Tuberculosis epidemic desperately needs new vaccination strategies

At the beginning of November, a tuberculosis (TB) outbreak in Minnesota killed six people and made front page news. A single case in New York State made regional news last week. And so it goes, here in the U.S.. Wherever it appears, TB is an unexpected and frightening intrusion likely to draw media attention.

In most of the world, however — especially in more impoverished places — TB is better known and much more dangerous. TB is the world’s top infectious killer, taking 1.7 million lives in 2016. Yet, while the disease continues to evolve and spread, essential research and development needed to fight the epidemic for medical treatments, a vaccine, even the diagnostic equipment has not kept up.

To defeat the TB epidemic, we need nothing short of a research-and-development revolution.

In mid-November, Russia, with one of the largest caseloads of drug-resistant tuberculosis in the world, hosted representatives from 100 countries and 120 partner organizations and institutions at the largest-ever gathering of cabinet-level officials focused on ending TB. At this conference, there was a drumbeat of calls for new tools and technologies for fighting TB. The rhetoric was right. Now we need to see these world leaders put research money on the table.

The only TB vaccine available, bacille Calmette-Guerin (BCG), is nearly 100 years old and only moderately effective in preventing severe TB in infants and young children. It does not adequately protect teens and adults, who are most at risk for developing and spreading TB. An effective vaccine is essential to ending the epidemic can limit the, but vaccine development takes time and money.

Currently, investment in TB research and development — especially in vaccines — is embarrassingly low. Global investment in TB vaccines in 2016 was just $95.4 million, while $894 million was invested in HIV vaccine research. HIV is an exceptionally deadly virus, especially in Africa, and this R&D investment needs to continue. However, TB vaccine R&D—which would prevent an even deadlier infection—needs to at least match this funding level.

As a point of comparison, the annual global cost of TB is about $21 billion — $9 billion in public health and medical costs and $12 billion in lost productivity and wages. Looking ahead, new projections from KPMG released last week estimate that TB will cost countries $983 billion between 2015 and 2030. By failing to invest in TB R&D, this economic drain will continue indefinitely.

Treating the disease requires a combination of strong antibiotics taken for a minimum of six months. The drugs used in treatment are decades old, however, and were developed before we put a man on the moon. Strains of the disease have evolved to become resistant to this “first-line” combination, and new drugs are desperately needed.

Diagnosing the disease remains complicated and drug resistance is often missed in the initial diagnostics. This means that many patients are treated with drugs that do not work on the strains of TB that plague them. Only one in five people needing multi drug-resistant TB treatment receive it, and only half who receive it are cured.

We are failing the thousands of people that are fighting and succumbing to this disease every day. We can and must do better. And it starts with an investment in new technology.

Attendees at the Moscow Summit learned that results from several mid- and late-stage vaccine studies will be released over the coming months. The data collected will provide experts with new insights into immune responses to this tricky and elusive disease, but we need to push harder and invest more dollars if we are to capitalize on this new information. We must keep driving research forward until we have a vaccine.

Investing in R&D over the long term will mean future generations — our children and grandchildren — will not have to suffer from this devastating disease. Outbreaks like the one in Minnesota may be alarming, but they will never be eliminated unless we develop new and better tools.

Public health victories that eliminate infectious diseases—or bring us to the brink of elimination—have never happened without a vaccine. The entire world — not just the hotspots — desperately needs new TB vaccines and vaccination strategies to bring an end to the TB epidemic.

José Luis Castro is the executive director of the International Union Against Tuberculosis and Lung Disease, based in New York City.