Research Roundup: What we’re reading this week

In this guest post, Eleonora Jiménez-Levi—senior researcher at the Treatment Action Group (TAG)—writes about the latest report on the state of funding for tuberculosis (TB) research and product development. Mycobacterium tuberculosis (MTB) is one of the oldest known human pathogens that continues to pose a global public health threat in the 21st century. The World Health Organization reports that MTB—the bacterium that causes TB disease—was responsible for 1.4 million deaths in 2011, including 430,000 deaths among people with HIV. Current strategies and tools cannot effectively prevent and control TB. BCG, the only vaccine approved for TB, is over 100 years old. BCG cannot offer protection against pulmonary TB, and cannot be used among HIV-positive infants. The most widely used diagnostic tool—sputum smear microscopy—detects roughly 50 percent of pulmonary TB cases, and fares far worse among people with immature or compromised immune systems. Treatment against drug-sensitive TB involves 6–9 months of first-line drugs, and drug-resistant TB requires 20 months or more. The lengthy treatment regimen results in suboptimal and, at times, deadly outcomes because of several challenges including difficulty of adhering to treatment, drug stock-outs, toxic side effects, treatment costs, and incompatibility between TB drugs and antiretroviral medicines for people with HIV. A doctor examines the chest x-ray of a TB patient. Photo credit: PATH. For the seventh year, TAG and the Stop TB Partnership have published the latest investment data and analysis on the state of global TB research and development (R&D) funding. The 2012 Report on Tuberculosis Research Funding Trends: 2005–2011 builds on seven years of investment data to report on annual funding trends and gaps among the leading TB R&D donors. The report analyzes current spending levels across six research areas to assess how they compare to the R&D funding targets in the Global Plan to Stop TB 2011-2015. The new report found that in 2011, 81 donors invested $649.6 million in TB R&D. This is an 82 percent increase from the baseline year of 2005, but only a 3 percent increase over 2010 funding. The top ten donors disbursed $506.7 million of the $649.6 million total, or 78 percent of the global share. Despite the small funding increase observed between 2010 and 2011, the world continues to fall $1.35 billion short of the annual $2 billion funding target recommended by the Global Plan. To accelerate global TB R&D and capitalize on the scientific gains achieved in the last decade for drug, vaccine, and diagnostic development, more financial resources are needed, particularly in: Biomarker discovery to modernize TB drug and vaccine development by demonstrating the progress and effects of treatment or immunity early on, which in turn radically reduces the time and costs of the clinical trials. Biomarker discovery for the development of a point-of-care diagnostic test that can identify people with latent TB at risk of developing active TB, as well as biomarkers associated with infection, treatment response, cure, and drug susceptibility or resistance. TB sample banks that support biomarker discovery with well-characterized specimens. Late-stage drug and vaccine clinical trials, many of which will take place in high-burden countries with limited laboratory capacity or infrastructure that meet good clinical practice standards. Basic science research to enhance our scientific understanding of TB disease and the MTB pathogen. The global TB community should also give further consideration to: Establishing access plans to optimize the rational use of new TB drugs and regimens when they become available, as well as prevent the emergence of resistance to new TB treatments. Developing pediatric investigational plans to ensure child-friendly formulations are available as quickly as possible. Conducting drug-drug interaction studies for novel TB drug regimens. Providing compassionate use and expanded access, which are particularly important for people with drug-resistant TB who have limited treatment options. Modernizing TB regulatory guidelines and streamlining regulatory requirements across and within regions. All of these recommendations and more can be accomplished if policymakers, researchers, activists, clinicians, donors, implementers, and people affected by TB pledge their commitment to achieve zero TB deaths, zero new TB infections, and zero suffering from TB. The Zero Declaration, created by a worldwide group of TB stakeholders in June 2012, is a new strategy that calls on the international community to embrace a “new global attitude in the fight against TB … and mobilize sufficient political will and resources to prevent needless transmission, sickness, and death.” The goal of the campaign is to organize and inspire people to work toward eliminating TB as a public health threat with greater urgency, more political will, and increased investments. Promising new tools are on the horizon, but without political will and adequate funding to support the development of new vaccines, diagnostics, and drugs, the world will not be able to contain the growing problem that drug-resistant TB poses, much less eliminate TB as a public health threat by 2050.

In this guest post, Mandy Slutsker, senior project associate with the ACTION Partnership, writes about a new report that calls for increased efforts to fight tuberculosis among children worldwide. When Sipho* was just 18 months old, he began coughing and his feet began to swell. His mother Masia was sent home from a clinic near their home in Swaziland with medicine for a common cold, but his condition only worsened. Eventually, Sipho was diagnosed with a drug-resistant strain of tuberculosis (TB)—and so began an exhausting daily odyssey for him and Masia. Every day for six months, the pair traveled six kilometers so Sipho could receive a grueling treatment regimen of injections and crushed pills. Despite recent progress toward addressing childhood TB at the global level, children like Sipho are still misdiagnosed and subject to harsh treatment regimens meant for adults. Increased investments in research and development are needed to develop new child-friendly TB diagnostics, drugs, and vaccines. Photo credit: PATH As an advocate, I am thrilled to see childhood TB receive this attention—the issue gained recognition at international conferences, served as the theme of this year’s World TB Day, and is the subject of new guidelines from the World Health Organization. But I can’t forget TB takes the lives of 1.4 million people every year—and children remain largely unreached and uncounted. If we want to end TB as a killer of children, we need to do more than just talk. It’s time for action. Unfortunately, many barriers stand in our way—a lack of political will, inadequate funding for TB programs, and failure to invest in research and development (R&D) for child-friendly diagnostics, drugs, and vaccines. The standard microscope method available in many high-burden countries to diagnose TB largely isn’t effective in children, few child-friendly TB drugs exist, and the current TB vaccine fails to protect both children and adults against the most common form of the disease. How do we overcome these challenges? In my opinion, it all comes down to advocacy. It’s time for civil society, healthcare workers, governments, and the private sector to come together and ensure no child dies from this preventable and treatable disease. Civil society must mobilize to ensure governments and donors quickly invest additional resources in R&D to create new child-friendly diagnostics, drugs, and vaccines. In addition to R&D investments, we have to ensure new treatments—and better formulations of existing treatments—can reach children as quickly as possible. So donors, the private sector, and regulatory authorities must all work together to clarify the development pathway for childhood TB drugs. For too long we’ve worked in silos, not communicating with one another. We each have a role to play. We’ve built the momentum, now it’s time to act. Read the full brief, Children and Tuberculosis: From Neglect to Action, at Action.org and join the #kidsTB #putkids1st conversation on Twitter. *Names have been changed to ensure confidentiality