

BULAWAYO, Jul 15 2025 (IPS) – Every day, Yondela Kolweni has to hold down her son, who screams and fights when it is time for his daily life-saving TB tablets—a painful reminder of her battle with the world’s top infectious killer disease.

“It is a fight I win feeling awful about what I have to do,” says Kolweni (30), a Cape Town resident and a TB survivor. “The tablets are bitter, and he spits them out most of the time, and that reminds me of the time I had to take the same pills.”

Kolweni’s five-year-old son is battling Multidrug Resistant TB (MDR TB), a vicious form of TB that is rising among children globally.

The global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower social and economic development levels, according to a recent study. In addition, the top three highest incidence rates of MDR TB in 2019 were recorded in Southern sub-Saharan Africa, Eastern Europe, and South Asia, while the top three highest rates of deaths in the same period were recorded in Southern, Central, and Eastern sub-Saharan Africa.

South Africa is one of 30 countries that account for 80 percent of all TB cases in the world and has the most cases of drug-resistant TB.

A Bitter Pill to Swallow

Kolweni’s son was diagnosed with MDR-TB five years ago, having tested positive for TB which has affected his grandmother and his mother. He was immediately on treatment, a drug cocktail that included moxifloxacin—a pill not for the yellow-livered.

“There were two medications he had to take, and there was one specifically, the yellow one, that he did not like, and with the color he knew what it was,” Kolweni told IPS in an interview, explaining a daily battle to get her son to take his meds.

It was down to a fight. She crushed the tablets, mixed them with a bit of water, and fed them through a syringe.

“We would sometimes hold him or wrap a towel around him so that we could feed him the medication, but he would still spit it out, which meant he was not taking the dosage he was meant to take,” said Kolweni. “We then came up with the idea to put his tablets in his yogurt, but that technique did not work because, being a smart kid, he took the bait but would soon spit out the medication.”

Moxifloxacin, an exceptionally bitter medicine, is one of the key drugs in the new all-oral treatment for multidrug-resistant tuberculosis (MDR TB). The treatment is a combination of the drugs Bedaquiline, Pretomanid, Linezolid and Moxifloxacin, known as BPaLM. The BPaLM regimen is specially formulated for children but is a bitter pill to swallow.

Sweet Medicine

But there is sweet hope. A new study, by Stellenbosch University and the TB Alliance, found that sweet, bitter-masked versions of Moxifloxacin significantly improve kids’ willingness to take the drug—easing the burden on parents and boosting treatment adherence.

Two formulations of moxifloxacin have been identified by children as tasting better than new generic versions of products currently on the market.

The results from the ChilPref ML study—a Unitaid-funded effort sponsored and led by Stellenbosch University in collaboration with TB Alliance—will help improve MDR TB treatment and adherence in children.

Dr. Graeme Hoddinott, of Stellenbosch University and the principal investigator of the study, notes that children cannot be treated in a humane manner for drug-resistant TB if the medicines taste so terrible that children refuse them or must be forced to take them.

Children diagnosed with drug-sensitive TB have good outcomes even within the four months because there is usually one tablet given, and there is a child-friendly formulation that dissolves easily to be given on a spoon or in a syringe, Hoddinott said. However, for drug-resistant TB, the situation is complicated. Most drugs for MDR TB are no longer used because of their toxicity and have been replaced by new drugs.

MDR-TB drugs are not child-friendly, Hoddinott admits. The active ingredient that kills TB in Moxifloxacin makes the pills incredibly bad tasting for children who have to take the medication daily for between six and nine months in cases of MDR TB.

“These drugs are incredibly bad tasting; they are genuinely awful to a point where adults who have been on extended TB treatment have been unable to administer the same drugs to their children because the smell evokes the time when they were sick,” Hoddinott told IPS. “It is a trauma to administer such bad-tasting drugs to a child, both for the parent and the child, particularly for the young children.”

The ChilPref study recruited just under 100 healthy children, ages 5–17, from two diverse settings in South Africa. The children evaluated flavor blends using a ‘swish and spit’ taste panel—tasting the medicine, which was dissolved in water, and then spitting it out without ingesting any of it.

Each child participant ranked the flavor blends among the three from each manufacturer and also rated the taste, smell and other characteristics of each. For moxifloxacin, there was a clear, strong preference for the new flavor blends (“bitter masker” and orange for Macleods, and strawberry and raspberry and tutti frutti for Micro Labs) over the existing commercially available flavors for both manufacturers. For Linezolid, there was no preference between the flavor blends.

“Ensuring children have access to effective and palatable TB treatments is a crucial step in improving adherence and treatment outcomes,” said Koteswara Rao Inabathina, one of the study’s authors and CMC Project Manager at TB Alliance.

“Through close collaboration with manufacturers, we have addressed critical unmet needs by developing practical solutions that make available and effective drug-resistant TB treatments not only accessible but also palatable and acceptable for children.”

The results of the ChilPref study showed that children preferred two new flavor blends of moxifloxacin, produced by Macleods Pharmaceuticals, India, and Micro Labs Pharmaceuticals, India. The results were communicated to the manufacturers, who are already updating their products.

