Tag Archives: tuberculosis

Global Disparities in Tuberculosis Treatment Highlight Need for More Research

We are reminded yet again why global health issues matter for Americans with recent news coverage of a possible tuberculosis outbreak at a Virginia high school that may have affected over 430 faculty and students. Health officials are recommending that all individuals at the school be tested for the disease.

Courtesy of CDC/ Dr. Ray Butler

Tuberculosis bacteria
Photo credit: CDC/ Dr. Ray Butler

Historically, tuberculosis has been the world’s greatest infectious killer, taking an estimated billion lives over the past 200 years. Tuberculosis remains a global threat today – in 2011 alone, the disease sickened 8.7 million people. Even more alarming is the rise of drug-resistant forms of the disease. WHO estimates that more than 5% of TB patients worldwide have multidrug resistant (MDR) TB, meaning that typical frontline drugs will not be effective. Because it is often expensive to test for drug-resistance, only a handful of patients are appropriately diagnosed so many experts estimate that this number may be even higher. Doctors are also discovering cases of extensively drug resistant (XDR) TB in which patients do not respond to a majority of existing drugs. Continue reading →

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Health and Economic Returns on Science and Innovation Investments for Global Health

by Morgan McCloskey, Global Health Intern and Ellie Dehoney, Vice President of Policy and Programs at Research!America. This entry was originally posted as a guest contribution to the USAID IMPACT Blog. 

Doctor prepares malaria treatment. Photo credit: IMAD

In the past decade, U.S. investments in science, technology and innovation have led to critical breakthroughs in prevention, diagnosis and treatment of deadly global diseases. We now have a meningitis vaccine for African populations, a new test that can quickly diagnose drug-resistant TB and promising data indicating that a vaccine could prevent HIV infection. We have developed desperately needed new drugs for neglected diseases and have determined pathways to expand access to treatment for millions through programs like PEPFAR and USAID’s Neglected Tropical Disease (NTD) program. Continue reading →

Lancet Publishes Series on Drug-Resistant Tuberculosis

On March 24, World Tuberculosis Day, the Lancet published a series of papers on the need to combat drug-resistant tuberculosis. Cases of drug-resistant TB are on the rise, posing a growing threat to the health of populations in all parts of the world.

The series consists of six papers written by international experts in the tuberculosis field, including Professor Alimuddin Zumla, Director of the Centre for Infectious Diseases at the University College London Medical School and Dr. Marco Schito at the National Institute of Allergy and Infectious Diseases. Some papers focus on TB diagnostics, highlighting advances such as the Xpert MTB/RIF test as well as the dire need for new affordable and effective diagnostics that can detect drug-resistant strains of the disease. One paper focuses on the more technical aspects of the disease and identifies the need for additional funding to research biomarkers for drug-resistant TB. Yet another paper discusses the importance of integrated health service and control efforts, as countries are facing a high burden of TB as well as non-communicable diseases such as diabetes and cancer. Finally, the last two papers discuss the importance of community engagement in research and the need for visionary political leadership to advance global efforts to control TB.

Taken together, this series not only warns of the danger of the TB, but of the danger of inaction. If we are to make progress in the global fight against TB, we must take some of the recommendations for research and control efforts laid out in these papers. It will take concerted action from political leaders, health policy makers, funders and researchers to stem the growing threat of drug resistant TB.

-Morgan McCloskey, global health intern

Drug-Resistant TB in the U.S.

Last week, the Wall Street Journal reported that a Nepalese man detained at the U.S.-Mexico border has extremely drug-resistant tuberculosis, XDR-TB. Tuberculosis, a potentially fatal disease that can be passed through the air, has historically been curable with appropriate treatment. However, new strains of TB that are resistant to available drugs have recently emerged and pose a significant public health threat. Some strains are resistant to only a few drugs (multi-drug resistant TB) while other strains, such as the one carried by the man in this story, are resistant to nearly all existing drugs. Because of this, XDR-TB is extremely difficult to treat and experts warn that new drugs will be necessary to treat growing numbers of patients with this disease.

In addition to the need for new drugs to combat XDR-TB, this case underscores the need for improved TB diagnostics. Because this man was tested in the U.S., his samples were sent to an advanced laboratory that had the equipment necessary to detect the drug-resistant strain. However, many developing countries where TB poses the largest burden do not have the technological or health infrastructure to accurately diagnose XDR-TB cases. Therefore, patients may not receive appropriate treatment, which is detrimental to their own health and means that they can continue to pass drug-resistant TB onto others. Research to develop simple, efficient and low-cost TB diagnostics is urgently needed.

