At a glance
- Tuberculosis (TB) remains a leading cause of death from infectious disease worldwide, with an estimated 10 million new cases in 2019.
- Current approaches to preventing, diagnosing, and treating TB are inadequate. Drug-resistant strains of TB have also emerged, creating a growing sense of urgency to control the spread of the disease.
- We are working to better understand the basic science behind the TB epidemic and to support the development of new tools for prevention, diagnosis, and treatment as well as optimal delivery of TB care.
- Our partners in combating TB include donor governments, multinational institutions, the pharmaceutical and biotechnology industries, and governments.
The foundation’s Tuberculosis team aims to address key gaps along the TB care pathway through new approaches to protecting against infection, preventing progression from infection to disease, and improving diagnosis and treatment. Our efforts are diversified based on the understanding that vaccines, diagnostics, drugs, and improved care delivery are all essential to addressing the TB epidemic.
Areas of focus
Our efforts to develop a treatment regimen that is safer, shorter, simpler, and more affordable began with the TB Drug Accelerator (TBDA) program, a partnership that aims to identify new drugs that work differently than existing drugs to kill TB bacteria. We also support other initiatives to develop new TB drug regimens, including the European Regimen Accelerator for Tuberculosis (ERA4TB) and the Project to Accelerate New Treatments for Tuberculosis (PAN-TB collaboration).
To address the complexity of developing multi-drug regimens for treating TB, we have joined with partners to create the Critical Path to TB Drug Regimens (CPTR) initiative, which brings together leading international pharmaceutical companies, public health experts, nongovernmental organizations, and U.S. and other regulatory authorities. CPTR aims to identify new pathways to regulatory approval and expedite testing of promising TB drug candidates in combination.
We are also co-funding multiple drug trials, with the goal of achieving an effective, short, and simple treatment regimen for all forms of TB, including drug-resistant TB. New regimens will benefit those with extensively drug-resistant TB (XDR-TB) and multidrug-resistant TB (MDR-TB), while providing important safety data and insights that will ultimately help us expand our efforts to address drug-sensitive TB.
Of the estimated 10 million new cases of TB worldwide each year, 3 million go undiagnosed and/or unreported. We are developing less expensive, more effective diagnostic tools that can reach more people who are infected with TB.
One new technology we helped fund, the GeneXpert diagnostic test, has led to an increase in overall TB case finding and has the potential to more effectively guide proper treatment. It better detects drug-resistant cases of TB from sputum samples, helping providers select the most appropriate treatment.
We continue to support development of next-generation TB diagnostic tests based on samples that are easier to obtain than sputum, including blood, urine, and potentially even breath or sweat. While these techniques are in the early stages of development, new diagnostics could improve TB detection, facilitate faster treatment, and reduce transmission.
Bacille Calmette-Guérin (BCG), the only available TB vaccine, was developed almost 100 years ago and has limited efficacy after childhood. A more effective option is needed to prevent TB.
We work with multiple partners to better understand how to protect people against TB with a vaccine, with a focus on how the immune system responds to new vaccines. For example, we established the Collaboration for TB Vaccine Discovery (CTVD) to facilitate the exchange of ideas among TB scientists and develop guidelines for safely and effectively moving vaccine candidates through clinical trials.
In India and China, we work with governments and other partners—including the World Health Organization (WHO), USAID, and the World Bank—to pilot innovative approaches to modernizing TB control. With the government of India, WHO, USAID, and the World Bank, we are expanding TB-control efforts into the private health care sector, where most Indian patients seek care. In China, we have supported the government’s shift to hospital-led TB care, which increases referrals while maintaining a high standard of treatment.
We recently began expanding our efforts in South Africa, where we aim to support evidence-based policy recommendations and improved monitoring of TB patients and programs.
We are expanding all of our TB control efforts through partnerships such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria; WHO; and UNITAID that maximize the impact of resources and investments. We support the use of data and analytics to drive policy and funding decisions globally and at the national level. We also support the use of adherence technologies that help patients complete treatment and increase their probability of being cured.
