Mario Raviglione, MD, is the World Health Organization’s Director of the Stop TB Department. He is a world leader in devising strategies to fight multi-drug resistant tuberculosis (MDR-TB). In an interview with John Donnelly on Friday, he responded to comments made by Ezekiel “Zeke” Emanuel, MD, PhD, Special Advisor for Health Policy at the Office of Management and Budget, in a blog post filed Thursday on Science Speaks. Here are excerpts from Raviglione’s interview:
“First of all, we have to praise the fact that someone like Dr. Emanuel, who is so influential worldwide in terms of global health policies, went to a hospital to look at the tragedy of MDR-TB. This is a very positive step that allows an informed appraisal of what the needs are in the world of MDR-TB and TB as well.
“TB is the No. 1 infectious disease killer in the world, if you calculate the TB deaths and HIV-TB deaths, you come up with 1.8 million a year. In addition, there are an estimated 440,000 MDR-TB cases every year – that’s new cases every year — of which we are capable of discovering about 10 percent, and we put on proper treatment even less than that. So you see the burden we are facing.
“But it is not a hopeless situation. There have been models around the world showing very clearly what we can do in ways that are cost-effective with community-based approaches. If one visited Lesotho and looked at their program, or looked at the Philippines’s program, one would realize that this is doable, this is cost-effective, and chances of success are very high.
“If we don’t face this problem, we will once again face what happened in New York City in the early 1990s, when there was an outbreak that cost hundreds of millions of dollars to sort out.
“We have now a big hope from a new tool that, while it is not yet a point-of-care test, it is much more powerful than anything ever discovered in the field of diagnostics in TB. We are looking intensively into this, and bringing a big group of experts to Geneva in late November to talk about how do we make this operational. This test, which was written about in the New England Journal of Medicine, would give a patient a diagnosis in a couple of hours, not a couple of months. It changes dramatically the way we can do things. If we go ahead following this November meeting – if we figure out a way to make this operational – we then may want to start this in a couple of countries next year. This could be a great opportunity for the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, UNITAID, or others to take this and expand it worldwide.
“On the cost of drugs, Emanuel is right. They cost too much and there is a problem with supply. This is a concern we have faced for a decade or more. The fact is the price of these drugs is not coming down. We have a great partnership with the Eli Lilly MDR-TB Partnership Project, which allowed for the transfer of technology of their two second-line drugs (capreomycin, cycloserine) to companies in four countries – South Africa, India, China and Russia. The issue is now how do we increase the companies’ interest in producing these second-line drugs, especially now that it looks like we will have a powerful new diagnostic tool. We need to create a market for these drugs. We need to call a meeting of drug companies, stakeholders, bilaterals, multilaterals, everyone! We can’t have the price of these drugs be an impediment anymore.
“One last point: Research is essential now. The achievements in this decade have been so major. However, we are just at the start of the response. We are still using old tools. Now with the new diagnostics, we are at the verge of a new era in terms of dealing with MDR-TB. But right now the way we have to treat people with MDR-TB takes two years. We need new drugs desperately. We need to open new investments for research and development.
“Let’s not get discouraged about fighting MDR-TB. It’s very important to face it head on. We can do it, we can fight it effectively. I’m sure of it.”