The Director-General of the Tuberculosis World Health Organization is determined to eradicate one of the oldest and deadliest diseases.Last week, Tedros Adhanom Ghebreyesus stated, “We have an unprecedented opportunity to write the final chapter in the history of tuberculosis, unlike any generation before us.”
This tale dates back thousands of years, with evidence of tuberculosis found in Egyptian mummies from 2400 BCE. However, recent events in 2023 indicate that there are still chapters to be written before Tedros’s vision can become a reality.
Tuberculosis
Encouraging news surfaced at the Union World Conference on Lung Health in Paris last Thursday. Two clinical trials conducted in South Africa and Vietnam examined levofloxacin, a commonly used antibiotic for drug-resistant TB. The trials provided strong evidence that taking the drug could reduce the risk of developing drug-resistant strains by approximately 60%. This promising development, applicable to both children and adults in high-exposure environments, may influence future global TB guidelines.
However, the battle against TB faces significant challenges, exacerbated by the COVID-19 pandemic. The focus on the SARS-CoV-2 virus disrupted health systems, hindering the diagnosis and treatment of TB and diverting resources from essential TB services and future treatment development.
According to a recent WHO report, the toll of tuberculosis remains grim. Globally, an estimated 10.6 million people fell ill with TB in 2022, up from 10.3 million in 2021. Despite progress before the pandemic, TB-related deaths reached 1.3 million in 2022, and the goal to reduce TB-related deaths by 75% from 2015 to 2025 is far from being achieved.
Moreover, only 52% of the 30 million people targeted for preventive TB treatment received care, and fundraising efforts fall significantly short. The 2018 goal of $13 billion in annual global funding for essential TB services in low- and middle-income countries remains largely unmet.
While advancements in TB diagnosis and treatment are being explored, challenges persist. The most common diagnostic method, a 130-year-old microscope test, lacks effectiveness. Molecular lab tests offer greater sensitivity but are underutilized. Existing vaccines are limited in scope, and access to the best drugs is inconsistent, with affordability and side effects posing significant obstacles.
However, there are glimmers of hope. The patent expiration of the drug bedaquiline may lead to more affordable generic versions, and advocacy efforts have prompted price reductions for diagnostic tests like GeneXpert. Nevertheless, the development of a home test, similar to those for COVID-19, requires funding.
Funding remains a critical barrier to progress, as acknowledged by advocates. The TB Alliance President, Mel Spigelman, emphasizes the need for increased funding for research, development, infrastructure, and vaccines. With adequate resources, the testing of numerous vaccines in the pipeline, including the 50% effective M72, could be expedited, potentially making a substantial impact on public health.
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