高清福利片

You聽probably think聽TB is a disease of the past.聽But聽that鈥檚聽not because聽we鈥檝e聽beat it.聽It鈥檚聽because聽we鈥檝e聽moved it elsewhere.聽

Every year, over 10 million people fall ill with tuberculosis听补苍诲听it's聽concentrated where people are poorest, where overcrowding helps it spread, and where a six-month treatment course can mean losing your job, or even your social life.

Professor Greg Fox is an infectious diseases physician who treats TB patients in Sydney and leads research across Southeast Asia.聽

Greg聽outlines Australia鈥檚 responsibility to its neighbours in battling聽TB, and聽explains聽why cultural barriers聽like stigma聽make treatment so difficult in countries like Vietnam.聽

Read more about tuberculosis in聽

惭补谤办听厂肠辞迟迟听听00:01

This podcast is recorded at the University of Sydney's Camperdown campus on the land of the Gadigal people of the Eora nation.聽They've聽been discovering and sharing knowledge here for 10s of 1000s of years. I pay my respects to elders past and聽present, and聽extend that respect to all Aboriginal and Torres Strait Islander people.

骋谤别驳听贵辞虫听听00:30

Tuberculosis connects to so many聽different parts聽of history, so many parts of society. People like John Keats and聽Anne聽Bront毛, Franz Kafka, George Orwell, Erwin Schr枚dinger, Louis the 13th and Edward the聽6th, all died of tuberculosis.聽So聽TB has had a major effect historically. But if you look today, tuberculosis really falls in the dividing line between rich and poor, between people who have access to health care and who聽don't. In a way聽it's聽shocking, because we have treatments that can work. The main problem is that in those countries, people聽don't聽get diagnosed early, and so often they spread the disease before they come to the attention to healthcare services.

惭补谤办听厂肠辞迟迟听听01:26

It's聽killing millions of people,聽impacting聽more than 10 million new people every year, and yet,聽you聽probably almost聽never think about it.聽Maybe you聽didn't聽even know it was still around.聽Tuberculosis,聽or TB, is ancient.聽It's聽a bacterial disease that attacks the lungs, and it shaped human history, even influencing our architecture and urban planning. In the 20th century though,聽TB rates plummeted in wealthy countries. We developed treatments. We thought聽we'd聽won, but TB聽hasn't聽gone away.聽It's聽just concentrated in the places where people are poorest, where overcrowding helps infectious diseases spread rapidly, and聽where聽taking time off work for treatment often聽isn't聽an option.聽So聽what's聽preventing the solutions we already have from reaching the people who need them the most?聽And how can Australia help its neighbours defeat this deadly disease? This is聽the聽Solutionists,聽I'm聽Mark Scott. Professor Greg Fox is an infectious diseases physician who treats TB patients at Royal Prince Alfred Hospital in聽Sydney, and聽leads tuberculosis research across Southeast Asia. For the past 17 years,聽he's聽been working between Australia and Vietnam, training local health staff, running clinical trials,聽and redesigning how communities detect and treat tuberculosis.聽So聽Greg, I imagine that some of our listeners might be surprised that聽we're聽doing an episode on tuberculosis. Most Australians of this generation聽probably don't聽know much about TB, let alone know anyone聽who's聽had it. Can you tell us what tuberculosis does to the聽body, and聽then talk about the scale of the problem?

骋谤别驳听贵辞虫听听03:18

Tuberculosis is a聽bacteria聽that's聽been around as long as human civilisation.聽It's聽caused by bacteria that lives聽mainly in聽the lungs, and it can spread through the air in small droplets. And so that means that in places where people are living close together,聽it's聽easy to spread. And if聽you're聽living in Sydney in 2026,聽then you聽probably never聽met anyone who had TB. But back in the 18th century, about 1/3 of the young population died of tuberculosis, and it was聽really only聽until the mid 1960s that the problem in Australia had been brought under control.聽So,聽our experience now in Australia is that we really protected from the effects of TB. But聽that's聽not the case around the world. In fact, in in the last year,聽there's聽more than 10 million people who develop TB, so聽it's聽actually as聽common numerically now as it ever has been,

惭补谤办听厂肠辞迟迟听听04:06

And the reason that we聽largely sold聽it in Australia was because of drug products that effectively treated TB?

