Sustaining the momentum

There is a renewed sense of urgency the world over to tackle the TB epidemic. Last year, the Global Ministerial Conference (GMC) on Ending TB in the Sustainable Development Era brought together nearly 80 health ministers in support of TB elimination efforts. The momentum created there will be taken forward this year, in New York, at the United Nations General Assembly high-level meeting on TB. It will be attended by the heads of state.

Focus on research

The key takeaway from the GMC was the thrust on research and development (R&D), to develop new and safer drug regimens, point-of-care diagnostics, and an effective vaccine. It is well known that TB research has been neglected which has resulted in the disease becoming one of the leading infectious killers in the world. Despite the World Health Organisation’s End TB Strategy listing R&D as key to eliminating the disease, TB research remains severely underfunded. According to estimates in the Global Plan to Stop TB, $9.84 billion (₹65,000 crore) was required the world over for TB research (2011-2015), of which just a third, $3.29 billion (₹19,500 crore), was spent.

At the GMC, member states committed to significantly increasing capacity and funding for TB research. India has taken a leadership role in this regard and set up the India TB Research Consortium, under the Indian Council of Medical Research, to spearhead research efforts.

Importance of a vaccine

The only licensed TB vaccine, the BCG (Bacille Calmette-Guérin) vaccine, dates back to the 1920s. While BCG is moderately effective in preventing severe forms of TB in children, particularly TB meningitis, it does not adequately protect adolescents and adults, who are at the highest risk for developing and spreading TB.

Globally, R&D efforts have made progress towards developing an effective TB vaccine but there are challenges. It is crucial to understand the type of immune response a successful vaccine should generate. We need to continue exploring a diverse range of vaccine candidate types including those that provoke different immunological responses.

However, no critical breakthroughs will be achieved without increased and sustained investments. With 10.4 million new cases and 1.7 million deaths in 2016, TB is deadlier than HIV, malaria, or even Ebola. Yet, TB vaccine research receives only under $100 million (₹650 crore) a year, a fraction of the investment made towards ending other diseases. While there is a strong government push for increased investments in R&D, the private sector can also play a pivotal role. The Rotavirus vaccine, which was made available for less than $1-a-dose (₹65), is an excellent example that illustrates how public-private-partnership can be the way forward.

In India, the government has introduced several initiatives to drive vaccine research. The Indo-U.S. Vaccine Action Program, between the Department of Biotechnology (DBT), the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, of the U.S. Department of Health and Human Services, supports a broad spectrum of activities relating to immunisation and vaccine research. Similarly, the DBT’s National Biopharma Mission, launched last year, aims to promote product discovery, translational research and early-stage manufacturing of vaccines in the country.

To discuss the road ahead in terms of vaccine research, the Indian Council of Medical Research and the DBT partnered with other international organisations to host the 5th Global Forum on TB Vaccines, in New Delhi last week. The forum, represented by the world’s largest gathering of multi stakeholders, strives to create vaccines. It provided an opportunity to share the latest research and identify new and innovative approaches to vaccine R&D.

With increasing global commitment to enhance investments in this area, we are certainly off to an encouraging start. We must sustain this momentum if we are to achieve a TB-free world by 2050.

Prof. K. VijayRaghavan is former Secretary, Department of Biotechnology