Unfortunately, this story is not an isolated case. Prior to entering the U.S., the man had made his way through 13 countries and had likely come into close contact with hundreds of people, many of whom may have been infected. In this era of globalization, diseases will continue to cross international borders and it is imperative that public funding for new tools and for this type of research is sustained.

Morgan McCloskey, global health intern 

TB Vaccine Trial Paves the Way for Future Research

On February 4, Aeras released the results of a clinical trial of one of their TB vaccine candidates. The trial was conducted in South Africa with nearly 3,000 infants and while the vaccine was safe and well-tolerated, ultimately it was not found to provide protection against TB. Although the results were not what researchers had hoped, the trial was the first of its kind and proved that a large-scale clinical trial to test a TB vaccine in infants can be successfully run in a country with a high TB burden like South Africa. Researchers also pointed out that there are twelve other TB vaccines in clinical development and the infrastructure built through this trial can be used to test these candidates in the future.

Instead of being disappointed with the results, the global health community must move forward in the fight against TB with renewed urgency.  TB kills 1.4 million each year and over 12 million suffer from TB infection. Cases of drug-resistant TB are on the rise and the existing treatments are extremely complex and expensive, meaning that only 3% of drug-resistant patients receive proper treatment. The economic cost of TB is also enormous – in South Africa alone, TB control costs nearly $300 million each year. New drugs, diagnostics and vaccines are urgently needed to saves lives and money.

-Morgan McCloskey, global health intern

Importance of Affordable Diagnostics

An article in the most recent issue of The Scientist highlighted the importance of affordable diagnostics for global health. Although scientific advances have improved treatment options for many global diseases, a lack of effective, low-cost diagnostics hinders the health of many in the developing world. For example, medicines to treat HIV and tuberculosis have been life-saving for many individuals, but they can cause liver damage and patients on these medications must be monitored. However, the primary test for liver damage requires expensive equipment that is simply not available in low-income countries. To solve this problem, a Massachusetts biotech company, Diagnostics For All, developed a 10 cent paper-based test that can diagnose liver damage with a single drop of blood.

Other U.S.-based companies are working on similar low-cost diagnostics. In Texas, Global BioDiagnostics Corp is developing a more effective test for tuberculosis that will cost just $5. Both of these projects are excellent models for incorporating the idea of access into the research process and designing products that can actually be utilized in low-resource settings. However, there is often not enough money for companies to develop these kinds of products. In fact, a principal investigator at PATH says that “the problem [with low-cost diagnostics] is almost always funding.” Therefore, it is crucial to increase funding for affordable diagnostics. Not only would increased investment support these U.S.-based companies, but the end products could truly transform health care in the developing world.

Update: Another article, published in The Scientist on January 10, also addresses the urgent need for better diagnostics in resource-limited countries. In addition to making diagnostics more affordable, truly successful new diagnostics must also be “sensitive, specific, user-friendly, rapid, equipment-free and deliverable” and these considerations must be built into the R&D process. Overcoming these research challenges hinges not only on additional funding, but collaboration between research companies, the healthcare industry and local governments. Several Product Development Partnerships (PDPs) are leading the charge in these kinds of innovative collaborations. For example, the Foundation for Innovative New Diagnostics (FIND), a PDP based in Geneva, Switzerland, is working with manufacturers, health organizations and ministries of health and developing diagnostics from the initial design to the operational research phase to determine the diagnostic’s efficacy in a low resource setting. The importance of these kinds of new tests, which will result in more appropriate treatment plans that can save lives and money, cannot be overlooked.

-Morgan McCloskey, global health intern

NTD Highlights of the Week: January 4th

As we ring in the New Year, 2013 promises to be an exciting time to be involved in the fight to raise support and awareness for neglected tropical diseases. As the world becomes more interconnected and global warming changes disease patterns, NTDs are increasingly spreading across borders – including right here at home. For example, Slate recently published an article addressing the return of dengue in the United States. In the past few years, dengue has sickened hundreds in Florida and other southern states. Experts warn that the combination of the virus, a lack of immunity to dengue and widespread mosquitoes provide the perfect storm of conditions for larger dengue outbreaks in the U.S.

