In early 20th century, the Boston Red Sox were the best team in baseball. They won the first World Series in 1903 and put together powerful teams that captured four more championships through 1918.
The Red Sox were perennial winners because their management stocked the roster with future Hall of Famers. They had spectacular defense combined with aggressive hitting. They had veteran catchers who groomed young pitchers into confident performers. And they had the best arms in baseball, including a smart young lefty named Babe Ruth.
But Boston’s fortunes changed in the 1920s when new ownership sold off the team’s best players, including Ruth, who switched to right field when he joined the Yankees and redefined the game.
The result? The Red Sox failed to win another World Series for 86 years.
In the past decade, however, Boston has turned it around. Last month, the franchise won its third title in the 21st century, more than any other club. As the saying goes, the Red Sox are “Boston Strong.”
While some fans say the team finally beat decades of bad luck, the truth is that the Red Sox suffered 80 years of bad management. Their long losing streak didn’t end until new owners with a winning strategy and deep pockets took over in 2001.
So what do the Red Sox have to do with the search for better TB drugs?
TB drug research has faced similar ups and downs. Until the 1950s, TB research was robust and well-financed because TB was one of the most fearsome diseases around. It was a leading cause of death in the world’s increasingly crowded cities, and it often struck the well-to-do. Universities and private philanthropies hired talented scientists to develop new drugs, vaccines, and diagnostics.
But the discovery and development of antibiotics changed the course of TB investment. Suddenly, there were effective treatments capable of curing what had been an incurable disease. Public health programs in the United States and Europe dispensed these miracle medicines, driving down incidence and mortality. TB isolation hospitals – once a feature of society and a fixture of romance novels – closed down.
This success led to decades of underinvestment. Drug makers no longer had an incentive to produce new TB treatments because the number of people living with the disease in wealthy countries didn’t justify the R&D costs. The result was a 40-year drought in the approval of new TB drugs.
But about a decade ago, new management arrived. New investors recognized that the dry spell in TB drug development had created risks for people everywhere. The most common treatments had been in use for 50 years, and the TB microbe was starting to outsmart existing medicines, developing drug-resistant strains that are prohibitively expensive to treat and take two years to cure.
Into this gap stepped a coalition of government, private-sector, civil society and philanthropic partners who agreed to accelerate R&D. Today, their commitment is starting to pay off.
In December 2012, the first new TB drug in 40 years – bedaquiline – was approved by the U.S. Food and Drug Administration. And last week, the European Union approved a second new TB drug – delaminid. That’s two new drugs in less than a year.
This news is worth celebrating, but we need to keep the winning streak alive. While bedaquiline and delaminid are breakthrough drugs that give hope to people living with drug-resistant TB, we won’t be in a position to make sustained progress until there are new combination regimens that can treat all strains of TB and prevent drug resistance.
That’s why the Global Alliance for TB Drug Development and special initiatives like the TB Drug Accelerator and the Critical Path to TB Drugs Regimens are so important. Scientists are searching the chemical compound libraries of the world’s major drug manufacturers to identify novel molecules that could deliver a rapid cure for TB in combination with other drugs. The desired end product is a new combination therapy capable of delivering a complete cure for TB in just a few weeks vs. the current minimum of 6-9 months.
The Red Sox turned around their fortunes by recognizing that they needed new leadership, a new strategy, and renewed investment to get back to winning. Here’s hoping that this year’s great news for TB drug development is a sign of many more wins to come.