HIV’s “Tireless Warrior,” Anthony Fauci, Calls for Transformation of TB Research

6/18/09Follow @xconomy

Anthony Fauci is known around the world as a leading scientist and advocate, starting in the early 1980s, for research to fight HIV. The Voice of America once called him a “tireless warrior” for the cause. Now, Fauci says, biologists need to channel their creative energy to fight another deadly bug that has been around for centuries and rarely makes headlines—tuberculosis.

Fauci, 68, has been the director of the National Institute of Allergy and Infectious Diseases since 1984. This division of the U.S. government has a $4.7 billion annual biomedical research budget, which happens to be a lot more than the Bill & Melinda Gates Foundation gives away every year. So people listen carefully to what Fauci has to say. He delivered a high-intensity call to action yesterday to a crowd of 250 global health stars at the Pacific Health Summit, and I followed up with him for an exclusive interview.

First, a quick reminder of why anyone should pay attention to TB. It’s a contagious bacterial infection, and kills an estimated 1.7 million people a year worldwide, ranking it right up there with the world’s biggest scourges, like HIV and malaria. Yet it’s basically been treated like a research backwater for too long, Fauci says. The state of the art is depressing. There’s no vaccine. Diagnostics are lousy. The standard course of therapy—which has seen no improvement in 40 years—involves four drugs that must be taken daily for six months. Fail to comply fully with doctor’s orders, and you increase the odds of developing drug resistance, making it harder to treat.

Incrementalism in this field won’t cut it—a bigger transformation of TB is required to get serious about the disease, Fauci says. Here are the edited highlights of our conversation:

Xconomy: Why has TB been on the back burner of research priorities for so long?

Anthony Fauci: When you think about how basic and applied research drive a particular field, a lot of it has to do with the interest and energy of investigators who get involved in the field. They see it as an opportunity for them to make a contribution, as well as to advance their own careers.

TB has suffered a lot because of its own success historically. There were some blips when TB rebounded in the mid-80s and early 90s, and most recently with the serious issue of multidrug resistant TB and extensively drug resistant TB that has sort of rekindled interest. But most young investigators have not seen, with some exceptions, a career in research of TB as something to pursue. A lot of the transformational research from the past few decades, from the end of the 20th century and early 21st century, in the arena of systems biology, genomics, and all the other -omics fields, and all sorts of host-pathogen interaction study, has really passed by TB research.

The point I made in my talk is we’re starting to see a rekindling of some effort. We are really going to have a research agenda, and have research play a role in what is a very broad, heterogeneous, comprehensive approach to TB control, of which research is only one element. We have, in our possession, many of the tools if properly implemented, that could go a long way to control TB, including MDR and XDR TB. But we don’t have … Next Page »

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  • Peter Small

    There has been a tremendous amount of innovation for TB after 40 years of nearly no progress. Today we have a pipeline of 9 drug candidates and 5 vaccines. People in BRICS countries, and across the developing world are taking ownership and contributing to this innovation. There is always more to be done – more new ideas, more collaboration, more money — but today we have great optimism about where the field is heading.

  • King Holmes

    Tony’s call to action was very timely and was a highlight of the Summit, which aims to achieve transformational strengthening of the global response to TB.

    I also expressed the need to improve health systems, and the global commitment to more effective use of the tools we do have available today to prevent TB. Specifically, we need to strengthen not only more effective treatment of clinically active cases of active TB, but also implementation of intensive TB case findings and isoniazide prophylactic therapies in populations who are particularly vunerable to TB, e.g., those with HIV infection and those recently exposed to active TB.

    For example, we can more effectively use Community Health Workers for close follow-up of those on isoniazide preventive therapy; we can prevent transmission of TB in clinical, hospital, prison settings, and other places where people congregate.

    In conclusion, we need more effective tools, including diagnostic tests, new drugs for treatment and eventually vaccines for TB, but meanwhile we need to make more effective use of the tools we have.

    King Holmes
    William H. Foege Chair, Director, Center for AIDS and STD, Global Health
    Harborview Medical Center