To eliminate TB, we need new tools and investments!
By Madlen Nash & Vaidehi Nafade
This week, Moscow hosted the first-ever World Health Organization Ministerial Conference on tuberculosis. The meeting culminated in the Moscow Declaration to End TB, a commitment by country representatives to step up their efforts in the fight to end TB. Commitments made this week will hopefully inform policy developments at an UN General Assembly meeting on TB, slated for 2018.
In preparation for the Ministerial Conference, the WHO Global TB Programme prepared a policy brief, titled ‘Global Investments in TB R&D: Past, Present, and Future’. The report, released today, includes contributions from several partners. We were pleased that McGill International TB Centre was also given a chance to contribute to this important report.
Research is the third pillar of the End TB Strategy. The policy report begins by reviewing just how important TB research is: from the past discovery of streptomycin to current improvements in diagnostics, TB R&D has helped reduce incidence and mortality in many countries. But the current rate of decline is not enough - incidence needs to fall by 10% rather than 2% to meet End TB targets. To eliminate TB, we need better diagnostics, better treatments, and better vaccines. All of this requires better research and more investments in R&D.
Unfortunately, better research is a difficult goal to achieve when funding for TB R&D has never matched the world’s targets. In fact, globally we’ve never managed to obtain more than one-third of the funding needed. Currently, there isn’t a single area of research that doesn’t fall short. And most of the funding that is available comes from the public sector, and from a few countries, especially the United States.
The next chapter looks at where the field stands, and where it needs to go. There’s good news and bad news. There are many diagnostic assays being developed, but they are mostly high-complexity assays that may not result in a simple, point-of-care test; there are 30 compounds in the drug pipeline while 17 years ago there were none; 12 vaccines are in clinical development and more in preclinical research, but these vaccines are not very diverse.
Our team at the McGill International TB Centre was tasked with the job of assessing how global research in TB has evolved over the past decade and how it aligns with key research priorities. We conducted a bibliometric analysis of all TB research published from 2007 to 2016. Bibliometric analysis involves analyzing citations to examine trends in research output, countries of publication, and the dynamics of international collaboration.
Some of our findings weren’t too surprising: the number of publications is growing every year, and the United States has the most publications of any country. But the rate of publication growth was much higher among BRICS countries, and India, China, and South Africa were among the top 5 publishing countries (graphic below). We found that countries have been collaborating more and more throughout the years, but low-/middle- income countries are mostly collaborating with high-income countries, and not with each other.
Overall, the report demonstrates that there have been some great breakthroughs in TB research but financial investment hasn’t been enough to facilitate the development the field needs. And the final chapter in the report illustrates just how little money TB has been getting through the years: only 0.25% of global health spending. Other diseases - that often infect the same population susceptible to TB - such as HIV and malaria receive significantly more funding, even relative to measures of burden.
Unfortunately, we’re at a time where the future of funding for TB R&D seems shaky: the new administration in the U.S. has proposed cuts to major funding sources for TB and global health, including the NIH, CDC, and USAID. As the U.S. is still the top research-producing and major funder of TB research, these budget cuts pose a serious threat to productivity in the field.
However, the retreat of the U.S. from global health represents an opportunity for other countries, particularly BRICS, to step up. As we described in our chapter, BRICS countries are publishing more than ever, and some BRICS countries, notably China, are also emerging as major research funders. As their ministers meet in Moscow this week, there is an excellent opportunity for these countries to collectively increase their investment in TB. As rapidly developing economies with the largest burden of TB, BRICS have the resources and obligation to commit to TB R&D, collaborate with each other and accelerate progress towards elimination.
As Canadian students passionate about social justice and global health, we also hope our country will step up and make a bigger contribution to global TB control and R&D. Canada's official development assistance is about 0.26 per cent of our country's gross national income (GNI), well below the target of 0.7%. So, we must do better. In addition to increasing development assistance, Canada has much more to offer. Canada is blessed with some of the best academic researchers and innovators working in global health, especially TB. So, we hope Canada will go well beyond provision of international aid, and find a way to harness the abundant scientific talent in Canada, including budding researchers like us!
Madlen Nash (@madlennash) and Vaidehi Nafade (@vnafade) are graduate students at McGill International TB Centre & Department of Epidemiology & Biostatistics, McGill University, Montreal. Their research is focused on tuberculosis control, and they will be doing their MSc thesis research in India. They are grateful to Sophie Huddart, doctoral student at McGill University, for her mentorship and support with the bibliometric analysis.
This article was originally published in Nature Microbiology on November 17, 2017.