Guest Blog by John Godwin, International Development Consultant & Australia Representative for Aeras, a non-profit product development organization dedicated to the development of effective tuberculosis (TB) vaccines and biologics to prevent TB.
TB should be a priority for AusAID because of the high burden of disease in Asia and the Pacific. Eight low and middle-income countries in the Asia Pacific region – Bangladesh, Cambodia, China, India, Indonesia, the Philippines, Thailand and Vietnam – are among the 22 countries with the highest burdens of TB globally.
Earlier last month, AusAID released a Draft Medical Research Strategy to guide funding of medical research. AusAID’s initial priorities will be funding product development partnerships (PDPs) for malaria and TB research. This is great news and comes at a time when so many other donor governments are cutting back due to the financial downturn.
The current TB vaccine, BCG, has not been effective in curbing the TB epidemic, leaving TB To continue having enormous public health impacts. The spread of drug resistant strains is an alarming development. Globally, approximately 440,000 new cases of multidrug resistant TB (MDR-TB) occur each year, killing more than a third of its victims. Most worryingly, MDR-TB has gone from being the result of poor adherence to frontline drugs, to primary transmission in a significant proportion of cases.The only way to stop the spread of TB is to prevent its emergence. In this regard, the most cost- effective weapon would be a vaccine that prevents adolescents and adults from developing the disease. Newer TB vaccines that will either replace or boost BCG are being developed and a number of these have entered late stage clinical trials.
The new AusAID Strategy presents an opportunity for Australia to provide leadership in vaccine research. However, concerns have arisen that one aspect of the Draft Strategy may severely limit AusAID’s ability to play a lead role in this critical area. The Draft Strategy proposes a condition that research will only be funded if there is “a short time (up to 5 years) to an outcome for poor people”.
In the vaccine development field, the requirement of a new product in less than five years is unduly restrictive. Imposing a strict five-year timeframe does not take into account the time required to enrol more than 20,000 participants in a Phase III trial and conduct the necessary follow-up. That said, the global epidemic will continue to spread, costing the health system and the global economy billions each year without a vaccine.
Until recently little attention or investment had been devoted to new TB vaccines. However, tremendous progress has been made in the past 10 years. The pipeline has grown from a single vaccine candidate in clinical testing in 2000, to now more than 12. Development of new TB vaccines is at a crucial juncture right now with a number of candidates in late stage trials. With sufficient support from governments, private donors and industry partners, we will be able to sustain this momentum toward an improved vaccine to prevent TB by 2020.
Australia is home to a robust network of TB researchers that can be leveraged to accelerate global TB vaccine development. For example, researchers at the Centenary Institute at Sydney University are providing global leadership in aspects of TB vaccine research and are important partners.
Over the past 25 years, there has been a significant increase in funding for TB research, with support from the Bill & Melinda Gates Foundation and the US, UK, Dutch, British, Norwegian,and other European governments. Mass vaccination campaigns would save millions of people from TB-related morbidity and mortality and would benefit economies. It would also protect countries where TB is not currently endemic, for example, Australia, from the threat of drug- resistant TB.
There is a risk that reduced funding for TB vaccine research as a result of reduced donor budgets may see the R&D effort lose momentum. Australian participation alongside other donors in funding the vaccine development effort would help accelerate progress, and build on AusAID’s leadership role in tackling the Asia Pacific region’s major health challenges. With the finalization of the Medical Research Strategy, AusAID should commit funding to the multinational global TB vaccine effort, particularly since almost a third of the world’s MDR-TB burden is in the Western Pacific region.
The world simply cannot afford to not invest in the ultimate weapon against TB – a vaccine.
*Image from Aeras homepage