Bill Gates donates $25M to TB’s new drug group

Gift proves TB advocates are educating public

The Global Alliance for TB Drug Development, not even a year old, received a birthday gift in March from Microsoft chairman Bill Gates. Gates celebrated this year’s World TB Day by handing the alliance a check for $25 million.

Because it’s still in the process of incorporating as a nonprofit, the new organization doesn’t even have a bank account where it can stash the money. And no one knows yet exactly what will be done with the gift because the person charged with writing a business plan for the foundation — Carol Nacy, PhD, the street-smart scientist who presides at Sequella Global TB Foundation in Rockville, MD — was still fretting over the first draft at press time.

None of that appears to ruffle Gates, however. "TB is a good example of how if we don’t pay attention to these diseases, we’ll go backward," he was quoted as saying.

To Nacy, the big question now is whether the new alliance will look and act like a business, an advocacy agency, a funding entity, or something else. "It’s like, OK, folks, what do you want this alliance to be when it grows up?’"

Meanwhile, Gates’ magnanimity offers heartening evidence that TB advocates are finally making a dent in public awareness, others say. "When we started in the fall, TB drug development wasn’t part of the international agenda and hadn’t been for over a decade," says Ariel Pablos-Mendez, MD, MPH, scientific adviser to the Rockefeller Foundation in New York City and the spearhead behind formation of the new alliance, which seems to have gotten TB drug development off the table and breathing again. "Now governments are geared up. Donors are geared up. Agencies are geared up. And more opportunity will be coming our way."

Others are equally upbeat. "To put together a group and have it get funding so quickly is really very encouraging," says Jim Yong Kim, MD, director of the program of infectious disease at Harvard Medical School in Boston. "It shows how one foundation can alter the vision of the entire public health community. What if an even larger percent of all the ridiculously wealthy people in the world got interested in public health? I think you’d see a fundamental shift."

Part of the effect of Gates’ gift is to shift thinking away from the "minimalist approach" Kim says has plagued public health thinking for so long. "That approach assumed public health budgets would always be very limited and that the most you could hope for would be a single, cost-effective strategy," he explains. "With this gift, Gates is essentially asking why? And I think he’s exactly right."

Kim and others, Pablos-Mendez among them, say policy-makers’ blinkered commitment to pushing the World Health Organization’s approved strategy for TB treatment — directly observed therapy, short-course, or DOTS — has inadvertently caused some of the problem.

"WHO has tried very hard to implement DOTS, and of course that’s been the right thing," Pablos-Mendez says. "But after a decade of trying to implement DOTS and finding that we’re only at 25%, we see that DOTS alone is not enough. What we need is a new drug to simplify treatment."

By April 18, alliance stakeholders were to have met in New York City to hash out business plan details, says Pablos-Mendez. Those on hand were to have included a representative of the Bill and Melinda Gates Foundation as well as other potential donors, plus virtually every major public health agency and nongovernment organization with an interest in TB.

At a meeting in Capetown, South Africa, earlier this year, those stakeholders set a goal of seven to eight years to find a drug that will shorten therapy to less than three months. Some candidates on the scene, though they don’t seem likely to meet that goal, still might improve TB treatment, says Pablos-Mendez. Some are derivatives of other drugs; for example, Pathogenesis PA 824, which is a rifamycin derivative like rifapentene.

Other candidates are drugs already approved for other indications that look as if they also might have activity against TB. A fluroquinalone, moxifloxacin, is one such example, says Pablos-Mendez.

Still other candidates developed by using findings from exciting new genomic research have yet to emerge. That’s the group to watch most closely, he adds.