22 Mar 2012, Saptarshi Chaudhuri, BioSpectrum
Bill & Melinda Gates Foundation is the largest transparently operated private foundation in the world, founded by Bill and Melinda Gates with the aim of enhancing healthcare and reducing extreme poverty. Dr Peter Small, senior program officer of Bill & Melinda Gates Foundation shares his views on the various activities carried out by the foundation with regard to TB.
What are the most significant achievements of the foundation in the battle against TB?
After a decade of committed investment from the Gates Foundation and hard work by our partners, we now have a promising pipeline of new diagnostics, drugs and vaccines. In terms of diagnostics, a new molecular test called GeneXpert can diagnose TB with virtual certainty in less than two hours and identify the most common form of drug resistance. It is a transformative technology that could change the landscape of TB care. The test was developed by the Foundation for Innovative New Diagnostics (FIND), Cepheid and the University of Medicine and Dentistry of New Jersey, US, with the support from the US National Institute of Allergy and Infectious Diseases and the Gates Foundation.
In the last five years, there has been extraordinary growth in the pipeline of new drugs. In late 2010, the Global Alliance for TB Drug Development and its partners, with support from the Gates Foundation and other donors, started the first human trial in which two experimental TB drugs were brought together at the same time.
Who are your major partners and how are these partnerships fulfilling your objectives?
The Gates Foundation supports the goals of the Stop TB Partnership and the Global Plan to Stop TB, which is to treat 50 million people and prevent 14 million deaths from the disease by 2015. We work with a broad group of government, donor, private sector, research institutes, non-governmental organizations and community partners to support this objective. Our partnerships range from the World Health Organization; to product development tie-ups like the Aeras Global TB Vaccine Foundation, the Foundation for Innovative New Diagnostics, and the Global Alliance for TB Drug Development; to advocacy groups like the RESULTS Educational Fund.
How is the GeneXpert platform contributing towards the fight aginst TB?
The GeneXpert molecular diagnostic is the first new test to dramatically reduce the time it takes to accurately diagnose TB. By accurately detecting TB and one common form of drug-resistance in less than two hours, this test and others likely to follow, have the potential to revolutionize TB diagnosis. That is why the WHO has recommended all countries to incorporate Xpert into their disease testing programs.
What are the key challenges associated with the availability of GeneXpert?
The high-cost of GeneXpert could limit its uptake, so we need to bring the price down. It is still too expensive for widespread implementation in developing countries. But, at the same time, manufacturers in India and elsewhere have already shown interest in developing low-cost generic molecular tests that would be widely affordable for health systems globally. Researchers are also exploring other, improved molecular diagnostics as well as serology tests for TB that will be faster, more affordable and easier to use in the field, including eventually a point-of-care test.
What are the new programs in the pipeline?
The foundation will continue to invest in the innovative delivery of existing TB control strategies and development of better tools to prevent and treat the disease. We hope that, once ready, these innovations can be implemented on a wide scale to save more lives.