Tuberculosis is an ancient disease that has been proven uncontrolled and difficult to handle, but it has progressed over time. Puneet Dewan, senior program officer at the Gates Foundation, revealed that some of the most exciting innovations in the R&D pipeline could transform the lives of people with TB.
According to an estimate, over 1.6 million people die due to TB. This is recorded that it is more than the quantity of people who die from HIV and malaria. a large number of such people live in low and middle-income countries. There is only one kind of vaccine for TB, which was invented 100 years ago.
New innovations have transformed the progress that how to cure TB or detect it. Recent work on TB was very slow but the world has progressed and worked on it.
The partners that are being supported by our foundation in the private and public sectors are working on the next-generation tools for TB. However, for this purpose, political commitment and resources are required to turn innovations with potential into impact for people affected by this disease.
As Puneet dewan said, ‘’ 3000 pills over two years with six months of daily injections, I mean, just hell. It will only work three-quarters of the time if you take all your meds.
He said,’ he is a medical epidemiologist. He is an internal medicine doctor by training. When he was a medical student, he went to India. He was in the pediatric ward. Then every day, this kid would be brought in and he would have a towel at the moment that would be a sign at that time. You must have held something that because you knew as soon as they took the towel off, there would be this giant swollen head on this little tiny baby.
In addition, that was the disease named tuberculosis meningitis and it happened every day, day after day, multiple times, that was the time when it gave me the idea that people are suffering from this disease and there was no cure for this. This was not available in my training. Then after realizing this, I pursued my career and focused more on public health. I wanted to save people from dying because of TB. There was a reason that why TB was not going away or why we were not able to treat it properly, the reason was, we had 100-year-old tools to cure for TB. These have become outdated and were not very effective. For years, we have relied on a century-old diagnostic test that is far from reliable. However, there is no real progress being made. A range of new diagnostics is emerging, offering much lower costs than current tests and delivering on-the-spot results, even at the most basic levels of healthcare.
Treatment for TB is set to improve significantly, potentially reducing the current six-month regimen of multiple pills to just two months. There are at least seven drugs in advanced clinical trials, which could be combined into powerful new treatments, a fantastic breakthrough. Some vaccine candidates in the pipeline are showing early signs of partial efficacy, something that has not been achieved yet with TB vaccines. These could be used in adults and adolescents to boost immunity and prevent TB altogether, which would be a remarkable achievement.
Historically, it was believed that even with a vaccine, vaccinating the world’s population against an infectious disease would be nearly impossible. However, COVID-19 proved this wrong. We now know that if a TB vaccine is developed, there are mechanisms in place to rapidly deliver it to those in need. This reinforces the urgency and possibility of finding one.
Looking ahead to the next three to five years, we have a realistic vision for earlier TB detection in both clinical and community-based settings, paired with simpler treatments. One of the most exciting developments is point-of-care molecular testing, which could revolutionize TB diagnosis. Instead of being limited to 15% to 30% of healthcare settings with diagnostic access, testing could become as accessible as a pregnancy test in most clinics. This is the first major advancement coming through the pipeline, with submissions for approval to the WHO expected next year.
Another critical breakthrough is the BPaL regimen for treating multi-drug-resistant (MDR) TB, particularly for those resistant to rifampicin, a key TB drug. In the past, MDR TB treatment involved expensive, grueling courses of up to 3,000 pills over two years, with six months of daily injections, and success was only achieved three-quarters of the time. Now, the regimen is much simpler: a handful of pills each day for six months, a treatment that can even be decentralized to local clinics. This new regimen is being rolled out globally with great enthusiasm, offering a much cheaper, easier solution for hundreds of thousands of people suffering from drug-resistant TB.
What drives me is witnessing these systemic changes—seeing countries shift from neglecting TB to prioritizing it, watching the number of children affected by conditions like TB meningitis decline, and observing how TB survivors mobilize to support each other and ensure they complete their treatments. These are the transformative moments that keep me going.