This week, as health ministers, diplomats and other representatives meet to discuss tuberculosis (TB) at the World Health Organization (WHO) Ministerial Conference in Moscow, millions of people are suffering from the disease. The governments around the world can and must end this suffering through a major and sustained investment in TB research and development (R&D).
There were 10.4 million new cases of active TB in 2016—of which only 6 million were diagnosed and notified. Drug-resistant infections are on the rise. There remains a dire need for better, faster-acting drugs, a new vaccine, and technologies that quickly diagnose TB and determine the degree of drug-resistance.
Science is not holding us back, funding and political will to implement is.
The WHO estimates that R&D budgets need more than US$1 billion annually to turn around the odds of patients potentially losing years of their lives to a toxic treatment course, missing the opportunity for treatment due to poor diagnostics, or contracting TB in the first place because of an ineffective vaccine.
The WHO also reports that despite accounting for about 2 percent of deaths globally, TB receives only 0.25 percent of the estimated US$265 billion spent worldwide on medical research each year.
Simply put, TB science is woefully underfunded. Governments must work together to dramatically reshape the investment landscape.
Today, the time needed to treat drug-resistant TB ranges from nine months to two years or more—and yet in common practice the success rate is only about 50 percent. The majority of drugs that these patients are given are probably not helping at all—but they are producing side effects, everything from nausea and dizziness to deafness and kidney failure. For some, the treatment can be worse than the disease itself.
A true point of care test is needed to find the 4 million missing patients every year, where and when they first seek care. New diagnostic technology is critical to ensure that the right treatment regimens are used—right from the start—to prevent the lengthy and arduous road to diagnosis and cure faced by many patients.
Making matters worse, there is no vaccine that can effectively play a major role in eliminating this disease. Today, the Bacillus Calmette–Guérin vaccine is the only TB vaccine available. It is nearly a century old, only moderately effective in preventing severe TB in infants and young children, and it doesn’t adequately protect teens and adults, who are most at risk for developing and spreading TB.
Progress has been made but we need a greater commitment. There are 12 different TB vaccine candidates in clinical trials today, a significant increase from 2000—when there were zero. Data from multiple mid- and late-stage efficacy trials will become available over the next 3 years, providing data that will help optimize and accelerate TB vaccine development. But it will take a significant increase in resources to achieve critical breakthroughs—and to reach success quickly.
Similarly, only a handful of drug candidates were being tested in clinical trials. Today there are more than 30. Two new experimental treatments show promise—one that might be able to cure all forms of TB except for the most drug-resistant strains (known as extensively drug-resistant TB or XDR-TB), and another that might be able to cure XDR-TB. Both could take substantially less time and money than current treatments.
At first glance, the TB diagnostics pipeline looks healthy. However, emerging game-changers are at risk due to underfunding at the clinical trial stage. In addition, very few diagnostic candidates would address the most critical need—a point of care test for primary care facilities. Diversification of the point of care pipeline, and identification of new biomarkers are urgently needed.
While the meeting in Moscow will inform future discourse on TB, it must also serve as a springboard toward decisive action against the disease. TB is the world’s deadliest infectious disease and efforts to curb it remain underfunded. We are calling on governments to make major commitments to fund the R&D that will end TB once and for all.
Catharina Boehme, CEO, FIND
Nick Drager, Executive Director, TBVI
Jacqueline Shea, CEO, AERAS
Mel Spigelman, President and CEO, TB Alliance