Here’s how we can still beat tuberculosis by 2030

Tuberculosis (TB) is ranked the 13th leading cause of death globally and the second leading infectious disease after Covid-19. A staggering 10 million fall ill with the disease annually. And asymptomatic infections constitute a quarter of these. Of these, 5 to 10 per cent will develop clinical TB during their lifetime. In 2022 alone, TB claimed 1.3 million lives.

The TB epidemic is complex, fuelled by a host of factors. First is the multiple-drug resistance (MDR). While global estimates show the annual MDR-TB cases relatively stabilising in 2020–2023, after 2015–2019 downward trend, the drug resistance is still a formidable hurdle, enhanced by the inefficacy of an increasing number of drugs specifically designed for the disease.

Also, BCG, the only vaccine licensed for TB has some noticeable limitations, like variable effectiveness, contraindications in those co-infected with HIV/Aids and lack of protection against TB reactivation. Worse, there’s little evidence BCG prevents the development of TB in adults and adolescents, who account for 90 per cent of the disease incidence.

These critical gaps have necessitated the global urgency to develop new and effective countermeasures against the disease, most importantly, through the World Health Organization End TB Strategy and United Nations Sustainable Development Goals 7 and 8, which set global targets. WHO has identified new and repurposed vaccines as key to this strategy, with the ultimate goal to build a world without TB.

TB vaccine

Globally, clinical trials assessing the effectiveness and safety of TB vaccine candidates targeting adults and adolescents have surged, with about 17 candidates actively in the pipeline. Six of these have progressed to phase three of the clinical development, for tests on their potential to prevent disease or prevent infection. Also, the BCG (re)vaccination is being repurposed for adults and adolescents. However, clinical development alone is not enough. We must now maximise the public health impact of these new and/or repurposed TB vaccines to save lives.

The Global Roadmap for Research and Development for TB Vaccines, and WHO’s Evidence Considerations for Vaccine Policy have both identified key actions and considerations to prepare for the effective implementation of a new and repurposed TB vaccine, post-approval. To successfully target adults and adolescents in developing countries, for instance, the two documents recommend a focus on understanding the disease burden and its public health and economic impact.

Others include developing and implementing strategic plans for TB vaccination, strengthening healthcare capacity and infrastructure, broadening public awareness, and increasing acceptance among the public. We can still beat TB by 2030.

Mr Onyango is a Global Fellow at Moving Worlds Institute. [email protected].