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You mentioned an anecdote of a scientist in your talk who told you that TB is something we’ve already figured out, haven’t we?
AF: I wouldn’t call it scientific snobbery, but I’d call it a lack of appreciation for the opportunities involved with TB research. That’s the reason I carefully chose my introductory paragraphs in that talk. I know people will say we already have in our grasp what we need to control TB. All we need to do is implement that. You need to look at TB in the broader context of global health in general. And of infectious diseases in general. Because what you learn about host-pathogen interactions for TB, although it’s specific for TB, it’s applicable to many other infectious diseases. So when you encourage young people to get involved with TB research, you’re not just talking about one microbe, you’re talking about a whole constellation of host-pathogen interactions that will have relevance well beyond TB.
X: You talked about instead of thinking incrementally, for scientists to think transformationally about TB. How would you define success five or 10 years down the road?
AF: I’d define success as having a self-sustaining research endeavor, with spinoffs that go well beyond TB. That’s success. Probing host-pathogen interactions. Understanding what the nature of TB latency is [in which the infection lies dormant]. We need to know what the spectrum of latency is.
You really need something concrete. You need a state-of-the-art, point-of-care molecular diagnostic tool. You need new drugs and drug regimens. You need a vaccine that works against pulmonary TB. You also need a sustainable research community in TB that will not let it go again into the valley.
X: Could this follow the HIV model, in which you start out with a less-than-optimal paradigm of people taking a whole bunch of pills per day, but the regimens get simplified or combined over time?
AF: Absolutely. That’s what I mean by saying let’s not be incremental, let’s be transformative. We need to understand what the nature of resistance is. What the nature of latency is. Should we be treating certain people who have latent infection? If so, which ones? Everything is on the table.
X: What would you say are the top two or three rate-limiting factors against progress now?
AF: One of the rate-limiting factors is the number of qualified investigators entering the field, and the other is that we’re dealing in an era of limited research resources. That doesn’t mean we throw up our hands and give up. We just push harder and harder.
X: Didn’t you also mention the clinical trial network, and how there’s a shortage of available facilities for clinical testing of new TB drugs?
AF: Yes. There’s no problem there. I’m going to try to utilize the network we have to incorporate questions that are relevant to TB, more than we have been. I haven’t made that decision yet. I’m calling on a group of advisors to see what the feasibility of that is. We already have a very well-funded, extensive, clinical trial network. Can we incorporate clinical trials related to TB into that network? I don’t know the answer to that, but I’m going to explore that.
X: What can the biotech and pharmaceutical industry do to be a better partner? Or do you see them simply following along after the basic research priorities get set by NIH?
AF: They don’t. We contribute to their capabilities in what they can pursue, by making fundamental basic observations. The biotech companies and pharma are eminently more qualified than the basic research community in taking that concept and developing it into a product. I see it as a continuum of the basic research that we fund, and the development of a countermeasure like a diagnostic, a therapeutic, a vaccine. It’s an important part of the continuum.
X: But this wasn’t a big priority of the U.S. government in the 1980s. It’s becoming a little bit more so, but it’s still certainly not a front-burner priority in pharma either, right?
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