Renewed Tuberculosis Research Expands Drug and Vaccine Pipelines

A coordinated effort between public and private sectors is driving the largest drug and vaccine pipeline in history to combat tuberculosis (TB), an infectious disease that routinely ranks as a leading cause of death globally. After decades of stagnation, renewed research and development are expanding the available candidates to bring the epidemic under control.

In 2024, tuberculosis caused 1.23 million deaths worldwide. The disease is caused by Mycobacterium tuberculosis, which infects approximately 25% of the global population, with 5% to 10% of those infected developing symptomatic disease.

The Current Drug Pipeline

There are currently 29 candidates in clinical development. This pipeline includes 18 new chemical entities or next-generation candidates and eight repurposed drugs.

three approved drugs are being utilized in trials specifically aimed at shortening the duration of TB treatment.

The primary goals of these pharmaceutical developments are to shorten the duration of treatment, reduce the toxicity of the medication and ensure that the resulting treatments remain affordable for the communities most affected by the disease.

Vaccine Development Progress

Vaccine research is seen as a critical component for success in global TB control. There are currently 16 vaccine candidates in development.

A phase 3 trial of M72/AS01E is currently leading the effort to introduce the first new vaccine class in 100 years. Other vaccine candidates are currently in phases 2b and 3 of clinical trials.

Global Strategy and Public Health Context

The World Health Organization (WHO) has integrated research and innovation as one of the three pillars of its End TB Strategy, which was adopted by Member States in 2014. The strategy aims for significant reductions in the TB disease burden by 2035, specifically targeting a 90% reduction in the TB incidence rate and a 95% reduction in deaths compared to 2015 levels.

The WHO notes that achieving these targets will require substantial technological breakthroughs, particularly the widespread availability and use of a new TB vaccine.

Member States have reinforced these goals through several international agreements and declarations, including:

• The Moscow Declaration to End TB in 2017
• The Global Strategy for TB Research and Innovation in 2020
• Political declarations from United Nations high-level meetings on TB held in 2018 and 2023

These frameworks emphasize the necessity of strengthened research efforts and increased investment to overcome the historical underinvestment in TB, which has been perpetuated by the fact that the disease burden falls heavily on lower- and middle-income communities.

a very promising full pipeline

Bern-Thomas Nyang’wa, medical director of the Médecins Sans Frontières Operational Centre Amsterdam

The current landscape of TB research involves a diverse community of researchers and funding bodies, including the Bill & Melinda Gates Medical Research Institute, which focuses on therapeutics development to address the lack of commercial draw typically associated with TB treatments.