A physician fighting against one of the world’s most vicious killers: tuberculosis. Mario Raviglione, a member of Aspen Institute Italia’s “Italian leaders abroad,” is director of the Stop TB Department of the World Health Organization.
After receiving his degree in Turin and many years of work in the U.S., today he is in Geneva fighting against a disease that still counts “1.5 million victims a year” as he told the Aspen site.
You are head of WHO program against TB. Where are we in the fight against this disease?
After AIDS, TB is the world’s second largest killer, taking 1.5 million lives a year. So it is has certainly not been wiped out. We calculate that a third of humanity has been infected, although not yet ill, and therefore at risk of falling ill. At the World Health Organization, we study tuberculosis from the beginning to the end: we are concerned with regulations, global monitoring, assistance to individual countries and research. Among other things, there is a great deal of political pressure here. One of the United Nations Millennium Goals was to reduce the yearly rate of TB, together with that of other pathologies such as AIDS and malaria, by 2015.
What results have been achieved, and what goals must still be reached?
The goal of the World Health Organization is to eliminate tuberculosis by 2050. From a practical viewpoint, that would mean reducing the death rate from the present 1,400 per million a year to 1 per million a year. Research is making progress and that’s where our hopes lie, although given the difficulties in effectively simulating the illness under laboratory conditions, a vaccine is still far away. For now, there are no preventive measures that can be administer on a large enough scale to wipe it out, as occurred decades ago with smallpox. However, there was a peak starting in the middle of the 2000’s and now the rate seems to be slowly dropping. Thanks to more effective cures, there is a rapid decrease in the number of deaths. We estimate that as many as 7 million people have been saved thanks to the control strategy that WHO enforced between 1995 and 2000.
What brought you to head up the WHO’s Stop TB Department?
I studied in Turin and – after getting my degree – did clinical research in the United States for several years in the fields of infectious illness, AIDS and tuberculosis. In 1991, the Italian government appointed me as a junior professional officer in the World Health Organization. The decision to come to Geneva was also the result of my experience in Swaziland in 1987. Working there convinced me to search for an international situation where I could do something useful for developing countries. Today, 90% of the cases of tuberculosis occur in the poorer countries in the world
What is the situation of medical training in Italy? How can excellence be encouraged?
I believe that the Italian system has been Americanized, a progressive change that has brought many improvements. The introduction of a closed number over recent years has probably helped raise the level of medical schools that were so crowded that even going to class was hard. In addition, some private centers are as good as U.S. university hospitals, even though a great deal still needs to be done. The key is to give opportunity and recognition to people who want to contribution. That would help keep our better resources from leaving. Italy should increase its ability to attract and retain qualified researchers from abroad. Without proper circulation of experts and investments in talented young people, we can only achieve so much.
