Are new TB treatments the real solution?

But despite these scientific steps forward, it’s worth bearing in mind that TB rates were declining in developed countries decades before antibiotics and even before scientists had actually even identified the TB bacterium itself. What caused that dramatic decline was not therefore modern medicine, but improvements in living conditions, a sentiment echoed by Anastasia Koch, co-founder of the non-profit Eh Woza in South Africa…

Anastasia - I don't believe that solving an infectious disease like TB is going to come only from a new biomedical intervention. And I think that's quite unusual for a scientist. I think HIV showed us, and then Covid showed us, that you can have really amazing biomedical interventions, like new antibiotics, new vaccines, but if people don't buy into it and you don't get people to trust you or trust the intervention, it's not going to have its intended impact. And I think in order to get people to trust you, you have to also address the social conditions in which the disease occurs. TB occurs within a bunch of other social conditions, and those are really important to address as well.

And pathologist Sebastian Lucas also emphasises the importance of good quality infection control as probably our best weapon against TB in the near term…

Sebastian - The secret to reducing tuberculosis impact globally is to have better surveillance so we can identify people who have tuberculosis, treat them properly, find who they have been with, in other words, contact tracing to see who they might have infected. And to do this very efficiently, we always need better drugs, and especially because of drug resistant tuberculosis, we would like to think an effective vaccine is on the horizon. Now, we've had BCG vaccination since 1921. This is derived from attenuated tuberculosis or microbacteria bogus, actually. But unfortunately, it is not terribly effective. It seems to have a little bit of an effect on whether a person who is infected actually develops disease, but it doesn't seem to have much effect on whether you actually catch TB in the first place. And so a lot of people have been looking for a long time for a better vaccine. And at the moment, I'm not aware that there are any good candidates around. And the final point relates to special populations such as those who have active HIV disease because they are particularly susceptible to a very severe form of tuberculosis and has a much higher fatality rate than in people who have not got an immunosuppressive condition like HIV.