Article: U.S. Joins the World in Global Battle Against Tuberculosis

20 March 2002

Article: U.S. Joins the World in Global Battle Against Tuberculosis

State Department official interviewed on problems and hopes for TB

By Charlene Porter
Washington File Staff Writer

"Stop TB, Fight Poverty" is the campaign theme for World TB Day March 24, an occasion to be marked by health organizations around the world.

Even though an effective cure was discovered decades ago, tuberculosis remains one of the world's most dangerous and pervasive diseases. The World Health Organization (WHO) reports that 2,000 million people, or fully one-third of the global population, carry the TB-causing bacilli. In many healthy people the bacilli remain dormant, but 5 to 10 percent will develop the disease. That's about 8 million new cases a year, according to WHO estimates.

Dr. Jack C. Chow is the deputy assistant secretary of state for international health and science in the Bureau of Oceans, International Environmental and Scientific Affairs. President Bush intends to nominate Chow for ambassadorial rank as the special representative of the secretary of state for HIV/AIDS.

Chow talked with Washington File Staff Writer Charlene Porter about the global trends in the effort to contain tuberculosis.

Question: What is the current status of the TB epidemic?

Chow: The statistics about TB are compelling. Two million people die annually from the disease. Sixty percent of these TB cases are in Asia, but it is a global disease. No populated continent is spared.

The recent rise of multi-drug resistant forms of TB is a worrisome trend. To treat a case of multi-drug resistant TB can run up to $250,000 and more. It takes up to two years to treat, instead of the six to nine months for a non-resistant case. The last TB drug was developed more than 30 years ago. Multi-drug resistance has resulted from two major factors, among many others. One was the failure of treatment in certain cases where treatment was not applied consistently or persistently. Two, it reflects the increased TB burden in developed and developing countries -- a burden that has not resulted in an effective response.

So the statistics for action are compelling, but the question is what action do we need to take? Donor nations and developing nations need to look at what we can do to bring about better treatment, better living conditions and greater global awareness to the impact of tuberculosis.

Q: What is the lesson for the world community in the resurgence of TB after a time when it was widely thought that this was a disease under control?

Chow: At least in the United States, the rates of tuberculosis were coming down until the 1970s when budget pressures caused a relaxation or a cessation of TB control efforts. As a result, the number of cases began to rise. The lesson there is you have to be vigilant, and we have to intensify our efforts against this disease in particular. If you relax the efforts, TB will continue to propagate because of its biological ability to spread through aerosolized droplets -- brought on by coughing or sneezing -- from infected people.

It is a treatable and curable disease, but it takes a health care system with an adequate public health infrastructure. It takes commitment and will to maintain that effort. Unfortunately, in the United States, that cessation in the past contributed to the resurgence of TB here in the United States. Globally, it means we have to invest in public health infrastructure. We have to raise awareness about the nature of this disease, and we have to raise awareness of the cost of not treating the global population.

Q: Do you see a heightened awareness and an increased commitment to building health care infrastructure in the international community?

Chow: I do. There are new partnerships being formed to confront tuberculosis among nongovernmental organizations, government and U.N. agencies. There is a relatively new global alliance for TB drug development. It involves the World Health Organization, some major pharmaceutical manufacturers and other health groups to come up with novel ways to identify and produce the next generation of medications.

We have the WHO's "Stop TB" effort. We have the new Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. So there is a broader recognition that governments themselves often cannot be the sole provider of resources. In the case of global diseases like TB, you need all parties -- governments, NGOS and the private sector -- to be involved in producing medications, creating awareness, committing resources and garnering public support for anti-TB efforts.

Q: In the context of the Global Fund, what is the linkage between TB and HIV/AIDS? Why are both diseases being targeted as a common enemy by health care providers?

Chow: The medical linkage between HIV/AIDS and TB is well documented. Because of HIV's capability to debilitate people's immune systems, HIV-infected people are much more likely to acquire tuberculosis. The bacilli can much more readily infect a person who is immuno-compromised than a person who is otherwise healthy. Tuberculosis is one of the prime opportunistic infections, and is the leading cause of death of people with AIDS. So the growing population of people infected with HIV may become an unwitting reservoir of TB infection for others.

Treating AIDS and TB is a synergistic challenge because not only are you treating a person with HIV, you are also treating them for TB and its complications as well.

So in establishing the Global Fund, there was recognition of that point, but there was also recognition that these three diseases -- HIV/AIDS, malaria and tuberculosis -- are broadly propagated around the world. Both collectively and individually they have a heavy impact on societies and economies around the world.

Q: The Global Fund was organizationally established just in January. It is now accepting proposals for local projects to combat these diseases. The first round of funding awards is set to be announced in April. What are your hopes about innovative projects that may emerge from the process and win funding?

Chow: We'd like to see proposals that incorporate public-private partnerships -- partnerships between the government, NGOs and the private sector in fighting these diseases. In reference to tuberculosis, we hope to see innovations in ways that access to care can be delivered to poverty-stricken regions or at-risk populations. With HIV, we've seen cases where private sector companies provided workplace education, NGOs provided education materials and the government provided health care workers. So, in the realm of TB, we think these kinds of similar efforts could be replicated or scaled up in regions where tuberculosis is a threat.

Q: "Stop TB, Fight Poverty" is the campaign that the World Health Organization is launching with this year's World TB Day. How is that consistent with U.S. policy on this issue?

Chow: The president has announced his proposal to provide greater development aid to poverty-stricken regions. Confronting poverty, giving people economic opportunity, providing them with education, providing them with basic public health care infrastructure -- these are the necessary efforts to lift people out of poverty. Doing this also relieves the pressures that build to cause increased propagation of tuberculosis -- crowded conditions, lack of sanitation, lack of health care, lack of nutrition. So the fight against tuberculosis is not only a medically focused challenge, but an economic and development challenge as well.

Q: And there's a scientific challenge involved here too, isn't there?

Chow: The scientific challenge is to understand how the defenses of the tuberculosis bacteria can be overcome; how we can develop new lines of medications; how we can develop a vaccine. These challenges will take considerable resources and considerable intellectual capital from our scientific community to find a way to eventually eradicate tuberculosis.

Q: In trying to discover what phenomena are at work when the TB bacilli mutates and becomes resistant to drug treatment, do scientists also hope to find a payoff in how that discovery could unveil similar patterns in other diseases?

Chow: Absolutely. The realm of drug resistance in bacteria and viruses is a scientific challenge that applies across all treatable infectious diseases. The lessons learned in the mutability of tuberculosis may also inform how we think about malaria, HIV and some of the parasitic diseases. That would inform our strategy in drug development. What scientists glean today may not lead to a breakthrough tomorrow, but it may over time be the basis for one scientist to someday say, "Aha!" and find the compelling breakthrough.

(The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)