TB deserves same effort devoted to H1N1 vaccine
By DAVID McMURRAY
Oct. 7, 2009, 8:50PM Share Print Share Del.icio.usDiggTwitterYahoo! BuzzFacebookStumbleUponLast month, the U.S. Food and Drug Administration announced its approval of four vaccines against the H1N1 influenza virus. This rapid progress only six months after H1N1 first gained worldwide attention with cases in Mexico and the United States has been Herculean, and shows we can mobilize rapidly against a frightening new enemy.
Tuberculosis, another contagious respiratory disease affecting countries all over the world, deserves a similarly substantial effort to develop a new vaccine. Since April, when we first became alerted to the "swine flu," nearly one million men, women and children have died from TB, compared to 4,200 who have died from H1N1 flu globally. Why didn’t you see any headlines? Because 98 percent of the nearly two million people who die each year from TB live in the developing world, in places like Kenya, where I once worked as a Peace Corps volunteer. Yet TB continues to be a problem in this country as well because in an age of globalization, germs cross borders without a passport.
Thought by many to be a disease of the past, TB is a devastating pandemic, driven by the emergence of drug-resistant strains and the devastation of HIV/AIDS. The two diseases are a deadly pair, each making the other worse. A third of the world’s people – two billion – are already infected with latent TB. When HIV weakens a person’s immune system, TB is quick to reactivate, or to prey upon those previously not infected, especially in places of high poverty where TB is most prevalent. Even in New York City, it cost $1 billion to control an outbreak of 420 cases of multi-drug resistant TB in the early 1990s, largely fueled by HIV. And right here in Texas, 1,500 people develop TB each year.
When she was 36, Rachel Orduño of El Paso developed symptoms that were diagnosed consecutively as flu, colds, allergies, respiratory infections, pneumonia and asthma over the course of three years. Her three-year-old niece meanwhile developed recurring cysts that were surgically removed. Finally, after three agonizing years of wondering what was causing their mysterious symptoms, both Rachel and her niece were diagnosed with TB and started treatment for active TB disease. Yet treatment takes months to complete. A vaccine that prevents TB would represent a major step forward.
Texas ranks fourth in the United States for the highest number of tuberculosis cases. U.S. Reps. Kay Granger and Gene Green of Texas have both been champions on Capitol Hill for increased U.S. government support for tuberculosis research and development. The U.S. established itself as a global leader in HIV/AIDS response with the implementation of George W. Bush’s greatest legacy, the President’s Emergency Plan for AIDS Relief. This model program mobilized funds for prevention, treatment and care that served as the moral touchstone for foreign aid agencies worldwide.
To date, however, the government has failed to take up TB vaccine research as a priority funding area, despite prominent U.S. government leadership on HIV and malaria vaccine research.
There is complacency about tuberculosis, despite the ever more dangerous evolution of the pandemic globally and the fact that thousands of Americans become ill with TB each year. Dr. Tom Frieden, now the director of the Centers for Disease Control and Prevention, said it best when he told Congress in 2007 about his experience combating the New York outbreak: "When TB is in the headlines, resources increase. Once those resources succeed in reducing the disease, we neglect the modest investment that needs to be maintained to prevent future epidemics – epidemics that will cost lives and money."
The U.S. government has made substantial investment in infectious disease research and prevention, notably the construction of a high-containment Biosafety Level 4 laboratory in Galveston. The new lab, which is capable of safely handling the world’s most highly contagious and lethal pathogens, is likely to play an important role in testing new TB vaccine candidates against the most virulent strains of drug-resistant TB.
But much more needs to be done to support the development and testing of new vaccines. The research community has several promising candidates. Seven are currently undergoing early stage clinical testing for safety and efficacy, but millions of dollars will be needed to take them through the full stages of testing before they can be licensed for use.
We have confidence that the enormous resources invested to speed new vaccines for H1N1 will help protect us and our families from this recent headline-grabbing scare. Let’s do the same to stop TB.
McMurray, a professor at the Texas A&M University System Health Science Center, is an expert in tuberculosis, including mechanisms of vaccine-induced resistance to TB.