骋谤别驳听贵辞虫听听04:15

Look, it's fascinating that the decline in TB in Australia happened before drugs became available, and so we think it has a lot to do with the fact that the general health of the community improved, and also that people who were sick were聽were聽isolated from聽from聽other people. And in the mid 60s, there was a community screening program in Australia where X-Ray vans went round every year, and people had these TB screens. And we think that at that time, it聽really dramatically聽reduced the rate of TB in Australia, and so by the 1970s there was hardly any transmission.

惭补谤办听厂肠辞迟迟听听04:45

And do we see any incidences of TB in Australia today?聽

骋谤别驳听贵辞虫听听04:49

We do. So,聽I'm聽a respiratory physician, and I run a TB clinic here in Sydney, and we see around Australia-wide, around 14-1500 cases of TB each year. But聽9聽out of 10 cases occur in people聽who've聽been infected overseas. So very much,聽in order to聽stop TB in Australia, we need to be looking at TB in other countries, because that is where the TB transmission is occurring.聽

惭补谤办听厂肠辞迟迟听听05:13

And if聽in聽fact聽you're聽diagnosed with TB, are there drugs today that effectively work and treat that?

骋谤别驳听贵辞虫听听05:20

TB treatment in Australia is about 98% effective.聽So聽we have聽really effective聽drugs which work for聽almost all聽forms of TB, and there are some people who have drug resistant TB,聽where the treatment success is not as high. But even then,聽there's聽been a lot of progress over the last 10 years in developing new, better tolerated treatments.

惭补谤办听厂肠辞迟迟听听05:39

So,聽it's聽not really a problem in Australia, but with our near聽neighbours, this is a real problem. Why is it such a challenge still across Southeast Asia?

骋谤别驳听贵辞虫听听05:49

So聽two-thirds of the global TB burden occurs in the Indo-Pacific region.聽And,聽so people who come to Australia from that region often have been infected there and bring the TB bacteria with them in their body. And we think that the reason聽it's聽so common in the Asia-Pacific region is that TB has been there for a long time, and as these countries have often had lower聽socio-economic聽development, TB鈥檚聽spread much more easily.聽So聽countries such as Indonesia, Vietnam, the Philippines,聽and Papua New Guinea have extraordinarily high rates of tuberculosis still, and that's,聽in a way,聽it's聽shocking, because we have treatments that can work. The main problem is that,聽in those countries, people聽don't聽get diagnosed early, and so often聽they spread the disease before they come to the attention of their healthcare services.聽So聽one of the things that聽we're聽doing through our research here in the University of Sydney is trying to detect TB earlier, so we can prevent that transmission, which is what we think worked so well in Australia in the 1960s and 70s.

惭补谤办听厂肠辞迟迟听听06:47

So聽let's聽talk about the research journey that聽you're聽on now to diagnose people earlier and get effective treatments聽to聽them earlier.聽What's聽the key to successful early intervention and treatment?

骋谤别驳听贵辞虫听听07:00

One of the things that聽we've聽learned in the last decade is that, surprisingly, about a half of the tuberculosis in the world is not symptomatic. And so that means that a lot of people are carrying the TB bacteria, and聽they're聽infectious, but they聽don't聽have any reason to go to see a doctor to get screened. And聽so,聽we've聽discovered that in Vietnam, around 35% of the whole community has been infected with TB at some point in the past.聽

惭补谤办听厂肠辞迟迟听听07:27

I mean, so聽they've聽had it, whether聽they've聽been aware of it or not.聽

骋谤别驳听贵辞虫听听07:30

That's聽right,聽that's聽right. And聽so聽when we screen people in the general community, the people who are infectious, only about a half of them have symptoms.聽So聽what our research program has been doing is saying,聽鈥渉ow聽can we go out into the communities, and how can we detect TB earlier?鈥澛燭here's聽a lot of聽new technologies聽that help us to do that. One of the real breakthroughs has been rapid PCR testing, which is testing for the DNA of the TB bacteria in the sputum.聽

