Mike Frick
Treatment Action Group

Hi, I'm Mike Frick. I am the co-director of the tuberculosis project at Treatment Action Group. We're a non-governmental organization based in New York City. I became a TV advocate from my experience as an HIV advocate first, and it was working at the intersection of TB and HIV that brought me into TB advocacy full time.

For the purposes of this course, new TB tools is a phrase we used to refer to new diagnostics, medicines, and vaccines.

In recent years, we've seen a few new TB tools become available. This includes three medicines for drug-resistant TB, drugs called Delamanid, Bedaquiline, and most recently a drug called Pretomanid.

Xpert MTB/RIF is a new diagnostic platform used to diagnose TB and drug-resistant TB. When it became available in 2010, it completely revolutionized the way that TB is diagnosed.

And on the prevention side, the 3HP and 1HP regimen gave us options for preventing TB with preventive treatment that can last as little as 12 weeks to one month, a major improvement over the older, longer standard of TB preventive treatment.

These were important additions to the TB tool box, but we need more and additional TB tools. And in this lesson, we're going to focus on why we need new tools for TB.

What are the limitations of currently available TB tools?

We're going to go through this question for diagnostics and then for medicines, and finally for vaccines.

The most important thing to know about the need for new TB diagnostics is that a lot of the diagnostic tests being used today need some form of a laboratory infrastructure in order to get the test results. We need more tests that are simple, cheap, and can be used anywhere. Tests that do not need a laboratory or electricity, and that can be given at the point of care.

The point of care means that this is the place where somebody goes to seek diagnosis and treatment initially. It's close to where they live. It doesn't require them to walk or find transit to a far away health clinic or hospital. It's convenient to them, easy to access and affordable to reach; and putting TB diagnostics in these places is essential. We need tools that are suitable for these locations, and that's a big focus of efforts to produce new diagnostics for TB.

You will learn more about this in the module on new TB diagnostics.

What are the limitations of currently available TB medicines?

Standard TB treatment for drug sensitive disease takes at least four months and usually lasts for six months. And the treatment can be hard for people's bodies to tolerate. A person who is taking TB treatment needs to take multiple medicines at the same time, usually every day. And the medicines we have today can cause side effects that make it difficult to keep taking the pills week after week, month after month.

One of the biggest problems with TB treatment being so long is that when treatment is interrupted or if the person on treatment does not take all of the pills as needed or doesn't receive their next supply of medicines on time, then drug resistance can develop. And when drug resistance develops, it's more dangerous for the person on treatment because drug-resistant TB has to be cured with a different set of medicines that have their own complications and drug-resistant TB is also more dangerous for the community where it can spread.

For these reasons we need simpler, shorter treatments with fewer side effects, treatments that are easier to complete in full, that can cure people safely, quickly and permanently.

You will learn more about this in the module on new TB medicines.

What are the limitations of current TB vaccines?

There's actually only one vaccine for TB given to people today. And it's called BCG. It's over a hundred years old. The BCG vaccine is given to infants soon after they're born, and it's widely used around the world.

The vaccine does give some protection against dangerous forms of TB in infancy. Things like TB meningitis. The problem is that the BCG vaccine doesn't offer much protection to adolescents or to adults who account for most TB cases that countries see each year.

We need vaccines that are more effective at preventing TB in all age groups. And you'll learn more about this in the module on new TB vaccines.

Before the COVID 19 pandemic TB was the leading cause of death from an infectious disease globally. The need for new TB tools has never been more apparent in the wake of COVID. We've seen that government investments, partnerships, and the collaboration of industry, government, and community can rapidly accelerate the development of medical technologies that are lifesaving. The same energy and level of funding, if applied to TB, would bring forth the new tools that are needed to end this epidemic.

The bottom line is that the TB tools we're using today are not sufficient. They all have limitations that make it harder than it should be to prevent, diagnose, and treat TB in all of its forms, from TB infection to drug sensitive disease, to drug-resistant disease.

And we need tools that work for all kinds of people who get TB, including people living with HIV, children, pregnant women, people who use drugs and other key populations that too often are left behind and left out of research efforts.