Interview with NIAID Director on the Subject of TB
As part of its observance of "World TB Day" on March 24, the National Institute of Allergy and Infectious Diseases has updated its "Focus on TB" web site, featuring TB research being done in NIAID's labs in Bethesda, Maryland, and by NIAID-supported scientists across the country and around the world.
Schmalfeldt: As part of its observance of "World TB Day" on March 24, the National Institute of Allergy and Infectious Diseases has updated its "Focus on TB" web site, featuring TB research being done in NIAID's labs in Bethesda, Maryland, and by NIAID-supported scientists across the country and around the world. I had a chance to sit down with NIAID Director Dr. Anthony S. Fauci to discuss the ongoing war against TB. I asked him if it was a mistake to discount TB with all the current information about other diseases like bird flu and HIV/AIDS demanding so much attention.
Fauci: Well, I think it is and that's why we have certain things like TB Awareness Day. Tuberculosis is one of the great killers in civilization and in our history. If you look at some startling numbers, one-third of the world's population is infected with tuberculosis. They're not sick with tuberculosis, but they're infected with tuberculosis. There are close to two million deaths per year. There are millions and millions of people each year who get seriously ill with tuberculosis, but because it has been a classical scourge on our civilization, in some tragic respects it's taken for granted. If you have a disease that's killing a couple of million people a year consistently from year to year, you would think that people would sit up and take notice of it. But in many respects it's similar to malaria where you have an enormous number of people who are dying as well as those who get seriously ill, and yet because it has been around for so long, it's accepted as just part of what life is on this Earth and that is something we really need to change because we have not brought the science and technology of the 20th and 21st Century up to tuberculosis to allow it to benefit from that. Apart from recently, the pipeline of drugs and vaccines and things you would take for granted with other serious diseases — that has not happened with tuberculosis. We've let it slip, and it's time to play very fast catch-up.
Schmalfeldt: I asked Dr. Fauci what the NIH and NIAID were currently doing to defeat the scourge of TB.
Fauci: Well, several things that have been accelerated over the past few years, and that is to — for the first time in a very, very long time — have a robust pipeline of new drugs that could be used for tuberculosis. Tuberculosis is an eminently treatable disease. It takes therapy for a considerable period of time, and there's always the problem of multiple drug-resistant tuberculosis. Over the last several years, we've had a number of new drugs in the pipeline that are hopefully going to be able to provide us with the capability of, one, circumventing the issue of drug-resistant tuberculosis, but also having us be able to treat tuberculosis in a much more "patient-friendly" form where you could have duration of therapy that's less than we're used to as well as a potent-enough anti-tuberculosis drug that you could have complete eradication of tuberculosis in an individual. I think you could say the same thing for vaccines. You know, there is a vaccine for tuberculosis — BCG, Bacillus Calmette-Guerin. BCG is a(n) attenuated form of tuberculosis that has been used for decades for the prevention of tuberculosis. It's reasonably effective in preventing the serious complications like tuberculous meningitis in children, but it is not at all very effective in prevention against the adult pulmonary tuberculosis that we see so commonly in the world. So we need to do better than BCG. And right now we have a couple of candidates that are in the pipeline, some of which are now begun testing. Just last year we started a clinical trial on one of these vaccines which was actually, interestingly and amazingly, the first clinical trial of a new tuberculosis vaccine in 60 years. So, as I mentioned, we really need to play some serious catch-up in bringing the science of the 21st and 20th Century to be applied to tuberculosis. So that's what the NIH's goal is, to accelerate that process, and get some of the newer vaccines and newer therapies available for such an extraordinary disease. As you can see, it's one of the top handful of killers throughout the world.
Schmalfeldt: I told Dr. Fauci that it seems like there isn't as much attention paid to TB as there was years ago, with such programs as Christmas Seals that raised public awareness concerning the disease. He said that, in some ways, the fight to prevent TB in this country has been something of a victim of its own success.
Fauci: In some respects, in this country certainly, tuberculosis has been a success story. If you looked at plotting the curve of tuberculosis active cases and deaths in the United States over the last half a century, they've gone down dramatically. It reached a little bit of a stumbling block in the mid-80s when HIV came in and we started to see a re-birth, as it were, of a problem with tuberculosis — particularly multiple drug-resistant tuberculosis among individuals who were HIV-infected, because since the immune system of HIV-infected individuals is compromised, the normal mechanisms that keep tuberculosis in check are not there, so you have people that develop active tuberculosis out of latent tuberculosis (at a) much higher rate than in the normal population. When that happens, they spread it to other people. When they get treated, not infrequently, they're not completely and thoroughly and effectively treated, so they develop a drug-resistant tuberculosis. And before you know it you have the spread of drug-resistant tuberculosis. We had a problem with that in the mid to late-80s and into the 90s, but then things started to turn around again so we're doing much better in this country. But we have to go beyond this country. You have to look at tuberculosis as a global public health issue. And since there's such an emphasis these days on global health, tuberculosis is right up there among the chosen few of the great challenges in global health.
Schmalfeldt: Every second of every day, someone is newly infected by the bacterium that causes TB. The ancient affliction still reigns as one of the world's leading killers. To read more about research studies and progress against the disease, visit the "Focus on Tuberculosis" web site. Log on to www.niaid.nih.gov for more information. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
About This Audio Report
Reporter: Bill Schmalfeldt
Sound Bite: Dr. Anthony S. Fauci