惭补谤办听厂肠辞迟迟听听07:54

Like we all did with聽COVID.聽

骋谤别驳听贵辞虫听听07:55

Yeah, like聽we did with聽COVID, except TB is a little bit聽more tricky聽to聽pick up on聽a point of care test.聽So聽we have these machines now聽that聽can diagnose it in less than an hour, just by putting a bit of saliva onto a test cartridge and then testing it. So聽that's聽a real breakthrough. We also have ways of detecting聽drug-resistant聽TB early as well, using the same techniques. And in the last 10 years, AI-guided chest X-Rays have also been a real breakthrough. It means that you can take this portable device out into the community, you can do a digital chest X-Ray and get a reading within a few seconds, and then the doctors or healthcare workers can聽make a decision聽about what to do.聽

惭补谤办听厂肠辞迟迟听听08:36

So聽what's聽the role of AI in that X-Ray聽then?聽

骋谤别驳听贵辞虫听听08:38

So聽an聽X-Ray is taken with this digital reader, and a laptop computer will have an AI algorithm on it,聽there's聽a number of聽different ones. And the AI will聽essentially give聽a probability that this person has TB, and if聽it's聽above a certain probability, then the person will get further testing.

惭补谤办听厂肠辞迟迟听听08:55

And once聽you've聽run that diagnosis, then you have an array of medical interventions, drugs that you can then give to that person that cures them of the TB?聽

骋谤别驳听贵辞虫听听09:06

That's聽right.聽So standard TB treatment for drug-susceptible TB is six months long, and we usually use four drugs to treat TB.聽So聽it's聽not an easy disease to treat, but as I mentioned, the聽disease response is usually聽very good, so long as people take the treatment. One of the challenges that聽we've聽had in many places聽though, is getting people to complete treatment.

惭补谤办听厂肠辞迟迟听听09:28

I was going to say,聽it's聽kind of quite聽a disciplined effort聽isn't聽it, to stick on it for six months, particularly if聽you're聽not feeling sick.

骋谤别驳听贵辞虫听听09:35

Completely, and as聽you've聽taken, say, two or three months of treatment, you feel聽almost back聽to normal. And聽so聽there's聽a lot of reasons why people might stop taking treatment. Now, here in Australia, we have ways of聽maintaining聽very close聽contact with people during treatment, and in fact, in New South Wales, we have video observation of therapy every day for people who take treatment. But in many places,聽that's聽not聽feasible聽because of the case numbers.

惭补谤办听厂肠辞迟迟听听09:59

Can I just聽ask?聽The failure to complete treatment, is聽that a driver of聽drug-resistant聽TB?聽

骋谤别驳听贵辞虫听听10:09

Yes.聽So,聽if you聽don't聽take the treatment, or you聽don't聽take it regularly enough, what that means is that the level of the drug in the blood can become low enough that the TB bacteria can evolve to be resistant to it. So,聽we do think that聽acquired聽drug resistance is really driven by people who have intermittent treatment. And there's good research to show that if you can make treatment support better, then that can reduce drug resistance, and if you can detect drug resistance early, then you can prevent it from becoming more amplified, so聽having more extensive drug resistance.

惭补谤办听厂肠辞迟迟听听10:41

And do you see a pathway where drug treatment聽isn't聽dependent on a聽six month聽course, but is more targeted, more specific, more聽immediate,聽and shorter term?

骋谤别驳听贵辞虫听听10:54

Absolutely. A聽lot of the work that聽we're聽doing is focusing on individualising therapy.聽So聽what that means is using some of these molecular tests to detect the drug resistance pattern of a particular individual early and give them targeted therapy. And for people who have taken therapy,聽to try and shorten the duration of treatment.聽So聽in Vietnam聽at the moment,聽we're聽working with international collaborators to evaluate a聽four month聽treatment for tuberculosis, and聽there's聽a number of聽trials ongoing for drug resistant tuberculosis to also shorten treatment as well.

惭补谤办听厂肠辞迟迟听听11:28

So,聽you're聽based in Sydney, a professor here at the University of Sydney, but so much of your research work has been in Vietnam. Tell us about what聽you've聽learned from your time on the ground in Vietnam,聽about the contribution you can make to improve the efficacy of treatment of聽tuberculosis.