“We are not surprised that a lot of kids did not like any of the tastings because we knew that they were horrible taste-wise, but we got a very clear signal for both manufacturers that the flavor blends we recommended were more preferred,” Hoddinott said. “We changed which flavor was going to market with relatively simple research.”

Dr. Cherise Scott, Senior Technical Manager at Unitaid, said the easier it was for children to take their medicines regularly, the more likely they were to complete their treatment successfully.

“We will not allow children to be neglected in global health responses simply because their needs are more complex.”

A Promising Treatment for MDR TB

As multi-drug-resistant TB transmission increases among children and adolescents, the development of new treatments is imperative, Hoddinott explained.

Moxifloxacin may also be increasingly used in the future for the treatment of drug-susceptible TB, which affects an estimated 1.2 million children globally each year.

Drug-resistant TB, has previously been one of the most difficult diseases to manage because of limited child-friendly treatment options, but scientists have made strides in developing new treatments for children, explains Dr. Anthony Garcia-Prats, one of the study authors and an associate professor at the University of Wisconsin-Madison.

“Now we are making sure that these medicines are appropriate for children, starting with an aspect that children and parents say is critical: taste,” Garcia-Prats said in a statement.

The new treatment is given when TB is either resistant to rifampicin, a critical first-line drug, or rifampicin and isoniazid, another first-line drug combination. These resistant strains are collectively referred to as RR/MDR-TB.

Annually there are an estimated 32,000 new cases of RR/MDR-TB among children 14 years and under—a population that is extremely sensitive to the taste of medicine, according to researchers.

This discovery could help improve adherence to TB medication and move a step closer towards the United Nations Sustainable Development Goal 3 to end TB by 2030.

“It is not a silver bullet,” Hoddinott cautions. “It does not solve everything, as people affected by TB still face many other challenges, and even the preferred flavor blends still do not taste nice. But, as part of the overall fight against TB in children, it’s an important step.”

Kolweni welcomes the development of masked TB medication.

“My experience with TB medication was not nice, and for children it is worse, and I think flavored tablets would make it easy for children to take, like  Gummies,” she said. “Every child loves flavors; even a suspension would be nice. My son would love it, and I will have no trouble getting him to take his medicine.”

Note: This article is brought to you by IPS Noram, in collaboration with INPS Japan and Soka Gakkai International, in consultative status with the UN’s Economic and Social Council (ECOSOC).

IPS UN Bureau Report

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Africa Will Not Cope with Climate Change Without a Just, Inclusive Energy Transition

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Climate change impact on Africa has been devastating as this photo taken in the aftermath of Cyclone Idai in Mozambique shows. A just transition is needed. Credit: Denis Onyodi / IFRC/DRK

Climate change impact on Africa has been devastating as this photo taken in the aftermath of Cyclone Idai in Mozambique shows. Credit: Denis Onyodi / IFRC/DRK

NAIROBI, Nov 24 2023 (IPS) – A just transition should be viewed as an opportunity to rectify some of the wrongs where women are not prioritised in the energy mix, yet their experience of the impact of climate change is massive, says Thandile Chinyavanhu, a young South African-based climate and energy campaigner with Greenpeace Africa.

Recent UN scientific research on the state of the climate change crisis and ongoing climate action reveals that the window to reach climate goals is rapidly closing. The world is not on track to reach the goals set out in the Paris Agreement, which commits all countries to pursue efforts to limit the global temperature increase to 1.5°C above pre-industrial levels.

To achieve this goal, emissions must decrease by 45% by 2030 and reach net zero by 2050. Ahead of COP28 in Dubai, United Arab Emirates (UAE), expectations are high that a clear roadmap to net zero progress will be reached, bringing issues of energy, a global energy transition, and energy security into sharp focus.

The energy sector has a significant impact on climate as it accounts for an estimated two-thirds of all harmful greenhouse gas emissions. The burning of fossil fuels is the primary cause of the ongoing global climate change crisis, significantly altering planet Earth. The issue of energy and climate is of particular concern to African countries, especially the Sub-Saharan Africa region, as they also relate to increased vulnerabilities for women, especially rural women. The intersection between energy security and economic growth, poverty reduction, and the empowerment of women and girls is not in doubt.

Still, despite access to reliable, affordable, and sustainable energy for all being articulated under the UN’s SDG 7, one in eight people around the world has no access to electricity. In sub-Saharan Africa alone, nearly 600 million people, or an estimated 53 percent of the region’s population, have no access to electricity. Currently, less than a fifth of African countries have targets to reach universal electricity access by 2030. For some, the silver bullet is to dump fossil fuels and go green; for others, it is an urgent, just, and equitable transition to renewables.

IPS spoke to Chinyavanhu about her role as a social justice and climate activist. She says she wants to contribute to climate change mitigation, ensuring that people and cities are prepared for climate change and can adapt to what is coming.

Thandile Chinyavanhu

Thandile Chinyavanhu

Here are excerpts from the interview.

IPS: Why are current energy systems untenable, considering the ongoing climate change crisis?

