In 1921, we were recovering from a major flu pandemic and the First World War. Telephones were still a rarity, and those that did exist were clunky, static and expensive. We were still five years away from the world’s first television screening and Charlie Chaplin had just released his first full-length film. 1921 was also the year in which the Bacillus Calmette-Guérin vaccine – more commonly known as the BCG – was first used.
The BCG should be celebrated for what it has achieved in the last century. Over its one hundred years of use, it has arguably saved many thousands of lives and prevented millions of cases of Tuberculosis (TB). However, the BCG is not enough. On its own, the BCG does not protect against the deadliest and most infectious forms of TB in adults, only protecting against some forms of the disease, like childhood TB meningitis.
Yet despite its flaws, the BCG remains the only TB vaccine 100 years on. This is staggering when taking into account the pace of change that has happened in the past century, with many of those other characteristics and events of 1921 now seeming complete relics of the past.
And it’s not that TB is not a problem anymore. Despite not receiving a great deal of attention from the world’s media or politicians, particularly in rich countries where incidences have decreased enormously over the last century, TB is still the second most deadly infectious disease globally – trumped only by COVID-19 since 2020. Even through the course of the pandemic, TB has still killed more people in Africa and Asia than COVID-19 did between March 2020 and April 2021. A number of new countries, including Cambodia, Russia and Zimbabwe have recently entered WHO’s list of high burden countries with TB and the pandemic has set back progress on TB by twelve years. This is why TB needs to be given more attention now.
The lack of innovation for TB is even more staggering when taking into account the progress that has been made against COVID-19 in the short time that we’ve been aware of it. Historic underinvestment in TB is a major factor in this discrepancy. Compared to the 100 years that have passed since the last successful TB vaccine innovation, in just 100 days after COVID-19 was declared an international health emergency, we saw investment into and development of a multitude of vaccine trials with the first developed in just 25 days and a successful candidate being approved in the UK after just 307 days.
In comparison, there is no new vaccine for TB to date. After years of trials, there have been some breakthroughs in TB vaccine development. For example, in 2018 a study of the M72 TB vaccine candidate showed protection against active pulmonary TB disease in adults. But we need trials, research and roll-out to be fully funded. This extends to TB diagnostic and treatment tools, as well as vaccines. Delay in diagnosis because of localised issues like a lack of electricity at health centres, expensive tests and complex drug-resistant TB testing call for urgent development of better point-of-care diagnostics. Current TB treatments are long and the side effects of the cocktail of medicines can be severe and costly. New, cheaper and shorter courses of treatment should be developed to ensure that TB treatment works for everyone who needs it.
The response to COVID was an incredible feat of science which should not be expected for every disease, but it does set a precedent for what can be achieved with sufficient investment, media attention, public engagement and political will. Unlike COVID-19, TB has suffered historic underfunding and a severe lack of knowledge and engagement from the politicians behind the budgeting. The fact that there has been no successful innovation in TB vaccine research and development in the last century is therefore perhaps not unsurprising.
But in order to combat TB and to stop the 1.4 million deaths experienced in 2019 alone, we need to see investment and commitment to finding a new TB vaccine – as well as improved diagnostic and treatment tools - to meeting SDG 3.3: to end TB epidemics by 2030.
COVID-19 offers a blueprint for how investment can truly make a difference in vaccine development. COVID-19 has also demonstrated how access to tools to prevent and treat infectious disease is increasingly being viewed as a human right to which everyone deserves equal access. This should be extended to TB.
However, the UK government is failing to take this lesson and apply it elsewhere. As part of the Government’s decision to reduce the UK’s Official Development Assistance (ODA) budget from 0.7% of Gross National Income to 0.5%, global health research and development funding has been slashed. In March, we saw UK Research and Innovation – a public body funded by the Department for Business, Energy and Industrial Strategy - announce that its ODA funding had been cut, leaving a £120 million funding gap for critical global health research projects. Just last month, funding for Product Development Partnerships – a key tool in developing new global health products where commercial interest in investing is too low – was cut from an average annual commitment of £88 million to just £2.5 million for the year 2022-23.
At a time when we are all too aware of the value in investing in preventing infectious diseases, the Government’s decision to slash funding is shocking.
We hear a lot about “building back better” from the pandemic and “leaving no one behind”. But we are leaving behind those affected by TB. We want to "build forwards" towards a world which is free from TB and which truly values the lives that could be saved if we invested in a more effective TB vaccine. Ending the TB epidemic by 2030 will require political commitment of leaders and increased investment into TB research and development. States and stakeholders need to collaborate and forge ways to develop and implement mechanisms to finance TB research and development. Now it is the time to work towards developing a new TB vaccine that is accessible to all.
The Government has recently committed to developing vaccines for new infectious diseases within 100 days of a health emergency being declared. In order to meet our global commitments and end preventable deaths, we must also combat existing neglected diseases like TB and ensure that we never have to wait 100 years for another vaccine.