Innovations for Tackling Tuberculosis in the Time of COVID-19 Current Tools and Challenges: Proceedings of a Workshop—in Brief (2021) / Chapter Skim
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Innovations for Tackling Tuberculosis in the Time of COVID-19: Current Tools and Challenges: Proceedings of a Workshop - in Brief
Innovations for Tackling Tuberculosis in the Time of COVID-19: Current Tools and Challenges: Proceedings of a Workshop - in Brief
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INTRODUCTION Kenneth Castro, professor of global health, epidemiology, and infectious diseases at Emory University, set out the charge for the workshop: to examine the current state of TB as a global health issue in the context of the COVID-19 pandemic. Castro cited two statistics from WHO as evidence for setbacks caused by the pandemic in the global effort to eradicate TB: a 21 percent decrease in notifications of TB cases worldwide, and an additional 500,000 deaths between 2019 and 2020.1,2 Gail Cassell, senior lecturer on global health and social medicine at Harvard University Medical School, explained that the workshop was intended to create a detailed picture of the progress made toward the goals set for ending TB before embarking on further discussions of the technical and strategic innovations that may help to meet these goals in the second half of the workshop (held in September 2021)
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According to Kim, public health leaders and programs in the TB community have an opportunity to take a central role in building new public health systems that can stop TB, COVID-19, and other infectious disease threats yet to come. In response to a question from Cassell on the role of development banks in accomplishing this goal, Kim said his colleagues at the World Bank are responding to needs expressed by countries for public health systems that are equipped for a full range of health threats, including chronic and non-infectious diseases.
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cases • An estimated 1.5 million people died from TB -- including 251,000 people living with HIV • About 500,000 new people fell ill with drug-resistant TB -- only one in three had access to treatment, and only one in five were cured • 56 percent of total TB treatments were successful Progress Toward the Goals Set by the End TB Strategy • Incidence rate: goal of 20 percent reduction between 2015 and 2020, achieved 9 percent • Number of deaths: goal of 35 percent reduction between 2015 and 2020, achieved 14 percent • Share of patients facing catastrophic treatment costs: goal of 100 percent reduction by 2020, achieved 49 per cent reduction Progress Toward the Goals Set by UNHLM for 2018–2022 • TB treatment: goal of 40 million, treated 14.1 million in 2018 and 2019 • TB preventive treatment: goal of 30 million, treated 6.3 million in 2018 and 2019 ° In people living with HIV: goal of 6.0 million, reached 88 percent of goal in 2018 and 2019 ° In household contacts under the age of 5: goal of 4.0 million, reached 20 percent of goal in 2018 and 2019 ° In household contacts older than the age of 5: goal of 20 million, reached less than 1 percent in 2018 and 2019 • TB treatment in children: goal of 3.5 million, treated 1.04 million in 2018 and 2019 • Treatment for MDR or rifampicin-resistant (RR) TB: goal of 1.5 million, treated approximately 20 percent of goal in 2018 and 2019 • Treatment of MDR or RR TB in children: goal of 115,000, treated approximately 8 percent of goal in 2018 and 2019 SOURCE: WHO, 2020.
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He further pointed out that by extending the capabilities and deepening the reach of clinics into communities, TB programs can essentially become community-based delivery platforms for a wide range of diseases -- including endemic infectious diseases, non-communicable diseases (e.g., diabetes, heart disease, and mental illness) , and emerging infectious diseases like COVID-19.
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In contrast, the pipeline for TB drugs is more robust than that for coronavirus drugs, and researchers are experienced in designing and embarking on cost-efficient clinical trials due to limited funding. Rubin lauded the rapid advances in vaccine development during the COVID-19 pandemic.
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Improving Treatment Regimens and Vaccine Development Emilio Emini, director of the HIV and TB program at the Bill & Melinda Gates Foundation (BMGF) , spoke about the challenges and opportunities related to developing effective TB therapeutics and vaccines.
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at the U.S. Centers for Disease Control and Prevention, with collaboration from the AIDS Clinical Trials Group funded by the National Institute of Allergy and Infectious Diseases.
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,13 spoke about the policy and economic considerations for building new antibiotic development business models, and potential translatable lessons for ongoing efforts in TB. He observed that organizations, funding streams, government agencies, and scientific communities associated with infectious diseases are separated by strong disciplinary boundaries drawn around diseases of focus.
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Instead of competing for funding streams, experts from different disciplines of microbial threats could coordinate to discuss common needs and the broader social values of innovation. Outterson also suggested a "subscription" model for government funding of antimicrobial innovation in which a set level of government funding is steadily available to drug developers regardless of the actual market demand for new antibiotics.
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Outterson acknowledged the distinction that Emini described between cost of goods and price, and added that the discussion of social value further distinguishes a difference and shifts the focus from a company deriving revenue from market mechanisms to other reimbursements for its activities, including research and development. This is known as "delinkage," Outterson explained, and the subscription-style funding model of the Pioneering Antimicrobial Subscriptions to End Up surging Resistance (PASTEUR)
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Finally, following up with the examples Keshavjee cited, Outterson proposed that this health system strengthening could be thought of as "broad-spectrum defenses to unknown or unknowable microbial threats," adding that: The preparedness value of that is immense, and it crosses all silos, because it's not a preparedness system to surveil for any of our particular diseases, it should be something that surveils for all infectious diseases, and … even chronic diseases that aren't infectious. Closing Remarks In closing, Cassell entreated the audience and participants to work toward developing the goals Kim laid out in the opening presentation.
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2016 Study. Lancet Infectious Diseases 18(12)
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