* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
About one-third of the world’s population is “latently” infected with the bacteria that cause tuberculosis
The recent announcement that tuberculosis (TB) was responsible for 1.5 million deaths worldwide in 2014 - more than the 1.2 million HIV/AIDS deaths - might come as a surprise to some. The news from the World Health Organization (WHO) confirms, however, what clinicians, researchers, and advocates working in the TB field already knew - this is a neglected disease that continues to thrive in the more impoverished parts of the world. In fact, the WHO’s announcement serves to highlight what many in the TB field have been saying for a long while.
While substantial progress has been made, the TB epidemic is still not controlled. The world desperately needs new technologies - vaccines, drugs and diagnostics - to eliminate it. We have become immune to the fact that people in poverty are still dying of TB in great numbers.
About one-third of the world’s population is “latently” infected with the bacteria that cause TB, and about 10 percent of them are expected to develop an active TB infection. According to the WHO’s report, an estimated 9.6 million people became ill with this debilitating disease.
The threat of this epidemic is growing even more so because of the spread of dangerous strains of multiple drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) around the world. While MDR-TB is resistant to at least two of the key front-line drugs used to treat TB, XDR-TB is resistant to nearly all current drug options, and the costs these strains are enormous. In the U.S., a case of MDR-TB costs about 15 times the amount to treat drug sensitive TB. And treating a single case of XDR-TB could cost more than half a million dollars—enough to wipe out a small U.S. city’s total public health budget for a year.
XDR-TB has been reported in 105 countries, representing almost 10 percent of all MDR-TB cases. This is why we in the TB field say, “TB anywhere is TB everywhere.”
This September the United Nations endorsed a set of development goals to guide international efforts to fight poverty (known as the Sustainable Development Goals) that build on the “End TB Strategy” adopted by the World Health Assembly in 2014. A core component of these goals was a target to end the TB epidemic by 2030, yet without new approaches we have no clear path to achieve this.
Improvements in diagnostics and outreach have led to a better understanding of the epidemic, but we remain too far away from developing solutions. The current front-line TB drugs were developed in the 1950s and 60s.
The current vaccine is even older, dating back to the 1920s. Research and development are urgently needed to discover new tools—a new vaccine in particular could provide protection from all strains of TB, including MDR- and XDR-TB - but TB research and development is woefully underfunded The new WHO report points to an estimated $1.3 billion a year funding gap.
Our mindset about TB must change. We have so many promising scientific avenues worthy of exploration, but they remain untouched without sufficient resources. And with these tools left undiscovered, the disease continues to take a tremendous personal and economic toll around the world. TB needs to become rare and then nonexistent: here and everywhere.
Jacqueline E. Shea is the CEO of Aeras, a nonprofit, global biotech organization developing new tuberculosis vaccines. She holds five patents, including those for gene identification technology and Salmonella virulence genes, and received her Ph.D. from the National Institute for Medical Research in London.
