Exclusive interview with Mr David Greeley, Senior Vice President, External Affairs of TB Alliance

Mr David Greeley, Senior Vice President, External Affairs/Photo: TB Alliance

Tuberculosis (TB) is one of the world’s deadliest pandemic diseases and is becoming increasingly resistant to current drugs. Only with faster, better and affordable cures for tuberculosis can we save millions of lives and overcome this global epidemic. TB kills 1.4 million people each year or more than one person every 25 seconds. Propelled by global poverty, the AIDS epidemic, and drug resistance, the global threat of TB is greater than ever.

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Mr David Greeley, who joined the TB Alliance in 2012 as Senior Vice President, External Affairs, with responsibility for TB Alliance’s resource mobilization, policy, advocacy and community engagement initiatives spoke in an exclusive interview to Musah Ibrahim Musah, Editor at AfricaNewsAnalysis in Berlin recently. Excerpts:

Musah: Mr Greeley, TB is by all indications a treatable disease. How do you ensure that it is actually treatable?

Greeley: So, currently, the regimen that is used to treat most populations, these drug sensitive populations is something called HRZE. And that is effective in many, many patients. But adherence is a problem. And adherence is a problem because it takes anywhere from six months to nine months to treat. And many patients feel better after a shorter period of time, but in fact, they live in resource poor settings, and, as a result, with this long regimen, it becomes difficult for them to adhere to and that results in drug resistant. So, the TB Alliance is focused on, as the only organization involved in discovering and developing a new TB medicine, is to shorten treatment, make it easier for patients to be able to be on an effective regimen. And we have trials now that can reduce treatments up to four months and potentially down to two months, making adherence much more easy as well as trying to resist the onslaught of drug resistance which is a big, big problem forcing patients to treat beyond treatment anywhere from two-years to two-and-a-half years and much more expensive and difficult to treat regimen.

Looking at your vision to shorten TB treatment from 7 to 10 days, do we have the technology to achieve that?

A vision is a vision; and we’re working in that direction and already we have shown in our clinical work the potential to reduce treatment from 30 months down to two months; and we hope one day to be able to treat it like any other antibiotic, after all, that’s what TB treatment is, down to 7 to 10 days.

Why are the strains drug resistant? Is it because of patient non-compliance or are the strains becoming more clever?

The strains are becoming cleverer and some of the statistics demonstrates that there are an increasing number, up to 15% I believe in Eastern Europe, near Germany, of new cases of drug-resistant. So, most drug-resistance comes about because people do not adhere to the regimen, and they become resistant. But resistance, drug resistance now can be passed onto new patients who have never before been, have active TB. Instead of being drug sensitive TB jump already to be drug resistant TB. That’s an increasing problem with increasingly difficult complicated strains of TB.

Is TB a disease of neglected people?

TB is a disease of neglected people. It occurs for the most part, in poor settings, whether that be, in Africa, or in parts of China, or even in the US, and in western countries. And it is a disease of poverty and it’s really a vicious cycle because the more the TB broods in poverty, the more poverty takes place. And TB itself is a drain on one’s personal income; and that, itself, means that more disposable income has to be spent on TB treatment, and long TB treatment, rather than something else. TB is also bred in poverty because it is a disease that’s transmitted through the air. TB is everywhere and anywhere and its low resource settings, where sanitary conditions are not good with its over-crowding habitations. TB is spread much more quickly. One active TB patient is estimated to infect up to another 15. So, until and unless we have better diagnostics, early detection and shorter treatment we can’t really do anything to transform the TB disease which today kills more than 1.4 million people every year.

Finally, Mr Greeley,is the TB Alliance satisfied with the current collaboration with governments in Africa in fighting the disease?

Yes, I think, to be effective in delivering healthcare in any country in the world including in Africa, in African countries, collaboration with the governments is critical. What they must understand is TB regiment has not been on the market, new ones in almost half a century. So, we have to work with them to get them prepared whether it is regulatory approval, registration, changing protocols, and practices and guidelines, for the introduction of new transformative TB treatment. So national TB programs and governments need to be very active in that regard, and also advocate when they are not able themselves to finance some of the drug TB R&D (Research and Development) to get donors and other institutions that have the means to be able to fund TB trials in their countries so that one day, more patients can be effectively treated with more effective shorter and less expensive regimens.

