The success of mRNA technology in the fight against Covid-19 makes scientists dream of a similar vaccine against tuberculosis. Such a vaccine could save more than a million lives a year.
Tuberculosis is the second deadliest infectious disease in the world, but it is curable and preventable. The disease is caused by the bacterium mycobacterium tuberculosis and is spread through the air. The bacteria can live longer in rooms without fresh air or sunlight. Poor living conditions and overcrowding increase the risk.
This makes TB a real poverty disease, which mainly affects people in developing countries. In 2020, according to the World Health Organization, there were ten million infections and one and a half million deaths. Just eight countries accounted for two-thirds of all TB cases, including India, China, Indonesia, Nigeria and South Africa.
There is a vaccine, Bacillus Calmette-Guérin or BCG, but it is a century old. It is a live, attenuated vaccine that protects young children but does not provide reliable protection for adults and adolescents.
Scientists see a great opportunity in the mRNA technology that has yielded several covid vaccines. They are pushing for more funding and political commitment to accelerate research and development.
Clinical Trials
In February wrote members of the Tuberculosis Vaccine Roadmap Stakeholder Group already in The Lancet Infectious Diseases that the tremendous speed at which covid-19 vaccines have been developed and produced could set an example for research and development of tuberculosis vaccines.
The idea is not really new: in 2004 showed British research to mRNA technology already suggested that an mRNA vaccine provided “modest but significant protection” against the infections in mice.
And in July last year announced the German biotechnology company BioNTech to start clinical trials this year on an mRNA vaccine, developed in collaboration with the Bill & Melinda Gates Foundation.
Suvanand Sahu, director of the Stop TB Partnership, an umbrella organization of more than 2,000 organizations, governments and patient groups, says other research groups around the world are also working on mRNA vaccines against tuberculosis.
According to Sahu, the scientific teams that developed the covid vaccines are in the best position to quickly reuse the technology for a TB vaccine.
Outlook
The 1921 BCG vaccine remains the only approved vaccine to date. “BCG is 100 years old and only offers reliable protection against severe forms of tuberculosis in children,” says Sahu. “Clearly it’s not the drug that will help us overcome the disease.”
The importance of using mRNA platforms for accelerated vaccine development has “become obvious,” was told last year at the Global Forum on TB Vaccines. Mustafa Diken of BioNTech said, among other things, that the mRNA vaccine technology used for covid-19 could be adapted for TB.
More than ten clinical trials of vaccine candidates have been launched since October last year, according to Tuberculosis Vaccine Initiatives, five of which are already in Phase III. But none of those candidates use the mRNA platform.
Also, according to Patrick Tippoo, executive director of the African Vaccine Manufacturing Initiative in South Africa, it is theoretically possible to develop an mRNA vaccine against tuberculosis. But, he says, in practice it will depend on whether scientists can find a suitable target for the antigen. “The right vaccine targets need to be identified, and those have so far proved elusive,” he says.
WHO-hubs
The World Health Organization has established regional technology hubs for mRNA development, sparking new optimism about a vaccine for TB. According to the WHO, the hubs could help low- and middle-income countries produce their own vaccines, medicines and diagnostics, as well as develop new vaccines for diseases such as tuberculosis, malaria and HIV.
“We strongly believe that mRNA technology can be used to develop a TB vaccine,” said Sahu, who helped set up India’s polio eradication campaign in 1997.
According to Sahu, the mRNA vaccine that proved successful in mice in 2004 failed to make it to human trials due to lack of resources and the perception at the time that mRNA would be too complicated.
“But the technology has evolved a lot in recent years and has made huge strides during the covid pandemic,” he says. “The right time has come to use the technology to develop a new and effective vaccine against TB.”
Resources and access
Multidrug-resistant tuberculosis is a global public health threat and is increasing the need for a safe and effective vaccine. As the disease gains attention and may accelerate vaccine development, experts are calling for more financial support to tackle the deadly disease.
The lack of research and development resources remains a major obstacle: a total of $901 million was spent on the disease in 2019 – well below the WHO target of at least $2 billion a year.
“There is tremendous scientific advancement in TB diagnosis, treatment and prevention,” said Mel Spigelman, president and CEO of the Global Alliance for TB Drug Development. “The major limiting factor so far has been the great scarcity of research resources.”
Inequality
Some NGOs already want to start negotiations on the resources, access and affordability of the vaccines to avoid the inequalities that plagued the distribution of the covid vaccines. Now that an mRNA vaccine for tuberculosis seems within reach, problems with patents and production capacity in developing countries are also coming to the fore.