骋谤别驳听贵辞虫听听11:48

Tuberculosis is common in Southeast Asia, and Vietnam is one of the high burden countries. And聽so聽it makes a lot of sense to be studying tuberculosis in settings where聽it's聽more common. I had the privilege of living in Vietnam for four years when I was studying my PhD looking at tuberculosis screening. And during that time, I had the opportunity to travel around the country and to meet local healthcare workers, meet with patients,聽and to try and help me to understand how聽tuberculosis was affecting people in Vietnam. What I learned was that there is a huge interest in tackling tuberculosis, but they lack often, the tools and the investment to do so.聽And often there's not good evidence to guide best practice. And so,聽over the last 15 years,聽we've聽been working very closely with our partners in Vietnam to develop new methods to screen and treat and prevent tuberculosis.聽It's聽really important聽that our efforts are guided very much by collaboration.聽So聽we're聽working very closely to understand what they see as their priorities, and then to develop research that can address that.

惭补谤办听厂肠辞迟迟听听12:55

Yeah, and talk a bit more about how being on the ground gives you聽insights that聽that you聽wouldn't聽have picked up or understood just trying to do this from afar, from Sydney.

骋谤别驳听贵辞虫听听13:06

Look,聽it's聽critical, when working in an international setting, to be there and to spend time with people. When I was living there, I learned how to ride a motorbike, and I have vivid memories of riding through rice paddies on the way to the TB clinic to go and see doctors there, and stumbling through my broken Vietnamese to try and understand what the patients that they were seeing were experiencing, and to try and build capacity in TB screening. And that experience taught me that聽it's聽one thing to have a plan on paper,聽it's聽another thing,聽very different, to implement it in practice. So one of the real insights that I gained from living there was that there's a huge role for trying to look at how we take the treatments and the approaches we know work, and how to make it work in practice, and that translational research is just as important as the discovery research to develop new treatments and screening approaches. We're聽heading out to do a screening with the screening team in聽Kh贸m聽Ph峄�,聽in聽C脿聽Mau.聽So,聽I'm聽about to go into a house with one of the screeners to do some聽TB screens.聽

惭补谤办听厂肠辞迟迟听听14:31

One聽of the things you see increasingly in聽health-related聽research, I think, is drawing on the experience of the patient. I suppose you聽probably wouldn't聽really call them a customer, but聽almost like聽the voice of the experience from the person who is unwell and receiving treatment. How is the voice of experience like that played a part in the research work聽you're聽doing in Vietnam on tuberculosis?

骋谤别驳听贵辞虫听听14:56

Involving patients in the research journeys聽are聽incredibly valuable.聽It's聽important to help us to see what is聽actually important聽for people with tuberculosis, and聽it's聽important for us to then be able to design the research in a way that will help them to engage with us. An example is in Vietnam, we have since 2019,聽had a consumer advisory board where we involve TB survivors and healthcare workers in a group that whenever we develop a new project, we talk to them about their project, get their feedback and input, and that is incredibly valuable for us. At the University of Sydney, we're hosting a聽Centre聽of Research Excellence in tuberculosis, supported by the National Health and Medical Research Council, and Professor Sarah Bernays, who's one of our academics, is leading the work into consumer engagement within tuberculosis, not just in Vietnam and Australia, but much more broadly.聽We've聽discovered that the more you involve consumers, the more you involve patients in these discussions, the better the research will be, and the more relevant it will be when it finally is completed.

惭补谤办听厂肠辞迟迟听听15:58

And can you think of examples where your approach has changed or been developed because of the insights聽you've聽had from patients?

骋谤别驳听贵辞虫听听16:06

A trial that聽we've聽completed recently in Vietnam, the V-SMART聽trial, was looking at the use of mobile phone app support for patients with drug resistant tuberculosis, and we worked very closely with social scientists to understand how patients use the smartphone app. And you would think, well, you know, it should be obvious, if you give them an app, then it will work. But what we discovered was that聽there's聽a whole lot of other things around the app, you know, the way the app interfaces with the health system, the way that people who聽maybe have聽limited literacy use the app.聽There's聽many challenges that we need to evaluate when聽we're聽looking at how the how the app works. And so,聽we performed a series of studies before we started the trial and during the trial to see how we could optimise the use of the app. And so now that聽we've聽completed the trial, the qualitative research is聽really important聽to help explain our findings, and it will be important when聽we're聽developing the next聽technology-based聽study,

惭补谤办听厂肠辞迟迟听听17:08

I聽can聽imagine, if you got a diagnosis of TB in Sydney,聽you'd聽immediately聽get medical treatment and hopefully be on the road to recovery very quickly, but聽you've聽discovered through your research in Vietnam, there are deep cultural issues, including a stigma that is attached to the disease that can make identification and treatment more difficult.

