It's time to stop the world's oldest pandemic: we need a new tuberculosis vaccine

This week, experts and policymakers will hold the following meetings: United World Congress on Lung Health We discuss tuberculosis (TB), the world's deadliest and most neglected infectious disease. Since the early 20th century, more than 1 billion people have died from tuberculosis, more than malaria, smallpox, HIV/AIDS, cholera, plague and influenza combined.

The United Nations' official goal of reducing tuberculosis deaths by 75% between 2015 and 2025 is currently out of reach. Many commentators believe that the 2030 goal of reducing tuberculosis by 90% will be difficult to achieve unless there is urgent increased investment in new tools to stem the curve of the epidemic. .

Promising tuberculosis vaccine pipeline

Advances in tuberculosis science over the past five years have dramatically improved treatments for the disease, but just as importantly, effectively ending tuberculosis as a public health crisis requires long-awaited treatment. History suggests that a vaccine will be developed. .

The BCG (Bacillus Calmette-Guerin) vaccine, developed 100 years ago, remains the world's only vaccine against tuberculosis. It is mainly given to infants and young children to prevent more serious forms of tuberculosis, such as tuberculosis meningitis, which affects the brain. However, this vaccine is essentially ineffective against the more than 9 million adults and adolescents who develop tuberculosis each year.

One of three prophylactic vaccines currently in Phase III trials (MTBVAC sponsored by IAVI and BioFabri, M72/AS01E vaccine sponsored by the Gates Medical Institute, and the Serum Institute's VPM1002 candidate) has demonstrated safety. ,efficacy.

However, you will need sufficient funds to make this happen. Unfortunately, tuberculosis, a disease that disproportionately affects the world's poorest people, has traditionally been underfunded.

Science has brought us this far. And now it's time to finish the job. We cannot afford to wait another 100 years before we finally have a widely effective vaccine. While we await the results of clinical trials, we must also start preparing now for the rollout of successful vaccine candidates.

Avoiding inequity in tuberculosis vaccines

Once a new TB vaccine is approved by regulators and recommended by public health authorities, a clear understanding of the scale of demand for TB vaccines is needed to build and maintain adequate manufacturing capacity to supply the required doses. It is essential to do so. This is new territory for tuberculosis control and will be an expensive endeavor requiring significant lead time.

The response to COVID-19 has provided some valuable insights into what can be achieved with appropriate investment in clinical development, de-risking scale-up of manufacturing, and widespread distribution of vaccines. At the same time, it spotlighted supply inequalities across vaccine producing and non-producing countries and promoted a movement towards sovereign local manufacturing.

Tuberculosis Vaccine Promotion Council

The Tuberculosis Vaccine Acceleration Council, announced last year by the World Health Organization (WHO) in collaboration with health ministers from high-burden countries, investment banks and major philanthropic organizations, could help lay the foundations for TB vaccination in the coming years. There is sex. Effectively roll out new tuberculosis vaccines primarily to people living in countries with the highest prevalence of the disease. This goal must be achieved in light of the urgency of the COVID-19 response, but with an unwavering commitment to equity that has been lacking in the COVID-19 response.

The Council's efforts were strengthened earlier this year when the vaccine alliance, Gavi, decided to include tuberculosis vaccines as part of its vaccine investment strategy. Gavi funding provides a critical lifeline to ensure access to TB vaccines in 54 Gavi countries.

Gavi's support is critical to helping these countries not only secure the funding they need to procure vaccines, but also to stop new waves of TB infections among adults who are not covered by the regulations. and support the establishment of channels to reach young people. Routine childhood immunization program.

Challenges faced by high-burden countries

But we also need strategies to support access to TB vaccines in middle-income countries (MICs) that have transitioned, are in transition, or are not eligible for Gavi support but face the greatest burden of TB. .

These strategies must include investments in vaccine supply platforms and mechanisms for countries, including regions, to jointly engage in collective purchasing and increase bargaining power. All of us convening for this week's Coalition meeting will need to consider policy solutions, including debt relief and relief, that indirectly allow the Ministry of Internal Affairs and Communications to invest more in health systems and vaccine supplies.

According to the WHO, accelerating the scale-up of vaccines could prevent up to 76.6 million infections and generate an economic impact of $372 billion by 2050. It's human life. Every year, more than a million lives are lost because we are stuck in the fight against tuberculosis, failing to mobilize the investment and political will it deserves. Together, we can and must stop this from happening.

Shelly Malhotra is Vice President of External Relations and Global Access at IAVI. She has more than 20 years of experience in global health with a focus on leveraging public-private partnerships to foster access to innovation.

Mike Frick is co-director of the Treatment Action Group (TAG) Tuberculosis Program. He has been promoting access to tuberculosis prevention measures for more than a decade.

Image credits: USAID Asia.