The global status of MDR- and XDR-tuberculosis (TB) infection is considered a public health crisis. The United Nations Global Plan to End TB 2023–2030 is considered a blueprint of priority actions and resources needed to end TB. This plan builds upon the previous edition for 2018-2022. The plan emphasizes the need for a rights-based, people-centered approach and is focused on prevention as a public health priority along with universal access to TB care. The projected impact of the Global Plan is to:34
- Successfully treating 50 million people with TB
- Successfully treating 3.3 million people with drug-resistant TB
- Providing TB preventive therapy for at least 35 million people
- Increasing global investment in TB prevention, diagnosis, treatment, and care
- Increasing global investment in TB research and development
- Member states committing to taking concrete actions
- Global target: End TB by 2030
Drug-resistant infection (MDR- and XDR-TB) requires a greater effort to improve healthcare facilities, create new diagnostic methods, develop new anti-TB drugs, and develop vaccines. Although newer molecular testing methods are rapid and specific for MTB/rifampin (RIF) resistance, the cost is prohibitive in particular developing countries; pharmaceutical companies are reluctant to support new antimicrobial products they expect will not be lucrative. Vaccine development remains the only hope of eradicating selective antimicrobial resistance, which has precipitated the transmission of quasi-incurable strains of MTB.
TB Vaccine Initiatives
For years, BCG has been the only licensed vaccine for the prevention of severe forms of TB disease in children living in high-burden countries. Recently, the M72/AS01E vaccine, a highly promising candidate, has been allowed to enter Phase II trials addressing the adult population. This promising vaccine candidate comprises an immunogenic fusion protein M72 derived from two MTB antigens (MTB32A and MTB39A) combined with a GlaxoSmithKline proprietary adjuvant.
The TuBerculosis Vaccine Initiative, funded by European countries, non-governmental organizations, The Gates Foundation, and private individuals have supported the research and development behind new vaccines. MVA85A, once a highly promising TB vaccine, is now being reworked (trials ran from 2009 to 2019 and results were disappointing, according to Brazier and McShane, 2020).35,36 Although the MVA85A TB vaccine trial did not improve protection (when combined with BCG) against M. tuberculosis, other vaccine candidates, such as M72/ASO1E, are highly effective in clinical trials. Other promising vaccine candidates include VPM1002 and H56:IC31. No fewer than 18 vaccine candidates are currently in different stages of development.
