Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: What effect has the Gates Foundation had on the global TB epidemic?
Neil Schluger: I think the Bill and Melinda Gates Foundation has had significant effects in two different ways. One is a very direct way, they’ve put money into an area that is desperately in need of money and they do fund basic science projects whose application are probably still many years away. They fund many more direct service projects that have the ability to affect people’s lives in a day to day way. In tuberculosis they’ve made significant investments in development of new drugs, new vaccines, new diagnostic tools. So they’ve had a very significant impact just because of the money they’ve put into it but I think they’ve had another impact as well, Bill Gates is one of the most well known people in the world, greatly admired and I think his recognition and focus on some of the great and neglected public health problems in the world brings other people’s attention that. There’s no question in my mind that public health to a certain degree and certainly to a greater degree than has happened previously. But public health to a certain degree is now becoming I wouldn’t say glamorous, that’s probably too strong a word but becoming something that’s capturing people’s imagination. We see I think many more young people now coming into the School of Public Health or people entering medical school who are interested in public health and global public health and I think the influence of someone like Bill Gates is as much in that as it is in the funding that he’s provided.
Question: Is another way to combine the public and private sectors?
Neil Schluger: Well I think what the Gates Foundation is doing is a start but it’s certainly not going to be enough. For example, just to give you one example, the NIH alone for AIDS research spends about 3 billion dollars a year, just on AIDS research. The total amount of money and that 3 billion dollars includes very basic science things as well as clinical research, you know, supporting trials of new drugs or drug combination, the total package, 3 billion dollars. The total amount of money spent in the world on development of new TB drugs is about 120 million dollars so even with what’s going on it’s a tiny fraction. I think the amount that’s being spent on AIDS is an appropriate but TB is not very far if it’s at all behind AIDS and its impact in the world. So it’s a beginning but it’s not the solution, I think the future lies in these ideas of public/private partnerships but also I think lies in enlightened self interest to be honest. The market’s not gonna solve the problem, it’s very clear about that, a new TB drug if it were developed today for example would earn about 350 million dollars a year worldwide. That’s not a good enough return on investment for most drug companies. Drug companies are looking to develop drugs that sell a billion or more per year. I mean the biggest drug in the world Lipitor which half the world takes for cholesterol is a 13 billion dollar a year drug. That’s what drug companies are interested in developing, 350 million’s not enough, it’s very expensive to develop new drugs. So market forces alone won’t do it and I think investment by foundations, even incredibly generous foundations like Gates probably can’t generate enough money. But enlightened self interest might, I think if you realize that economic development and health go hand in hand then with that realization there’s a motivation for governments to invest more heavily in addressing the major health problems for non medical companies to invest. So in South Africa for example we see now that mining companies have started some of the best programs for delivering HIV care because without healthy workers, they can’t do business. So I think that kind of enlightened self interest may work. 75% of all people who die of tuberculosis are between the ages of 15 and 54 and so that’s an important part of the workforce in any country and so for poor countries to progress and develop, they need to keep those people healthy, so maybe that sort of realization will be important and will motivate people.
Recorded on: 04/25/2008