A golden era of tuberculosis vaccines is coming – but is the world ready?

For over a century the world has been waiting for a new vaccine for one of the deadliest infectious diseases – tuberculosis, or TB. Each year TB claims over a million lives, with more than 10 million people falling ill from the disease annually.

Contrary to popular belief, particularly in high income countries, TB is not a disease of the past. It remains the world’s biggest infectious disease killer, causing more deaths than malaria and AIDS combined. Having received the BCG vaccine for TB as a child, most might think they are protected against TB. But this is far from the reality.

While still widely used around the world, the BCG vaccine does not provide adequate protection for those most at risk. Though it provides good protection for young children against severe forms of the disease, its effects wane over time and offer little protection for adults and adolescents, who account for most TB cases. Its effectiveness also varies dramatically by region, likely due to environmental exposure to non-tuberculosis forms of the bacteria.

Despite the evident urgent need, vaccine development for TB has long been neglected. The BCG, the only vaccine we have, will mark its 105th birthday next year.

There is a new era of TB vaccine approaching – multiple new vaccine candidates are currently in the pipeline. Many of these vaccines are aiming to meet the World Health Organization’s preferred product characteristics of protecting adults and adolescents, offering longer protection duration, as well as improved safety and efficacy for this group. They range from vaccines using an inactive, or live but harmless, form of the bacteria to mRNA vaccines, among others. Together, these vaccines have the potential to transform our ability to respond to and reduce cases, putting us on the pathway to elimination.

We still have to wait for the clinical trial results. However, if all goes to plan, we could see at least one of these vaccines delivered to affected communities by the early 2030s. So we need to get ready now.

Work needs to start now to make sure that, for any TB vaccines that are approved, they are deployed effectively so they reach the countries and the people who need them most. We need pathways to financing and delivering these potentially game-changing vaccines to be in place, in good time, in the countries where they can have the most impact.

Countries are facing difficult decisions around priorities for global health at a time of global political instability. Funding cuts in global health and overseas aid have forced countries to prioritise resources for urgent needs like outbreak response and provision of medicines. Budgets for national TB programmes, focused on diagnosing and treating cases, are already stretched to their limits. This leaves little to no headroom to finance vaccines that, however effective, will take time to save lives and save money at scale.

Even if TB is prioritised, getting a vaccine to affected communities presents a number of challenges. TB is most prevalent in low- and middle-income countries. These are countries that already have conflicting demands on resources.

Middle-income countries don’t qualify for support from Gavi, the Vaccine Alliance. As a result, they cannot rely on the organisation for vaccine access and distribution. However, while they could face challenges accessing doses, these countries are also well placed to play a leading role in developing new, innovative financing mechanisms. This will drive a shift to enable them to procure more affordable vaccines at scale.

The challenge of ensuring accessible and equitable delivery of TB vaccines in countries with the greatest need is what the World Health Organization’s TB Vaccine Accelerator Council was set up to solve. Composed of technical and strategic working groups, one of its aims is to support countries to prepare for the arrival of new TB vaccines for adults and adolescents, and solve challenges they may face in introducing one.