Chinyavanhu: On going green and dumping fossil fuels, there are several issues at play, and they vary from country to country. Fossil fuels—coal, oil, and gas—are by far the largest contributors to global climate change, as they account for more than 75 percent of global greenhouse gas emissions and nearly 90 percent of all carbon dioxide emissions. South Africa, for instance, has a big coal mining industry and is one of the top five coal-exporting countries globally. The country relies heavily on coal for about 70 percent of its total electricity production. We need to move away from energy consumption models that are exacerbating the climate crisis, but we must also ensure that we are centred on a just transition.

IPS: What should a ‘just energy transition’ look like for Africa and other developing nations?

Chinyavanhu: Overall, we are looking at issues of socio-economic development models that leave no one behind. To achieve this, renewable energy is the pathway that provides us with energy security and accelerated development. We have serious energy-related challenges due to a lack of preparation and planning around the energy crisis. The challenge is that Africa needs energy and, at the same time, accelerates its development in a manner that leaves no one behind, be it women or any other vulnerable group that is usually left behind in policy responses.

There is a need to address challenges regarding access to energy for all so that, in transitioning to clean energy, we do not have any groups of people being left behind, as has been the case. This is not so much a problem or challenge as an opportunity for countries to address gaps in access to energy and ensure that it is accessible to all, especially women, bearing in mind the many roles they play in society, including nurturing the continent’s future workforce. A just energy transition is people-centred.

We must recognise and take stock of the economic impact that moving from fossil fuels to clean energy could have on people and their livelihoods, such as those in the mining sector. It is crucial that people are brought along in the process of transition, giving them the tools and resources needed for them to be absorbed into new clean energy models. There is a very deep socio-economic aspect to it because people must be given the skills and capacities to engage in emerging green systems and industries.

IPS: As a young woman activist, what do you think the roles of women in an energy transition are?

Chinyavanhu: Women are generally not prioritised, and so they do not have the same opportunities as men, even in matters of climate change adaptation and mitigation, and this is true for sectors such as agriculture and mining. Women have great economic potential and have a very big role to play towards a just energy transition as key drivers of socio-economic progress.

In the green energy space, economic opportunities are opening up. Men are quickly taking over the renewable energy industry, but there are plenty of opportunities for women to succeed if given the right resources. We are at a point in time when we have the opportunity to leave behind polluting technologies and, at the same time, address some of the key socio-economic challenges that have plagued societies for a long time.

This transition should be viewed as an opportunity to rectify some of those wrongs in a way that is people-centred and inclusive. No one should be left behind. It is really about building harmony with nature while also addressing many of the socio-economic issues that plague us today. This is more of an opportunity than a hurdle. It is about understanding and rectifying systems’ thinking that contributes to women being left behind. It is important that we see the bigger picture—identify and acknowledge that different groups—not just women, but any identifier that places people at a point of vulnerability—have been left furthest behind. The energy transition process has presented an opportunity to make it right.
IPS UN Bureau Report

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Malawi Looks to Cannabis to Supplement Lost Tobacco Earnings

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legalizing cannabis,
legalizing cannabis,
Malawi Looks to Cannabis to Supplement Lost Tobacco Earnings

Written BY: Lameck Masina

LILONGWE, MALAWI — Malawi is the latest African country to look at legalizing cannabis, the plant that produces hemp and marijuana, after similar moves in Lesotho, South Africa, and Zimbabwe. As Malawi’s tobacco industry, the country’s biggest foreign exchange earner, has dwindled due to anti-tobacco campaigns, farmers are now looking to grow cannabis.

Malawi has long relied on tobacco, which accounts for 13 percent of its gross domestic product and 60 percent of its foreign exchange earnings.

But as tobacco prices per kilogram have fallen, farmers like Phineas Chimombo have struggled.

Chimombo says in most cases farmers like him who are already poor struggle to find money to transport tobacco to the market and sell their tobacco as low as 50 cents per kilogram.

Health campaigns have eaten into tobacco profits, so farmers like Chimombo are looking to cannabis, the plant that produces marijuana and hemp.

Chimombo says once one grows hemp, just a small portion of it fetches more money than one can get from any crops a farmer can grow.

Malawi is joining African nations Lesotho, South Africa, and Zimbabwe in looking to legalize cannabis after years of debate.

In March, legislators will consider a bill on legalizing medical marijuana and hemp products.

Malawi parliament member Boniface Kadzamira has long pushed for the legalization of cannabis.

“We were the first in this part of Africa to start discussing this thing. Those countries that came after us have gone ahead of us and have already started issuing licenses,” Kadzamira said.

Malawi’s anti-drug campaigners worry legalizing medical marijuana will encourage more recreational use.

Nelson Zakeyu is the executive director of Drug Fight Malawi.

“And because local marijuana is commonly used in the country, then [it is] is legalized, [it] is like they are telling young people to use local marijuana. And that is what we are fearing,” Zakeyu said.

But supporters of legalizing cannabis appear to have won the debate, that it is better to regulate the trade and help Malawi’s economy to grow.

Source: VOA News