Dr. Rajiv Shah, Administrator of the United States Agency for International Development (USAID), addressed the importance of investing in innovation and harnessing the power of new global health technologies to achieve widespread impact on those suffering from disease in the most impoverished regions of the world. Dr. Shah’s speech, delivered at the 2010 David E. Barmes Global Health Lecture, highlighted tuberculosis as one of the areas that provide opportunities for realizing transformative health-based successes through the development and introduction of new technologies and tools.
In many disease areas, delivery of services is often identified as the pathway to ultimately improve patient outcomes. While such improvements would certainly be welcome and highly beneficial, Dr. Shah noted, “Integrated service delivery alone will not achieve success. Our real opportunity rests in harnessing the power of invention—scientific, technological, and behavioral—on behalf of the developing world.”
Indeed, the elimination of TB as a public health threat is simply not possible without the development of new, faster-acting, novel treatment regimens. “We must fight TB now before it becomes an unparalleled global killer,” Dr. Shah remarked. “The frightening growth of drug-resistant strains of TB makes the case for combating the disease more urgent than ever. But continuing to do more of the same—often the result of a relentless drive to report on the number of people in treatment—will not work to turn the tide against TB.” Instead, he said, “We need to focus our efforts on facilitating a continuum of invention and innovation from bench to bush.”
The problems with the current TB drugs stem from the length of treatment. As Dr. Shah articulated, “Our current treatment regimens require direct observation and a long course of treatment—up to two years for MDR-TB. This makes patient compliance extremely challenging, leading to incomplete treatment and further drug resistance.”
Like the TB Alliance, however, Dr. Shah has reason to be optimistic about the future of TB control. He called attention to the promising developments in TB drug development, noting, “Late-stage clinical trials of shorter-course treatments are currently underway, and within a few years will be registered and ready for use. The shorter regimens will result in improved adherence and higher cure rates, decreasing TB transmission and antibiotic resistance.”
USAID has been a strong supporter of TB drug research and is a donor to the TB Alliance. Dr. Shah further stated USAID’s commitment to the development of new TB treatment regimens, claiming, “USAID will strengthen its capacity to assist the development of these new courses of treatment. “
He also called on others to share that commitment and direct their energies toward an innovation-centered approach to improving TB control. “We need NIH, CDC, WHO, and others to focus on dramatically reducing the length of treatment regimens, the effectiveness of new combination therapies, and on integrating TB control tightly into health systems,” he said. “Together, if we can craft a new approach to TB based on these new technologies, we can turn the tide of the epidemic.”
The TB Alliance shares Dr. Shah’s vision on the key role innovation plays in combating the world’s most urgent and deadly global health threats. New, improved TB treatment regimens would save millions of lives and drastically improve the treatment of multidrug-resistant tuberculosis (MDR-TB), as well as help fully integrate the treatment of HIV/AIDS and TB, for the millions of coinfected patients around the world.
The realization of the potential in the global TB drug portfolio that Dr. Shah referenced is only possible with the continuing and strengthening of the commitment of the research partners, international donors, and private philanthropic communities that fund this important work, and the continued effort of those who advocate its importance and urgency.