Infectious disease in top 10 of all mortality causes worldwide
Tuberculosis (TB) is the world’s deadliest infectious disease and still claims about 4,500 lives each day. This statistic was reason enough for world leaders to increase awareness of TB at the United Nations General Assembly in late September. 'Combating infectious diseases is seldom discussed there', according to Frank Verreck, who is responsible for tuberculosis research at the Biomedical Primate Research Centre (BPRC). ‘Only HIV and Ebola fever have ever been the subject of a high-level meeting at the UN. The fact that TB has now been discussed on the highest level attests to the importance and urgency of this theme.’
The UN’s declaration will hopefully encourage world governments to make the necessary resources for combating TB available. Policy and money are sorely needed to stimulate research into and development of new instruments for prevention, diagnosis and treatment.
Since the World Health Organization (WHO) declared tuberculosis to be a 'global emergency' 25 years ago, science has made progress in various areas, but the pace of development for improved prevention and treatment methods is slow. ‘Not only is the illness complex, but we are also hampered by a lack of money for additional research and development’, explains Frank Verreck. 'TB is an illness that is strongly linked to poverty. As a result, it generally receives limited attention or contributions from the pharmaceutical industry. It is therefore very fortunate that the public sector is now calling for cooperation in the effort against TB.'
Over 1.5 million fatalities per year
For many people in the Netherlands, tuberculosis – formerly known as consumption – seems to be a thing of the past, a matter of little concern to us. Unlike HIV infections, TB is an illness with no public image. It occurs only rarely in western societies such as ours. The better the living conditions and health care are, the less chance there is of active tuberculosis. There are about 1,000 new cases in the Netherlands every year. Because of the strong infrastructure in the Netherlands, any TB outbreak can quickly be suppressed. There is no reason why people should die of the disease, certainly not in high-income countries. In reality, however, someone in the world dies of the consequences of tuberculosis less than every 20 seconds, adding up to over 1.5 million people each year.
On Europe’s doorstep
‘TB can be treated with medicine,’ stresses Frank. ‘That is the positive side of the story. To be honest, though, those drugs usually work quite poorly. In contrast to most bacterial infections, antibiotics for TB must be taken for six months or sometimes even longer. Even then, a complete cure is not guaranteed. The side effects of these drugs can be severe.’
Particularly in countries where living conditions and health care are not up to our standards, long-lasting commitment to this antibiotic treatment is not a given. There is always a danger that the bacteria will develop resistance to the antibiotics. ‘This anti-microbial resistance (AMR) poses an enormous challenge. It is especially alarming that resistance to antibiotics is most often found on the eastern borders of Europe, in places such as Russia and the Baltic states. This threat to Europe is literally around the corner. New antibiotics and alternative therapies are urgently required.’
Prevention is better than cure
To break the vicious circle of infection, illness and proliferation, prevention is better than cure. The Bacillus Calmette-Guérin vaccine (BCG), now nearly one hundred years old, is administered to newborn babies as part of numerous national vaccination programmes. Although BCG saves the lives of an estimated 100,000 children per year in this manner, it falls short at later ages and the epidemic rages on.
Laboratories all over the world have embraced the task of TB vaccine research. The BPRC is playing its part as well. Frank: ‘Clinical research on the effect of new vaccines in humans is costly and slow. The "field capacity" is a limiting factor. Moreover, it is still not considered ethical to attempt experimental infection of humans with such a serious disease, which is so difficult to treat. In contrast to animal testing, the complex interactions between the host and its immune system on the one hand and the pathogen with its escape mechanisms on the other can still not be simulated in laboratory settings. We are trying to improve the efficacy of the BCG vaccine under controlled conditions. In the process, we are investigating what elements of the immune system play a decisive role.’
International tuberculosis conference in The Hague
After the General Assembly of the UN, interest in the battle against TB will soon receive a concrete follow-up in the shape of the 49th Union World Conference on Lung Health in The Hague from 24 to 27 October. Approximately 4,000 experts from more than 125 countries will gather at the World Forum. Prior to this conference, the Netherlands Tuberculosis Fund (KNCV-TB) will organise the TBScience2018 conference in cooperation with other parties. This scientific conference will cover three areas: TB diagnosis, therapy and vaccination. Researchers from three primate centres will speak about the latter subject, among whom Frank Verreck of the BPRC. They will present their most recent results, which constitute an important step forward in TB vaccination research. More information to follow.