OPINION | TB research still crucial in a time of Covid-19

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  • Let's not lose sight of other pandemics to which people are succumbing daily
  • In South Africa, TB kills about 58 000 people every year
  • But a world free of TB is indeed possible

It has been just over a year since our planet was struck by the Covid-19 pandemic. This has caused several governments and authorities to enforce restrictions on the movement of people worldwide. More importantly, to a large extent the ensuing events shifted the way we do research and think about health systems.

During the last 12 months, scientists, with funding from high income countries and their designated authorities, were able to research the SARS-CoV2 virus and produce several vaccine candidates. Vaccines have been rolled out in large numbers (at this stage in mostly developed countries) to frontline healthcare workers and those with co-morbidities.

Indeed an impressive collection of events to curb the spread of a virus that has caused a pandemic and infected more than 120 million people (with 2.6 million succumbing to the disease).

And this response - some have referred to it as the Covidization of health and research activities  - was unquestionably needed to protect people around the world.  

But as we enter the next phase of our lives with the ongoing Covid-19 pandemic, we shouldn’t lose sight of other pandemics to which people are succumbing daily. Take Tuberculosis (TB) for example.

It has been around for centuries and kills about 1.5million people worldwide every year. In South Africa, TB kills about 58 000 people per annum. 

The disease also disproportionately affects low- and middle-income countries. The Global Tuberculosis Report 2020 shows that India, China, Indonesia, Philippines, Pakistan, South Africa, Nigeria and Bangladesh are the top eight countries in terms of numbers of cases for those countries that had  at least 100 000 cases and which accounted for two-thirds of the global incidences  in 2019.

These are sad numbers considering the global TB targets as set out by the Sustainable Development Goals (SDG) deadline for 2030. 

The SDG 3: Target 3.3 declares that we should aim to end the pandemics of AIDS, TB and malaria (and others) by 2030. The World Health Organisation (WHO)’s End TB Strategy further calls for an 80% reduction in the TB incidence rate and a 90% reduction in the annual number of TB deaths by 2030. In support of these targets, the United Nations high-level meeting in 2018 advised and committed that funding be provided and increased.

Funding of at least US$13 billion per annum for universal access to TB prevention, diagnosis, treatment, and care. As well as at least US$2 billion per year for TB research for the period 2018-2022.

This is a far cry from the funds made available to tackle the Covid-19 pandemic. As an example, by April 2020 (four months into the pandemic), the European Commission alone had committed €137.5 million (US$165 million) to scientists working on the pandemic, which is more than it spent on research into HIV/AIDS, TB and malaria combined in 2018.

These funds are needed to boost the development of key areas related to the TB pandemic. With several new drugs in different stages of development, research and innovation are needed to push the new diagnostic tests through the pipeline. We also need to increase the relatively short pipeline of TB vaccines in clinical development.

But all the measures require, beyond a significant influx of financial support, the political will to combat the ongoing TB pandemic. We now have the opportunity to bring together the different TB stakeholders and address the way forward for TB research and how it will overlap or inform the programmatic management of TB.

The current pandemic has required dedicated reactions from virtually all sectors of society and disturbed clinical research, including in TB. But, with all its challenges, the pandemic provides an opportunity for us to examine the lessons learnt and innovative resources created and how we can use this new knowledge and resources to renew our fight against TB, whether it be to enhance active case finding or to address the issues surrounding TB-related mental health.

When this pandemic ultimately blows over, the next one will follow. We will, therefore, have to continue to innovate and modify our research activities for the coming plagues. In the short term, individuals affected by TB are especially susceptible due to underlying lung disease and new hurdles to diagnosis and care In the future this will be due to the slackened pace of research advancement toward ending the TB epidemic.

It is, therefore, imperative that those concerned with the management and research on TB must sustain a mutual collaboration so that the priorities of local partners inform our actions and drive the research agenda.

On World TB Day (24 March), as we celebrate the strides we have made to combat TB, let's continue our efforts to engage the different stakeholders and step up the fight so that we can move beyond imagining and actually realise that a world free of TB is indeed possible.

*Prof André G Loxton is Professor of Immunology and leader of #Loxtonlab in the Division of Molecular Biology and Human Genetics at Stellenbosch University. He’s also a Specialist Scientist in the Centre for Tuberculosis Research at the South African Medical Research Council.

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