On World TB Day, TB is not dead

Today is World Tuberculosis Day, an annual remembrance of the 1882 discovery by Dr. Robert Koch of the bacteria that causes TB, the planet’s leading infectious killer at the time. World TB Day is both a celebration of a seminal discovery in medical history, and an opportunity to draw attention to the ongoing impact of this global epidemic, which continues to kill 1.3 million people every year and is evolving into a drug-resistant superbug that we are hard-pressed to contain. While we evaluate our past efforts combatting this disease, we must also turn our eyes to the future.

Looking back, it is clear to see that we are winning some important battles in the fight against TB, but also that the outcome of the war is far from decided. Current efforts to address TB are absolutely essential to controlling the disease and minimizing its health impact today. There are limits to what today’s efforts can achieve, however, and these limits must be acknowledged.

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Heroic efforts by the public health community have expanded diagnostic and treatment services to millions in need around the world, contributing to a greater than 45% reduction in TB-related deaths over the past two decades. With the rise of drug resistance, however, TB is becoming more expensive, difficult to treat, and deadly, and the ability of today’s tools to respond to this evolution is being outpaced. Globally, there has been undeniable success in the effort to reduce overall disease burden, but the rate of progress being achieved is too slow, and drug resistance threatens to undermine the gains of the last 20 years. In the United States, the overall number of new TB cases is at an all-time low, but with an increasing proportion of domestic cases occurring among foreign-born residents, we cannot afford to ignore the growing threat of drug-resistant TB outside our borders. Until TB is eliminated globally, we will never be rid of the disease here at home.

Looking ahead, doing more of the same will only get us so far. Treating our way out of this epidemic is neither possible nor affordable. If we are to achieve TB elimination, innovation – and by this I mean truly transformative change – is required.  We need new tools with which we can get ahead of the disease and drive meaningful declines in TB incidence.

The World Health Organization (WHO) estimates that upwards of $8 billion per year will be required to adequately respond to the TB epidemic in low- and middle-income countries. Even if these monies are fully mobilized, however, and if current efforts are scaled-up and optimized for maximum impact, WHO still expects that progress against TB will fall far short of the TB elimination objective. The most effective way to stop an infectious disease like TB is to prevent its spread, and for this reason new, preventative TB vaccines must sit at the center of our innovation agenda. Without such a vaccine, TB transmission will continue, rendering efforts to save lives and reduce disease burden increasingly difficult and expensive.

Despite longstanding recognition by the U.S. government of the importance of new TB vaccines, support for TB vaccine research and development has been limited. This must change.

The U.S. government commits more than $400 million annually through USAID programs and contributions to the Global Fund to Fight AIDS, TB, and malaria to support TB treatment and control programs. Given the current rate of progress against the disease, these expenditures are unsustainable, and will not prevent further transmission of the TB bacteria. In contrast, as little as $1 billion in additional funding is expected to be necessary over the next 10-15 years to bring to market an effective new TB vaccine that could provide a long-term, sustainable solution to the disease.

Decades of research have taught us much about the TB epidemic, leading to a robust pipeline of vaccine candidates being tested in the clinic today. This World TB Day, let those lessons inform our future. Alongside its current TB programs, the U.S. government must improve support for the ultimate TB solution: contribute to the global effort to develop new TB vaccines. It’s an investment that makes sense.

Stoever is vice president of External Affairs for Aeras, a global nonprofit biotech with a mission to develop new tuberculosis vaccines that are affordable and accessible. She has more than 15 years of experience in global strategy, fundraising and leadership with non-profits, NGOs and government agencies.