As featured in Science Speaks by Meredith Mazzotta
“As you and I both know, people that dedicate their lives to global health are special,” said U.S. Agency of International Development (USAID) Administrator Dr. Rajiv Shah at the opening session of the Stop TB Partnership Coordinating Board Meeting, taking a moment to recognize the passing of his colleague, former USAID Tuberculosis (TB) Team Lead Susan Bacheller. He then asked for a moment of silence in her honor.
“She is deeply missed.”
Shah addressed an audience of physician-scientists, industry representatives, advocates and government officials that make up the Stop TB Partnership Coordinating Board, in addition to the ministers of health from Lesotho, Swaziland and South Africa. Shah commented on the current status of TB control efforts around the world, noting that, “we won’t meet the overall Millennium Development Goals (MDGs) unless we make some fundamental changes,” he said.
Part of the 6th MDG is to have halted by 2015 and begun to reverse the incidence of major infectious diseases including tuberculosis.
“We need to take some bold actions and risks and introduce new innovations, new technologies, new drug regimens and new ways of working to reach the outcomes that we all seek,” Shah said.
The changes he highlighted were the need for new technologies in diagnostics and treatment including for drug-resistant forms of TB. He noted that the development and deployment of the Gene Xpert rapid TB test is encouraging, but continues to be quite costly. He encouraged the audience to think about what types of strategies might exist to try to introduce these diagnostics to better understand their value and performance in the field, while looking for opportunities to reduce their cost.
The reality of treatment targets, Shah said, is our ability to reach them or not to reach them is not tied to our immediate budget, “but rather if we can continue on the path to reduce the cost per unit of treatment. I hope we will greatly exceed these targets,” even in an environment where we are facing serious constraints on our ability to invest, here and abroad, he said. Using efficiency gains to achieve and exceed new targets, Shah said, could make a much stronger case for future investment in TB as a means of furthering overall global health targets.
Assistant U.S. Secretary for Health Dr. Howard Koh noted that even the U.S. still sees 11,000 cases of TB every year. “We had a goal of eliminating TB in the U.S. by 2010 and we have not reached that goal,” he said, adding that the health of every nation affects the overall health of the globe.
During a question and answer session with an extended panel, Lesotho Minister of Health Dr. Mphu Ramatlapeng listed her thoughts on the three most important unmet needs inhibiting real progress against tuberculosis. First, she cited the need for diagnostic and other technologies that can be used across diseases. For example, “there is work underway with the Gene Xpert so that it also can be used to detect [sexually transmitted infections] and other diseases,” she said. Gene Xpert developer FIND announced in February that the company was investigating potential rapid HIV viral load measurement to be added to the current machine. Ramatlapeng also noted the need for fixed-dose combination drug regimens, “because they will make life very easy for all involved,” and better access to drugs as key to success in fighting TB.
When asked how the ministers were addressing the spread of TB among the mine workers in Lesotho and South Africa, Ramatlapeng said she is working with the World Bank to convene a meeting with the ministers responsible for natural resources and mining, as well as the ministers of finance to more holistically address how to move ahead.
Other future goals in TB control mentioned at the meeting included ensuring successful roll out of new technologies to those who need them most, access to health systems to ensure new cases are detected as early as possible, achieving the most value for investment, and making certain that TB is a party of primary health care that is universally accessible.