As the spread of NTDs adds urgency to the fight, scientists continue to work every day to develop innovative ideas to combat NTDs. In a trial experiment in Africa, researchers are testing the ability of prawns to combat schistosomiasis. A parasitic disease that can be fatal, schistosomiasis is spread through water snails. Prawns are the primary consumers of snails, so researchers hope that re-introducing prawns to rivers at the African test site will help decrease transmission of the disease. In addition to innovative experiments, every week there are reports of new scientific breakthroughs that will help save lives.  Just last week, the FDA approved a drug to fight drug resistant tuberculosis, the first new drug for the disease in over four decades. Developed by Johnson & Johnson, the drug cures patients in less time than older treatment options. It is these kinds of innovations and breakthroughs that demonstrate the power of research investments and the importance of research for global efforts to eliminate neglected diseases. Be sure to check back soon for new NTD highlights!

Morgan McCloskey, global health intern

Lives in the Balance

On December 13 and 14, the global health community gathered at the Mount Sinai School of Medicine in New York for a conference called “Lives in the Balance: Delivering Medical Innovations for Neglected Patients and Populations.” Hosted by Mount Sinai Global Health, Doctors Without Borders (MSF), and Drugs for Neglected Diseases initiative (DNDi), the conference aimed to spur innovation for new tools to combat neglected diseases.

Several key themes emerged from the conference. First, there is a ‘fatal imbalance’ between the burden of neglected disease and medical innovations to combat these illnesses. Neglected diseases affect more than 1.4 billion people worldwide and account for nearly 11% of the global disease burden. In contrast, MSF’s Jean-Herve Bradol, MD, pointed out that of 850 new therapeutic products approved in the past decade, only 4.4% were for neglected diseases. Furthermore, only 1.4% of 148,445 clinical trials were for neglected diseases. To solve this problem, many presenters agreed that there must be a new global framework for global health R&D. A new framework would place an emphasis on public financing and some called for all countries to pledge 0.01% GDP to government-funded R&D.

In addition to reforming the global R&D system, several panelists mentioned the importance of improving access. This means not only improving access to medicines among neglected patients but improving information sharing and access to essential compounds among researchers. The idea of access must also be built into the beginning of the research process. For example, considering storage temperatures or dosage early on in the R&D process will help to ensure that the new tools being developed can be easily utilized in the field.

The conference has put a spotlight on the need for more research to combat neglected diseases. Diseases that once only existed in the developing world are becoming an increasingly large threat in Europe and in the U.S. Cases of multi-drug resistant TB are on the rise, and we need much better treatment options to cure patients. Only two drugs are currently available to treat Chagas disease; both were developed more than 35 years ago, have toxic side effects and are not effective in all patients. It is more important than ever before that governments, philanthropic groups and the private sector come together to help reform the global R&D system, improve access and find new tools to help neglected patients and populations around the world. Many have called this time, these partnerships and current innovations in modern science an unprecedented opportunity for neglected disease R&D. Others are frustrated by the seeming regression in global health due to non transformative “stopgap” efforts, citing drug resistant TB as an example. Both may be right. With unified advocacy to raise awareness and engage political and civic will for NTDs, we can successfully channel both the frustration and the opportunity ahead of us.

Report Highlights Need for More R&D Funding for Neglected Diseases

On December 3, Policy Cures released its fifth annual G-FINDER report, a comprehensive survey of funding for research and development for neglected diseases. The report tracks global public, private and philanthropic investments into R&D for 31 diseases, including HIV/AIDS, tuberculosis, malaria and NTDs.  In positive news, this year’s report shows that total funding has actually increased by $443 million since 2007.

The report demonstrates that government funding, which accounts for over two-thirds of all investment, is increasingly going toward basic academic research, rather than product development. Research!America believes it is vital that the entire research pipeline be fully funded. Basic research will help us understand the best ways to tackle these neglected diseases and give us a better understanding of disease and the human body.  However, we also need robust funding for the development of urgently needed tools like drugs, vaccines and diagnostics. This urgency is worsened by the fact that private and philanthropic investments in product development for NTDs have also decreased.

Because NTDs disproportionately affect the “bottom billion” or individuals earning less than $1.25 per day, there is essentially no market demand for new NTD tools, so the private sector is unlikely to fund these projects. Dr. Moran, director of Policy Cures, believes that governments must step up to the plate, saying that “if [governments] want products for neglected diseases, they must fund product development as well as basic research.”

-Morgan McCloskey, global health intern