China to spearhead anti-tuberculosis drive

Gates Foundation partners health initiative.

Bill Gates and Chen Zhu: tackling TB together Credit: World Health Organization

China's government has launched an initiative to tackle tuberculosis (TB) in partnership with the Bill & Melinda Gates Foundation, which is providing the scheme with US$33 million over 5 years.

Chen Zhu, the Chinese health minister, and Bill Gates announced the partnership on 1 April at the start of a three-day conference in Beijing, during which health officials from 27 countries will compare notes about their efforts to deal with the disease — particularly in its drug-resistant forms.

The partnership will pilot new diagnostic tests, monitoring tools and treatments for TB, with the most effective strategies being scaled up midway through the programme, Chen explained. Gates called China the "perfect laboratory" for large-scale testing of new treatments. China's government, which announced a US$130-billion health-care initiative in January, will add further undisclosed funding.

According to the World Health Organization, more than 9 million people contracted TB worldwide in 2007, and around 1.8 million patients died. Of the new cases, an estimated 1.3 million were in China, where, in 2007, TB claimed about 200,000 lives.

Although drugs to combat TB exist, many TB-sufferers are not diagnosed or properly treated owing to poor infrastructure. And multidrug-resistant strains of the bacteria accounted for about half a million new cases in 2007.

Testing treatments

Among the new tools that China will pilot during the first half of the programme are 'line-probe assays' which can distinguish multidrug-resistant strains from other types. Whereas conventional methods require weeks or months of in vitro testing, the line-probe assay picks out genes known to confer resistance from bacterial DNA samples. Multidrug-resistant strains can be identified within hours and treatments adjusted before more people are infected.

The assays will be difficult to get into local clinics, however, as they require laboratory techniques such as the polymerase chain reaction, says Daniel Chin, a representative of the Gates Foundation who is based in China. "It's complex and needs to be done in an advanced laboratory with a separate room," he says. The assays will be trialled in four cities to begin with.

New drug combinations, financial incentives for local clinics, and mobile-phone text messages are also being trialled to help patients to stay on their treatments and take their medication regularly. Failure to follow treatment courses is a major driver of the development of drug-resistant strains.

Work in progress

In total, the first half of the project, lasting two-and-a-half years, will see new technologies trialled on 20 million people in 40 cities. During the second half of the project, when the Chinese government is expected to provide the majority of the funding, successful strategies will be scaled up to cover 100 million people.

Peter Small, the senior TB programme officer for the Gates Foundation's Global Health Program, says that the crucial thing is to prove to local officials that the pilot scheme works, and that it is cost-effective enough to merit the extra spending on infrastructure and training.

The partnership is not the only Chinese initiative focusing on TB to be announced this week. On 31 March, the Chinese Academy of Sciences (CAS) and the Gates-supported Global Alliance for TB Drug Development signed a partnership to search for anti-TB drugs among Chinese herbal medicines. A pilot study by the CAS Institute of Microbiology in Beijing has identified 24 natural products with potential anti-TB activity.

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Cyranoski, D. China to spearhead anti-tuberculosis drive. Nature (2009). https://doi.org/10.1038/news.2009.227

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