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Posts Tagged ‘Mario Raviglione’

What is more worrisome when it comes to drug-resistant TB: What we do know about the epidemic? Or what we don’t know?

The latest World Health Organization report on the epidemic provides plenty of both—some grim facts and some disconcerting question marks.  Take these nuggets:

*A shocking 41 percent of countries cannot provide reliable data on the scope of drug-resistant TB within their borders, according to the report, on the eve of World TB Day.

*The up-to-date tools needed to diagnose drug-resistant TB are not available in more than half of the 27 countries most heavily affected by multidrug-resistant TB (MDR-TB).

*An estimated 440,000 new cases of MDR-TB emerge each year, but only 7 percent of those cases are actually being detected. And even fewer are being treated. One-third of the estimated new cases each prove fatal. As for extensively drug-resistant TB (XDR-TB), there’s even less information.

In many of the places that do report good data, the WHO found MDR-TB at record levels; in one region of northwestern Russia, for example, 28 percent (more than 1 in four) new TB cases involved a strain of the bug that could not be treated with standard TB medicines. Other places could be even worse. But poor surveillance, inadequate laboratories, and antiquated diagnostics obscure the full scope of the threat.

 Dr. Mario Raviglione, Director of the WHO Stop TB Department, and Dr. Marcos Espinal, Executive Secretary of the Stop TB Partnership, ran through some of this data in a briefing for TB advocates and experts in Washington today. They also highlighted the lack of adequate funding or political commitment to TB, saying this urgent global health threat simple was not getting the attention it requires.

Dr. Raviglione said Europe is “de facto” asleep when it comes to TB, no UN leader “has ever recognized TB as a priority,” and no rich countries have ever launched a presidential-level initiative to combat the disease. They two WHO officials commended U.S. leadership on TB but said much more needs to be done here and around the world.

Click here to see the full WHO report.

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This post is by Global Center Director Christine Lubinski.

The excitement in the room was palatable today as FDA Commissioner Margaret Hamburg joined representatives from the Global Alliance for TB Drug Development, the Bill & Melinda Gates Foundation, the Treatment Action Campaign, and representatives from the pharmaceutical industry to announce a new collaboration to accelerate the development of combination treatments for tuberculosis.

Known as the Critical Path to TB Drug Regimens (CPTR), the initiative will test promising combinations of individual TB drug candidates from different companies early in the development pipeline—and identify the best new treatment regimens.

“We are here today because every year almost two million people die from a disease we have known how to cure for decades,”   Dr. Hamburg said in opening remarks at the event. She went on to describe the scientific enterprise in TB as stagnant and characterized TB research as the “only field in medicine where you could go into hibernation for decades and emerge to find that nothing has changed.” 

She also spoke about her experience leading the effort to combat resurgence in TB, including MDR-TB in the early 1990s in New York city, and noted that $1 billion in costs associated with that effort might have been saved if appropriate resources had been marshaled to control TB in the first place.  She articulated her commitment–and that of the FDA–to advancing regulatory processes that bring urgently needed advances in the treatment of drug-susceptible and drug-resistant TB.

Mario Raviglione, MD,  the lead on TB for the World Health Organization, noted that 4,500 people who die of tuberculosis every day. And he pointed out that while there is a disproportionate burden of TB in some parts of the world—notably Asia and Africa—no country has even come close to eliminating tuberculosis.  He described the coalition of companies coming together to develop new, more effective combinations of drugs for TB treatment as “unprecedented” and pledged that the WHO would move forward rapidly to develop policies relevant to getting new treatments to the field.

Dr. Regina Rabinovich, head of infectious diseases for the Bill & Melinda Gates Foundation, said the CPTR the initiative was groundbreaking and forged “a new pathway.”  She also noted that the Gates Foundation could not do this alone and said it’s is essential that industry and governments step up to help finance this effort.

Paul Stoffels, MD, head of global research and development for Johnson & Johnson, talked about clinical trials under way for a new drug for MDR-TB in South Africa and said it’s been so long since there have been major TB clinical trials, that both capacity and know-how are a problem.

Professor Charles Mgore, executive director the the European and Developing Countries Clinical Trials Partnership (EDCTP) pledged the cooperation of his organization in the implementation of this initiative.  EDCTP aims to accelerate the development of new or improved drugs, vaccines and microbicides against HIV/AIDS, malaria and tuberculosis, with a focus on phase II and phase III clinical trials in sub-Saharan Africa. Dr. Mcgore noted the imperative of conducting trials in high burden countries but highlighted the challenges that exist from poor infrastructure to personnel in need of training.  

Mark Harrington, executive director of the Treatment Action Group, offered himself as a living example of what can be achieved when there is an effective collaboration among government, pharmaceutical companies and activists, as there was in the HIV context.   He also said he never thought he’d find himself in a room with five pharmaceutical companies interested and willing to invest in TB drug development, while highlighting the incredibly modest level of resources being invested today in TB research and development—only $178 million on drug development worldwide.

This collaboration, with its promise of game changing new tools to combat tuberculosis, challenges those of us who are advocates to press even harder for an allocation of resources from the U.S. and other wealthy countries for research and development and TB programming at a level commensurate with the impact of this ancient and deadly disease on the poorest people on earth.

More information on this exciting project can be found here: http://www.tballiance.org/newscenter/view-brief.php?id=904. And for a Q&A with Dr. Mel Spigelman, president and CEO of the Global Alliance for TB Drug Development, about this project, click here.

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An estimated 8 million tuberculosis-related deaths have been averted over the last 15 years through aggressive global efforts to combat this ancient and deadly epidemic, according to a new report released today by the World Health Organization.

Dr. Mario Raviglione, of the World Health Organization, highlights success in treating TB

 The epidemiological report, which provides more up-to-date figures than usual, says there were an estimated 9.4 million new cases of tuberculosis in 2008, a slight increase from the 9.3 million new cases in 2007. The disease claimed more than 1.8 million lives last year, including .5 million women.

Despite the continued global threat posed by TB, and reflected in the report’s new numbers, WHO officials said significant strides have been made in treating the disease. Over the last 15 years, an estimated 36 million patients have been cured of TB, Dr. Mario Raviglione, director of WHO’s Stop TB Department, said at a Congressional briefing to unveil the WHO report.

“We are now getting to the level of very high success rates,” Dr. Raviglione said of treatment under the DOTS strategy, or Directly Observed Therapy Short-Course. An estimated 87 percent of patients globally were successfully treated using DOTS, he said, marking the first time the global 85 percent treatment goal was surpassed since being set in 1991.

He noted that even in some countries with a high HIV burden, which fuels the TB epidemic, TB treatment has been successful. “That’s partly due to antiretrovirals being used abundantly in those countries,” he said. Still, in some parts of Africa, up to one percent of the population gets TB every year, “which is extraordinary,” Dr. Raviglione said.

Rep. Eliot Engel, D-N.Y., who also spoke at the briefing, said Congress must not falter in its commitment to fighting TB.

Rep. Eliot Engel, D-N.Y., called it "reprehensible that we allow over a half a million women to die each year of a preventable, treatable disease."

(more…)

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