Tuberculosis (TB) is responsible for the deaths of more people than any other infectious disease today. In 2017, TB sickened 10 million people and killed 1.6 million worldwide. In India, more than 1,100 people die from TB each day.
New support for research is critical to ending the epidemic. As India is home to one-quarter of the world’s TB burden, the country has an opportunity to make huge strides in public health by becoming a global leader in TB research.
The medicines, diagnostic tests and the vaccine currently available for TB are grossly inadequate. They need to be updated with truly modern tools. What is needed is a diagnostic test that rapidly delivers results and can be provided to patients of any age anywhere, including rural areas where electricity is unreliable, and without needing to send test samples away to a laboratory.
Instead of needing to take multiple antibiotics for six months or more, TB patients need a short, simple, well-tolerated and affordable treatment. And instead of a vaccine that is more than a century old, and which has primarily been beneficial in preventing some severe forms of TB in infants, we need a new vaccine that will also do a good job at preventing adolescents and adults from getting TB. This could the disease from spreading.
Fortunately, there are reasons to be optimistic. Last year, the UN held its first ever General Assembly high-level meeting on TB, where many of the world’s leaders committed to ending the epidemic by 2030. To its credit, the Government of India has committed to ending TB by 2025. To reach these goals, governments also pledged to increase their funding support for TB research. The aim now will be to ensure governments take the steps to fulfil these commitments.
New research funding would build on some important recent breakthroughs in TB research, helping scientists deliver the new tools that patients and communities urgently need.
For example, the results from two recent clinical trials, each published last year in the New England Journal of Medicine, provide new optimism that a TB vaccine is within reach. These vaccines were partially effective. In one case, the vaccine could potentially help protect people from becoming infected in the first place and, for those who have a TB infection, the other could help prevent them from actually becoming sick. What scientists have learned from this research is also laying the foundation for the development of even more successful vaccines.
But for people to benefit from these advances, countries must prepare to make new vaccines available to the people and communities that need them, and new funding must be available for the additional research needed to bring new vaccines to market.
We have also seen new developments in TB treatment just in the past few years, with two new TB drugs that may make treatment easier and shorter. New data show that these two TB medicines are safe to be taken together within the same treatment regimen. And earlier this year, results from the STREAM clinical trial showed how to treat multidrug-resistant TB in nine months instead of 20, with the same effectiveness. Meanwhile, a third novel TB medicine, Pretomanid, is now being evaluated for use against extensively drug-resistant TB.
All of these are promising developments but they are not nearly enough. Available funding for TB research falls far short of what is needed to have a major impact on the epidemic. At last year’s UN General Assembly, governments committed to investing an additional $1.3 billion (Rs 8,889 crore) annually – a modest sum for medical research. That new investment is worth the cost. The new Lancet Commission report on TB, published by an international panel of experts in March this year, found that even if the current medicines, diagnostics and vaccine were put to their maximal use in India, TB deaths will still cost the national economy at least $32 billion (Rs 2.18 lakh crore) each year for the next 30 years.
Because most research funding already comes from high-income countries, new investment, funded publicly and privately, from South Africa, India, China, Brazil, Russia and other middle-income countries with high TB burdens is essential.
Science has given us the tools we have to help prevent, diagnose and treat TB, but those tools are falling short of what we need to have real impact on the epidemic. We can end the TB emergency, but only with a durable commitment to new investments in scientific research.
Thanks to increased government support, India has begun to emerge as an important world leader in fighting TB. The national TB program budget, which funds the delivery of TB care in the public health sector, has more than tripled since 2016. As a global research hub, India now has an important role to play by also investing more in TB research.
Dr Paula I. Fujiwara is scientific director of the [International Union Against Tuberculosis and Lung Disease (The Union). The Union will host the 50th Union World Conference on Lung Health taking place in Hyderabad between October 30 and November 2. Dr Mark Feinberg is president and CEO of the International AIDS Vaccine Initiative (IAVI).