World TB Day

March 24, 2002

Statement by Christine Sizemore, Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases
National Institutes of Health

Today, on World TB Day 2002, nearly 6,000 people will die from tuberculosis (TB), a complex and debilitating infectious disease that is a leading cause of illness and death worldwide. The greatest impact of TB is in developing countries; however, the United States is not immune from the disease. In the year 2000, more than 16,000 new cases of TB were reported in the United States. This number, though troubling, is dwarfed by the occurrence each year of more than 8 million new cases of TB worldwide. An astonishing one-third of global population -- about 2 billion people -- is infected with Mycobacterium tuberculosis (Mtb), the bacterium that causes TB. Of those infected, one in 10 will likely develop active TB during their lifetime.

Although TB is almost always curable with proper treatment, about 2 million persons die each year from the disease, as anti-TB medications frequently are unavailable in endemic countries. In addition, new strains of Mtb resistant to standard anti-TB drugs are spreading throughout the world, making a cure far more costly and sometimes impossible. TB is the leading infectious killer of women of reproductive age, destroying families and destabilizing communities. The burden of TB has increased with the spread of the HIV pandemic: 30 percent of patients infected with HIV also are infected with Mtb. Without TB treatment, these individuals face a greatly increased risk of death from TB. In addition to its human toll, TB constitutes an immense burden on the economies of endemic countries, because men and women in their prime working years are frequently affected.

As recently articulated in the NIAID Global Health Research Plan for HIV/AIDS, Malaria and Tuberculosis, decades of NIAID research into global infectious disease threats have taught us that a sustainable research infrastructure at home and abroad is critical to our response to any infectious disease threat, including TB. In this regard, the Institute continues to bolster our TB research capacity with domestic and international programs such as the TB Research Unit, the International Centers for Tropical Diseases Research, and the International Collaborations in Infectious Disease Research program. The central goals of our research are the development of new and improved drugs to treat TB, better TB diagnostics, and an effective vaccine that prevents infection with Mtb and/or disease caused by the pathogen.

In addition to the expertise of our intramural and extramural investigators, we have many powerful research tools and resources at our disposal. Advances in genomics are now being utilized to identify and characterize gene products that may serve as drug, vaccine and diagnostic targets. To date, the genomes of two strains of Mtb and several related mycobacterial species have been sequenced. With the establishment of the TB Structural Genomics Consortium, co-funded by NIAID and the National Institute of General Medical Sciences (NIGMS), we anticipate that the three-dimensional structures of over 400 mycobacterial proteins should become available to the research community over the next few years. These structures, combined with our increased understanding about the basic biology of TB disease, will provide new candidates for therapeutic and preventive intervention.

To help advance basic science findings through translational research and ultimately to “real world” implementation, the Institute has established a comprehensive resource infrastructure for TB research that is available to qualified investigators worldwide. NIAID provides resources at every step in the research process, from basic research to clinical studies, including provision of standardized research reagents, genomic tools, testing resources for the evaluation of novel chemotherapeutics, small animal models for the initial evaluation of promising vaccine candidates and drugs, and resources to conduct early clinical studies for drug, vaccine and diagnostic candidates.

One example of our success with an integrated program of basic and translational research is in the area of vaccine development. For the first time in many decades, promising new TB vaccine candidates, developed with NIAID support, are ready to be moved from animal models to the first stages of safety evaluation in humans. This progress demonstrates that with appropriate infrastructure, political will and sustained funding, a formerly neglected infectious disease such as TB can benefit from cutting-edge science that translates research hypotheses into product candidates.

Our ultimate success in defeating TB will require a sustained commitment to fighting TB by rich and poor countries alike, and the resources and expertise of both the public and private sectors. In the months and years ahead, NIAID will continue to strengthen our role as an active member of the global team working to expedite TB drug, diagnostics and vaccine research and to produce viable solutions for the reducing the burden of this deadly disease.

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Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health. Christine F. Sizemore, Ph.D., is Tuberculosis and Leprosy Program Officer in the NIAID Division of Microbiology and Infectious Diseases.

NIAID is a component of the National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

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