TB Research: Why Should Everyone Be Worried

October 22, 2014 - Geneva/New York - More than a million and a half people die from tuberculosis every year. One third of the world’s population is infected with TB and of those, 10% will develop active TB during their lifetime. TB is airborne and we are all at risk. In spite of these facts, we are fighting TB with archaic tools - we use the same vaccine and drugs that our grandparents did. But there are not enough investments in TB research, to make treatment accessible, drugs cheaper, regimens shorter and diagnostics more accurate.

The annual R&D report by Treatment Action Group (TAG), shows that the world invested only a third of the required US$ 2 billion needed every year for new drugs, diagnostics and vaccines to fight the global TB epidemic effectively. In 2013, a total of US$ 676.6 million was spent on TB research.

TAG, a partner of the Stop TB Partnership, is a research and policy think tank advocating for better treatment for AIDS, and TB and hepatitis C.

Of the US$ 9.8 billion in funding required for TB research during 2011-2015, as estimated by The Global Plan to Stop TB, only 20% of this amount has been mustered up at the end of 2013. The report registered a significant funding shortfall across every category of TB research: basic science, diagnostics, drugs, vaccines, operational research, the report said.

The report also shows one of the lowest ever annual R&D spending by pharmaceutical companies for TB. According to the TAG report, the industry spent US$ 99.6 million in 2013, lower than what it spent at the peak of the financial crises in 2009. Following Pfizer in 2012, Astra Zeneca and Novartis exited TB research over the last two years.

A structural shift in the pharmaceutical industry has resulted in investments being diverted away from research on infectious diseases, towards new biologicals including vaccines and drugs for chronic illnesses.

As a result the onus is on the public sector. The public sector provided four times more money to TB research than private industry, and philanthropic institutions provided twice as much in 2013, according to TAG. Public sector contributed to 60% of the total research spending - of this, the United States accounted for the largest share.

In 2013, donors gave only 33% of the US$ 740 million needed for drug research. Investment in R&D for TB drugs accounted for nearly 38% of overall R&D spending for TB in 2013. The Gates Foundation is the largest contributor for TB drug development. It spent US$ 147.9 million, half of all philanthropic spending.

TB vaccine research received only 25% of the estimated annual requirement of US$ 380 million in 2013.

Funding gaps in basic science may discourage young investigators entering TB R&D. Investments in basic science contribute to discovery of biomarkers that help in diagnostics, vaccine and drug research.

On diagnostics, the TB community cannot rest on the success of GeneXpert MTB/RIF. New point of care diagnostics are essential keeping patients and health systems in mind, if we are serious about eliminating TB.

Private sector funding for R&D for TB drugs is critical, because when pharma companies exit, TB drug compounds "languish" in early stages of the pipeline. Intellectual property protection often makes these compounds out of bounds for public research. The public sector cannot take these forward in trials of new TB drug regimens. The pharmaceutical sector’s absence is felt most acutely in phase I and early discovery. Phase I of the TB drug pipeline sits empty, according to TAG.

The world has waited 40 years for a new TB drug, it took 120 years to find a new diagnostic test since the advent of smear microscopy and there has been no new TB vaccine since 1921.

We need increased funding for TB research and we need it now! The challenge of drug-resistant TB in the backdrop of increasingly pervasive antibiotic resistance, make the need for robust investments critical. Any delay now will cost us much more in the future.

Dr Lucica Ditiu
Executive Secretary
The Stop TB Partnership