The number of individuals falling ill or dying from tuberculosis (TB) worldwide has slowly been declining. However, the global burden of this ancient disease is still substantial. In 2012, an estimated 8.6 million people became ill with TB and 1.3 million people died, according to the World Health Organization (WHO). Each year, roughly 500,000 children develop TB and as many as 74,000 die from the disease. For HIV-infected individuals, co-infection with TB represents the leading cause of death. Furthermore, multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB is now recognized as a growing problem, threatening overall TB care efforts.
The WHO’s theme for World TB Day 2014, Reach the 3 Million, highlights that of the roughly 9 million people who become ill with TB each year, 3 million are not adequately diagnosed, treated or cured of their disease. Many of these people live in the world’s poorest, most vulnerable communities or are among marginalized populations. Collectively, scientific research organizations, health care providers, governments, civil society organizations, and communities must do more to help those needlessly suffering from this curable disease.
Biomedical research is essential to accelerating progress in global TB care and addressing the growing problem of drug resistance. In this regard, NIAID is committed to applying state-of-the-art, innovative approaches to better understand the disease and find new and improved tools and approaches for diagnosis, treatment and prevention.
Tomorrow’s scientific discoveries and products will be fueled by the important basic science being conducted today to better understand TB and how Mycobacterium tuberculosis (Mtb) causes disease. Through innovative approaches, such as systems biology, and functional and structural genomics, researchers are developing an understanding of the dynamic nature of TB and how to characterize the various stages of the disease—from latent infection through active disease to persistence of bacteria during antibiotic therapy. But there are still many questions for which we do not have answers. For example, we do not know why most people who are infected with Mtb ultimately do not develop TB. Also, it is not known why TB cannot be cured in a few weeks like most other infectious diseases. The pursuit of these and other important basic research questions will lead to novel ideas for drugs, vaccines, and diagnostics.
The benefits of biomedical research in the fight against TB are readily apparent. The point-of-care GeneXpert MTB/RIF TB diagnostic test, developed with NIAID support, has been rolled out to more than 20 countries worldwide. The test, which was endorsed for global use by the WHO in 2011 and approved by the U.S. Food and Drug Administration last summer, detects Mtb and drug resistance in sputum samples within two hours. NIAID is working to expand the utility of the test, so that it can also identify XDR-TB and use non-sputum specimens to facilitate diagnosis in children and people co-infected with HIV. Furthermore, the NIAID-supported TB Clinical Diagnostic Research Consortium is currently evaluating several early-stage TB diagnostic tests for the identification of drug-resistant TB and TB in children. Also, by mapping the genomes of drug-resistant and drug-sensitive Mtb from patients from different regions of the world, researchers are aiming to gain insight into the next generation of diagnostic tests to more rapidly identify MDR and XDR TB.
NIAID has had an important impact on the development of much-needed new TB treatments, contributing to more than two-thirds of the roughly 20 investigational TB drugs and drug combinations currently in clinical testing and to more than half of the 13 TB vaccines tested in human clinical trials to date. NIAID also has significant investments in discovery and preclinical testing to ensure that the pipeline of investigational TB drugs and vaccines contains the most promising candidates for clinical testing.
Collaborations with other research-funding organizations, clinical trials and genetic sequencing consortia, as well as public-private partnerships have been instrumental in supporting these important but costly endeavors, demonstrating the significant accomplishments that can be made through coordinated efforts. NIAID is also working to make strides in the fight against TB through each of the five newly awarded, NIAID-funded HIV/AIDS clinical trials networks, which have been expanded to include TB research, as well as through its genomic and bioinformatics infrastructure to address critical questions in TB research.
World TB Day reminds us that while progress is being made, difficult challenges remain. We must renew our efforts to significantly curtail TB and to end the suffering that this disease has caused for so many.