Tuberculosis (TB)

Interview with Dr Peter Small, Senior Program Officer for TB, Bill & Melinda Gates Foundation

Dr Peter Small is the Senior Program Officer for TB at the Bill & Melinda Gates Foundation.
Bill & Melinda Gates Foundation

Dr Peter Small, Senior Program Officer for TB at the foundation, has done extensive research into the genetic variability of TB. He spoke from his office in Seattle, WA (USA).

John Donnelly Q: How can improved technologies help in the fight against MDR-TB?

Dr Peter Small A: Right now, the best example is the use of molecular diagnostic tests that can detect within three hours whether the patient has a drug-susceptible or drug-resistant strain.

Q: Who will be using these tests in the next few years?

A: That’s really the point of several international meetings [on drug-resistant TB] that will take place over the course of the next year. We need to figure out how to introduce these tests in many more countries – and quickly. Lesotho is already using them. But there’s clearly a quantum leap between starting this in a small country with fairly significant external help and introducing it on a large scale in big countries. I’m optimistic about what is happening in China now. We know China is one of the global experts in going to scale with TB control. The government has also shown real leadership in hosting the Beijing meeting [in April 2009] and ensuring TB is discussed at this year’s World Health Assembly [in May 2009].

Q: How would you characterize the world’s response to drug-resistant TB?

A: We are pitifully behind. To be honest, even our understanding of the epidemiology is severely limited. We don’t actually know where the worst situations are. Nor do we know whether in most places the situation is getting better or worse. We do know enough to get started, and there are clearly places in the world where we can fully treat the drug-resistant TB cases. We can waste no time in getting started.