We advocate for greater political commitment and funding to fight TB, particularly for research and development that can lead to new tools. We believe that strengthening partnerships with donor governments and multinational institutions, the pharmaceutical and biotechnology industries, and governments of TB-endemic countries is critical to fighting the disease. These partnerships can lead to greater investments in research and development as well as in the delivery of existing and new tools.
Why focus on TB?
Over the past two decades, the world has made significant progress in the fight against TB. Between 2000 and 2019, TB mortality fell by 45 percent, and an estimated 63 million lives were saved thanks to coordinated global efforts and the use of the recommended treatment, the directly observed therapy short-course (DOTS) strategy.
While effective diagnosis and treatment have saved millions of lives, TB remains the leading cause of death from infectious disease worldwide. In 2019, an estimated 10 million people had newly developed TB, and nearly 1.4 million people died from the disease.
In recent years, drug-resistant strains of TB have created a growing sense of urgency to control the spread of the disease: MDR-TB, which is resistant to first-line drugs, and XDR-TB, which is also resistant to some second-line drugs. MDR-TB has appeared in nearly every country, with an estimated 465,000 new cases in 2019. These forms of the disease are difficult and costly to treat. The TB epidemic has also accelerated in concert with HIV: In 2019, about 208,000 people with HIV died of TB.
Current approaches to preventing, diagnosing, and treating TB are inadequate. The BCG vaccine protects young children against severe forms of TB but offers limited protection against pulmonary TB in adults, which is the most common form of the disease. The most widely used diagnostic method, microscopic detection of bacteria from sputum, identifies only half of all cases. It also requires special skills and is labor-intensive. Standard treatment regimens also have significant side effects. Many patients are unable to stay on treatment long enough to be cured.
As a result of these issues, current TB care and treatment programs identify, diagnose, and successfully treat only about 71 percent of all patients with active TB disease. While this represents a significant improvement, nearly 3 million cases remain unidentified each year.
Over the past decade, innovative new tools and delivery strategies have reduced deaths from TB and improved the quality of patient care. But more investments and greater collaboration are urgently needed to accelerate progress in treatment delivery and expand the pipeline of safe and effective drug and vaccine candidates.
A more effective vaccine would be the single most powerful tool to reduce the incidence of TB. Even a partially effective new vaccine, if introduced in 2024, could decrease TB incidence by up to 70 percent by 2050, according to some projections.
As efforts to develop a better vaccine continue, newer tools are needed to interrupt the TB epidemic in the short and medium term. Improved diagnostic tools would reduce delays in starting treatment. A simpler, safer, shorter, and more affordable drug regimen would improve treatment success rates. New ways to use existing tools in order to identify patients early, link them to care, and facilitate faster and more effective treatment would help reduce the burden of TB.
The field of TB also needs more funding. The drugs and diagnostics currently in clinical development can reach the people who need them most only if they are affordable and can be deployed efficiently. Substantial funding is needed for research and development, and investments from developed and TB-endemic countries, pharmaceutical companies, and foundations must be sustained.
In 2017, the foundation’s Tuberculosis team brought together a diverse group of experts within and outside the TB field to provide feedback on our strategy and our progress.
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We partner with The Global Fund, which aims to accelerate the end of the AIDS, TB, and malaria epidemics. It mobilizes and invests more than US$4 billion a year to support programs run by local experts in more than 100 countries.
We support the Stop TB Partnership, an international network of more than 1,700 partners working to eliminate TB as a public health problem and ultimately achieve a world free of TB.
We support the TB Alliance, a not-for-profit organization dedicated to accelerating the discovery and development of affordable new TB drugs.
WHO is a specialized agency of the United Nations whose primary role is to direct international health within the United Nations system and to lead partners in global health responses. The WHO Global TB Programme coordinates WHO’s global efforts to end TB.
We support FIND, a global nonprofit that advances the development and delivery of diagnostics to combat major diseases affecting the world’s poorest populations. FIND is working to develop easy-to-use, rapid, and reliable TB diagnostic tests and speed up access to new and existing tools.
We support TBVI, a research and innovation partnership that works to advance research and development leading to new TB vaccines that are safe, effective, accessible, and affordable for all people.