Abstract
AS AN INTERNATIONALLY DISTINguished immunologist who has spent a significant portion of his professional life researching tuberculosis (TB), Barry R. Bloom, PhD, offers a unique perspective on the public health community’s ability to control or eliminate this disease. Bloom, dean of the faculty of public health at the Harvard School of Public Health in Boston, has worked with the World Health Organization (WHO) for more than 30 years and is a member of its Global Advisory Committee on Health Research. In the United States, he was associated with the Institute of Medicine’s 2000 report, Ending Neglect: The Elimination of Tuberculosis in the United States. Bloom, who in 1999 received Germany’s prestigious Robert Koch Gold Medal recognizing his TB research and his efforts to foster cooperation between scientists and health policy decision makers, continues to run a laboratory researching the immune response to TB. JAMA: People were optimistic in the 1970s that TB was under control and that elimination was possible. How did this attitude affect the responsiveness of the public health community when TB rates soared in the late 1980s and early 1990s? Dr Bloom: When TB rates exploded, people realized that there was very little expertise at the scientific level— researchers had moved onto other problems since it had looked like the disease was going to go away all by itself. It was like the Cultural Revolution in China; we were missing a generation of scientists who knew about the disease. We also didn’t have data on the burden of TB in many developing countries. JAMA: Now that the scientists have returned, what are some of the obstacles they face in developing vaccines and drugs for TB treatment? Dr Bloom: The TB field is very hard to work in. It takes TB at best 3 weeks to grow up on a plate—if you want to study latency, it’s about a 9-month experiment. There aren’t good animal models, making persistence particularly difficult to study. You need human experiments.
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