骋谤别驳听贵辞虫听听17:27

Stigma is a聽really major聽challenge for people who have tuberculosis.聽A聽PhD student of mine, Sarah Redwood,聽looked at stigma in drug-resistant tuberculosis in Vietnam as a part of her research, and she found that there are extraordinarily high rates of stigma. That is, people perceive that they will be excluded from society, that they may lose their job,聽and that their family may disown them if they have TB. And in the cultural context of Vietnam,聽it's聽seen as being a sign of moral failing, as well as physical weakness, to have tuberculosis.聽So聽you can imagine, if somebody gets that diagnosis, then聽all of聽these messages that聽they've聽grown up with through their cultural upbringing will influence the way that they think of their own disease.聽That's聽one of the reasons why here in Australia,聽it's聽so important that when聽we're聽providing clinical service, that we try and destigmatise TB, and not blame the person who has TB, but try and support them.聽And also,聽to try and make the health care experience one which is not stigmatising. The challenge is though, when聽you're聽in, say聽Vietnam, and聽you're聽wanting to screen people for TB, they often聽don't聽want to know that they have the disease, because of聽all of聽the secondary consequences that that brings. And that's where it's so important to develop health promotion campaigns like was done with HIV in the 1990s and 2000s to try and show people that there's a solution, that it's not a fatal condition if they take treatment, and that they will benefit themselves and their communities from doing so.

惭补谤办听厂肠辞迟迟听听18:52

You've聽done such important work in Vietnam. How significant are those聽findings and those insights聽and the success聽you've聽had applicable in countries like PNG and Indonesia and other places in the region that have significant rates of TB?

骋谤别驳听贵辞虫听听19:07

In Vietnam, the work that聽we're聽doing is about developing evidence that is applicable beyond Vietnam. And in fact, some of the studies that聽we've聽done,聽looking at TB screening and TB prevention have influenced聽WHO聽policies, and then those policies are taken up in other countries in the region and globally. An example is the work that聽we've聽done looking at prevention of聽drug-resistant聽tuberculosis. Our VQUIN聽trial in Vietnam found that we could halve the rate of聽drug-resistant聽TB among people who are at聽high risk. And just last year, the聽WHO聽made the treatment that we evaluated,聽a聽six month聽antibiotic, the recommended treatment around the world. And so now that is being used throughout the Asia-Pacific region to prevent drug-resistant TB, and聽we're聽also using that treatment in Australia.聽

惭补谤办听厂肠辞迟迟听听20:06

One of the聽very interesting聽things in the last year or so is this book by John Green. I know聽you've聽got a copy there. I mean, listeners聽probably know聽of John Green's work. I mean a phenomenally popular writer, particularly of young adult fiction,聽very popular聽on聽YouTube, and then聽all of a sudden, he develops a book on tuberculosis. Tell us about the book, and tell us why you think聽at this time, this book is of real significance.

骋谤别驳听贵辞虫听听20:34

You're聽right聽John Green has really become a major advocate for tuberculosis globally, and it all began when he visited Sierra Leone about 10 years ago, and he was visiting a TB hospital and met a young boy called Henry who had drug resistant tuberculosis. And over the years after he met Henry, he went through the journey of treatment with聽Henry, and聽saw him go through the challenges of having to take these聽very long聽and complex treatments. And what John Green discovered was that tuberculosis connects to so many聽different parts聽of history, so many parts of society.聽So聽TB has had a major effect historically, but if you look today, tuberculosis really falls in the dividing line between rich and poor, between people who have access to healthcare and who聽don't. And聽so聽John Green has taken this聽really serious聽and widespread disease and used it to frame the broader conversation around inequality globally as well.聽

惭补谤办听厂肠辞迟迟听听21:28

And do聽you think that will have an impact more broadly? You know, being such an influencer of public sentiment and public culture, what do you hope the impact of his work and听补苍诲听leadership of advocacy might bring?

