Global funding for tuberculosis research and development (TB R&D) has reached an all-time high, but funding goals for efforts to eliminate the disease remain far out of reach, according to two reports released today.
In an analysis of TB research funding trends from 2005 through 2018, the Treatment Action Group (TAG) found that global funding for TB R&D totaled $916 million US for fiscal year 2018, an increase of $134 million US from 2017. But the Stop TB Partnership’s (STBP’s) updated Global Plan to End TB calls for $2.6 billion US per year for R&D of new diagnostics, new drugs, and a new vaccine. That’s in addition to $13 billion US a year needed for TB prevention and care, the group says.
The STBP’s plan is aligned with commitments made at the United Nations High-Level Meeting on TB in September 2018, where world leaders agreed to pick up the pace of funding for TB prevention, care, and R&D by 2022.
The STBP, which announced the plan in Indonesia, one of the top three highest TB burden countries in the world, said reaching these funding goals would help provide care for 40 million people with the disease (including 3.5 million children and 1.5 million people with drug-resistant TB), enable 30 million to get preventive treatment, and put new diagnostic and treatment tools on the horizon by 2030. But a delay in reaching those goals could result in 2 million more people dying and an additional 13.5 million developing TB.
“The coming three years—up to 2022—will be very important for the TB community at large,” Brazilian health minister and STBP board chair Luis Henrique Mandetta said in an STBP press release. “This is when we make it or [break] it.”
More getting treated, but funding lags
In its most recent annual TB report, the World Health Organization (WHO) said that more people around the world are getting treated for TB than ever before. Seven million of the estimated 10 million new TB cases in 2018 were diagnosed and treated, up from 6.4 million in 2017. Deaths from TB also declined, dropping from 1.6 million to 1.5 million.
But the WHO noted that the fight against TB, the world’s leading infectious disease killer, remains chronically underfunded, with significant shortfalls in funding for prevention and care ($3.3 billion US) and R&D ($1.2 billion US).
According to the TAG report, the $906 million in TB R&D funding in 2018 is the highest level of funding ever recorded by the group and represents the third straight year of funding increases. More than half of that funding ($512 million, 56%) came from the US government and the Bill and Melinda Gates Foundation. The TAG report acknowledges, however, that a massive funding increase will be necessary to meet the goals of the WHO’s End TB strategy, which calls for an 80% reduction in TB incidence by 2030.
“As long as TB research is underfunded, TB will continue to exact a heavy toll on human health,” the TAG report states. “The more than 10 million people who fell ill with TB in 2018 represent 10 million reasons why the global community must rally with a sense of purpose and urgency to accelerate the science needed to end this epidemic.”
The STPB report suggests that closing the R&D funding gap will help build on the progress made over the last 5 years, which has seen the approval of a new antibiotic—pretomanid—for treating extensively drug-resistant TB, the emergence of new rapid molecular TB diagnostic tests and drug-susceptibility tests (DSTs), and promising results from two phase 2b vaccine clinical efficacy trials. It says that new funding should be used to increase support for research institutions, partnerships, and collaborations that can accelerate the develop of new diagnosis and treatment tools.
Among the R&D priorities outlined in the report are new novel drug candidates, treatment regimens that are shorter and more effective than current regimens, next-generation vaccine candidates, rapid and affordable non–sputum-based tests for TB diagnosis or triage, and accurate DSTs for critical TB drugs.
STBP says countries can support TB R&D by developing and funding national plans for TB research, or by integrating TB into national health research agendas. It also calls on TB researchers, survivors, and affected communities to work together to hold governments accountable for fulfilling their commitments.
“Engaging communities affected by TB at all stages of the research process—including in research that identifies and helps to overcome the social, legal, political and economic hurdles in the way of developing and providing access to new tools—is vital to the ultimate success of any research initiative,” the group writes.
Child-friendly drugs for resistant TB
At the launch event in Jakarta, STBP also officially announced an effort to ensure proper treatment of young children with drug-resistant TB.
According to the group, in recent years only an estimated 500 children under the age of 5 have received treatment for drug-resistant TB annually, and those who were treated received medicine intended for use in adults. With so few young children with drug-resistant TB being diagnosed and treated, getting child formulations developed, produced, and distributed has been difficult.
To address this challenge, STBP’s Global Drug Facility launched the Pediatric Drug-Resistant TB Initiative, which has identified early adopter countries that could implement new pediatric formulations quickly and pooled the countries’ demand. The dissolvable, flavored forms of the oral medications have already been procured by 56 countries and introduced in Haiti and Nigeria.
STBP has set a target of treating 47,000 young children with these new, child-friendly formulations by 2022.
Dec 10 STBP Global Plan to End TB: 2018-2022
Dec 10 STBP press release