Eliminating Tuberculosis: A Lifelong Mission

Randall Reves, MD, Clinical Professor, University of Colorado School of Medicine

Q: What inspired you to pursue a career in public health and infectious diseases?

A: My journey into public health started in medical school when I went to Bangladesh for a three-month research elective with cholera researchers. In the third month, I stumbled on an outbreak of smallpox in a settlement of landless, impoverished people. After a few weeks as a volunteer working on smallpox eradication, I was invited by the Centers for Disease Control and Prevention (CDC) director in Dhaka (Dacca), Bangladesh to extend my stay for three months as a consultant working with the Bengali field staff who were able to stop the outbreak and further spread to a city of 100,000.

That experience opened my eyes to the power of targeted public health interventions—how you can control an infectious disease without vaccinating everyone, but by focusing on case identification and containment. This was possible only by supporting and enhancing the skills of community field workers who overcame stigma and cultural barriers to isolation and vaccination. That led me to the Epidemic Intelligence Service (EIS) at the CDC, where I worked on tuberculosis (TB) outbreaks and other public health crises.

Q: How did you become involved in TB research and treatment?

A: When I was assigned to work in Mississippi with the CDC, I investigated a TB outbreak at a high school. It turned out to be the first well-documented case of multidrug-resistant TB (MDR-TB) from the sanatorium era (resistance to Isoniazid (INH), Streptomycin (SM) and Para-aminosalicylic acid (PAS). That experience showed me how complex TB transmission was, how difficult treatment could be, and how important it was to strengthen public health systems locally to control the disease and protect public health. Over the next decade as a faculty member in Infectious Diseases at the UT Medical School in Houston and the School of Public Heath, my experiences reinforced the connection between TB and HIV as co-infections.

In this work, though, I longed for a more direct connection with TB in the public health setting. In 1990, a former residency colleague of mine, Dave Cohn, mentioned a position at Denver Public Health (now the Public Health Institute at Denver Health) in HIV research, I came to Denver for the rare opportunity to join colleagues in combined clinical infectious diseases and public health in HIV and TB. Dave provided guidance on this new intermittent regimen and introduced me to the key resources in the clinic, the TB nurses who find a way for each unique patient to safely complete treatment. These nurses were BJ Catlin, Jan Tapy, and Bennie Thompson.

This was the opportunity I was seeking: to be able to provide TB clinical care, conduct research and advocate for improved TB policies.

Q: TB remains one of the deadliest infectious diseases worldwide. What has hindered its eradication?

A: Unlike HIV, where groundbreaking treatments transformed outcomes quickly, TB has been treated with essentially the same standard regimen since the 1970s. The standard four-drug TB treatment regimen requires at least six months and is poorly tolerated because of side effects, which can make adherence challenging. Poor adherence may lead to acquired drug-resistance, so direct observation of drug ingestions has been employed.

TB advocacy also hasn’t had the same level of urgency as HIV activism, which pushed for rapid drug development. There is a critical need for new TB treatments that are as simple and effective as modern HIV regimens. The Global Alliance for TB Drug Development has made major strides for the treatment of MDR-TB, but several drugs are poorly tolerated and require monitoring for adverse effects.

Q: You’ve been a strong advocate for global TB elimination. What strategies do you believe are most critical?

A: One major step is expanding TB prevention efforts, particularly for people immigrating from high-TB-burden countries. The U.S. has made progress by TB screening immigrants entering the country as legal permanent residents or refugees. Obtaining sputum cultures for those with abnormal chest X-rays after 2008-2010 had an immediate impact on TB case upon arrival. Recently, testing for latent TB before departure has begun. The next challenge is ensuring these immigrants receive proper treatment for LTBI once they’re here. Additionally, accelerating research into shorter, better-tolerated TB treatments would be transformative. Internationally, we need more investment in TB research and control programs, particularly in resource-limited settings where TB remains a leading cause of death.

Q: Our conversation is making me think of the arc of public perception of public health. In your mind, how has it changed over your career?

A: Before COVID-19, public health worked mostly in the background, preventing and controlling diseases quietly. In my prior experience, local press coverage was often helpful in communicating the public health problem (a second high school TB exposure and transmission in Colorado, high school measles outbreak in MS). During COVID-19, public health became highly visible, first as the hero and then as the villain when pandemic fatigue and misinformation spread. It has been challenging, but it underscores the need for better communication of the value and impact of public health. Public health isn’t just about individual choices—it’s about protecting families, communities and even countries. That message needs to be stronger and clearer as we enter a new age.

Q: We have had the occasion to sit down and talk because of World TB Day, which is March 24th. What role can TB prevention play in public health—can it have a larger message?

A: TB prevention is a perfect example of how public health benefits society. Most people who are exposed to TB don’t develop active disease right away—it can take years. But when prevention measures like testing and treatment for latent TB are widely adopted, we can stop future cases from developing. It really is like seatbelt laws—it’s not just about individual safety. It’s about about protecting the broader community now and over the long term.

Q: You retired in 2013 but continue to volunteer in TB research and patient care. Why?

A: I continue working because TB is preventable, treatable, and yet still persists. I’ve seen firsthand how early intervention saves lives. Many TB patients don’t initially believe their diagnosis because they feel fine. Helping them understand why treatment matters—for their own health and to prevent spreading TB to loved ones—is incredibly rewarding. I also hope that I am able to participate with Bill Burman and Bob Belknap in mentoring younger providers to ensure they can continue this work in the future.

Q: Looking ahead, what gives you hope for the future of TB and public health?

A: The scientific advancements in other infectious diseases, like HIV and hepatitis C, show that dramatic progress is possible when there’s enough investment. We need that same energy for TB. There are promising new TB drugs in development, and if we can implement them effectively, we could drastically reduce TB cases worldwide. The challenge is making sure public health funding and political will keep up with the science.

Q: What message do you hope to share on World TB Day?

A: TB elimination is possible, but only if we commit to it. For those at risk, get tested. If you have latent TB, complete treatment to protect yourself and your community. For policymakers, invest in TB research and prevention. The world has the tools to end TB—we just need the will to use them.