Welcoming the National Action Plan for Combating Multidrug-Resistant Tuberculosis: Important first steps, critical next steps

In this guest post, Dara Erck, vice president of external affairs at Aeras, discusses the new White House National Action Plan for Combating Multidrug-Resistant Tuberculosis and how it could accelerate research and development (R&D) of new technologies to combat multidrug-resistant TB (MDR-TB).

When the World Health Organization (WHO) unveiled its Global Tuberculosis Report 2015 last October, the most striking revelation was that tuberculosis (TB) is now the world’s leading single infectious disease killer, accounting for 9.6 million illnesses and 1.5 million deaths in 2014. And the report’s findings about MDR-TB were also alarming, noting 480,000 cases of MDR-TB globally in 2014, with nearly 10 percent of these being extensively drug resistant (XDR-TB). Considering this high human toll in context of the estimated annual US$1.3 billion funding gap for TB R&D, it is clear we must achieve a sea change in the global approach to TB R&D funding.

This is why there was much hopeful anticipation for the release of the White House’s recent plan to address MDR-TB, as a follow up to its 2014 National Action Plan for Combating Antibiotic Resistant Bacteria. Released in late December 2015, the National Action Plan for Combating Multidrug-Resistant Tuberculosis is a product of countless hours of collaboration between the Obama Administration and its partners in government, including the White House Office of Science and Technology Policy which convened an interagency working group including the US Agency for International Development, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the State Department, and others. During the course of the plan’s development, TB advocates vigorously urged the Administration to broaden the goals related to MDR-TB. And the White House listened.

The goals of the action plan are to strengthen domestic capacity, improve international capacity and collaboration, and accelerate basic and applied research to combat MDR-TB. I am especially pleased to see this acknowledgment of the critical role of TB R&D. Accelerating basic and applied research to combat MDR-TB is absolutely necessary if we are to conquer the TB epidemic. The plan recognizes that “ultimately, an effective vaccine to prevent all forms of TB will be required to eliminate TB globally.” This acknowledgment is an important step, indeed. But we must not ignore that funding this critical work is a necessary next step. We simply cannot discover and develop the new tools required to end this deadly epidemic without urgently needed additional resources. I urge President Obama to include robust funding for implementing agencies in his fiscal year 2017 budget.

The plan outlines a significant focus on R&D. In the coming year, NIH is directed to expand its TB dialogue among basic scientists, funders, and vaccine developers to identify novel strategies for vaccine development, encourage research related to vaccine design, and educate partners about resources available to contribute to vaccine development, as well as continue to support studies to map the diversity of immune responses required for vaccine efficacy. Within three to five years, NIH is tasked with continuing its support for TB research, preclinical studies, and clinical trials and studies for the evaluation of new vaccines, adjuvants, and preventive drugs. NIH and CDC will also intensify collaborations with domestic and international vaccine developers to leverage preclinical and clinical resources for vaccine development. These directives are an important move in the right direction—but without significant new strategies and resources, the scientific community will struggle to advance new vaccine candidates that can prove effective in providing protection against TB.

I am particularly encouraged to see the call for collaboration with private-sector organizations including nonprofit product developers. At Aeras, we partner with a wide range of academic and pharmaceutical organizations dedicated to TB vaccine research. And we aren’t alone—other nonprofit product developers such as TB Alliance and FIND lead their fields in new drug and diagnostic development, respectively.

The release of this plan was an exciting moment for all TB advocates and researchers, as it attracts new and much needed attention to the threat of MDR-TB. It provides the opportunity to create renewed accountability for ending this deadly epidemic. It also validates and supports other initiatives, including the WHO’s aim to end the TB epidemic by 2035, and the United Nations’ new Sustainable Development Goals which target ending the TB epidemic by 2030. But for the plan to be successful, Congress will need to dedicate the resources necessary to achieve its ambitious treatment, diagnostic, and vaccine development targets. The US government is a key partner in this critical work. I deeply appreciate the Administration’s efforts to create this plan and hope that the US Congress will provide the funding that is so urgently needed to realize a TB-free world.