In 2021, more than 10 million people fell ill from tuberculosis and 1.6 million people died. Effective vaccines would undoubtedly be the best solution to prevent and potentially eradicate TB. However, no new TB vaccine has been licensed in 100 years. The prospects for novel effective TB vaccines have improved recently, with at least 16 vaccine candidates under development. What mechanisms can accelerate development and deployment of safe and effective TB vaccines?
Speakers discussing the topic at World Economic Forum 2023 are Gloria Arroyo, Deputy Speaker of the Philippines, Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Jeremy Farah, Director of the Wellcome Trust, Dr. Tedros Gabrielsis, Director General of the World Health Organization, and Mansukh Mandaviya, Minister of Health of India.
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Political Viewpoint On Tuberculosis
Speaker Gloria Arroyo said, “When I first became President of Philippines in 2001, we were number seven in tuberculosis in the world. We put together a national tuberculosis program that featured the direct observed treatment short course, or DOTS, and a strong public-private sector partnership. So tuberculosis prevalence went down during my time. By 2007, there was a 31 percent reduction in bacterially positive TB and 27 in smear positive TB compared to 10 years before that. And another thing we did was we had mandatory testing of children. So we improved our ratings somewhat. From number seven, we improved somewhat to number nine.”
She said in 2019 they ranked at number four because after her term, there were slippages in the implementation of the tuberculosis program, which was due to slippage in the strong public-private sector partnership. She said the burden of treatment medicines was more with the public sector and the role of the private sector became less. She also pointed out like a coin, DOTS had two phases to it. One, the political will to implement, and the other one were the technical matters, microscopy, direct observed treatment, monitoring systems, etc.
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She continued, “There are three political factors that are crucial in facing tuberculosis today and trying to eradicate it. First is implementation and executive management. The second is political vision. And finally third is political will. Because we’re all concerned about COVID, how to get now the political will to realize that we may have to shift somewhat from a COVID-centric mindset to deal with other important and essential health issues, including tuberculosis.”
Vaccines and Other Health Systems
Jeremy Farah talking about the importance of health systems said, “Vaccines are a game changer, but they’re never going to be enough on their own. Some vaccines change all things. But actually, the truth, one of the lessons of the last three years is you can have vaccines, but you do need other systems, health systems. You need diagnostics. You need trust in your systems. You need health systems that can deliver that. And of course, you need treatment. There’s a focus on vaccines but put vaccines into a broader system rather than thinking it’s going to be the only thing.”
He said we have come a long way since COVID. He continued, “And that’s because of advancing in science that’s been supported and invested in by a number of different places over many years, by the progress we’ve made in science over the last three years through COVID. And because I think with the coming of a greater appreciation of the importance of diagnostic testing, the surveillance systems that WHO, Global Fund, national government’s put in place to allow you to know more people have TB and the ability then to make science work for us on vaccines. Vaccines will be a game changer, but only when they’re integrated into everything else.”
Tuberculosis Today
Highlighting the status of Tuberculosis today, Peter Sands said, “I think we should be a little embarrassed or ashamed about where we are with TB. This is a disease that’s been around for a very long time that we’ve proven that we can eliminate 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. And we’re in a funny position in that we are 77 percent, so we are by far the largest provider of external financing for programs against TB. But we spend less than a billion dollars. 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 fighting COVID-19.”
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He said the positive thing is that there is a political will to really tackle the issue. There is also a new generation of tools, the prospect of a vaccine, better diagnostics, better treatments for drug-resistant TB. His concern as he expressed was that TB is essentially the disease of the poor, the marginalized, the people who aren’t on the TV screen. He said unless governments and communities and those of who work in the multilateral sector are determined to reach out to the affected people, the objective is not going to be achieved.