So, the question is not whether we need novel drugs, vaccines and diagnostics, but when they will become available. The new GeneXpert test diagnoses not only TB, but also, in the same step, multidrug-resistant-TB, which means that it can rapidly direct adequate treatment and prevent infection of contacts — a true breakthrough. Unfortunately, the test is expensive and sophisticated, putting it out of reach for many poor countries.
A number of other drugs — some new and some repurposed — are currently in the last stage of clinical trials, and one new drug has been approved by US regulators for treatment of multidrug-resistant-TB even before such trials have been completed. However, the first potential vaccine to be tested for efficacy recently failed miserably. So, the good news of the past decade is just a glimmer of hope.
We still have a long way to go, and accelerated research and development for new drugs and vaccines can be achieved only with increased funding. Unfortunately, private sector incentives for developing new TB interventions are too weak, so new approaches are needed, such as partnerships between public research institutions and private industry. While clinical trials of the most promising drugs and vaccines need to be pursued, we also need to go back to the drawing board and develop entirely new tactics.
Current annual funding for research and development devoted to TB is estimated to be US$500 million, yet more than US$2 billion is needed annually. That amount may seem unrealistically high, but it is a negligible proportion of the estimated US$160 billion spent on health-related research and development worldwide. More important, the economic burden of TB has been put as high as US$20 billion annually, and even higher if the losses in human capital are included.
If we choose to continue suffering these losses, we might save some money in the short term, but the wiser course is to make the necessary investments today, thereby averting a much larger bill tomorrow.
Stefan Kaufmann is a professor of immunology and microbiology at the Charite University Clinics in Berlin and founding director of the Max Planck Institute of Infection Biology.
Copyright: Project Syndicate