A new initiative to tackle tuberculosis (TB), the Global Alliance for TB Drug Development, was launched last week at the international conference on health research for development in Bangkok.
The alliance has pledged to have an effective new antituberculosis drug on the market, at a price developing countries can afford, by 2010. Set up with huge international support, the alliance will function as a virtual research and development organisation and outsource its projects to public and private partners.
The catalyst for the formation of the alliance, was a meeting held earlier this year in Cape Town, South Africa, attended by international experts who wanted to tackle the escalating tuberculosis epidemic.
In a declaration after this meeting (International Journal of Tuberculosis and Lung Disease 2000;4:489-90) the working alliance set out the scale of the epidemic and the need to accelerate the development of new drugs to shorten its treatment time and improve its control.
Currently, a third of the world’s population is infected with Mycobaterium tuberculosis, and tuberculosis causes two million deaths a year. A third of all HIV positive people die from the disease. Although 95% of this burden falls on poor countries—in India tuberculosis kills one person every minute—globalisation is fuelling its spread internationally, and no country is immune. This has been recognised by the G8 countries, who in July issued a resolution to halve the morbidity from tuberculosis within 10 years.
Treatment with DOTS (directly observed treatment short course) has increased globally over the past decade, but over half of all patients are not detected. Of those that are, cure rates over 90% are possible.
In practice, however, supervision has proved difficult and costly to administer, and compliance is poor. Less than two thirds of patients complete treatment. BCG vaccination has had only limited impact on controlling the epidemic, and there has been a growth in multidrug resistant disease.
Despite the undisputed need for new and better treatments for tuberculosis no new antituberculosis drugs have been developed in 30 years. This is largely because pharmaceutical companies have been reluctant to make the huge investment required because of the poor prospects of commercial return from the countries where the disease is common.
Much therefore hangs on the success of what Dr Gro Bruntland, director general of the World Health Organization, described at its launch as "this innovatory new partnership."
"Without new drugs to simplify TB treatment and reduce its duration to less than three months," she warned, "another 50 million people will die over the next 20 years for it will take at least that time to develop a new more effective vaccine."
Three factors underlie the optimism that was evident at the launch of the new initiative. Firstly, the alliance, which has unprecedented international support, has already attracted strong financial backing. The Bill and Melinda Gates foundation has donated $50m (£35.7m) and the Rockefeller Foundation has pledged $10m.
Secondly, the alliance has the support of the Hever Group, which consists of the senior research and development directors of the worlds 10 largest pharmaceutical companies. Thirdly, Professor Malegapuru Makgoba, president of the Medical Research Council of South Africa, emphasised, "The recent advances in molecular genetics, particularly with the sequencing of the M tuberculosis genome, means that there has never been a more promising time for more effective and rational drug design and development."