An international partnership yesterday laid out a plan to treat 50 million people with tuberculosis and save 14 million lives over the next 10 years, in part by accelerating ongoing research on the first new TB drug in four decades and the first new TB vaccine since 1921.
The strategy seeks to detect at least 70 percent of all tuberculosis cases worldwide and to cure 85 percent of them. That would include 800,000 cases of multi-drug-resistant TB, nearly 100 times the number treated in the past decade. At the same time, about 200 million people infected with the AIDS virus would be screened for TB, which is often rapidly fatal in them.
"We really do believe we're in a revolutionary time for tuberculosis," said Maria C. Freire, head of the Global Alliance for TB Drug Development. The New York-based nonprofit group helps develop and test compounds that appear promising as TB drugs but that pharmaceutical companies do not want to develop on their own for various reasons.
The Stop TB Partnership consists of about 400 organizations, companies and government agencies. It was created in 2000 and set goals for 2005, progress toward which is now being assessed.
The partnership is one of several efforts to rapidly improve treatment of major fatal diseases in the developing world. Similar campaigns exist for malaria and AIDS.
Tuberculosis is caused by a slow-growing bacterium that most commonly damages the lungs, although it can infect any organ. Unlike many microbes, it can live inside the body for decades before causing illness. About one-third of the world's population has such "latent" infection.
Although only a small fraction of those people will develop active tuberculosis, the total numbers are huge. In 2003, the last year with complete statistics, there were 8.8 million new cases and 1.7 million deaths, including 229,000 people also infected with the AIDS virus.
One goal is to cut TB mortality to less than 1 million a year by 2015. Worldwide there are about 57 million deaths from all causes each year.
The global death rate for TB peaked in the 1990s. The annual incidence, or rate of new infections, is stable or falling in most regions, but for the world as a whole it is rising slightly because of an explosion of the disease in Africa. There, it is the leading cause of death in people infected with human immunodeficiency virus.
"It has become apparent in the last decade that with TB and HIV we have a catastrophic collision of epidemics with a synergistic effect, each making the other worse," Richard E. Chaisson, a physician and epidemiologist at Johns Hopkins University, said yesterday at an event in Washington to describe the Global Plan to Stop TB.
Chaisson is helping to test several novel strategies to reduce TB in heavily infected populations in South Africa. In one, gold miners will be given the preventive drug isoniazid to see if mass treatment reduces the number of TB cases.
One of the targets laid out in the 167-page plan is to expand the "DOTS" (directly observed treatment, short course) strategy in which people with TB are given a proven combination of drugs for at least six months. Health workers watch patients take their pills to ensure treatment is not stopped prematurely.
From 1996 to 2005, about 24 million TB patients were treated that way. The goal is to treat 51 million with DOTS from now through 2015.
Another goal is to bring fast, gene-based diagnostic tools to poor countries. Most diagnose TB by examining samples of phlegm under a microscope to look for bacterium, and culturing it for 45 days, the same methods used a century ago.
The total cost of the plan for the next decade is $56 billion, of which $9 billion is for research and development and the rest for treatment, prevention and other activities.
At the World Economic Forum in Davos, Switzerland, yesterday, Microsoft's Bill Gates announced that the foundation he and his wife created will commit $600 million more to TB by 2015. It has already spent $300 million on the disease.