As we commemorate World TB Day, this year’s theme — "On the Move Against Tuberculosis: Innovate to Accelerate Action" — inspires us to think anew about how best to marshal the talents of scientists and public health officials to defeat this deadly resurging epidemic. Despite progress toward improved control of TB, significant challenges remain to reach the goals set forth in the Global Plan to Stop TB (http://www.stoptb.org/global/plan/) as this effort reaches its midpoint.
Currently, one-third of the world's population — about 2 billion people — are thought to be infected with Mycobacterium tuberculosis (Mtb), the organism that causes TB. According to the World Health Organization, an estimated 11.1 million people had the active form of the disease in 2008. TB is especially dangerous and is becoming more prevalent among people who have certain other diseases, such as HIV/AIDS and diabetes. In 2008, about 1.8 million people died of TB, including an estimated 520,000 people co-infected with HIV. Globally, TB is the leading cause of death among people with HIV/AIDS, and HIV greatly increases the risk of developing active TB.
TB has afflicted mankind for millennia. Multidrug-resistant and extensively drug-resistant TB are spreading amid an already overwhelming burden of drug-sensitive TB and HIV/AIDS, particularly in resource-poor nations. The increased transmission of drug-resistant forms of TB threatens to undermine impressive advances in TB control. Interventions that have worked in the past to control TB globally must now be re-assessed and tailored for individual regions.
The need to adapt and innovate also holds true for biomedical research in TB. We are now halfway through the timetable for the Global Plan to Stop TB (2006 to 2015) and must re-evaluate the way we approach TB research and product development.
To achieve the goals of global health initiatives being proposed and implemented by the United States and our international partners, we need to enhance and expand our collective research efforts. As a first step, the international biomedical research community must define the key fundamental research questions that can best advance the field and then focus our research agendas to provide answers. By identifying these essential questions, we can then organize our collective efforts in basic, translational and clinical science to expedite the development of new TB drugs, vaccines and diagnostics.
To fully understand TB in its natural context, we must incorporate into our research efforts our evolving knowledge of the diverse nature of the disease, how it manifests in patients and how it spreads in communities. This can be done only through even closer collaboration between basic and clinical TB research, and a tighter integration of resources in settings where TB and HIV/AIDS are prevalent. NIAID is committed to such partnerships in its support for a continuum of basic, clinical and translational research, and in its participation in a number of important leadership and coordination organizations.
On this World TB Day, we are reminded that we can change global health by working together. We must renew our commitment to research as the source of innovation, and work aggressively to develop more effective TB control measures, so that millions of lives affected by TB will be saved around the world.
The need for new knowledge and innovation is urgent. But history has proven that by engaging outstanding scientists and providing long-term support, we can meet and overcome global health challenges such as TB.
For more information about TB, visit NIAID’s Tuberculosis Web portal (http://www3.niaid.nih.gov/topics/tuberculosis/default.htm) and the HHS TB Web site (http://www.hhs.gov/tb/).
Anthony S. Fauci, M.D. is director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health. Christine F. Sizemore, Ph.D., is chief of the Tuberculosis and Other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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