“The world will not end the TB epidemic without new vaccines.” The TB Vaccine Pipeline Report, Part 1

So states the summary of New York’s Treatment Action Group’s recent analysis of the current pipeline of new TB vaccines. Written by Mike Frick, the Report does its best to be upbeat – part of the reason for this is because being downbeat about anything related to TB generally puts off funders. As Jeremy Farrar (now WHO’s Chief Scientist) has said about TB vaccine research – “Optimism brings support. Funders like to support things that will work. Funding attracts young people. Optimism is crucial if we’re to make progress.”

Any such progress is, unfortunately, currently very much in doubt. In fact, the whole endeavour looks like it’s been near mortally wounded by the erratic policy announcements of 'Trump 2.0'.

Decades of TB research might, as Mike suggests, be revealing some slow but possibly promising progress – “starting to bear fruit with multiple vaccine candidates in late-stage efficacy trials” as he identifies – but at the same time the White House has without notice been withdrawing a range of financial support for most things health-related both domestic and global. And since 33% of funding for TB vaccine research was previously being provided by the U.S., there’s a lot currently that’s being lost in this field.

In other words, it's difficult to marry MIke Frick’s summary that the prevailing mood currently “feels more optimistic” with this political posturing going on in the background – particularly if we bear in mind that in 2023 the world spent only $227 million on TB vaccine R&D (a third of which was spent by the NIH). Though this was a significant increase on the year before, it was still a total spend that was woefully short of what all UN membership nations had unanimously committed to (just an abysmal 18% of the target, in fact).

And since we are being bombarded by the White House with arguments about fair-sharing contribution towards ‘defence’, it’s worth adding here that only two countries — India and South Africa — achieved their “fair share” of spending targets for 2023 in TB research (defined as investing at least 0.15% of their overall R&D expenditures in TB research - amounting to a miniscule a sixth of one percent, please note).

To put this in even more concerning perspective, in the 12 months between 2019 and 2020, a total of $15.3 billion was spent on research for an HIV vaccine (a whopping 70 times as much as for TB in 2023) – and 80% of this total was paid for by the U.S. federal government, incidentally.

Meanwhile, the total investment just by the U.S. government in vaccines for COVID-19 vaccines (from ground zero through to approvals and purchase) probably exceeded $32 billion (which makes this 140 times the total global spend on TB vaccine research in 2023, and over 450 times the U.S. government's spend on TB vaccine research that same year).

Much of this money was expended in subsidising the cost of clinical trials, specifically by Johnson and Johnson, Moderna, Sanofi, and AstraZeneca, with all of these companies also benefitting from further government support in building manufacturing capacity to mitigate their own investment risks – something that was well confirmed by these companies’ rising stock value over the same period. (For example, the U.S. government issued a $53 million contract to build manufacturing capacity for Moderna in May 2020, a sum that is itself roughly three-quarters of the total of all the money it spent on TB vaccine research in 2023.)

Is it unfair to wonder just how many politicians (or members of their families) held investments in these companies during this period.

We can take further note that an analysis by the Stockholm International Peace Research Institute (SIPRI) has reckoned that, in the 12 months between October 7th 2023 and October 2024, the U.S. transferred $22 billion worth of military support to the state of Israel (nearly a hundred times more than was globally invested in TB research in a similar period, and almost 300 times what the U.S contributed to TB research) - on a project which has been defined in a UN special committee along with many others as genocide.

We do really need to remind ourselves how TB persists as mankind’s most lethal infectious enemy, but we also must note that it takes its toll most mercilessly on the most vulnerable members of the human family - whose vulnerabilities surely demand much better protection. So when politicians talk about increasing investment in ‘defence’, perhaps we should be asking what sort of 'defence' they mean.

All governments have an implicit social contract with their citizens to protect them as best they reasonably can – but what exactly should this contract require them to protect or defend their populations against?

And whom exactly within the borders of their countries are they primarily defending anyway? The most vulnerable, who normatively should be the case? Or the interests of the super-wealthy and the industrial conglomerates?

Worldwide, probably 2 million people are already dying from TB each year but, given current U.S. political expediencies, that number is unquestionably going to rise remorselessly in the coming years. Most of those who die will be doing so unnoticed by the media because TB is such slow news and so it takes little notice of this disease. But worse (given the persistently deficient disease surveillance and reporting of both incidence and mortalities) many will die unnoticed.

So if a new vaccine really is a vital part of TB eradication as is hoped, then authorities everywhere need to start waking up to their responsibilities and collectively do something about it - and in the first place they can start by honouring their commitments.

(This is the first of a series of blogs that are intended to expose, not just the iniquities of lack government research spending, but also the implicit challenges of finding that “vital” new vaccine for TB. In the next blog, we will discuss the context of these challenges in light of the complexities of this ancient disease, and then we will further discuss the progress that is actually being made).