- Tuberculosis is an infectious disease that kills more than a million people each year, yet it is largely neglected.
- There is still no vaccine available to prevent the disease, with only a few clinical trials currently underway.
- Yet in less than a year, several Covid vaccine candidates have become available – a testament to what could happen if the same focus were placed on TB, experts say.
It’s a disease that claims the lives of around 1.5 million people each year and estimates last year suggested that 2 billion people were infected worldwide. It is present in all countries and age groups of the world. It is also a curable and preventable disease, but one that has been grossly neglected for years and especially sidelined in the past two years, where Covid-19 has taken center stage.
“Tuberculosis (TB) has always suffered from being easily overlooked. We’ve had a generalized epidemic since the 1900s – for over a century – and we haven’t really made progress,” Professor Linda-Gail Bekker, a medical researcher with a passion for HIV and TB, told Health24.
Bekker is also the co-principal investigator of SA’s Sisonke Covid-19 vaccine trial.
I would say that not only have we diverted our attention from TB over the last two years, but I would say that we haven’t really focused enough on the problem before Covid.
His comments underline this year’s theme for World TB Day – “Investing to End TB”. Save lives’.
“And there’s no question that when you see what’s been invested in Covid – the research that’s been put into preventive and treatment options – if we even have some of that for TB, that might be awesome,” she added.
According to the World Health Organization (WHO), the aim of this year’s theme is to draw attention to the urgent need to invest resources in the fight against tuberculosis, which it says is particularly critical in the context of the current pandemic. of Covid which has stalled progress towards ending TB.
Last year, a report from the Stop TB Partnershipfor example, noted that 12 months of Covid wiped out 12 years of progress in the global fight against TB.
“The biggest infectious killer in centuries”
Professor Thomas Scriba, who heads the South African Tuberculosis Vaccine Initiative (SATVI) Clinical Immunology Laboratory at the University of Cape Town, also stressed the seriousness of the TB epidemic.
“Tuberculosis is and has been the greatest infectious killer of human beings for centuries… Accordingly [of disruptions caused by the pandemic] thousands more people died from TB and for the first time in 15 years, the number of TB deaths increased year on year in 2021.”
Importantly, Scriba explained that even if a TB patient is successfully treated, they are likely to have lasting and debilitating health problems, especially with respiratory failure.
Tuberculosis doesn’t just stay in your lungs. If you have the disease, it is progressive, and many of the chronic lung conditions we see in this country are in people who have had TB before. And once you’ve had TB before, even if you’ve been treated, you have a high risk of getting it again.
There should be more awareness
South Africa is one of the 30 high TB burden countries which accounts for the majority of new cases. And in a country like ours, with a widespread TB epidemic, everyone needs to be aware of the disease, know what their risk is and what they could do to reduce their risk, Bekker said.
“It’s a bit like what we’ve learned with Covid – the two are very similar. They’re airborne diseases that can be reduced by having better ventilation, being aware of our close contacts and being safe. ensuring that infectious people do not infect other people.
“Yet, somehow, we haven’t had the same concerted effort. And instead of using the opportunity to say ‘same-same’ during Covid, we put all our energy into Covid and completely forgot about TB, which is a shame,” she added.
Know your risk
Unfortunately, people generally have a nonchalant attitude towards TB, even though it kills far more often than Covid, Bekker said, adding, “And so we have to take a whole new view of the TB epidemic.
Scriba said children under the age of five are particularly at risk of contracting tuberculosis. Adults living with HIV, diabetes, smokers, people who abuse alcohol and those who are undernourished are also at high risk. “That’s a very large part of the South African population,” he said.
Bekker also commented, “By the time a child enters primary school, one in five will be infected with tuberculosis. By the time they are halfway through high school, one in two are infected – this is actually far from normal and does not happen anywhere else in the world.
Take an active case-finding approach
Several researchers have pointed out that South Africa’s health system needs a better approach to adopting active case finding, which refers to locating and diagnosing TB, either in people who may not not recognize that they have symptoms of the disease, or in those who do but do not. , or cannot access health facilities.
Bekker agreed, saying the key to TB is finding a case before that case can transmit the pathogen to others.
“It’s not just about curing and treating someone who has had the disease for a very long time. You want to reach them as soon as possible so they don’t have a chance to pass on to others. This requires very active work – to try to reduce the time between acquisition and development of infectious TB and its transmission to others,” which is partly due to diagnosis, she said.
Similarly, Scriba believed that resources for finding and diagnosing people with TB and providing them with antibiotic treatment had been insufficient for decades. “It is imperative that much more is done to improve care for people with TB and programs to find, diagnose and treat people with TB,” he said.
SA’s neglected vaccine trial
About four years ago, SA conducted a trial of a candidate tuberculosis vaccine that showed a 50% reduction in the progression from infection to disease. A follow-up trial was not done, which means the data cannot be confirmed. “It’s not months, but years later, and we haven’t pursued that. It’s mind-blowing,” said Bekker, who drew attention to the few months it took to develop several Covid vaccine candidates.
The pandemic has shown what can be done when there is a real will to reduce the impact of a communicable disease, Bekker said.
Report by News Health-E last month noted that there are currently nine candidates in phase 2 and 3 clinical trials of the tuberculosis vaccine. But Mark Hatherill, a SATVI researcher, told the publication that if none of the candidates were successful, there were very few who could fill those positions in the next five to 10 years.
Investment, investment, investment
For Scriba, urgency and a real commitment to fight the tuberculosis epidemic are necessary.
“The unprecedented response to the Covid-19 pandemic shows that it is possible to mount a massive, rapid and comprehensive response to a deadly infectious disease of this magnitude. It is essential that much greater investment is made in research to improve strategies for finding, diagnosing and treating people with TB,” he said.
This would include tools and strategies used to find and treat people earlier, before they develop irreversible lung damage and spread the bacteria to others. “There has been exciting and promising progress in recent years, but chronic underinvestment makes that progress slow and frustrating,” Scriba added.
In addition, attention should also be paid to investing in TB prevention strategies. Says Scriba:
For a disease so difficult to diagnose and treat, vaccination to prevent the development of tuberculosis is a no-brainer. But, we have a vaccine against tuberculosis, which is 101 years old! Yet we have learned that it is possible to identify a new infectious organism and develop and deploy multiple new vaccines within two years if there is enough incentive, investment and cooperation.
Around 150 Covid vaccines are in clinical trials around the world. Unfortunately, this figure for TB vaccines is ten times lower. he response to TB should be no different from the response to Covid, Scriba said.
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