Tuberculosis Gets an Airing on Capitol Hill

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TB was all the talk on Capitol Hill Thursday.


The Global Health Council and the American Thoracic Society, among other groups, helped to orchestrate two fantastic briefings on TB, just as the WHO is set to release some alarming new data about TB-HIV co-infection.


“We’re really at a crossroads” with TB, said Diana Weil, Coordinator for Policy and Strategy with the WHO’s STOP TB Department.


Indeed, things could get much worse, or much better, depending on how policy makers in the U.S and across the globe respond, at this critical juncture, to the global TB epidemic and the rise of drug-resistant TB.  


Here are some nuggets from today’s events:


IDSA member Dr. Dick Chaisson, the moderator of the first briefing, warned against U.S. complacency in the fight against TB. He noted that starting in the mid-1960s, health experts began to feel like “science had delivered” on TB and that eliminating the disease was essentially “a done deal.”


Forty years later, Chaisson said, not only is TB not eradicated or even under control, but we’re seeing virulent new strains of nearly-untreatable tuberculosis.


Weil said new stats from the WHO show there are now more than 9 million cases of TB a year, and more than 1.7 million deaths. XDR-TB has now been identified in 55 countries. There are at least 50,000 cases of XDR-TB a year, and 30,000 deaths from that strain of the disease.


She said there could be a “tipping point” within a decade, in which the majority of TB cases in places like Eastern Europe are drug-resistant TB, not the more easily treatable, standard TB.


Dr. Gail Cassell, from Eli Lilly and Co., offered this startling fact: The total outlay for TB drug R&D in 2007 was a paltry $153 million world-wide. It typically takes more than $1 billion to bring one new drug to market.


Asked what would happen if PEPFAR is flatlined, as many fear, it would be a catastrophe. “The spigot is on,” she said of TB’s ability to spread quickly if it’s not detected, treated and prevented with forceful programs.


Philip LoBue, with the TB elimination program at the Centers for Disease Control and Prevention, reported that TB is down in the U.S. but the rate of decline is slowing. In 2008, he said there were 125 cases of MDR-TB in the U.S. and 4 reported cases of XDR-TB.


Dr. Payam Nahid, a TB specialist at San Francisco General Hospital, drew a strong connection from the global fight against TB to domestic control efforts. He said that the city of San Francisco saw a 20 percent uptick in its TB cases from 2007 to 2008. Meanwhile, budget cuts forced his hospital to lay off the TB charge nurse, and his clinic now has to share a nurse with the hospital’s STD clinic.


He offered a “glimmer of hope” by touting new TB drugs in the pipeline, even though they are years away from regulatory approval.


Finally, Jerald Sadoff, president and CEO of the Aeras Global TB Vaccine Foundation, talked about efforts to find a better version of BCG.


He called BCG “the world’s worst vaccine, the least effective,” but said Aeras efforts to develop a better one were very promising and would likely bear fruit by 2013.

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