No one is moving fast enough to end TB

Mel Spigelman | Updated on: Apr 04, 2022
Mel, Spigelman, President and CEO, TB Alliance

Mel, Spigelman, President and CEO, TB Alliance

India has lagged in implementing new TB treatments shown to be safe and effective

The commemoration of World Tuberculosis Day provides an opportunity to reflect on both the progress that has been made in the fight against the deadly TB pandemic as well as the challenges confronting the critical goal of eradicating this age-old killer.

Unfortunately, the past year has witnessed a worsening of the global TB pandemic. For the first time in a decade, more people died of TB last year than in the year prior. While this has in great part been due to the impact of Covid-19, there are certainly other factors that have contributed to this setback.

For example, in Eastern Europe, where drug-resistant TB has thrived since the Soviet era, Russia’s calamitous invasion is halting promising progress, especially in Ukraine where hospitals and drug supplies are being destroyed while patients are forced to flee while undergoing TB treatment.

This tremendous upheaval is compounded by a paucity of resources that are dedicated to the discovery, development, and delivery of much-needed new diagnostics, drugs, and vaccines for TB. However, despite scarce funding, there have been instances of remarkable scientific innovations in recent years.

Two examples of significant progress in the field of new TB therapeutics are the demonstration that treatment of drug-sensitive TB can be shortened from six months to four months and that the treatment of highly drug-resistant forms of TB can be shortened from 18 months (or longer) down to six months.

The progress in treating highly drug-resistant TB is especially noteworthy in that not only has the duration of treatment been markedly shortened, but the number of drugs that need to be taken has decreased from up to eight down to three (a combination of bedaquiline, pretomanid and linezolid – referred to as the BPaL regimen), the cure rates have increased from approximately 50 per cent to 90 per cent, and the cost of treatment has decreased.

Also of note is that all of this has been accomplished with relatively minimal investment in the research and development of new TB therapeutics. When one considers the amazing progress made in the rapid discovery and development of Covid-19 vaccines, diagnostics, and therapeutics when adequate resources were deployed, it is clear that TB could be eradicated if only similar resources were brought to bear against it.

However, another lesson learned from the Covid-19 pandemic, which we must never forget, is that new scientific advances will never achieve their potential if not accompanied by equitable access — all new products must be affordable, and readily available to all in need, and adopted or used. Similarly, we must embrace change and shed the shackles of complacency that may manifest as fear of the new.

Many countries have recognized this. Despite the disruption of Covid-19, more than a dozen countries acted quickly in response to new WHO guidelines in 2020 supporting the use of the BPaL regimen in operational research settings, including South Africa, Myanmar, Ukraine, Nigeria, and the Philippines among others.

Countries such as the US and Ukraine have vigorously pursued the adoption of the regimen and confirmed in these two diverse settings the very high efficacy and relative safety of the treatment.

The World Health Organization reports that India bears about one-quarter of the world’s TB burden, with TB killing close to half a million people in India every year. When it comes to treating patients diagnosed with drug-resistant TB, India’s treatment success rate is reported to be as low as 48 percent.

In 2020, India became the first country after the US to approve pretomanid and the BPaL regimen for some of the deadliest, most drug-resistant forms of TB. However, the implementation of this therapy has since lagged significantly. Only in recent months have a relatively small number of patients started treatment as part of a years-long, government-sponsored clinical trial.

Everyone committed to ending TB must move faster to adopt new technologies that are shown to be safe and effective. Above all, the country with the largest TB burden in the world must be a global leader in identifying and adopting the solutions that will end this pandemic.

Promising new TB diagnostics, drugs, and vaccines are already under development. With adequate funding and political will (even at a fraction of what has thus far funded the Covid-19 response), novel approaches and revolutionary tools for curbing TB are within reach. However, even if those new tools are realised, every person involved — including patients, healthcare workers, and government officials — must be prepared to take rapid and full advantage of them. Only then will an end to the TB pandemic become a reality.

The writer is President and CEO, TB Alliance. Views are personal

Published on April 03, 2022
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