But Sarah Fortune, Professor of Immunology at Harvard TH Chan School in Boston, believes the focus should be solely on research and development for now. “I understand there are concerns about the affordability of any vaccine,” she says. “But I think that threatens to shift the focus from the more immediate problem: whether a TB vaccine is biologically possible. We want everyone to consider this problem, because we fundamentally don’t know how to make a better vaccine for a disease that kills a million people a year.”
Tuberculosis is the second deadliest infectious disease in the world, but it is curable and preventable. The disease is caused by the bacterium mycobacterium tuberculosis and is spread through the air. The bacteria can live longer in rooms without fresh air or sunlight. Poor living conditions and overpopulation increase the risk. This makes TB a real poverty disease, which mainly affects people in developing countries. In 2020, according to the World Health Organization, there were ten million infections and one and a half million deaths. Just eight countries accounted for two-thirds of all TB cases, including India, China, Indonesia, Nigeria and South Africa. There is a vaccine, Bacillus Calmette-Guérin or BCG, but it’s a century old. It is a live, attenuated vaccine that protects young children but does not provide reliable protection for adults and adolescents. Scientists see a great opportunity in the mRNA technology that has produced several covid vaccines. They are pushing for more funding and political commitment to accelerate research and development. In February, members of the Tuberculosis Vaccine Roadmap Stakeholder Group wrote in The Lancet Infectious Diseases that the tremendous speed at which covid-19 vaccines were developed and produced could set an example for research and development of tuberculosis vaccines. The idea is not really new: in 2004 British research into mRNA technology already showed that an mRNA vaccine offered “modest but significant protection” against the infections in mice. And in July last year, the German biotechnology company BioNTech announced it would start clinical trials this year on an mRNA vaccine developed in collaboration with the Bill & Melinda Gates Foundation.Suvanand Sahu, director of the Stop TB Partnership, an umbrella organization of more than two thousand organizations, governments and patient groups, says other research groups around the world are mRNA vaccines against tuberculosis. According to Sahu, the scientific teams that developed the covid vaccines are in the best position to rapidly reuse the technology for a TB vaccine. The 1921 BCG vaccine remains the only approved vaccine to date. vaccine. “BCG is 100 years old and only offers reliable protection against severe forms of tuberculosis in children,” says Sahu. “Clearly it’s not the drug that will help us overcome the disease.” The importance of using mRNA platforms for accelerated vaccine development has “become obvious,” said the Global Forum on TB Vaccines last year. BioNTech’s Mustafa Diken said the mRNA vaccine technology used for Covid-19 could be adapted for TB. More than 10 clinical trials of vaccine candidates have been launched since October last year, according to Tuberculosis Vaccine Initiatives, which include five already in phase III. But none of those candidates use the mRNA platform. Also according to Patrick Tippoo, executive director of the African Vaccine Manufacturing Initiative in South Africa, it is theoretically possible to develop an mRNA vaccine against tuberculosis. But, he says, in practice it will depend on whether scientists can find a suitable target for the antigen. “The right vaccine targets need to be identified, and they have so far proved elusive,” he says. The World Health Organization has established regional technology hubs for mRNA development, sparking new optimism about a vaccine for TB. According to the WHO, the hubs can help low- and middle-income countries produce their own vaccines, medicines and diagnostics, as well as develop new vaccines for diseases such as tuberculosis, malaria and HIV. to develop a TB vaccine,” said Sahu, who was part of the Indian campaign to eradicate polio in 1997. According to Sahu, the mRNA vaccine that proved successful in mice in 2004 did not make it to human trials due to lack of resources and by the perception at the time that mRNA would be too complicated. “But the technology has evolved a lot in recent years and has made huge strides during the covid pandemic,” he says. “The time has come to use the technology to develop a new and effective vaccine against TB.” Multidrug-resistant tuberculosis is a global threat to public health and is increasing the need for a safe and effective vaccine. As the disease gains attention and may accelerate vaccine development, experts are calling for increased funding to tackle the deadly disease. the disease — well below the WHO target of at least $2 billion a year. “There is tremendous potential for scientific advances in TB diagnosis, treatment and prevention,” said Mel Spigelman, chairman and CEO of the Global Alliance for TB Drug Development. “The major limiting factor so far is the great scarcity of research resources.” Some NGOs are already looking to start negotiations on vaccine resources, access and affordability to avoid the inequalities that plagued the distribution of covid vaccines . Now that an mRNA vaccine for tuberculosis seems within reach, problems with patents and production capacity in developing countries are also coming to the fore. But Sarah Fortune, Professor of Immunology at Harvard TH Chan School in Boston, believes that the focus is only on research and development for now. must lie. “I understand there are concerns about the affordability of any vaccine,” she says. “But I think that threatens to shift the focus from the more immediate problem: whether a TB vaccine is biologically possible. We want everyone to consider this problem, because we fundamentally don’t know how to make a better vaccine for a disease that kills a million people a year.”
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