08 June 2009
U.S. Global Partnerships Key in Fighting Drug-Resistant TB
Pacific Health Summit will highlight public and private collaborations
Washington — Thousands of kilometers apart, a classroom in the Philippines, a network of clinics in Brazil and a medical research center in South Korea demonstrate a key element of the United States’ response to drug-resistant tuberculosis (TB).
Partnerships — involving governments, the private sector and nongovernmental organizations (NGOs) — are critical in global efforts to conquer multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant TB (XDR TB).
The World Health Organization (WHO) describes drug-resistant TB as a global health “time bomb,” with nearly 500,000 new cases of MDR TB reported in 2008. MDR TB occurs when a majority of TB drugs are ineffective; XDR TB, fatal in 53 percent of cases, occurs when no TB drugs are effective. The United States, the largest single-country donor to the Global Fund against AIDS, Tuberculosis and Malaria, is a leader in anti-MDR TB efforts.
“We must not forget the fact that 1.7 million a year die, guaranteed, like clockwork, with TB,” said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases (NIAID), and one of the United States’ leading infectious disease experts.
On June 16–18 in Seattle, the fifth annual Pacific Health Summit, which focuses on MDR TB as a major global health threat, will highlight the value of partnerships in the fight against drug-resistant TB. Hundreds of scientists, government officials, corporate leaders and researchers from more than 24 countries (including Peru, South Africa, Japan, Kenya, Switzerland, China, India, Brazil and the United States) will participate.
“There’s a growing sense that collaboration is key to the future of everyone,” said Michael Birt, executive director of the summit and director of the Center for Health and Aging at the National Bureau of Asian Research, one of the summit co-founders. “That is a fundamental part of U.S. strategic thinking right now.”
MULTIPLE PARTNERS AT MULTIPLE LEVELS
U.S. government efforts against MDR TB can be found at every level, from local and state governments to federal agencies such as NIAID, the U.S. Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH) and the U.S. Agency for International Development (USAID). Partnerships usually concentrate on the 22 nations with the highest number of TB cases, and focus on finding new drugs and diagnostic tools. (See “Innovation Critical in Battle Against Ancient Tuberculosis.”)
In the Philippines, the CDC and a Filipino tropical disease institute are creating a new MDR TB training framework for health care workers using a yearlong class schedule. Previous CDC training partnerships in Latvia, Malawi, South Africa and Peru centered on one-week, one-time sessions; the new course will be divided into four sessions that build on students’ skills.
“That’s the model we’re probably going to shift to,” said Dr. Timothy Holtz, a team leader in the international research branch of the CDC’s Division of Tuberculosis Elimination. Holtz is CDC’s representative to the Green Light Committee Initiative, an international partnership with WHO and the Stop TB Partnership that seeks new drugs and diagnostic tools to treat MDR TB.
Elsewhere, NIAID and the South Korean government support a research center in Masan, South Korea, that evaluates new anti-TB drugs, and USAID worked with the Brazilian Ministry of Health to increase the number of MDR TB centers in Brazil from 63 in 2004 to 122 in 2007. Other CDC projects include CureTB, a bilateral initiative with Mexico that coordinates TB care on the U.S.-Mexican border.
Efforts involve the private sector as well: The Bill and Melinda Gates Foundation signed a $33 million agreement with China’s Ministry of Health in April to work on TB and MDR TB in six Chinese provinces. NIAID also partners with pharmaceutical giant Eli Lilly and Company, researching new drugs as the Lilly Not-For-Profit Partnership for TB Early Phase Drug Discovery.
The U.S. government “can’t do everything, nor can we be all things to all people,” Fauci said. “So by necessity we had to develop strategic entities and strategic partnerships.”
GROWING GLOBAL RESPONSES
China, which along with India has some of the highest levels of MDR TB infection, is strengthening its effort to fight MDR TB. In April, Beijing hosted ministerial-level meetings on MDR TB that emphasized the role of “partners across the health system and beyond” to muster the estimated $2 billion needed to fight drug-resistant TB during the next two years.
“Controlling drug-resistant TB in India and China will have a direct impact in controlling drug-resistant TB in the United States,” Holtz said, given how readily infectious diseases can spread globally.
Scientists, activists and health care providers say they sense a new momentum in the fight against drug-resistant TB, exemplified by the Chinese ministerial meetings, a Stop TB Partnership meeting in Brazil in February and a World Health Assembly resolution on MDR TB adopted in May even as the H1N1 virus outbreak grabbed headlines.
The Pacific Health Summit is designed to capitalize on that momentum, said Claire Topal, the summit’s senior program director. Ultimately, all partners are focused on a key indicator: The global increase of TB cases has slowed somewhat, but the rise of drug-resistant TB has not.
“I think there’s reason for hope and optimism that things can get better,” Holtz said. “But we are still in the middle of … a global epidemic on TB.”
More information about the Stop TB Partnership and the WHO plan for MDR TB is available on their Web sites.
