Tuberculosis (TB) is once again one of the world's leading infectious disease killers, alongside COVID-19. Unlike COVID-19, it's not getting treated like one.
For two and a half years, COVID-19 consumed public health efforts as it became the world’s deadliest infectious disease. With that title, came large investments to fight the disease, leaps in scientific progress, and global collaborative efforts, all demonstrating an immense urgency to squash a disease.For years before COVID-19 emerged, TB held this title, killing more than 4,100 people a day across 129 countries according to the World Health Organization (WHO). Those are similar numbers to COVID-19 during the deadliest days of the pandemic. Since the emergence of COVID-19, TB cases have surged, returning it to the top infectious disease killer spot, but the world’s response struggles to keep up.
To RTI’s TB expert Dr. Doris Rouse, this is no surprise.
Dr. Rouse is the Vice President of Global Health Technologies at RTI International where she has worked on identifying new TB treatments through public-private partnerships for more than 20 years. In 2019, her team achieved huge success when the U.S. Food and Drug Administration (FDA) approved pretomanid, a treatment identified by Rouse’s team for extensively drug-resistant TB (XDR-TB), making it only the third anti-TB drug approved in the past 30 years.
Reflecting on this progress and the challenges of TB's surge during the COVID-19 pandemic, Rouse chats with RTI's Global Health Security Director Alisha Smith-Arthur about her career and the future of work to end TB.
Smith-Arthur: Why did you get into the global health field? What was it about TB that made you passionate about finding new drugs?
Rouse: I first became aware of TB when I served in the Peace Corps teaching in a rural village in Liberia. I was truly shaken by the scope of the global health disparities I saw there. One of my brightest students suffered from cerebral malaria. He survived but was never the same. So, my commitment to addressing global health disparities really started there.
Then when I came back from the Peace Corps, I focused my career on having an impact in global health – first, working for a pharmaceutical company addressing tropical diseases and then for RTI International focusing on public-private partnerships. Early in my time at RTI, someone at the U.S. National Institute of Health (NIH) approached me about partnerships to address TB and I really became committed to this issue of bringing together both the public and the private sector, as well as universities and the community, to address the challenges around TB treatments. The outcome was that we won a contract in 1999 to do just exactly that; to find new drugs and create partnerships to move them forward.
One of our first tasks was to work with the NIH and the Rockefeller Foundation to plan an international meeting in Cape Town, South Africa, in February 2000 which led to the Cape Town declaration for global collaboration to develop new TB drugs. We then helped to form a public-private partnership known as the Global Alliance for TB Drug Development (TB Alliance) in 2001 and continue to work with them to this day to develop more effective and affordable new drugs for TB.
SA: You had such a vision at the time around coalition building and aligning what corporations and private sector partners could bring to the table. I can only imagine how much work went into that, and that was even before developing the actual drug. What has the journey been like? What kept you moving?
R: It has been a long journey. We identified pretomanid in 2002. The long development process led to FDA approval in 2019. But what really kept us going was the commitment of the people at the TB Alliance to develop an accessible, available, and affordable drug for all.
In 2007, I went with some colleagues from the TB Alliance to a TB clinic in Cape Town for the first human trials of the drug. We spoke with one of the nurses at the clinic to see how it was going, and she said, ‘this drug really works.’ She said patients come in emaciated, they aren’t eating anything, they have night sweats and are clearly suffering, but after being on this drug for just a few days, they are eating, sleeping through the night.
I still get emotional talking about how clearly excited and hopeful this nurse was. And that’s when I knew we had to keep going. And we did. We crossed the finish line. There were some naysayers and problems early on, but the TB Alliance and RTI were committed to seeing this drug through to FDA approval.