骋谤别驳听贵辞虫听听21:43

The big challenge that we have in tuberculosis is that often patients聽don't聽have much of a voice when it comes to investment and when it comes to global policy. And聽so聽John Green, by standing up and being willing to advocate for people with TB, I think raises awareness,聽and therefore can give permission for politicians and leaders to invest in tuberculosis.聽We're聽actually聽very fortunate聽in Australia that we are a major investor in tuberculosis globally. Our government gives to the Global Fund, and聽also聽we have significant investment through our national Department of Foreign Affairs and Trade,聽and also聽NHMRC in tuberculosis. And people such as John Green, I think, can help to show our leaders the importance of that investment. And the way that he illustrates in his story the effect on one individual, I think, helps to go and puncture that problem that we often have of looking at numbers and statistics and show that this is a real disease, it affects real people.

惭补谤办听厂肠辞迟迟听听22:35

And if we were looking to humanise TB in Australia and increase awareness of its impact on our聽neighbours, and therefore its impact on our part of the world, how would you have Australians think about TB in this era?

骋谤别驳听贵辞虫听听22:51

Just like John Green's experience,聽I think we聽need to try and think of this disease as affecting individual people.聽I'm聽reminded of a patient of mine from my clinic. We'll call him Eddie, who came to me about six months after he had moved to Australia to work in a factory, and he had a six month old child, and he developed a cough, and about a week later, he was diagnosed with tuberculosis, and he was found to have the drug-resistant form of TB called multidrug-resistant TB. And that diagnosis, for more than 18 months changed his life. He had to stop working, he had to be isolated, he聽wasn't聽able to聽see his聽six month old聽child, and he had to take treatments which affected his eyesight聽and also聽caused nerve problems. In the end, he was able to be cured, but that journey was聽for him a real life-altering experience聽and for him, his聽wife聽and his child, you know has had major impacts. And if he had had that disease in another country, he may not have survived, but thanks to the availability of free treatment here in Australia, he was able to be cured, go back to a normal life,聽and you know, I saw his聽child five years later, and it was just lovely to see them together and to see how life had gone on.聽So聽I think from the Australian perspective, trying to relate to the experiences of people with TB is important. I also think聽it's聽important as Australians that we recognise we have a responsibility beyond our own shores as well. Because we have such bilateral trade and relationship with our region,聽I think we聽have an important responsibility to be working with them to look at tuberculosis. There's more than a million people from Southeast Asia living in Australia, and Southeast Asia is a place where there is a lot of TB, so it makes sense for us as researchers, as clinicians, to be trying to reach out and engage and see how we can contribute not just to the TB that occurs here, but also upstream to the TB that's occurring in poorer parts of our region.

惭补谤办听厂肠辞迟迟听听24:42

One of the fascinating things about working at the university is you come across brilliant people.聽You're聽one of our brilliant researchers, globally renowned for this work, but聽I'm聽very interested聽in how someone like you almost came to be almost enthralled by the intellectual聽challenge of this聽particular disease. Talk a little bit about your career and your research career, and what led you down the road of global leadership in the treatment of tuberculosis.聽

骋谤别驳听贵辞虫听听25:13

I think聽there's聽two aspects to it.聽There's聽the head aspect and the heart aspect. For me聽in 2000,聽when I was a medical student, I spent a couple of months in聽Blantyre,聽Malawi.聽And this was at the peak of the HIV epidemic there, where people were dying, mostly of tuberculosis, but of other diseases alongside HIV, which made the immune systems very vulnerable. And I could see at that point that this was such a contrast to the privileged,聽well-resourced聽setting that we lived in in Australia, where聽I'd聽done most of my medical training.聽So聽I think from the heart perspective, that motivated me to say, look, I have a responsibility as a doctor, as a future doctor, to do more than just treat patients that I see in front of me.聽And,聽I could see that it聽wasn't聽just purely about the treatment, it was about the health system and about the public health solutions as well. Then the second is the head聽component聽that is, tuberculosis is a聽really fascinating聽disease. It's been, as I said, present in human society for millennia, and despite the fact that we've spent a huge amount of time and resources looking at research into TB, we still don't know how to detect it early enough, and we still don't have a very good understanding of its biology. And so,聽tuberculosis provides a聽really fascinating聽area to study, because there are so many unanswered questions. One of the unanswered questions is, why is it that tuberculosis turns on at certain points in time? People can have the bacteria for years, and then suddenly it will wake up and affect them. Another unanswered question is, why is it that some people respond well to TB and other people聽don't?聽And also, how do we take the treatments and the evidence that we have from a setting where we know it works very well, and how do we translate it into other settings?聽So聽I find it fascinating from the perspective of having so many questions to still answer, I think聽that's聽the challenge.

