London School of Hygiene & Tropical Medicine

With more tuberculosis (TB) cases in the world today than at any other time in history, LSHTM staff and students joined the rest of the world to raise awareness about the epidemic.

WHO estimates that by 2015 more than two million people will contract a form of the disease resistant to standard drugs.

World Tuberculosis Day is held on March 24 every year to mark the day in 1882 when Dr Robert Koch announced his discovery of the TB bacillus, paving the way for diagnosis and treatment of TB.

Here, the School's Director, Professor Peter Piot, and John Bowis, former member of the European Parliament and former Minister of Health and Transport, make the case for investment in research and development for new TB vaccines:

We have the tools to eliminate tuberculosis, but do we have the will to use them?

Concerned Birmingham residents have urged government to reconsider tuberculosis vaccination. In Birmingham, 68 people have died of pulmonary tuberculosis in the past 5 years, most recently a 15-year old girl. The city is not alone in its struggles; last year London was dubbed ‘TB capital of Europe’. Meanwhile the protection that the current TB vaccine offers is incredibly limited.

Limited protection is of course better than no protection. As long as Bacille Calmette-Guérin (BCG) is the only available vaccine, it should surely be used. But BCG was developed in 1921 and has not been improved or been replaced since. It protects thousands of children against severe forms of childhood tuberculosis but its performance against pulmonary tuberculosis in adolescents and adults is poor or at best variable. Crucially the vaccine is not safe in children infected with HIV. The question is: why is there still no safer and more effective vaccine? Developing vaccines is a complicated and lengthy process but it seems that the answer to this question, as often, is money.

The introduction of new, more effective and safer vaccines against tuberculosis would be a giant stride towards eliminating an ugly disease. It would save millions of people around the world from huge suffering and it would protect Europe against a growing threat. It would bring welcome cost savings and economic benefit and it would put Europe at the forefront of innovation. So why not?

Developing and testing new vaccines is a costly business, but treating tuberculosis is much more expensive. In Europe alone, treatment costs around two billion Pounds a year. Once vaccines are fully developed and licensed, the return on investment will be significant; seriously reducing treatment costs and providing a direct return on the investment. From a scientific point of view, developing vaccines is always a challenge. Yet there are very promising candidate vaccines that are being put on hold because of lack of resources.

Around our world tuberculosis kills some 1.8 million people every year. The World Bank has calculated that tuberculosis costs 0.52% of the world’s GNI - several hundred billion Pounds a year. In Britain and specifically in London tuberculosis is on the rise. In a recent report, the situation was called ‘alarming’ and figures showed that cases have gone up by fifty percent over the past ten years. 2010 saw the largest number of new cases in the UK for over a decade.

Without new vaccines, TB cannot be eliminated. European governments and the European Union have already funded a great deal of tuberculosis research but another substantial amount is needed to bring vaccines to market. The question of whether it is realistic to ask Britain and Europe to make such an investment in times of tough budget cuts has to be answered with a resounding ‘yes’.

Europe is at the forefront of developing new TB vaccines. Around 40 research institutes and universities, united in the TuBerculosis Vaccine Initiative (TBVI), have already developed 39 promising vaccine candidates in various stages of development. The probability that out of this portfolio at least 2 new vaccines can be developed for the market is high. Further investment will prevent these promising candidate vaccines not only from leaving Europe for development but also from being abandoned, reducing dramatically the tools needed to fight TB at home and worldwide. It will allow also us to stand at the forefront of innovation and to fuel Europe’s knowledge-based economy.

Traditional funding mechanisms seem to be insufficient to realise the delivery of tuberculosis vaccines and aid and investment budgets are tight. TBVI has therefore developed a new funding model allowing governments to invest in this promising innovation with minimal risk for their already stressed national budgets. The organization has calculated a critical financing gap of €560 million, needed to bring the first vaccines to the market around 2020. Under this plan, European governments or agencies are asked to provide guarantees to take that money up gradually from financial institutions, according to the progress of vaccine developments. Countries will thus not have to provide any cash; the loan will be repaid through the profits of the final vaccines. This innovative plan will enable governments and the vaccine industry to battle a serious health threat and nasty disease whilst at the same time boosting Europe as a knowledge-based economy. Furthermore countries can live up to their commitment to invest in innovation without increasing their deficits. A win-win situation not to be missed.