Since its discovery in the 1800s, tuberculosis (TB) is an ancient disease that has resurged in recent years to become the leading cause of death from a single infectious agent ^[1] . More than one-quarter of the world’s population, 2 billion people, are infected with it, particularly in low-middle-income countries, where TB is the number one cause of death due to an infection. TB incidence has been declining by about 2% per year globally ^[1], but progress is still not fast enough to reach the 2030 milestones of the WHO’s End TB Strategy or the 2025 elimination goal set by Govt. of India. Exacerbating this, COVID-19 critically derailed global efforts to tackle diseases like TB. Globally in 2020, there was an 18% drop in the number of people newly diagnosed with TB and reported to national authorities (notified cases) compared with 2019 ^[2] .

Many innovations have been developed over the years to tame the ancient giant such as the application of TB skin test in the late 19th century for earlier detection and diagnosis; the discovery of the BCG vaccine in 1921 for the prevention of TB; introduction of antibiotics in the 1940s; and the development of more effective treatment regimen in 1950s. These advances have been instrumental in reducing the mortality rate linked to TB. However, unfortunately, and unsatisfactorily, the progress has not been enough. Globally every day 4400 people continue to die from treatable diseases ^[3] due to the unavailability and accessibility of new detection tools, treatment regimens, and vaccines.

There are several reasons why innovation in TB care has been limited. Firstly and historically, TB has been a neglected disease, particularly in terms of funding for research and development. Despite reaching US$1 billion in spending, at current financing levels, the SDG target to end the TB epidemic by 2030 will not be met; the number must grow to US$5 billion per between 2023 – 2030 ^[3]. Secondly, the complexity of the disease, with many different strains and drug resistance patterns evolving, makes it difficult to develop new and effective treatments. Lastly, TB diagnostics and pharmaceutical manufacturers face intellectual property hurdles in low- and middle-income countries, where there are limited market incentives and abilities to pay for new solutions.

New technologies hold the potential to play a critical role in the fight against TB by improving prevention, diagnosis, and treatment. They can facilitate the effective implementation of public health interventions such as contact tracing, screening, identifying at-risk people, and linking them to appropriate care and treatment.  Here are a few examples of how innovations can help:

• Faster screening &diagnostics: New diagnostic technologies can help detect TB accurately and quickly. For example, currently available molecular tests can diagnose TB within two hours and identify drug resistance. This has revolutionized TB diagnosis, particularly in low-resource settings where traditional diagnostic methods are unavailable, time taking, or show poor accuracy. Further, new approaches in artificial intelligence have the potential to improve TB diagnosis and surveillance, by analyzing chest X-rays, or reading cough signatures to identify signs of TB.
• Digital adherence technologies: New digital tools can be used to improve TB prevention and treatment outcomes. For example, mobile apps and text messaging can be used to remind patients to take their medications and to monitor their treatment progress. Digital technologies can also improve data collection and analysis, making it easier to track; respond to outbreaks and control transmission in communities.
• New drugs and regimens: New drugs and regimens are being developed to treat TB, particularly drug-resistant TB. There is a need to test new combinations of existing drugs which can improvise curing rates up to 90% for patients with multi-drug-resistant TB.
• Vaccines: The development of a new TB vaccine could help prevent TB infections, particularly in high-risk populations such as healthcare workers and people living with HIV. Several new TB vaccines are in development, and clinical trials are underway to test their safety and efficacy.

Despite the presence of these innovations, there remain obstacles to fully realizing their potential and achieving impactful outcomes at the last mile. It will be important to continue to invest in the research and development of new technologies and to ensure that they are accessible and affordable to all who need them. There is a need to increase global R&D investments which are less than 50% of total financial needs in diagnostics, drugs, vaccines, and operational research ^[4]. Additionally, reforms will be needed to build robust infrastructure, have talent flow into academic research, and establish strong linkages with national programs to accelerate the pace of innovation. Further, improved data and patent information-sharing practices will be needed to tackle the challenges and variability of regulatory processes for reviewing new protocols and products. To achieve the above, a step-by-step framework, that is framed around country needs and context is a must to nurture innovation.

Several global health agencies have begun to establish and implement these frameworks. World Health Organization (WHO) has developed a global strategy for TB ^[5] and calls governments to act, adapt and implement the strategy with high-level commitment and financing. Indian government’s National Strategic Plan for TB Elimination was launched to achieve the target of ending TB by 2025 in a mission mode. It is a multi-pronged, multi-sectoral approach that aims to detect all TB patients, emphasizing reaching TB patients seeking care from private providers and undiagnosed TB in high-risk populations ^[6]. Stop TB Partnership’s Global Plan ^[7] to end TB provides a blueprint of priority actions required with estimates of financial resources needed and brings alignment to global advocacy efforts. Initiatives of The Global Fund to fight AIDS, Tuberculosis and Malaria and FIND are optimizing TB diagnostic capacity, improving laboratory quality and data management across the public sector laboratory network thereby renewing focus on early diagnosis to guide appropriate TB treatment.

In this fight against TB and to achieve the global elimination goal of 2030, a collaboration between governments, innovators, healthcare providers, research institutes, public health professionals, and communities is a must. This would strengthen the progress towards the advent and adaption of new technologies and innovation.

In the long run, concerted, joint efforts at scale are perquisites to create an enabling environment for the development and adoption of innovations to bring a paradigm shift in TB care, reduce the global burden, and meet elimination goals.

About the Author:

Archita Chaudhary, Portfolio Manager, India Health Fund

As a portfolio manager, Archita Chaudhary collaborates with Indian start-ups and research groups to bring improved screening and diagnostics tools for respiratory care. In her previous roles, she has worked with Cipla, Bosch (India), and IQVIA on varied healthcare domains. Archita has a Master’s in engineering from the Indian Institute of Technology Roorkee.

References

[1] Tuberculosis Fact Sheet – World Health Organisation – update 27 Oct 2022

[2] Covid and TB – World Health Organisation – updated 29 Aug 2022

[3] Tuberculosis Research Funding Trends, 2005–2021 – Stop TB Partnership and Treatment Action Group, Dec 2022

[4] Global Strategy for TB research and innovation – World Health Organisation, 2020

[5] End TB Strategy – Global Tuberculosis program – World Health Organisation, 2015

[6] Pradhan Mantri TB Mukt Bharat Abhiyaan to eliminate TB by 2025, MoHFW, Govt. of India, 2022

[7] Global plan to end TB 2023 – 2030 – Stop TB Partnership

Publication Date: 17th Mar 2023