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TB: Fighting an Outdated Approach

The international community is not doing enough to curb the spread of tuberculosis (TB).  Despite increased efforts over the past decade, I found that the majority of attendees at the CSIS event Promising Developments in Global TB Control were brimming with concerns and questions about the future of TB prevention and care.  With a humble voice, Dr. Peter Small, Senior Program Officer at the Bill & Melinda Gates Foundation, shared his perspective and admitted to the uncertainty and challenges ahead.  As TB research and development (R&D) moves at a glacial pace, rates of drug-resistant TB are on the rise.  Meanwhile, communities do not have the capacity or resources to make treatment and care easy or convenient.  If we don’t begin making changes to our approach, we will lose all of the progress we have made.

So, what can we do?  Dr. Small indicated that one of the biggest problems fighting TB is our outdated approach.  We have a 125-year-old diagnostic test, an 85-year-old vaccine, and a 40-year-old drug regimen dominating the market.  Obviously, we need new tools.  We are trying to using a 19th century approach to curb a dynamic 21st century disease.  Dr. Small says it is a blatant “market failure” that calls for the U.S. to, “redouble our efforts” and work to “modernize interventions.”   But, we cannot stop there.

We need to make current and future tools accessible and convenient to everyone.  Anyone diagnosed with TB has the troublesome task of taking multiple pills every day for at least six months.  But many people, especially women and children, have an even more difficult time accessing and receiving TB care.  In women, TB goes largely undetected, leaving the rest of the family exposed.  Children must reluctantly cough up sputum on demand for the TB test, and there is no drug or treatment designed with children in mind.  Clearly, we must find innovative ways to make life easier for people with suspected TB and TB patients.

We need to make progress quickly because we are running out of time.  While it is taking years for potential vaccines and drugs to pass safety tests, Multiple Drug-Resistant tuberculosis (MDR-TB) is slyly   gaining strength and spreading.  When patients receive counterfeit medicine or do not finish all of their medication, MDR-TB—a more expensive and dangerous strain of TB—can develop.  MDR-TB requires the patient to try multiple lines of costly drugs over the course of years in hopes of finding a treatment that works.  In the words of Dr. Small, it is, “a catastrophe for the individuals involved and a nightmare for the budget”.  The frightening part is MDR-TB is only beginning its reign.

Right now, we have a relatively inexpensive and manageable situation at hand.  Dr. Small notes that there is not a fix-all solution, and we should expect a “long slog of incremental improvements”.  But, these expectations cannot excuse a passive attitude.  We need to actively and aggressively mobilize resources now, or this ancient disease will send us spiraling into a fiscal and public health crisis.