Gates Foundation lays out revamped TB strategy

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Jan Gheuens, Acting Director of the TB program at the Bill & Melinda Gates Foundation (BMGF) informed a packed audience at the International Conference of Lung Health of key changes in the Foundation’s strategy on tuberculosis.   

The goal of the revamped strategy is to accelerate a reduction in TB incidence, which Gheuens described as more ambitious than goals with an exclusive focus on reducing TB mortality and more realistic than the goal of the Stop TB Partnership to eliminate TB as a public health program by 2050, which he called “unachievable.” A focus on reducing incidence translates into a primary emphasis on pulmonary TB to reduce transmission, and to reduce diagnostic and treatment delays.

The early emphasis on public/private partnerships in vaccines, diagnostics and drugs will continue with an additional emphasis on discovery in each of these areas given limited pipelines, absence of adequate biomarkers to guide development and other challenges.  Gheuens noted that one of the lessons learned is to have a more realistic funding strategy that addresses the full cost of development.  Aeras and the Global Alliance for TB Drug Development are on the hook for 45-50 percent of the costs for late-phase clinical trials.  In this regard, the Foundation’s TB advocacy strategy will have a primary focus on advocating for resources for this research and development.

The strategy will also prioritize research on cost effective ways to use new tools in health systems with a focus on India, China and South Africa.  These high TB prevalence countries were selected for a variety of reasons, including their potential to supply the global market with low-cost TB vaccines, drugs and diagnostics. BMGF is now funding studies in China and South Africa evaluating the cost-effective use of Cepheid’s GeneXpert rapid TB diagnostic.  The Foundation is increasing its presence on the ground in South Africa, and has offices in India and China.

Gheuens described a new focus on market dynamics that while not fully fleshed out, will definitely focus on securing price reductions in critical TB control tools including diagnostics and second-line TB drugs.

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