Thanks for your time, Mr Greeley.

David Greeley

Mr. Greeley has spent more than 25 years working for various international non-profit development and health organizations, and for the pharmaceutical company, Merck & Co., Inc. Most recently, he was Vice President at the non-profit FHI 360, where he was responsible for developing and overseeing partnerships to provide health information, services and products in the developing world, and for garnering the financial support to do so. From 1998-2008, Mr. Greeley worked for Merck, first heading up the Latin America and Caribbean division’s Public Affairs and Policy Department, and then, leading the company’s global HIV/AIDS programs in the Office of Corporate Responsibility. In that capacity, he oversaw Merck’s access programs, public-private partnerships, policy, and stakeholder relations. Previously, Mr. Greeley worked at the non-profits PSI and CARE, including establishing PSI’s new business development department and overseeing programs in Asia. Mr. Greeley has travelled to 90 countries, and has worked and lived in the US, Latin America, Asia, and Africa.

Mr. Greeley holds a B.A. in political science from Brandeis University and an M.A. from the Columbia University School of International Affairs. He also serves as Chairman of the Board of Afropop.

About Tuberculosis

Tuberculosis (TB) is a global pandemic, killing someone approximately every 25 seconds — nearly 1.4 million in 2010 alone.

TB is second only to HIV as the leading infectious killer of adults worldwide. It is among the three greatest causes of death of women aged 15-44 and is the leading infectious cause of death among people with HIV/AIDS.

TB is global. The WHO estimates that two billion people — one third of the world’s population — are infected with Mycobacterium tuberculosis (M.tb), the bacillus that causes the disease. M.tb‘s unique cell wall, which has a waxy coating primarily composed of mycolic acids, allows the bacillus to lie dormant for many years. The body’s immune system may restrain the disease, but it does not destroy it. While some people with this latent infection will never develop active TB, five to 10 percent of carriers will become sick in their lifetime.

Once active, TB attacks the respiratory system and other organs, destroying body tissue. The disease is contagious, spreading through the air by coughing, sneezing, or even talking. An estimated nine million new active cases develop each year.

At any given moment, more than 12 million people around the world are suffering from an active infection.

Despite enormous advances in provision of services in recent years, TB’s deadly synergy with HIV/AIDS and a surge in drug-resistant strains are threatening to destabilize gains in TB control. While incidence is stable or falling in many regions of the world, global rates of new infections are still rising in many endemic areas where TB goes hand-in-hand with HIV/AIDS and the effects of poverty.

About TB Alliance

Our mission is to discover and develop better, faster-acting, and affordable drugs to fight tuberculosis.

We envision a world where no one has to die of tuberculosis. However, this cannot be achieved without new, better, and faster-acting tuberculosis drug regimens. The Global Alliance for TB Drug Development (TB Alliance) was established in 2000 as a not-for-profit product development partnership to lead the search for new TB regimens and catalyze global efforts for new TB regimens that can bring hope, and health, to millions.

Since it’s inception in 2000, the TB Alliance has been making leaps of progress toward this goal.

Before the TB Alliance was established, there were no clinical-stage TB drug candidates being developed, let alone realistic hope for novel TB drug regimens. Today, working with a broad range of public and private stakeholders, including pharmaceutical companies, universities, and other research laboratories around the world, the TB Alliance is leading the advancement of the most comprehensive portfolio of TB drug candidates in history. From this global network, the TB Alliance leverages the most promising science to advance new TB drug regimens that are needed to fight this pandemic.

We are driven by the needs of TB patients around the world, and committed to ensuring that approved new regimens are affordable, adopted and available to those who need them. To ensure our products reach the hands of those who need them most urgently, the TB Alliance and its partners are working with global, regional, and national stakeholders to facilitate regulatory approval, adoption by TB programs, and widespread availability of new drug regimens.