Partner-friendly TB research units must also collaborate externally, not least because partnerships with nonprofits can attract funds, which may be pharma's only chance to offset its TB research investment. It may seem counterintuitive for big companies to turn to nonprofits for funding, but it can make a difference. "You would think that the small amount of money we give Big Pharma is really insignificant," says Freire. "It turns out it is fairly significant because they operate on the model of no profit, but also no loss."

Indeed, today's major funders structure grants in a way that encourages partnerships. "Major funding streams have helped enormously to focus and to bring home the message that we either do it together, or we shall be stuck as we have been over the last three decades," says Alex Matter, MD, who is credited with discovering Gleevec (imatinib) and is now director of NITD.

But despite companies' willingness to partner, says AZ's Tanjore, collaborations between Big Pharma and third parties are still not easy.

The Social Translation

The oldest hospital in East Africa stands in the town of Bagamoyo, which used to be a major port in the slave trade. Now an up-and-coming town, and in recent years, hosted medical meetings on AIDS and tuberculosis—including a major international meeting held there this past October by NITD. But old Africa is still alive and well in Bagamoyo. TB is the leading cause of death in the town, says Hamisi, the hospital's TB coordinator. But even though free drugs are available to treat it, many patients still turn to what's familiar, available, and accessible—the local witch doctors and traditional healers.

In Africa, an epidemic is only half medical. The other half is social. That is especially true with TB. Bagomoyo is a rural district full of poor people, so TB diagnosis and treatment are difficult. The hospital serves 82 villages stretched across 9,000 square kilometers. The majority of people live on less than $1 a day, and often can't afford the time or the cost for transport to the hospital. Sure, clinical officers go into the field, and field sites conduct TB testing. But, with an annual operating budget of $70,000, the hospital can't hope to meet the growing need for treatment.

Certainly, these obstacles won't be overcome with a new drug or pill combination. Instead, pharma must get involved in fashioning effective treatment programs if they want the advances they make in the lab to affect TB care on the ground.

Integration, not separation Before TB drugs, isolation was the only means of controlling the spread of infection (a practice that continues to this day for many patients with multi-drug resistant TB). As such, many TB treatment sites are separate from other health services. The arrangement can make patients unwilling to seek treatment. "When you say, 'All AIDS patients go through this door,' it creates stigma," says Pascience Kibatala, MD, chief medical officer of St. Francis District Hospital, in Ifakara, Tanzania. "The same goes for TB."