Bill & Melinda Gates Foundation Awards $44.7 Million To Harvard Medical School To Control Multidrug-Resistant Tuberculosis Worldwide

BOSTON -- The Bill & Melinda Gates Foundation will give nearly $45 million to Harvard Medical School to develop a replicable model for controlling multidrug-resistant tuberculosis (MDR-TB). Hundreds of thousands of cases of MDR-TB have been reported each year since 1997, jeopardizing the worldwide effort to bring the spread of tuberculosis under control.

The grant will support a collaborative effort by the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), the Massachusetts State Laboratory Institute, Massachusetts-based Partners In Health, members of Harvard Medical School's Department of Social Medicine, and the Georgia-based Task Force for Child Survival and Development. The group will work with the internationally acclaimed Peruvian National Tuberculosis Program over the next five years to control drug-resistant tuberculosis in Peru, thereby developing a model for other nations to follow.

"Multidrug-resistant tuberculosis is a global threat," said Gordon Perkin, MD, Director of the Global Health Program at the Bill & Melinda Gates Foundation. "This new collaborative effort headed by Harvard will seek national solutions to multidrug-resistant tuberculosis in a developing country. Success with this program will provide a model for global replication."

"The spread of drug-resistant TB throughout the world is alarming, and the scale of suffering from the disease is tremendous," said Jim Yong Kim, MD, PhD, Director of Harvard Medical School's Program in Infectious Disease and Social Change and principal investigator on the grant. "This remarkable, visionary grant will allow us to take swift action to contain this public health threat before it spins completely out of control."

Tuberculosis, a highly infectious bacterial disease transmitted through the air by the coughs of those infected, destroys the lungs and kills more than two million people each year, making it one of the leading causes of death worldwide. The WHO declared TB a global emergency in 1993 and launched an aggressive program known as Directly Observed Treatment, Short-course (DOTS) to eliminate the epidemic. This cost-effective program, which can cost as little as $30 per patient, has been successful in many nations—including Benin, Guinea, Peru, Nicaragua, China, and Vietnam—in controlling drug-susceptible TB.

Strains of MDR-TB, however, are resistant to the two most important drugs in the DOTS strategy. A 1997 WHO study found that MDR-TB strains were present in all but one of the 35 countries surveyed, and in some known TB hot spots, MDR-TB accounted for at least 20 percent of all previously treated TB cases.

The partnership funded by the Bill & Melinda Gates Foundation will further test and improve an MDR-TB treatment pilot program in Lima, Peru called "DOTS-Plus." This program cures patients with MDR-TB at a fraction of the cost of treatment in the United States (as little as $800 per patient compared to as much as $100,000 in the United States).

"In tackling multidrug-resistant TB, Jim Kim and his colleagues at Harvard and around the world are trying to curb an epidemic that has the potential to drive the developed and developing worlds further apart at a time in history when we have the chance to do just the opposite," said Joseph B. Martin, MD, PhD, Dean of Harvard Medical School. "The grant from the Bill & Melinda Gates Foundation is coming at a critical time for the health and well-being of the world."

Harvard Medical School faculty members have worked closely with WHO and the CDC over the last two years to develop a global response to MDR-TB. Under the umbrella of the WHO Working Group on DOTS-Plus significant steps have been taken, but a lack of resources has been the major constraint in developing the knowledge base and practical experience to mount a global attack on MDR-TB.

Mario Raviglione, WHO's TB coordinator, stated, "This grant from the Bill & Melinda Gates Foundation represents a great boost to our combined efforts to control drug-resistant tuberculosis. We are particularly happy that this grant is going largely to support one of the best national TB control programs (Peru) in the world, which rightly is expanding its realm to address the problem of MDR-TB after having successfully implemented TB control and achieved the WHO global targets. We are now working to persuade other agencies to follow the Foundation's lead, so as to build up the much larger reservoir of funds that is needed to control TB worldwide."

Helene Gayle, MD, MPH, former Director of the CDC's National Center for HIV, STD, and TB Prevention, stressed the importance of accelerated efforts to stem the global spread of MDR-TB. "No nation is immune to the threat of MDR-TB, and international partnerships like this one will be essential to its elimination. TB has demonstrated its ability to adapt, to grow stronger, and to travel as easily as we do from one nation to another. We must join forces to combat this disease or risk becoming powerless to control it."

The Task Force for Child Survival and Development, an Atlanta-based organization, will work with the other grantees to establish a broad-based coalition to support a WHO/CDC-led campaign for global TB elimination. Mark Rosenberg, Executive Director of the Task Force, remarked, "When we combine the model that is developed in Peru with partners and resources in other countries, we can go a long way toward eradicating this disease." In the global effort, the Task Force will help raise the support needed for all aspects of TB control.

The initial phase of the project will focus on the refinement of the DOTS-Plus strategy in Lima. The program will then be expanded throughout Peru. Once fully implemented in Peru, the model will be used in other regions where MDR-TB is a serious public health threat. In particular, the grant will facilitate the participation of the partner organizations in efforts aimed at addressing the problem of MDR-TB in Russian prisons.