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Moral and Medical Disaster: The Fight Against TB

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It's been 20 years since the World Health Organization declared tuberculosis (TB) a global health emergency. This weekend, The Wall Street Journal (WSJ) declared: "Global TB Fight hits a wall."

Both declarations were an understatement.

The WSJ article, featured on the front page, focused on India, reporting that the government's emergency strategy to fight drug-resistant TB is actually doing the opposite: By treating some drug-resistant TB patients with drugs they are already resistant to, TB bacteria in India is actually building further resistance. A prominent researcher described the strategy as "morally and medically disastrous."

While most drug-resistant TB cases are found in India, China, and Russia, drug-resistant TB strains are edging up in the U.S., Eastern Europe and elsewhere. Less than two weeks ago, a new study also showed the substandard drugs widely used to treat TB are almost certainly adding to drug-resistance. The news came on the heels of the reported failure of the first new TB vaccine candidate in 90 years to complete a clinical trial, and further reporting on an increasingly scary struggle against a strain of TB recently found in South Africa that seems to be totally untreatable hit the papers in the U.S., the UK, and even Drudge Report was tweeting about it.

Bad drugs, bad strategies, and back to the drawing board on a vaccine.

What are we doing wrong?

It's not what we're doing wrong now that got us here -- its what we've been doing wrong for decades.

Despite TB's dual notoriety as the world's deadliest disease after AIDS, as well as the leading killer of those living with HIV/AIDS, TB prevention, detection, treatment, and research and development (R&D) are so woefully underfunded around the world that the whole enterprise can be described as a medical and moral disaster.

Even as President Obama mentioned the importance of an AIDS-free generation, of ending poverty, and of preventing unnecessary deaths in his State of the Union address, rumors abound that there will be cuts in his administration's budget to fight TB bilaterally, as well as to investments in the Global Fund, the single largest funder of the fight against AIDS, TB and malaria.

In his State of the Union address, President Obama also noted the importance of investing in R&D at a level "not seen since the height of the Space Race." However, decades of neglect have left us playing catch up on R&D for tuberculosis. It's only in the past ten years that the scientific community has had the resources to re-commit to developing a TB vaccine -- yet TB R&D still faces an annual funding gap of $US 1.4 billion.

What are we doing right?

We're starting to pay attention. Health ministers from Brazil, Russia, India, China, and South Africa plan to present a full plan to address drug-resistant epidemics in January 2014. South Africa, led by Minister of Health Dr. Aaron Motsoaledi, has already made great strides in efforts to tackle TB.

Despite disappointment that the recent TB vaccine candidate was found to be ineffective in preventing TB in babies, the trial's long-term achievements were historic: It brought together world class scientists committed to developing a safe and effective TB vaccine, and built the infrastructure -- laboratories, clinics, and partnerships -- necessary to develop and test new vaccine candidates. The safe completion of this large-scale efficacy trial for a TB vaccine is the first of its kind in 90 years and a dozen other vaccine candidates are in the pipeline.

Meanwhile, the first new TB drug in 40 years was recently approved by the U.S. Food and Drug Administration, and three other drugs are in late-stage clinical trials.

We're making progress, it is just not fast enough.

Our short game -- to detect, treat, and save lives from TB -- must be redoubled.

This means investment now.

Our long game -- to end TB with better diagnostics, drugs, and a vaccine -- must not lose momentum.

This means investment now.

I cannot say it better than two well-respected doctors who have been fighting TB for decades, Salmaan Keshavjee and Paul Farmer, did last year in the New England Journal of Medicine:

"The global AIDS effort of the past decade has shown how much can be accomplished in global health when effective diagnosis and care are matched with funding and political will. Stinting on investments or on bold action against tuberculosis -- in all its forms -- will ensure that it remains a leading killer of people living in poverty in this decade and the next."