DAVOS, Switzerland  – The World Health Organization (WHO) has announced plans to set up a new TB Vaccine Accelerator Council to increase momentum for the development of a vaccine to combat the world’s most deadly infectious disease. Speaking at a high-level panel at the World Economic Forum’s Annual Meeting where the plan was launched, WHO Director General Dr Tedros Adhanom Ghebreyesus called for the involvement of all countries to make it a reality. 

“We have 16 TB vaccine candidates under development, many of which from before COVID. The difference between COVID and the 16 candidates is the whole world focussed on really finding a solution for COVID and so accelerated the development of the COVID vaccines, while TB [vaccine research] started decades ago,” Tedros said, adding that research into the latter is still “lagging behind.” 

Urging countries to renew their commitment towards eliminating TB, Tedros urged high-income countries to take the lead. “Not only governments, you will need health agencies. I think some of us are here-academia, the private sector, the civil society, all of us together, like we did for COVID. If we can use the lessons that we have learned there to accelerate [vaccine development], it’s doable,” he added.  

In 2021, an estimated 10.6 million people fell ill with TB and 1.6 million died – partly as a result of the decline in rates of diagnosis and treatment during the COVID pandemic.  The only WHO-approved TB vaccine, Bacillus Calmette-Guérin (BCG) developed in 1921, is now over 100 years old, and only partly effective when it is used, mostly to protect children in high-burden countries.

In contrast, a vaccine with just 75% efficacy could prevent 110 million new cases and 12.3 million deaths over 25 years, a recent WHO study found.

The new accelerator council will include global agencies and governments, funders, and people who have TB.  A United Nations High-Level Meeting on TB is planned for the week of the UN General Assembly in September to review progress against commitments made in the 2018 UN political declaration on ending TB, WHO said, in a press release.

Lessons from COVID

COVID-19 set a precedent in how countries and scientists can cooperate to tackle a pandemic, said Gloria Macapagal Arroyo, deputy speaker of the Philippines House of Representatives who served as the country’s 14th president (2001-2010).    Arroyo said that the foremost lesson she took away from the pandemic was that vaccines are a game changer. 

“We saw it was a game changer in the face of COVID. It can be a game changer in the case of tuberculosis,” she said. 

Another lesson that Arroyo took away from the COVID-19 pandemic, she added, was that strong public-private partnerships in the development of tools for diagnosis and treatment as well as vaccines, works wonders.

But vaccines alone are not going to be sufficient to tackle an age-old pandemic like TB, warned Jeremy Farrar, of the Wellcome Trust.  While vaccines may have largely stamped out childhood diseases like polio and measles, there must also be access to diagnostics and treatment, in robust health systems that have gained public trust, added Farrar, who is set to assume the position of WHO Chief Scientist in the first quarter of 2023.  

“So my one caveat to this vaccine discussion would be to put vaccines into a broader system, rather than thinking it’s gonna be the only thing….Don’t wait for vaccines. I don’t know when we are going to have a vaccine. Don’t wait for vaccines to do the things that we already know work and double down on those.”

Private sector should invest in workplace-based TB programmes 

Even so, it is embarrassing that TB, a disease that’s been around for centuries still has not been eliminated, said Peter Sands, the executive director of The Global Fund to fight AIDS, Tuberculosis and Malaria said. 

“This is a disease that’s been around for a very long time,” he said, “we’ve proven that we can eliminate it as a public health threat in virtually all the richest countries in the world. And yet we allow millions of people to be sick and die continuing [in poorer countries].”  

The Global Fund is the lead agency in the fight against TB, and yet the total annual allocation to the disease amounts to less than $1 billlion, he admitted.

“I mean, it’s a shockingly small amount of money when you think about the tens and hundreds of billions of dollars that have been spent in fund, um, fighting Covid 19. And in 2022, the number of people in the world who will have died of Covid 19, and the number of people who will have died of TB won’t be massively different. It’s just that the people who died of Covid 19 are, on average, a lot richer than the people who died of TB.” 

Explaining that TB, and particularly multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB) are far more dangerous than COVID, Sands said, “That would be my message to the rich countries. If you’re worried about health security, you’ve gotta be looking at this one.” 

Sands called on the private sector to invest in workplace-based TB programmes. He said that companies that employ many workers in high TB-burden regions stand to lose out hugely in terms of productivity as a result of workers’ TB cases.

“There are companies who’ve done the work and know exactly how much they were losing because you lose people for six, nine months and that’s if they get better. It’s a very cost-effective intervention to do workplace TB programs where you screen people and you provide them the support in the workplace around treatment. It just works as an economic equation.”

Eyes pinned on India to champion fight against TB

While there are tools and even money available to tackle TB, the key to effective moblization is political will, particularly in high-burden nations, panelists agreed – echoing Farrar’s comments on the importance of systemic approaches. 

“The most important is the political leadership in a country like the Philippines,India and Bangladesh, Indonesia, in all the places where TB is,” Sands stressed. “Because without that domestic political leadership, you’re not gonna win it. It’s not gonna be done from outside.” 

Added Arroyo, who as president of the Philippines from 2001-2010, helped drive a decline in the national TB burden, executive governance is crucial for the success of global programs against TB.

“Policies and programs are good but in the end, the decisive action will be implementation and executive management. And that’s what we [politicians] would have to provide as a country that is dealing with tuberculosis.”

With India heading the G20 as President in 2023, eyes are also pinned on the country to lead the way in the global battle TB.

Already in 2018, Prime Minister Narendra Modi, declared that the country would eliminate TB by 2025, five years in before the Sustainable Development Goals (SDG) deadline. 

In opening remarks before the session, India’s Minister for Health and Family Welfare Mansukh Mandaviya, described the country’s latest scheme Pradhan Mantri TB Mukt Bharat Abhiyaan (the Prime Minister’s TB Free Mission) which takes a whole-of-society approach. It aims to provide TB patients with higher nutritional, diagnostic and vocational support through their communities. The initiative, launched in September 2022, has already seen over 50,000 volunteers delivering support to over 1.3 million TB patients across the country, he said.

“Just as vaccines were a game changer in the battle against COVID-19, the global plan calls for approving a new TB vaccine by 2025 and making it widely available to adults and adolescents in TB affected countries. India is fully prepared and in an advanced stage for taking this forward.” 

Added Tedros, “If we can use the opportunity of India’s G20 presidency, I think we can make good progress even this year. But we need to have everybody that can contribute, come to the tent and give their best to accelerate and make progress.”

Image Credits: Screengrab, Screengrab from WEF panel, Screengrab from WEF panel. , Megha Kaveri.