Increase in domestic budget for fight against tuberculosis

• According to a report from the World Health Organisation (WHO), India’s domestic budget for fighting tuberculosis showed a dramatic jump from about ?700 crore in 2015 to ?2,500 crore last year.
• Domestic resources accounted for 74% of the $525 million that was spent in India last year.
• Typically most of India’s budget to combat the bacterial infection used to be dominated by international funding. But, for the first time this has flipped.

Analysis:

• Tuberculosis (TB) has managed to remain a major global health problem, despite 100 years of research and more than 50 years of treatment being available. It still claims up to 1.5 million lives each year.
• Although there have been ongoing efforts that provide some hope in the fight against the disease, the TB drug pipeline remains thin and vaccine development slow as resistance grows.
• More than 9.6 million new TB cases were recorded in 2014. This prompted the Stop TB Partnership and the World Health Assembly to set a target of reducing TB-related deaths by 95% and cases by 90% by 2035. But new therapeutic and diagnostic interventions - including an effective vaccine - are urgently needed if these goals are to be achieved.
• There are several challenges that affect TB eradication. First, the TB burden has been aggravated by HIV co-infection. HIV compromises the immune response required to protect a person against TB. This increases vulnerability to the disease. The World Health Organisation’s most recent global TB report shows that of the TB-related deaths in 2014, just fewer than 27% of patients were HIV-positive. This is a slight increase from 2012.
• A second challenge is drug resistance. First-line drug regimens have saved millions of lives but have been marred by non-compliance and inconsistent use. TB patients who fail to adhere to their drug regimens often develop drug resistant TB. This means they have to go onto second-line drugs which are more expensive and may take even longer to complete.
• Further resistance to second-line drugs leads to extensively drug-resistant TB (XDR-TB). This is more difficult to treat.
• Drug resistance has led to a number of patients not responding to current treatment protocols, which is why there is a dire need for more treatment options.
• The third challenge is that there is no adequate vaccine for adults. The only approved TB vaccine, Bacille Calmette-Guérin, introduced 95 years ago, reduces the risk of TB in children. But it does not help adults with lung TB. An efficacious vaccine that provides a reliable protection against pulmonary TB is essential to eradicate TB.
• In the past ten years, there has been some progress in developing a vaccine. A new candidate, MVA85A, reached a phase 2b clinical trial.
• Although MVA85A failed the clinical end point trial due to limited efficacy, several lessons were gained from the study. These will be highly beneficial in guiding future vaccine development efforts.
• Currently over a dozen preventive vaccine candidates are progressing through the development pipeline, providing some hope in achieving the 2035 targets.

By: Vishal