Editor's Note: Humanity has coexisted with tuberculosis for over 5,000 years. It claimed the lives of renowned figures like Shelley, Empress Sisi, and Lu Xun. Ending the "white plague" is the responsibility and vision of the modern era, requiring collaboration from governments, medical professionals, researchers, and businesses. At the recent "2024 Annual Meeting of the National Clinical Research Center for Infectious Diseases and the 15th Tuberculosis Eastern Forum (September 19–23, 2024, Shenzhen)," Shitong Huan, the Bill & Melinda Gates Foundation Senior Program Officer, delivered a report titled “Eliminating Tuberculosis: Innovations in Health Systems and Tools.” In an interview with Infectious Disease Frontier, she shared the foundation's efforts and achievements in ending the tuberculosis epidemic and discussed innovations in tuberculosis prevention and treatment technologies.Ending the “White Plague”: The Gates Foundation’s Ongoing Efforts and Achievements
The Bill & Melinda Gates Foundation (Gates Foundation), founded in 2000, focuses on improving global health and development, particularly in areas such as infectious disease prevention and maternal and child health. Tuberculosis (TB) prevention and control are one of the foundation’s key focus areas. According to Huan, “The Gates Foundation has primarily invested in two areas for TB control: product development and improving health system efficiency.”
Innovation in Diagnosis and Treatment
For diagnosis, the foundation has driven advancements from the early days of sputum smear tests to modern molecular diagnostic techniques. It is also exploring new, more accessible sampling methods, such as tongue swabs for PCR testing, to make testing easier and more affordable. In terms of treatment, the foundation is funding research into shorter, universal TB treatment regimens aiming to cure TB, including drug-resistant strains, within 2-3 months. Another research direction is long-acting injections, which could potentially reduce the treatment burden to one injection per month.
The foundation continues to support innovations in diagnostic and treatment tools for TB.
Vaccine Development Challenges
TB prevention currently lacks an effective vaccine. Huan compared the difficulty of developing a TB vaccine to that of developing COVID-19 vaccines, stating, “If the difficulty of developing a COVID-19 vaccine is 10, the difficulty for TB is 100.” The foundation, along with partners, has invested heavily in vaccine research. For example, the M72/AS01E TB vaccine candidate is currently undergoing a $550 million Phase 3 clinical trial, supported by the Gates Foundation and the Wellcome Trust.
Integration with Health Systems
The foundation recognizes that innovative tools alone are not enough—they must be integrated into health systems to make a real impact. Since 2007, the foundation has collaborated with China’s National Health Commission, CDC, and other institutions to develop a comprehensive TB prevention model that has been successfully implemented in Zhejiang, Jilin, and Ningxia provinces. Similar efforts are underway in high TB-burden countries like India, Indonesia, and South Africa.
Through these collaborations, the foundation has worked to improve the efficiency of health systems, optimize patient referral and medication management, and ensure timely diagnosis and treatment of TB patients.
Shifting from Passive Detection to Active Screening
The foundation has been exploring more proactive strategies to identify TB patients. Studies have shown that active screening and treatment are highly effective, but costly. Huan noted that the foundation is working with global partners to explore new low-cost tools and methods, such as AI-assisted diagnostics and tongue swab tests. These innovations could help improve the early detection and treatment of TB, potentially reducing the spread of the disease.
Overcoming Challenges and Realizing Potential
Looking ahead, Huan emphasized two main focus areas: the potential impact of new tools and the difficulty of developing them. While developing an effective TB vaccine remains a monumental challenge, successful innovations in diagnosis and treatment, such as portable diagnostic devices or short-course treatments, could significantly improve TB control efforts.
In conclusion, Huan stressed the importance of a dual approach: continuing to innovate with new diagnostic, treatment, and vaccine tools while improving health system efficiency and service accessibility. These strategies not only apply to TB control but will also be crucial for managing future infectious disease outbreaks.
