Opinion | More global R&D is needed to tackle TB
While some countries have reduced their TB burden, the global progress against the disease has been slow
Tuberculosis (TB) has drawn unprecedented attention in recent times. A growing sense of urgency in dealing with this global threat made the United Nations (UN) schedule its first-ever high-level meeting on TB in New York on 26 September. The meeting offered participating nations the potential to energize the discourse on TB and chart a roadmap for global action on TB. One of the major discussion points focused on accelerating research and development (R&D) efforts to end TB.
In the last century or so, advances in science and technology have contributed significantly towards the longevity and improved quality of people’s lives. The discovery of antimicrobial therapy, the introduction of vaccines and the increased ability to identify infectious organisms have enabled countries to control the spread of communicable diseases such as cholera, plague, and leprosy that once ravaged entire populations. The importance of continued scientific innovation as we progress towards achieving the sustainable development goals cannot be overemphasized.
This is particularly relevant for TB, a disease that continues to kill more than 1.3 million people globally every year. While some countries have reduced their TB burden, the overall global progress against the disease has been slow. Arguably, the lack of advancement in TB R&D is one of the major reasons why the disease continues to thrive and exact a heavy toll on human life.
The facts speak for themselves: until 2016, we used a century-old microscopy test that detects only 50% of cases and treated TB patients with long drug regimens that have severe side effects.
We are also yet to discover an effective vaccine against the disease. This gap in scientific progress has been a serious concern as there is now a consensus that to transform the TB elimination response, we need better diagnostics and drugs, and an effective vaccine.
To achieve this, research must be prioritized and countries need to increase their investments in TB R&D. India has established the India TB Research Consortium (ITRC). Since its inception, ITRC has raised the profile of TB research, attracted investments in TB product development and conducted several validation studies on new TB tools.
The Indian Council of Medical Research (ICMR) has also recently taken steps to initiate trials for two new TB vaccine candidates. Thus, in the last few years, India has made considerable progress in advancing TB research. Recognizing this, the ICMR, under which the ITRC was formed, was awarded the prestigious Stop TB Kochon Prize for 2017.
Similar individual efforts have been made by other countries as well. However, our progress against TB would be far more successful through greater inter-country collaboration. An example of such a partnership is the BRICS TB Research Network through which the five nations are working together on multiple research projects covering TB diagnostics, vaccines, new drugs, and infection control.
In this regard, the BRICS network had a side meeting at the high-level meeting. While this is encouraging, more countries must come together not just to collaborate on future research, but to also facilitate cross-learning by sharing the results of their ongoing efforts. By doing so, they would spend less time reinventing the wheel and are likely to get faster results.
It is equally important for countries to quickly adopt new and emerging drugs, therapies, and devices within their borders. This can be done by agreeing to standardize regulatory processes. For example, the Asean countries have accepted a set of uniform standards for medical equipment in the region which helps in the easy registration of these devices.
Along the same lines, it is vital for countries to update their existing tools based on the latest scientific evidence. For instance, the World Health Organization’s new guidelines on the treatment of multi-drug resistant (MDR) TB needs to be adopted swiftly. These guidelines, which recommend the use of Bedaquiline as a frontline medicine to treat MDR TB, will revolutionize TB treatment by minimizing the use of painful injectable drugs that are known to cause serious side effects.
We also need to focus more research efforts on developing biomarkers to determine those who are predisposed to develop active TB among the close contacts of TB patients so that efficient preventive therapy can be provided. Shorter and more efficient anti-TB regimens need to be developed to improve the adherence to treatment and decrease the failure and relapse rates. Research for the prevention of transmission of drug sensitive and drug resistant tuberculosis in the healthcare setting is critical.
In the age of globalization, the containment of an infectious disease like TB within borders poses a considerable challenge, which is why eliminating the disease is a pressing global priority. The recently concluded meeting saw the endorsement of a political declaration that underscored the criticality of research in our common goal of eliminating TB. Hopefully, this will act as a starting point for countries’ efforts to advance future TB research—with those efforts built on the foundations of a collaborative spirit and a willingness to share individual strengths.
Srikanth Prasad Tripathy is director-in-charge, National Institute for Resarch in Tuberculosis.
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