Along with maintaining funding for fighting global tuberculosis, the United States government must better coordinate with the most affected countries on TB research and development, said global health leaders Monday at a Center for Strategic and International Studies event in Washington, examining challenges to global tuberculosis efforts. This point, along with the recommendation that the government formally recognize tuberculosis R&D as a priority, has been laid out in CSIS’s report on TB R&D – one of six reports in a series of policy papers on tuberculosis released Monday.
Former U.S. Global AIDS Coordinator Ambassador Eric Goosby said ensuring that innovations could be available and used in the places they are needed most must be a focus of research.
“We’ve under-emphasized the importance of coordination at the country level,” Goosby said. He was joined on the panel by Dr. Peter Small, Deputy Director of the Bill and Melinda Gates Foundation TB program, U.S. National Institute of Allergies and Infectious Diseases Director Dr. Anthony Fauci, and moderator J. Stephen Morrison of CSIS.
The world’s emerging economies are all TB high burden countries, Small, an author of the report noted. He added China, Brazil and India are increasingly upping their research and development budgets and becoming science and innovation leaders.
“We should give them credit for more than their disease burden,” he said. “Fostering local expertise and platforms in partner countries will lead to developing inexpensive products that are both locally and globally applicable.”
The report on TB R&D recommends the U.S. government engage in long-term TB research partnership initiatives with emerging economies, with the aim of creating or strengthening select TB research centers of excellence “through catalytic funding and expanded technical exchanges.”
“The initiative should be defined from the outset as a vital foreign policy “soft power” tool, drawing from multiple U.S. revenue streams and driven by U.S. health diplomacy, which will build the research platforms upon which many future scientific gains will emerge,” the report says.
“We can get a lot done by building up the capacity of low- and middle-income countries,” Fauci said.
Just returned from a PEPFAR meeting in South Africa, new Global AIDS Coordinator Dr. Deborah Birx noted from the audience that “we need to ensure programs back up innovation.” Ambassador Birx pointed to a “phenomenal gap” between identified tuberculosis patients and those who have been tested for HIV and are on antiretroviral therapy. “It’s still inexcusable that we have that gap,” she said. “100 percent of TB-HIV infected patients should be on antiretrovirals, while now about 45 percent are on ART.”
Fauci highlighted the importance of maintaining robust funding for research and development, noting that when he first took on the role of NIAID director, he thought the roughly $600,000 allocated for TB R&D at NIAID was a typo. Thanks to increased prioritization of tuberculosis research over the past couple of decades, that number reached $169 million in 2012. Funding from the NIH and donors, the CSIS report notes, has made the new drugs bedaquiline and delaminid, as well as the diagnostic tool GeneXpert, possible.
The gains made as of late are precarious, however, as the NIH has seen substantial loss in purchasing power over the past decade due to budget cuts and the rising cost of medical inflation, Fauci said. Even though “TB is smack in the middle of scientific opportunities and public health imperative,” he said, adding that with decreased funding, “we can’t move forward.”
David Bryden of RESULTS noted that the Obama Administration’s proposed 19 percent cut to USAID’s tuberculosis budget for fiscal year 2015 has R&D implications as well, as USAID supports late-phase clinical trials of new drugs and diagnostic tools.