World-Traveling Doctor on a Global Approach to Tuberculosis Elimination

a chest X-ray of a patient with TB is shown alongside a microscopic image of Mycobacterium tuberculosis bacteria
A chest X-ray (left) of a patient with tuberculosis and a scanning electron micrograph of Mycobacterium tuberculosis bacteria (right), which cause TB. Chest X-ray image by Sungkyunkwan University School of Medicine; TB image by NIAID

From the window of a four-seat plane, Mike Reid, MD, thought he could see men pushing cows across the desert. He squinted his eyes. He was right. They were pushing cows – to make space for a runway.

As an early career physician, Reid traveled to Botswana, where he spent three years providing treatment for tuberculosis (TB), HIV and other serious diseases to thousands of people desperate for medical care. From a base in Gaborone – the capital and largest city in Botswana – he made trips like this regularly, sometimes every week.

Mike Reid
Mike Reid, MD

“The lines of people were overwhelming,” Reid recalls. “It was exhausting.”

In 2014, Reid left southern Africa for San Francisco, where he joined UC San Francisco as a medical fellow, eager to gain expertise in infectious diseases and to make a stable life for his growing family. Given his knowledge of front-line challenges for TB treatment, and his expertise in clinical complexities of multidrug resistant TB, Reid began to collaborate with Eric Goosby, MD, professor of medicine at UCSF and the United Nations Special Envoy for TB.

In 2017, Reid joined the faculty of UCSF’s Division of HIV, Infectious Diseases and Global Medicine at Zuckerberg San Francisco General Hospital (ZSFG), where he is an assistant professor of medicine and part of a growing effort to eliminate TB – the world’s deadliest infectious disease – and HIV.

To that end, Reid is researching how to improve delivery of treatments for TB, HIV and other chronic diseases in sub-Saharan Africa. He is also involved in policymaking activities to improve TB programs and universal health coverage in low- and middle-income countries.

“My goal is to improve health outcomes in people in resource-limited settings,” says Reid.

On a Mission

Reid grew up in Home Counties, just outside of London. Inspired by Albert Schweitzer, the social justice missionary who helped the poor in Africa in the 1800s, Reid attended medical school in London (Imperial College), where he developed a passion for global health and intentions to work in India as a doctor.

But after completing a medical internship in the UK, Reid took a brief detour to study theology in Canada, where he met his American wife, Margo Pumar, MD, UCSF psychiatrist at ZSFG, which led him to the U.S.

After resuming his medical career with a residency in New York, Reid then worked for the U.S. President’s Plan for Emergency AIDS Relief (PEPFAR) for five years, where he fell in love again – this time with sub-Saharan Africa. He recalls his years working on the ground in that region as “deeply life-giving and enjoyable.”

Shaping Global Policy

TB is a curable disease, yet it remains the number one infectious disease killer globally, with three to four million cases a year being missed, says Reid. According to the Centers for Disease Control and Prevention, a quarter of the world’s population is infected with TB; in 2016, there were 1.7 million TB-related deaths worldwide.

Eric Goosby
Eric Goosby, MD

Reid is working with Goosby on the Lancet Commission on Tuberculosis, a committee chaired by Goosby that is developing recommendations for global TB policy leading to the U.N. General Assembly high-level meeting on TB in September 2018. Reid is excited about the prospect of reducing the global burden of TB by working to shape policy.

“It’s giving me a unique opportunity to meet with global leaders in TB,” he says. “It’s a rare privilege and a bit daunting.”

To be successful, Reid thinks it will be crucial to expand use of evidence-based strategies; to develop new tools for diagnosing, treating and preventing TB; to help countries move toward universal health coverage; and to convince countries worldwide to invest more money in TB.

“Investing in TB represents one of the best returns on investment of any health agenda issues,” he says.

Local Efforts

Clearly, the U.S. – a high income, low-burden country – is in a different stage of the TB epidemic compared to high-burden countries. Nevertheless, TB represents an important health issue in California, where more than 2,000 new active TB cases were reported in 2016.

Not everyone infected with TB bacteria becomes sick with the disease. Persons with latent TB are not infectious and cannot spread TB infection to others, however, five to 10 percent of those infected will develop TB disease during their lifetime.

“If we want to eliminate TB in the U.S., we need to address the burden of latent TB,” says Reid. “That often means screening high-risk populations.”

Risk factors for TB infection include HIV infection, injection drug use, and close contact with someone infected with TB.

Reid thinks local elimination will also require taking aim at the social determinants of TB.

“It’s not just about improving programs,” says Reid. “It’s about improving workplace conditions for miners. It's about improving prison health for inmates. It's about reducing indoor pollution for people living in slums. To address those things requires multi-sectorial engagement.”

The Lancet Commission on TB is expected to share recommendations for global TB policy around the time of the U.N. high-level meeting in September 2018. Reid is hopeful this will be a crucial step towards TB elimination.

“We can end TB,” says Reid. “This is a propitious, unique moment to shift global momentum in a profound and definitive way. Through our work and Eric Goosby’s leadership, UCSF is key to that effort.”