RESEARCH TRIANGLE PARK -- If you're like most Americans, you think tuberculosis was just a threat in your grandparents' day. That's because our country initiated a massive public health program in the 1940s and '50s to control one of the oldest infectious agents known to humanity.
Today, TB may be off our radar screen -- but its destructive potential remains. Throughout history it has hit cyclical highs and lows. Even though the United States is experiencing a "low," public health officials estimate that 10 to 15 million Americans are infected with the latent form of the disease. They have no symptoms, but the bacteria resides in their lungs waiting for the body to become weak so that it can attack.
About one in 10 people with latent TB becomes sick and contagious. If left untreated, he or she will infect on average up to 15 others each year.
According to the World Health Organization, the global pool of potential cases is massive: one-third of the world's population. This translates into 2 million deaths each year. As people in developing countries know too well, TB knows no boundaries -- it's just a plane ride away.
For that reason we must stay one step ahead of the disease. Having outwitted us for centuries, TB could certainly threaten public health in the United States once again.
We in the United States have some of the best resources and technology to make sure the rest of the world can be freed from this burden. The first order of business must be to develop the next generation of medicines.
More than 40 years have passed since the last major breakthrough in TB drug development, giving physicians no alternative but to prescribe existing medicines, which involve complex and lengthy regimens.
In treating active TB, the standard drug regimen lasts six months and includes a six-week period during which a person must take as many as 22 pills a day twice a week. In some countries, including the United States, people who refuse to adhere to the regimen may be jailed to enforce compliance and quarantine.
Our focus must be to develop new drugs that are not only more effective but also affordable. Existing medicines remain expensive for many developing nations, limiting access for those most in need.
Shorter treatments, too, could substantially reduce the overall cost of curing each case of the disease. Most costs associated with TB treatment are not drug-related. Shorter therapy would allow savings to be directed to other critical health needs.
In response to the need for new drugs, the National Institute of Allergy and Infectious Diseases established a program to test compounds for activity against TB and to create partnerships with industry for developing promising drug candidates.
Public-private partnerships and other creative, R&D models will be critical as we seek to speed drugs through the required conduits of basic and clinical science. One good example of such a partnership emerged this week when the Global Alliance for TB Drug Development and GlaxoSmithKline announced a joint TB drug-discovery program.
This new collaboration will help the pharmaceutical company to further its commitment to fight diseases of the developing world and to share some of the financial risk. For its part, the TB Alliance benefits from the company's facilities and expertise.
The TB Alliance also formed a partnership with Novartis last fall to contribute "discovery science" to the fight against the disease. Under the terms of each agreement, the pharmaceutical companies have pledged to make any treatments available without profit to poor patients in developing nations.
In our efforts to stem the tide of TB, initiatives of this kind are exactly the right prescription.