Biomarkers and Vaccines Across Borders

We have developed a new vaccine against tuberculosis (TB), which has proven highly effective and safe in preclinical studies and is currently being assessed in clinical trials. Also our team, together with numerous partners in Africa, is attempting to identify biomarkers of TB. Why are we interested in an infectious disease which is largely ignored because it has been with us forever? TB together with HIV/AIDS belongs to the deadliest of threats. Two billion individuals are infected with the etiologic agent Mycobacterium tuberculosis (Mtb); every year, we witness approx. 10 million new cases of active TB, of which one-quarter are fatal. Even though we have drugs to treat TB, numbers of multidrug-resistant infections are on the rise. Today 50 million people live with multidrug-resistant Mtb. Another such complication is the dangerous liaison between HIV/AIDS and TB. A vaccine is available: bacilli Calmette-Guérin (BCG). This vaccine, however, is ineffective against the most prevalent form, pulmonary TB in adults. We therefore need new drugs, diagnostics and vaccines for TB. Clinical trials for vaccines against TB are tedious, long-term endeavours. One possibility of accelerating these efforts is offered by biomarkers, which predict the clinical endpoint of a vaccine trial, i.e., outbreak of active TB or its prevention. Such biomarkers could also form the basis for diagnostics that can distinguish latent infection from active TB and predict risk of infected individuals to develop active disease. A first generation of better drugs, vaccines and diagnostics could reduce TB incidence up to 70%. To ensure success, however, financial support needs to be strengthened. Currently, approx. 500 million USD are spent on R&D in TB every year. However, annually at least 2 billion USD are needed to reach the ambitious goal of eliminating TB by the year 2050. Financially this could be profitable because TB currently requires expenditure of up to 20 billion USD annually. References: Kaufmann, S.H.E.: The New Plagues: Pandemics and Poverty in a Globalized World, Haus Publishing, London (2009) AIDS and Tuberculosis: Infection Biology Handbook Series (S.H.E. Kaufmann and B.D. Walker, eds.), Wiley-Blackwell VCH, Weinheim (2009)