Tuberculosis research needs the pace of Covid-19

India has made significant progress in managing tuberculosis (TB), but it will need to develop new approaches and tools to achieve our goal of a TB-Mukt Bharat. In fact, India has set an ambitious goal of eliminating TB by 2025, five years ahead of the international schedule. In 2021, it was estimated that around 10.6 million people fell ill with tuberculosis worldwide.

First, for effective management of any public health crisis on the scale of TB, a resilient funding stream must be in place to constantly fuel research and innovation in new technologies.

A December 2022 report (Tuberculosis Research Funding Trends, 2005–2021) found that for the first time in history, in 2021, funding for tuberculosis research and development reached $1 billion globally. . However, governments had pledged to double that amount at the 2018 UN General Assembly High Level Meeting on TB. Here I am very proud to say that the Indian Council of Medical Research (ICMR) has been one of the top three funders of infrastructure and other TB related investments.

The other two are the US NIH and USAID. The three together contributed 72% of the total investments in this area. ICMR’s expenditures have primarily been devoted to supporting science laboratories and health research activities – reflecting the priorities of the organization.

In addition, the report also reaffirmed that the public sector remains the largest source of funding for something critical to eliminating the disease in the future: TB vaccine research. Here too, the ICMR was one of three entities that spent more than $1 million on TB vaccine research in 2021.

TB R&D Priorities

Vaccines are undoubtedly the most effective way to protect people against disease. Again, the pandemic has demonstrated that effective vaccines can be developed in a shorter timeframe of 1-2 years. There is no reason for countries to still depend solely on a 100-year-old BCG vaccine against tuberculosis – when it is effective in preventing tuberculosis in children, its effectiveness in adolescents and adults is still controversial.

To that end, India is to be commended for making positive strides over the years in arriving at potential vaccines. For example, research has been done on a recombinant BCG vaccine that can be given to both children and adults. Other candidate vaccines are also in the pipeline that have been shown to be effective in preventing TB in HIV-negative adults infected with TB. But we still need market-ready vaccines and more precise and structured lab-to-bedside policies so that we can expect faster availability of these promising vaccines.

In addition to improving our preventive capacity, we must also ensure strong curative measures. More targeted investments and support need to be extended to the development of newer and safer TB drugs and treatment regimens. For example, treatment regimens such as BEAT-TB – which uses bedaquiline, delamanid, linezolid and clofazimine and can potentially reduce XDR TB treatment to 6-9 months from the current 18 months – should be explored urgently.

While research is ongoing, mechanisms to expedite specific research should be put in place. Here we must mention the BPaL regimen (Bedaquiline; Pretomanid and Linezolid) which uses the latest anti-tuberculosis drug, Pretomanid. This WHO-approved regimen is currently undergoing field trials in India and has the potential to reduce treatment duration to around 6 months instead of 18 months.

Also, the old drug regimen included almost 10+ different anti-TB drugs that a patient had to take daily. With BEAT and BPaL, only three to four tablets daily will likely be needed. However, we also need to ensure that trials of life-saving drug regimens are accelerated so that they can truly impact lives on the ground. In this context, it may be useful to explore collaborations between drug regimen developers (like BPaL) and research institutes in India so that the need for bridging studies for new drug regimens decreases. This can ensure that new treatment options for the future are effectively introduced into the country without delay.

We already have experience of accelerated deployments of therapeutics, diagnostics and vaccines against Covid-19. Based on these learnings, transparent policy mechanisms should be put in place to accelerate the deployment of new tools for other disease areas. India also has the required political will and has clearly expressed its intention to establish financial priorities for the fight against tuberculosis. We just need to deliberate on the motivations that drove us to accelerate Covid-19 R&D and use them to further fuel our John Andolan against tuberculosis.

The author is the director of the ICMR-National Institute for Tuberculosis Research. Views are personal.