Fauci: New TB research agenda desperately needed

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This live blog is from the Pacific Health Summit in Seattle, a three-day meeting that opened Tuesday night. Its focus is the global response to multidrug-resistant tuberculosis.

Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told the Pacific Health Summit today that it was urgent to begin a broad new research agenda to fight tuberculosis around the world.

In an invitation-only meeting involving 250 global TB experts from 25 countries, including representatives that ranged from industry to foundations to governments, Fauci delivered a sweeping “state of the science’’ speech that built a case for a major new sustained TB research effort.

“We have had decades of relative neglect given the extent the of the problem,’’ Fauci said. “There is much catching up to do and this will require a sustained effort’’ with major funding commitments.

Fauci, who took over NIAID nearly a quarter-century ago, made a striking parallel between HIV and TB research over that time.

For the past 25 years, he said, no new TB drugs have come to the market.

In that same period, 30 HIV and AIDS drugs have.

“To me, the key question for this meeting is why we do not have 30 new drugs for TB, a disease we know is eminently curable,’’ he said. “… A transformative research effort to TB has not begun. That is beginning to change. What we see is the winds of change, but what we really need is a storm.’’

He said that two factors would likely catalyze a new TB research agenda: the rising numbers of HIV-TB co-infection, especially in southern Africa; and the rising numbers of multidrug-resistant TB (MDR-TB), and extensively resistant TB (XDR-TB) cases.

“Given human nature, it is largely the fear that it would be our problem, that it is the developed world’s problem’’ that will drive a push for new TB research funding, he said.

Two years ago, after the suspected XDR-TB case involving an Atlanta lawyer who traveled to Europe, Fauci said that he and counterparts at the Centers for Disease Control and Prevention “were were called to testify (before Congress) several times on the dangers of flying in an airplane with someone with TB. I seized the opportunity to tell members of Congress that definitely all of them have flown on airplanes with people who are infected with TB, since a third of the world has been infected with TB. That got their attention.’’

Fauci called on several new areas of research to reduce a “significant gap in our knowledge,’’ including: development of new diagnostic tools; development of new drugs;  better understanding of the biology of host pathogens; better clinical management of patients with HIV/TB co-infection; development of preventative strategies that can immediately recognize the differences of drug-sensitive and drug-resistant TB cases; and development of a vaccine for pulmonary TB.

He said he was now “exploring the possibility’’ of using the existing and extensive HIV clinical trials networks for the implementations for  similar trials for TB and other infectious diseases. “That could provide an extraordinary boost for the clinical trials for TB,’’ he said.

“We should look to transform the field of TB research,’’ he said. “It’s not just taking an incremental approach to developing another drug and another diagnostic tool. TB is an ancient disease, but we need to understand it in modern terms, and we need to use modern technology to ask questions that were never addressed in the first place. We need to understand TB as a disease of the whole organism, namely, the patient.’’