Gates Foundation launches 3rd initiative in China

The Bill & Melinda Gates Foundation is launching its third major initiative in China, a $33 million partnership with the Chinese government to fight an epidemic of tuberculosis and stem the spread of drug-resistant strains.

Bill Gates made the announcement in Beijing today at a meeting of health ministers from the nations hardest hit by TB infections that defy conventional treatment.

The new program aims to show that with better diagnosis, streamlined treatment regimens and improved patient monitoring, China can control a disease that currently afflicts 4.5 million of its people and kills more than 200,000 a year.

Effective treatment of ordinary tuberculosis is also the key to slowing the evolution of drug-resistant strains, including multidrug-resistant, or MDR, TB, Gates said.

"The alarming threat of drug-resistant TB is rising because of gaps and mistakes in the way we treat TB," he said. "If we improve basic TB prevention and control, we will cut off MDR-TB at the source."

China has the world's second-highest number of TB infections, after India, and accounts for about a quarter of the world's drug-resistant cases. Worldwide, about 2 million people die from TB every year.

A cough from an infected person can spread the bacterium that causes the respiratory disease. Though largely a problem of the developing world, international travel and emigration mean no place is immune from tuberculosis. King County logged 121 new cases last year, and six people were treated for multidrug-resistant disease.

China's hosting of the TB meeting shows that the Communist government has learned from past global-health debacles, such as its failure to acknowledge the AIDS threat and attempts to deny the existence of the severe acute respiratory syndrome (SARS) virus, said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C.

"They see TB as a threat, they see it as a burden on their economy and something the citizens of China are upset about," he said.

China recently announced it will spend $124 billion over the next three years to bolster a dilapidated health system that has left many residents, particularly in rural areas, without access to affordable care.

The collaboration between the Chinese health ministry and the Gates Foundation will start with pilot projects and eventually expand across six provinces with a population of 100 million people and about 50,000 TB patients.

That's still just a tiny fraction of China's population, Morrison pointed out.

"The success of this particular initiative is going to be whether the government carries it to scale and takes responsibility for it," he said.

China remains suspicious of some Western nonprofits, but Bill Gates is widely admired and the government has welcomed his foundation's programs to combat AIDS and smoking. Even so, it took about two years to negotiate the TB collaboration.

Another aid group, Doctors Without Borders, also known as Medécins Sans Frontières (MSF), gave up after two years of "frustrating" talks with the Chinese government on a TB program for Inner Mongolia. "Many people have died while we were stalled in meetings these past two years," said Meinie Nicolai, MSF's operations director.

Gates said new tools, like tests that diagnose drug-resistant TB in one day instead of six weeks, will be a key to success in China. The program also will provide combination drugs to cut the number of pills people need to swallow from up to 13 a day to three or four, making it more affordable — and more likely patients will not give up on a regimen that can last up to eight months.

Few drug companies currently produce those combination pills, so China's commitment to buy will provide an important financial incentive to boost output, Gates said. Financial incentives will encourage health workers to ensure TB patients take their medication, and cellphone text messages will provide high-tech reminders.

"If China leads in the fight against TB — developing new approaches here in China and demonstrating them to the world — we can see a dramatic drop in the number of TB deaths in the next decade," Gates said.

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com