The world gets grade F in terms of its effort on TB: Bill Gates

31 March, 2014 - Stockholm/Geneva - At an event held at Sweden’s Karolinska Institutet on March 31st, Bill Gates, Co-chair, Trustee, Bill & Melinda Gates Foundation, and Hans Rosling, Professor of International Health, Public Educator at Gapminder Foundation, debated the end of extreme poverty. You can watch the video here.

The following is a transcript of Mr Gates’ response to a question raised on TB, by a member of the audience:

In the Western world, TB was a problem some time ago, but not really anymore. Who needs to do what differently regarding TB to get it under control in Sub-Saharan Africa?

Bill Gates: "TB is still a huge killer. With TB, it is sometimes valuable to look at the TB that is associated with HIV, and the TB that is not associated with HIV. They are not completely separate, but particularly in the African countries, where you have high HIV rates, you have seen TB go up a lot.

The worst country in the world for TB is South Africa. It is a confluence of factors. There is a huge HIV epidemic, and it is actually the weather - it’s almost an unnatural weather for people who are living there. Vitamin D levels, which are closely related to TB susceptibility, are still very low. So Cape Town, which does pretty well on a lot of health statistics, has an incredible TB problem - the worst forms of TB are MDR-TB and XDR-TB.

The world gets, really you have to say, an F in terms of its effort on TB. Once it was not a problem in the rich world, then we stopped coming up with new drugs. And the so called first line drugs - first of all you have to take them for 6 months, and it’s very difficult, particularly after 3 or 4 months, when you are feeling better, your motivation to keep taking those drugs is very low. Yet if you stop at that point, you have a high chance of reinfection, you can infect others, and that’s where you breathe these drug resistant versions.

So the world needs to get going on drugs. About 8 years ago, our Foundation and others got revved up. Unfortunately it takes a long time to get new drugs out. And particularly with TB, the whole idea of how you get drugs approved is very confusing, because it’s a multiple drug regime. So do you just take one drug through, and then try to put it in a 3 drug regime? It looked like it would take 20 years to go through the regulatory process. Now fortunately that has been shortened, they have changed it. It looks like we will have some new drugs come out within the next 3 years. And we can shorten the regime it looks like down to 4 months.

The other thing we need in TB - well, ideally we’d get a vaccine, and we are working hard on that, but that’s a big challenge.

The other thing you want in TB is a diagnostic, we are still doing it with X-rays and sputum microscopy, which are very limited approaches. They don’t work well for young kids. They have high rates where you have TB and it doesn’t show it. There is a diagnostic genetic test GeneXpert that we have been rolling out in a number of places. And that has been helping a lot, but we have to get it very close to the individual, because the sooner we can get you diagnosed and on drugs, then you are not coughing and infecting lots of people.

So I’d be optimistic about TB, but only because we are going to get some of these new tools. Better diagnostics, better drugs, and maybe a new vaccine - that one is the hardest to predict.