UN Special Envoy Eric Goosby Answers 5 Questions about TB

In 2015, the UN Secretary General named Dr. Eric P. Goosby, professor of medicine and director of Global Health Delivery and Diplomacy in Global Health Sciences at UCSF, UN Special Envoy on Tuberculosis. In recognition of World TB Day, Goosby sat down to talked about his role and how UCSF and Global Health Sciences support his work.

How did you come to be named the UN Special Envoy on Tuberculosis?

In late 2014, UN Secretary General Ban Ki-moon approached me unsolicited. He said, “You’re winding up your PEPFAR tenure; TB is in all the countries where you’ve worked on HIV, so you’re in a position to discuss TB with the same leadership. You also know infrastructure and delivery systems; so would you be willing to work with countries with a high prevalence of TB to strengthen their response?”

Why did you agree to his request?

Doing something about a problem has always energized me. The title Special Envoy affords me the opportunity to have a conversation with country leadership about addressing TB. And my PEPFAR work gives me credibility with these leaders so we are able to jump over a lot of preliminaries that someone else might have to work through.

For me, the other connection is the unusual co-infection with HIV. An HIV-infected individual is 40 to 100 times more likely to get TB than a non-HIV patient, which is why the two diseases run together In every location, including San Francisco. We saw a rise in TB in San Francisco in 1981 before we recognized HIV; so HIV infection gives you the risk of TB from day one.

How do you see your role as Special Envoy?

My focus has been to look at places in the world where TB is high and growing and at multi-drug resistant TB (MDR- TB) because antibiotic resistance is a security threat people are concerned about.

About 480,000 people have MDR- TB, and it’s fatal 50 percent of the time. The irony is that even though regular TB is curable 87 percent of the time, MDR-TB develops when patients don’t take the drugs consistently or when the health care delivery system is unable to keep the patient on treatment for the necessary 6 months.

Part of my role is also to raise awareness and to reach out to funders, mostly in the US and the UK, to invest in this work.

What are your priorities?

My first priority is to identify those who have contracted TB and get them tested. Of the 9.1 million who have contracted TB, 6 million are identified. Why haven’t we captured the other 3 million, and what do we need to do to identify the geography where data isn’t being captured? We’re defining high-risk groups and focusing on countries with the highest burden of MDR and XDR TB – extensively drug-resistant TB – a form of TB which is resistant to at least four of the core anti-TB medications: China, India, Pakistan, Nigeria, Mozambique, Uganda and Ukraine.

Second, we are reinvigorating the delivery systems that were set up 50 years ago. Most governments had a funded TB program dating back to the 1960s. I’m optimistic because the knowledge is there and if we put money behind it, we will see numbers drop. In fact, there’s been a 1.5 percent drop in incidence of TB annually since 1990. As a result, the UN Millennium Development Goal was met in 2015. But we can do much better with existing knowledge and resources if delivery systems are better and if we support Ministry of Health colleagues to play leadership roles again.

So, we’re working with the World Health Organization and UCSF’s Curry Center to develop a health-system strengthening plan. The Curry Center was the first to develop a treatment for TB outside of a sanatorium and they have real skills in providing technical assistance and in creating plans specific to a country’s situation.

Third, we’re using lessons learned from the response to HIV about the importance of engaging the community, including community leadership, to identify high-risk individuals and help keep them in treatment.

The fourth priority is identifying new diagnostics. PEPFAR developed a spit test for diagnosing HIV that also shows whether a person has TB and whether it is MDR -TB. Results of that test are available in two hours, so we can start people on the right drugs on day one. PEPFAR, UNITAID and the Global Fund have purchased and distributed the machines that read the tests, so we are at a pivotal moment in our ability to diagnose TB.

TB is treatable and curable; we have evidence-based ways to deliver antimicrobial medicines to be successful, but financing and political will are not consistent to make this continually happen.

How does being part of Global Health Sciences at UCSF help you in this role?

GHS and UCSF are central players in responding to the burden of disease on the planet through research, training, and treating. This university has played a central role in defining treatments and populations, and in looking at the implementation research challenges of building delivery systems.

We as an organization, as a university and as GHS, have the ability to rapidly help countries identify populations, develop diagnostics and deliver effective treatments that have been defined and refined by our clinical partners here. The unifying need globally is for there to be a concentrated capability somewhere in clinical and implementation science to connect the dots to put the correct knowledge in country. The skill of connecting is what we do better than anyone.