where do we go from here?
Tuberculosis has plagued human societies from prehistoric times. For thousands of years we had no effective way to prevent or treat this disease. Since the identification of the specific bacteria that causes tuberculosis in 1882, our arsenal against TB has expanded slowly. For over fifty years the BCG vaccine has been the only vaccine available (see Prevention: Calmette & Guérin - BCG). Similarly, the antibiotics streptomycin and isoniazid, discovered in 1943 and 1953 respectively, continue to be among the most frequently used drugs to treat TB.
Since the World Health Organization declared a global TB epidemic in 1993, scientific communities have made a concerted effort to increase the tools at our disposal to prevent and cure TB. Several organizations are bringing researchers together from around the world to develop and test new vaccines, diagnostic tools, and medications.
Tuberculosis is a preventable and curable disease. Medical innovations have ensured that tuberculosis need not be a death sentence; yet, millions continue to die needlessly every year from this disease We can do more to stop tuberculosis. What will you do?
- The Global Alliance for TB Drug Development (TB Alliance) is developing new affordable TB drugs that will dramatically shorten treatment time, work against drug-resistant TB, be compatible with HIV antiretrovirals and improve treatment of latent TB.
- The Foundation for Innovative New Diagnostics (FIND) is developing rapid, accurate, and affordable TB tests and point-of-care diagnostics to more efficiently detect TB and drug-resistant forms of TB.
- Critical Path Institute: is developing new TB drug regimens with shorter therapy durations.
- Aeras Global TB Vaccine Foundation is developing new TB vaccines.
- Global Fund to Fight AIDS, Tuberculosis and Malaria is a public-private partnership and international financing institution that raises and distributes funds and other resources to prevent and treat TB.
*The Museum of Health Care is not responsible for the accuracy, reliability or currency of the information provided by external sources.
Mario C. Raviglione, M.D., FRCP
Stop TB Department, World Health Organization, Geneva, Switzerland
what is one thing you wished more people understood about tuberculosis?
Often TB is considered a disease of the past, on its way towards elimination. This perception and the ignorance of the real situation generate poor commitment to fight TB and to invest [i]n TB. There is a need [for] a massive educational campaign to inform the wide public, the politicians and stakeholders about the fact that TB control is necessary in 2012 (as the epidemic in many parts of the world is poorly addressed), that TB kills 1.4 million people unnecessarily every year, that investments are highly cost-effective, and that there is progress when efforts are coordinated and assertive.
What remains the greatest hurdle for TB treatment?
In the case of normal TB (sensitive to treatment) the biggest obstacles are access to diagnosis and subsequent therapy. These require commitment by the government to provide access, to train health workers, to provide diagnostic and drugs. Some time[s] in some countries there are still drug stock-outs. For drug-resistant TB, the greatest hurdles are both the absence of adequate laboratory capacity and the scarcity of the expensive second-line drugs. These obstacles are complex and require a major investment by national authorities and the international donor community.
What accomplishments do you foresee will be made in the next five to ten years in TB research?
According to expectations, we should have a new point-of-care rapid test that allows early and reliable recognition of TB, a few more drugs that could treat MDR-TB effectively and shorten duration of both treatment of drug-susceptible and drug-resistant TB, and a new vaccine(s) allowing pre- and post-exposure prevention of disease. How many of these dreams can be realized in practice is unclear. In addition, more health policy and operational research will allow us to better understand what needs to be put in place, after proper and rapid transfer of technology, to accelerate incidence decline towards elimination.