Table 1.

The right to enjoy the benefits of scientific progress: Actors, duties and responsibilities related to Multidrug-Resistant TB (MDR-TB).

	Actor*
Domain of activity	Domestic state	Home state of pharma company	Private pharma	University and research institutions	Global foundations and consortia
An intellectual property system that enables the REBSP	Establish an IP system that rewards R&D but does not place obstacles to the REBSP for neglected diseases Duty to respect	Desist from using IP provisions when domestic state has thoughtfully and appropriately sought alternative routes. Duty to respect	Engage actively in translating CSR commitment into rights responsibilities for IP issues	Lobby for an IP system that rewards R&D but does not place obstacles to the REBSP for neglected diseases	Actively promote an IP system that rewards R&D but does not place obstacles to the REBSP for neglected diseases
Basic science to identify new drugs and trials to establish efficacy and effectiveness	An overarching science policy reflecting the REBSP Duty to facilitate	Strengthen research capacity in LMICs through technology and knowledge transfer without IP hindrances. Duty to facilitate	Respond to responsibilities outlined in Guidelines for Transnational Corporations by pursuing relevant research	Conducting research relevant to MDR-TB	nIcrease public accountability for decision making as to what is funded and how
	Direct state funding for research on MDR-TB Duty to provide	Subsidies or tax advantages to encourage private sector Duty to fulfill	Desist from ever-greening practices that remove potentially effective drugs from a development pipeline	University to develop and implement systems to support responsive research	Contribute to funding for R&D on new medicines
	State adherence to commitments for funding R&D Duty to provide	Investment in human resource capacity to do research Duty to facilitate	Translate responsibilities through technology transfer to LMICs	Capacity development of researchers to deliver research outputs needed.	Engage with (donor) states, NGOs, and international organizations to promote and organize R&D on new medicines
	Subsidies or tax advantages to encourage private sector Duty to facilitate			Allocate university resources to promote relevant research
	Soliciting partnership agreements to support research Duty to facilitate
	Regulatory action to ring-fence public sources (such as tax) Duty to facilitate
Basic science to identify new drugs and trials to establish efficacy and effectiveness	Investment in human resource capacity to do research Duty to facilitate
	Expedited regulatory approval for trials Duty to protect
Developing regimens for existing repurposed drugs#	Expedited regulatory approval for appropriate indication Duty to facilitate	Ensuring sufficient pharma capacity for drug manufacture	Ensuring sufficient pharma capacity for drug manufacture	Exploratory research to identify candidate drugs for repurposing	Mobilizing resources globally for development and operational research
	Negotiations on cost with pharma (tender agreements, with forecasting) Duty to facilitate		Ensure rights to a drug are available (give away rights) if pharma has no interest in manufacture		Setting up global consortia for purchasing
Regulatory approval post trials	Fast-track or expedited processes for neglected diseases Duty to facilitate		Pursue registration of drugs vigorously following successful demonstration of effectiveness	Providing expertise for advice in regulatory decision-making
Regimen development	Permitting operational studies; flexibility in registering drugs in post-RCT phase Duty to facilitate			Engage with government regulatory authorities
Operational implementation	Training of staff Duty to promote	Desist from imposing forms of patent protection on LMICs that inhibit access to essential medicines Duty to respect	Desist from lobbying home country governments for excessive patent protection	Active research dissemination; university commitment of resources for dissemination
	Development of treatment protocols for up-scaled implementation Duty to facilitate	Contribute to funding through donor and multi-stakeholder structures Duty to provide	Contribute to funding through donor and multi-stakeholder structures for accelerated drug-development for DR-TB	Training of staff in research dissemination
	Support operational research Duty to facilitate	Contribute to mobilizing multi-stakeholder partnerships to support implementation Duty to facilitate		Public education on TB science to strengthen civil society voice
	Public education on TB science Duty to promote
	Abstain from activities that delay, postpone, or block availability of new drugs Duty to respect
	Prioritize concrete and targeted measures aimed at reaching vulnerable members of society Duty to facilitate

^*Additional actors may include the World Health Organization, whose stewardship role obliges it to facilitate and coordinate cooperation for DR-TB drug development, and civil society, whose roles include holding state and other actors accountable, including bringing cases to court where appropriate, promoting public information and awareness, and mobilizing community voice.

^#The obligations and responsibilities with regard to developing regimens for existing repurposed drugs largely include those that pertain to different actors with regard to basic science identification of new drugs and establishing their efficacy and effectiveness, and are not repeated in this row—only matters that are specific for access to existing drugs.