As he gazes at the grant proposal on his office computer, Kunchok Dorjee is also seeing a path to better health for thousands of Tibetan children in India and Nepal who live in boarding schools and other congregate settings.

Since 2017, Dorjee, an assistant professor of infectious diseases at the Johns Hopkins University School of Medicine, has been working to curb the spread of tuberculosis (TB) among these vulnerable populations. He directs Zero TB in Kids, a tuberculosis elimination campaign that has reduced TB incidence by 87% in Tibetan refugee children by using a multipronged approach of community mobilization, screening, treatment and preventive therapy.

This public health initiative is aided by infectious diseases specialist Richard Chaisson and colleagues at Johns Hopkins, and is implemented on the ground by Delek Hospital in Dharamshala, India, and by in-country partners in Kathmandu, Nepal.

According to the World Health Organization (WHO), TB has again become the world’s leading cause of death from a single infectious agent, replacing COVID-19. In 2023, an estimated 1.25 million people died from TB, and 10.8 million people fell ill with the disease. India accounts for the largest burden of TB globally, and among Tibetan refugees, the rate of infection is three times that of the national average. As part of its End TB Strategy, the WHO aims to reduce TB incidence globally by 80% and TB deaths by 90% by the year 2030.

As a former exile himself, 45-year-old Dorjee says that helping this population is a personal quest. Born into a Tibetan refugee settlement area in northern India — his parents left Tibet after China invaded the country in the 1950s and the Dalai Lama fled in 1959 — the infectious disease specialist lived in boarding schools for 10 years before going to medical school.

He saw how TB affected many of his refugee classmates, making them less able to pursue rewarding careers like his because of the valuable time they had lost from their studies due to the disease.

Then, as a physician treating TB patients in Delek Hospital from 2004–2007, Dorjee encountered hallways filled with so many patients that two people often shared one bed. He realized the situation clearly required a public health approach.

In 2008 he was awarded a Fulbright scholarship to study public health at Stony Brook University in New York. He then received his Ph.D. in epidemiology at University of California, Berkeley, before coming to Johns Hopkins as a postdoc.

Directing Zero TB in Kids meant screening and treating more than 20,000 schoolchildren in three states of India from 2017–2024. The effort was highly successful, reducing the incidence of TB by 87%.

How was this accomplished?

“It was good public health work — attending to details. When we were designing the program, we met with all the community leaders, school leaders, school principals, and then we met with grassroots people, such as the home mothers,” Dorjee says. “Usually, all the decisions get made at an administrative level, while the people who actually see things and make things work are kind of left out. And home mothers are the ones who supervise the therapy to the kids.”

The program now consists of a mobile service delivery team of physicians and nurses who visit the schools to perform screening for latent as well as active TB, use artificial intelligence enabled chest X-ray screening for those with symptoms or latent TB to detect disease, and provide TB preventive treatment.

Dorjee says the team uses artificial intelligence to enable image reading, as well as point-of-care assays, ultra-short course treatment regimens, and digital contact tracing and case management systems to improve disease diagnosis and health outcomes.

“Now, we are now scaling up our program from the Tibetan refugee community in India to include children broadly in India and Nepal,” Dorjee says. “We have screened several thousand children in Nepal and provided preventive therapy, and I’m scaling up our program now in Mongolia. Our program has inspired the TB Free Schools Initiative led by the Gupta-Klinsky India Institute at Johns Hopkins, which will be implemented across several states in India.”

Dorjee says Zero TB in Kids is informing and providing insights into global TB elimination strategies, especially in low-income countries that shoulder most of the disease burden.

“This work has been really satisfying,” he says, “It’s something I really care about. I’ve always imagined helping to create TB-free schools where children can study without worrying about disease. So it’s like a dream coming true, although we still have a lot of work to do.”