Guest post by Kari Stoever, VP of External Affairs at Aeras
For centuries, the resilient and highly adaptable M. tuberculosis microorganism has survived and thrived alongside its human host. Tuberculosis (TB) was first reported in the Greek literature by Hippocrates as the most widespread and fatal disease of the times. Historically described as the “Great White Plague,” TB was the cause of more deaths in industrialized countries than any other disease during the 19th and early 20th centuries.
By the late 19th century, 70-90% of the urban populations of Europe and North America were infected with the TB bacillus, and about 80% of those individuals who developed active TB died of it. Today, more than 2 billion people, almost a third of the world’s population, are infected with TB, and this number will continue to grow without effective preventative measures. New TB vaccines would be the single greatest tool in mitigating the epidemic.
March 24 is World TB Day, and while we celebrate the great progress made by the public health community in reducing TB deaths, we cannot forget that there are nearly a million more cases of TB in the world today than when the World Health Organization (WHO) declared TB a global emergency 20 years ago.
Current efforts to address TB through active TB case finding, rapid diagnosis, increased access to drug susceptibility testing, and the prompt initiation of effective treatment are essential to controlling the disease and minimizing its health impact given the tools and resources available today. But this strategy has clear limitations. Three million people with TB went undiagnosed in 2012, equal to one third of all those falling ill with the disease every year. Of the estimated 450,000 new cases of multi-drug resistant TB in 2012, only slightly more than one-quarter were notified. Overall TB incidence has been declining at a mere 2% annually, and at this rate it will take at least 150 years to achieve TB elimination.
Nowhere are the limitations of the current TB strategy laid out more starkly than in the WHO's post-2015 TB targets, endorsed by the WHO Executive Board for consideration by the World Health Assembly in May 2014. Even if current efforts are scaled up for maximum impact, WHO's targets illustrate that the expected progress against TB will still fall far short of the TB elimination objective. The achievement of WHO’s TB targets for 2035 depend on the introduction of a new TB vaccine or other new prophylaxis by 2025. These expectations show that innovation will be required if we are to achieve TB elimination as quickly as possible, and that new preventive TB vaccines will need to sit at the center of this effort.
A new model incorporating data from 183 countries demonstrates that a partially efficacious (60%) adolescent and adult preventative vaccine, delivered to a mere 20% of the target population, could potentially avert as many as 30-50 million new cases of TB by 2050, depending on the year of vaccine introduction.
With recent advances in research and development of new drugs, diagnostics and vaccines, we are turning the tide on tuberculosis. Over the past decade, investments in TB vaccine R&D have resulted in a robust global TB vaccine portfolio with over a dozen candidates being tested in clinical trials and even more novel approaches to TB vaccination in early stages of discovery and development.
We must leverage growing public concern to catalyze political will and resources for the development of new vaccines, drugs and diagnostics to significantly accelerate global efforts to eliminate this ancient plague. While no one should be denied access to life-saving treatment today, austerity measures demand that we invest in longer-term strategies that could ultimately save billions in treatment costs while protecting future generations from one of the longest lasting and deadliest epidemics of mankind.
This World TB Day, we want to highlight a population highly susceptible to TB: mineworkers in southern Africa. South African gold miners are reported to have the highest rates of TB in the world, and, due to their migratory nature, they are spreading TB all across the region. Leaders of 15 Southern African nations, known as the Southern African Development Community (SADC), have pledged to confront the TB epidemic in the mining industry through investments in treatment and control programs. But these efforts alone cannot eliminate TB as a hazard to miners. The most effective way to protect mine workers, their families, and their communities, is with effective TB vaccines.
Kari Stoever is the VP of External Affairs at Aeras, a nonprofit biotech advancing new tuberculosis vaccines for the world. She has more than 15 years of experience leading all aspects of nonprofit and research initiatives. To learn more on what Areas and their TB research and advocate partners are doing to address TB in the mines, click here