Underfunded and deadly TB needs its own Bill Gates
BULAWAYO — Global efforts to end tuberculosis (TB) are futile without dedicated investment in research into the debilitating disease that is killing 4 000 people a day, Stop TB Partnership warns.
“TB is a disease that is not a darling of donors and investors,” Lucica Ditiu, the executive director of the Stop TB Partnership, told
in an interview from Geneva. “We do not have a Bill Gates that can support TB research, yet TB remains a disease of concern with deaths increasing for the first time in over a decade,” she added.
TB, a bacterial disease mainly affecting the lungs, has been around for over millennia and remains one of the top killer diseases globally. But it is preventable and curable with the right investment in diagnosis and treatment.
Ditiu attributed the rise in TB incidents to several factors; many people diagnosed and on treatment for TB have defaulted owing to the disruption of health services in the wake of the Covid-19 pandemic and global lockdown. Furthermore, many people remain undiagnosed because they have not been reached.
“Southern Africa has done a good job in respect of Zambia, Zimbabwe and South Africa as well as Rwanda in trying to disrupt as little as possible the treatment and diagnosis of people with TB,” Ditiu said. She commended awareness programmes in the media and community door-todoor campaigns to promote diagnosis and treatment.
Countries need to invest more in finding people with TB and putting them on treatment. Until you find people, you cannot put them on treatment, and this is where we are very much lagging, she said.
Ditiu fears the worst should the world fail to change the current TB transmission trend. An estimated 5.8 million people received treatment for TB in 2020; a drop of 21% from 2019, and more than 4 million people worldwide remain untreated. According to Stop TB Partnership, half of those untreated are likely to die from the disease.
Admitting that funding for TB has always been insufficient, Ditiu said TB was the poor cousin compared to the deep pockets for
HIV and Aids.
“In general, we have available only 30 percent of the funding needed globally. We have places that have done well in preventing TB in people living with HIV. Prevention of TB in people living with HIV is going well, especially in African countries because HIV has resources.”
According to the Stop TB Partnership, a network of international organisations established in 1998 to help end TB as a public health problem, funding for TB research and development (R&D) has remained flat since 2018.
Global funding for tuberculosis (TB) research totalled 915 million US dollars in 2020 — less than half the goal of 2 billion US dollars set forth by participating country governments at the 2018 United Nations High-Level Meeting on TB.
In 2021, TB had a funding gap of 13 billion US dollars globally, with only 5,3 billion US dollars available for its programmes. It experienced a drop in funding amounting to 500 000 US dollars in 2020 as many countries took money away from TB to respond to Covid-19.
A new report, Tuberculosis Research Funding Trends, 2005– 2020 by Treatment Action Group (TAG) and the Stop TB Partnership, found that TB received less than 1 percent of the amount invested in Covid-19 Research and Development over the first 11 months of the pandemic.
“The mobilisation of over 100 billion US dollars for Covid-19 research and development in the first 11 months of the pandemic shows us just how powerful a coordinated effort against a disease can be,” noted Ditiu.
While the pandemic has shown that effective vaccines can save lives, the world is still banking on a 100-year-old vaccine, Bacillus Calmette-Guérin or BCG. However, a more effective vaccine could have higher efficacy rates, especially for adults. Why has it taken so long to develop a new, more effective TB vaccine when the health burden of TB is increasing?
“This is the drama,” Ditiu commented. “We have a vaccine for a hundred years that we know for the last 40 years does not work (effectively) except for newly-born babies, and yet we have not done much about it.”
While ongoing research on new vaccines had been slow because of poor funding, Ditiu said several potential vaccines were in the pipeline, and a vaccine could be expected by 2027.
“It takes a long time to get a vaccine. But because of Covid (we realised), it is possible to have a vaccine much quicker, and we hope to use the learnings from Covid-19 to get a TB vaccine,” Ditiu said.
Tuberculosis vaccine research has been slowed by chronic underfunding with only one moderately effective century-old TB vaccine, compared to over 20 Covid-19 vaccines.
“What’s enabled the development of dozens of Covid-19 vaccines in less than a year has essentially been money,” noted Austin Aurinze Obiefuna, executive director of the Afro Global Health Alliance and incoming vice-chair of the Stop TB Partnership board.
“I think that the same enormous amount of funding should be applied with equal vigour to the development of TB vaccines. But that simply doesn’t seem to be happening.”
According to the Stop TB Partnership, making much-needed progress against TB demands investment that matches the threat of the disease around the world. This includes a commitment to rectify the inadequate funding of the past. Over the next two years, 10 billion US dollars are needed to close the tuberculosis research and development funding gap.
“Wealthy countries need to step up and put more money into correcting global health inequalities, which Covid-19 vaccine allocation inequities laid bare,” urged Mark Harrington, executive director of TAG, an independent activist, and community-based research and policy think tank.
“Covid-19 made more people around the world aware of the importance of research and development spending than ever before. Now is the time to finally start making investments ambitious enough to end TB for good.”—