What’s TB’s problem anyway

You’ve got to give it to the global health community to come up with atrocious goals and targets every once in a while. You might as well have been tempted to discount it for unwarranted grandiosity propelled by their own sense of hubris, had it not been for their penchant for achieving them.

The Stop TB partnership’s attempt to half  TB prevalence by 2015 (base levels at 1990) and  eliminate TB from the face of planet by the year 2050 is one such goal.

To those of us who have been down in the trenches with TB, such an attempt is nothing short of heresy. The problems with controlling TB are manifold. The tools of the trade are ancient. Sputum microscopy, the only available diagnostic tool in much of the world, has limited efficacy and is more than a hundred years old. Isoniazid, the mainstay of treatment everywhere is 60 years old. (See a brief timeline of TB here.) In much of the world the only “recent” innovation in the fight against TB was the implementation of DOTS- which to be sure, has been credited with a lot of success in halting or reversing the tide of  TB in some parts of the world. 

However, the partnership is well aware of the resource and knowledge  gap for the task at hand. Here (table, right) is an estimate of funding requirements up until 2015.

In order to accelerate and prioritize research, the partnership in conjunction with the with the Stop TB Department at the WHO, has come up with the TB Research Movement. Working groups operating across the continuum of  fundamental research to drug and diagnostics to implementation have come up with priority areas for research and knowledge creation to plug existing gaps. Estimates show around 9.8 billion dollars in research are required within 2015, the greatest requirements are for the development of novel therapeutics;  on a relative scale however, research in diagnostics has the largest funding shortfall (graph, below).

Implementation of such an initiative is expected cost around 37 billion dollars until 2015.

The agenda that has been laid out for research has been impressive. TB, despite the close to 2 million deaths that it causes annually, had up until recently been in the back burners of  innovation. The doubt however is if the funding shortfall can be overcome.

Health systems worldwide are already reeling under bitter  economic realities. The US and EU, which have traditionally marshaled resources, are finding it difficult to honor their prior commitments, let alone commit to new ones. The global fund, which has been the go-to funding mechanism for the three major killer communicable diseases, has already withheld its Round 11 of funds in view of the current economic climate, and replaced that with a transitional funding mechanism until 2014.

Hopes have been laid on some other sources of funding, most notably the BRIC (Brazil, Russia, India, China) nations where economic growth has been rapid. These countries incidentally, are also home to some of the largest epidemics of TB in the world.

This isn’t the first time the global health community has set its aims high depite seemingly insurmountable odds. Ten years ago. when the first drafts of the plans to fight the  HIV epidemic where being laid, it appeared as if HIV would wallop entire mankind. With incessant effort and ingenuity, we have been able to turn that tide for the first time. With similar efforts, and a modicum of luck,  we should be able to go even futher with TB, given a lot of  the operational framework for TB program implementation is present in most places, at least  in some form or the other.

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