惭补谤办听厂肠辞迟迟听听27:08

And if you look ahead in your career,聽and you聽think maybe,聽you're聽a young man聽Greg you know 25 more years at this, what excites you most about聽what's聽on the horizon? You think of technology, you think of drug development, you think of AI as a factor in all of that; what聽gives you hope of transformational breakthroughs in the treatment of TB?

骋谤别驳听贵辞虫听听27:30

I think we聽know now a lot more about the problems that we need to solve, and so I think that聽it's聽exciting that聽we're聽now starting to take steps towards solving those problems. For the last 15 or 20 years,聽under the聽WHO鈥檚 DOTS聽strategy, the strategy was, wait till people come to the hospital and then聽we'll聽treat them. And聽we've聽discovered over recent years that聽that's聽just not enough, and so now聽there's聽a lot more recognition that we need to be much more proactive in going out into the community. We did a big study called the ACT3聽study in Vietnam, where we screened around 100,000 people, and we showed that if you do screening every year for three years, that you can reduce the rate of TB in the community by about a half, which is a major breakthrough. Now聽building on that research,聽there's聽now a lot more investment in community mobilisation going into the community,聽to聽go and find聽people with TB.聽So聽I'm聽really excited聽that that shift in thinking has occurred, and now聽there's聽a lot more investment in that聽community-based聽approach.聽It's聽also exciting that we have new treatments that are much shorter and potentially much less toxic. There are trials underway聽at the moment聽of treatment for TB infection as short as one month. There's work being done looking at聽long-acting聽injectables, so maybe one shot, and then聽that's聽the end of your treatment. And there are new drugs that are coming on the market, which are next generation drugs that are likely to be less toxic for patients.聽So聽I think聽all of聽those things聽are聽very exciting. The challenge is we need to lift our ambition and lift our investment, like with the HIV pandemic. We need to have advocacy here in Australia and other western countries to mobilise the resources that are needed. Back in 2000 you聽wouldn't聽have guessed that HIV could become a problem that is soluble by large scale investment in antiretroviral drugs so that HIV becomes another chronic condition. We need to make tuberculosis the same,聽we need to聽invest majorly so that we can make TB history.

惭补谤办听厂肠辞迟迟听听29:27

That's聽Professor Greg Fox from the University of Sydney.聽He's聽the director of the Sydney Southeast Asia聽Centre聽and director of the Research聽Centre聽of Excellence in tuberculosis. And if you want to hear more about the future of medicine,聽you'll聽enjoy our episode with Professor David James,聽who's聽working on making medicine so precise that it can be matched to your DNA.

顿补惫颈诲听闯补尘别蝉听听29:51

What I would like to see is if we could do a test on people right at the get go, and that test would tell us聽鈥測ou聽should be taking drug聽Y鈥�,聽so that you immediately prescribe drug聽Y, save all those problems, and you save the potential dangerous adverse effects from taking four medications instead of one.

惭补谤办听厂肠辞迟迟听听30:17

You can listen to that episode of聽The聽Solutionists right now, and if you want to hear how the best minds in the world are tackling the biggest challenges, make sure you follow the show in your favourite podcast app so you don't miss an episode. The聽Solutionists is a podcast from the University of Sydney, produced by聽Deadset聽Studios.聽

The Solutionists is a podcast from the University of Sydney, produced by聽. Keep up to date with聽The Solutionists聽by following @sydney_uni聽on聽听补苍诲听, and @sydney.edu.au on聽.

This episode was produced by Liam Riordan with聽sound聽design by Jeremy Wilmot. Supervising producer is Sarah Dabro. Executive editors are Kellie Riordan, Jen Peterson-Ward, and Mark Scott.聽Strategist聽is Ann Chesterman.

This podcast was recorded on the land of the Gadigal people of the Eora nation. For thousands of years, across innumerable generations, knowledge has been taught,聽shared聽and exchanged here. We pay respect to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.