"A key part of the TBD-UK mission is to work with the UK government to help design and guide policy strategy. It will ensure that funding is targeted in the right places and is effectively used so that we can fully align with our global counterparts and partners to make sure that the UK makes a full and effective contribution to the development of new TB drugs and the overall eradication of TB."

The scientific research that we do is very complex, takes a long time and often leads to failure. Sadly, this is the nature of drug discovery. However, this is only a small piece of a huge jigsaw puzzle that will ultimately lead to new drugs to help eradicate the disease.

Our research depends on funding, capacity and a well defined research strategy, without which, we simply cannot do our jobs. The UK used to lead the world in antibiotic and TB drug discovery but this is no longer the case. In part, this is because of reduced funding and significant changes in the way that society, medicine, legislation and the pharmaceutical industry have developed.

It is wrongly perceived that TB is a disease of the past. Up to the mid 20th century TB was a significant health problem in the UK, and indeed what we now call the developed world. However, the introduction of the current TB drugs in the 1940's and 1950's, coupled with better living conditions and health care, virtually eradicated the disease.

Towards the end of the last century, there was a significant resurgence in the disease leading to the World Health Organisation's declaration of a "TB global emergency" in 1993. The resurgence was mainly in developing countries such as Africa and India and has been due to poor living conditions, poor health care and the fact that TB often co-exists with HIV/AIDS. Suffering from this modern health problem, patients with HIV/AIDS have compromised immune systems which is why they find it difficult to prevent TB from developing thus causing co-existence.

The fact that TB is most pronounced in the developing countries causes greater problems in terms of disease control and eradication when compared to the the US and Europe for example. Difficulty in logistics with health programs using existing drugs and the requirement of educational programs to increase patient compliance are particular factors. After all, if you need to travel several miles every other day by foot, in extreme weather conditions, to take an unpleasant TB drug cocktail for 6 months and then begin to feel much better after a few weeks, why would you make the same journey to complete the treatment if you did not understand why you needed too? Of course these are problems faced at the clinic and which require important policy implementation from government and health care officials. However this can this be greatly improved by better drugs.

It costs somewhere in the region of £400-600 million to invent and develop a drug and then get it in to clinical use and typically will take between 12-16 years to achieve. Clearly, if investment is to be made to find new drugs then the funders will want a return on their investment, and commercially, significant profit. After all, the pharmaceutical industry is business. Of course, this model is simply not appropriate for TB because no commercial market exists which has been, and still remains, a major problem in developing new TB drugs. Recently, however, not for profit organisations, such as the Global Alliance for TB Drug Development, have been formed to fast-track, and align the skills of willing commercial partners, governments and academia, new TB drugs by overcoming  these problems. Therefore, a key part of the TBD-UK mission is to work with the UK government to help design and guide policy. It will ensure that funding is targeted in the right places and is effectively used so that we can fully align with our global counterparts and partners and make sure that the UK makes a full and useful contribution to the development of new TB drugs and the overall eradication of TB.

Dr Geoff Coxon 31st October 2009