Scientists call for a global strategy for the development of new tuberculosis vaccines
For 80 years there was essentially a lull in tuberculosis research. Indeed, the last scientific breakthrough in 1921, the Bacillus Calmette-Guérin (BCG) vaccine, still forms the central pillar of tuberculosis prevention.
In most cases, immunisation with BCG protects children from the worst forms of the disease, but not against the most common form, pulmonary tuberculosis in adults and children.
The vaccine has therefore not helped to reduce the number of tuberculosis cases. Only since the start of the new millennium has research once again been able to report significant advances in the development of new vaccines and drugs.
There are now a number of promising vaccine candidates. But setbacks still occur: In 2013 the most advanced candidate proved disappointing in a clinical trial with children and in 2015 in a clinical trial with HIV-positive adults. Although several other candidates have passed preliminary clinical tests, BCG will remain the only available vaccine for some years to come.
At the same time, more and more cases of tuberculosis are occurring that are resistant to all drugs currently available. It therefore appears unlikely that the targets set by the World Health Organization (WHO) will be met, namely to reduce the global incidence of tuberculosis by 90 percent and the mortality rate by 95 percent by 2035. “The relentless rise in the number of tuberculosis cases appears to have been halted for the time being, and the incidence of tuberculosis is on a slow decline for the first time in decades. Nevertheless, we need to do a lot more to effectively contain the disease,” says Stefan Kaufmann, Director at the Max Planck Institute for Infection Biology in Berlin and member of several international research networks.
A major obstacle is the enormous cost of tuberculosis research. Even a phase 2 trial, which aims to evaluate efficacy and safety in a relatively few number of patients, costs about 20 million US dollars to run. A large-scale phase 3 trial costs a whopping 100 million dollars. Above and beyond that, ongoing tuberculosis research requires more than 100 million dollars per year. Yet the research and development costs for tuberculosis vaccines pale in significance compared to the financial burden imposed by the disease. According to a study, tuberculosis-related work incapacity and treatment costs the EU five billion euros every year. “We can only meet this financial challenge if public research organizations, industry, governments and non-governmental organizations join forces. At the same time, we need to do everything possible to make research more efficient,” says Kaufmann.
Together with Thomas G. Evans of Aeras and Willem A. Hanekom of the Bill & Melinda Gates Foundation, Kaufman proposes a number of measures for organising tuberculosis research more effectively in future. For example, it must be ensured that only the most promising vaccine candidates progress into subsequent trials. To this end, research institutes around the world must work closely together to coordinate their trials. For instance, they should define standardised targets for trials, compare vaccine candidates directly with each other in trials and establish exact criteria for measuring the protective effect of a vaccine. “In this way substantial costs could be saved. It would also be helpful to harmonise trials on tuberculosis vaccines with trials on tuberculosis drugs and HIV vaccines,” Kaufmann advises.
Considerable costs could also be saved if a way could be found to reduce the number of participants required for trials. One solution might be to conduct trials with subjects from high-risk groups. Individuals from such groups have a higher-than-average likelihood of becoming infected. Thus, the number of patients needed for informative trials could be recruited more quickly.
In addition, molecular tests such as the interferon gamma assay and the tuberculin skin test, which reliably demonstrate tuberculosis infection, could reduce the scope of trials and save money. Trials that measure the efficacy of vaccine candidates on the basis of such tests need fewer subjects. So-called biomarkers could also help identify those individuals in whom a vaccine is effective.
Moreover, the analysis of interim results of ongoing trials can improve their cost-efficiency. In this way, the trials can be quickly adjusted to take into account any new findings obtained, and the number of participants can be increased or reduced accordingly. “Other researchers should also have access to the data and samples from such trials so that future trials can also benefit from them,” says Kaufmann.
Prof. Dr. Dr. h. c. Stefan H.E. Kaufmann
Max Planck Institute for Infection Biology, Berlin
Phone: +49 30 28460-500
Fax: +49 30 28460-501
Stefan H.E. Kaufmann, Thomas G. Evans, Willem A. Hanekom
Tuberculosis vaccines: Time for a global strategy
Science Translational Medicine, 25. Februar 2015
Prof. Dr. Dr. h. c. Stefan H.E. Kaufmann | Max Planck Institute for Infection Biology, Berlin
Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine
Flexible sensors can detect movement in GI tract
11.10.2017 | Massachusetts Institute of Technology
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
17.10.2017 | Life Sciences
17.10.2017 | Life Sciences
17.10.2017 | Earth Sciences