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Moonshot for Life

TB number one killer of all infectious diseases despite tools to solve it

TB number one killer of all infectious diseases despite tools to solve it

“Tuberculosis (TB) has been around for about 6,000 years. It’s a huge problem. About one-quarterof the world’s population is infected with a dormant form called latent TB, and are at risk of developing active tuberculosis. Every year, there are approximately 10 million new cases of active TB, of which only 6 million are diagnosed and treated, so 4 million people are out there undiagnosed, untreated, and infecting other people. One of the biggest issues is drug-resistant TB because it is on the increase – there are about half a million cases a year and about 250,000 people die every year of drug resistant tuberculosis.”

Adrian Thomas of Johnson & Johnson’s Global Public Health team doesn’t want to bore us with the numbers, but he and his team are on a mission to develop new drugs, new regimens, and new innovations in drug and healthcare delivery to end drug-resistant TB, while bringing people together in partnership over this huge – sometimes forgotten – issue.

The clincher for Thomas is not just the scale of the problem, though: “This is a relatively slow, very lethal disease. It’s the world’s deadliest infectious diseases – killing more people annually than HIV and malaria combined. And yet, we have the tools – and the know-how to develop new tools – to solve it.”

Lessons From History

We spoke to Thomas in the lead-up to the first United Nations High-Level Meeting on Tuberculosis, an important meeting which ultimately proved that interest in this disease is on the rise in the medical field, but that more needs to be done at a policy level to really get the results so desperately needed. “Around the turn of the last century, tuberculosis was the number one infectious disease killer of people in Western Europe, in the US, and in Australia. And with public health modernization, we ended tuberculosis from many parts of the world with old tools and public health measures. And if you look at Japan, for example, tuberculosis was the single biggest public health emergency after World War II, and they eradicated it with modernized public health measures. So we know that if you use the right tools, and you’re aggressive – if you have a commitment to case finding and treatment – then you can solve this problem.”

Interest Rising

“If you look at TB today, it looks very much like how Hepatitis C looked about 10 years ago – I believe we’re at the edge of a scientific explosion in drug development and in diagnostics, if we want to actively pursue that.” Thomas explains that because of this exciting vibe in the field, it is encouraging more researchers and industry scientists to focus their efforts on TB. “I was talking to some HIV doctors from Africa and India some time ago in Dubai, and one of them shared that it’s very hard to get people – young doctors – interested in HIV today because it’s too simple a problem to solve: one pill once a day, you fail that, another pill once a day, and you’ve almost got normal life expectancy now. They’re going into TB because it’s exciting, it’s difficult, and it’s on the edge of technological explosion. Enthusiasm is not just about scientific breakthroughs, really, it’s about the community coming together.”

But interest in the scientific field rising is only one factor in the eradication of infectious diseases – there’s the rest of the population to convince. “The question is: is government interested? Is society committed and interested? Because if we want to solve this problem, we can – and we can focus on key regions. The missing cases are not all over the world, the missing cases are concentrated in high-population economies that usually have fragile health systems. For example, almost half the world’s drug-resistant TB is in India and South East Asia. If we focus, we can solve this. The sort of money we’re talking about here – about $1-2 billion a year – that’s nothing. We spend $270 billion on the next Strike Fighter jet because we choose to. Let’s choose to solve tuberculosis.”

Going Beyond Morality

The argument for solving the TB problem put through the lens of human life makes sense, but Thomas argues there’s even more reasons for more people to care about this disease. “It’s not a disease that’s prevalent today in the developed world, but it’s a global health security risk, and it’s also an economic disaster. If you look at where TB is concentrated, particularly drug-resistant TB, it’s in fragile health systems, in countries with the highest economic growth potential – we’re talking about India, South East Asia, China, and Ukraine - these are the countries where, regionally, we have the highest hopes for future economic growth and investment. These are also the countries that are the suppliers to the world. So the way I see it, it’s very simple: we should have an economic interest, we should have a human interest, and we should have a health security interest.”

Thomas is also optimistic about timeline in which real change can come about: “The problem can be solved. I think we need to be extremely practical, so I think 20-30 years is a nice goal, but it’s too far away. I think we should see progress in the next 2-5 years. Why not? We’ve seen it in South Africa – they’re seeing a reduction in the prevalence of TB and drug-resistant TB because they’re prioritizing this – and they’re finding and treating more people than ever before. That’s what we have to do: find the cases and treat them.”

Why not indeed?