Health experts pin their hopes on long-awaited trials into a new potential vaccine for tuberculosis.
In the few minutes it takes to read this article, some 15 people are likely to have died from humanity’s worst infectious killer disease. Over the course of the day, the toll will be around 3,600.
The victims are likely to have died slowly, spending months or years coughing and wasting away as their lungs were relentlessly weakened.
Those victims are also all likely to have been poor and from the developing world, or middle income countries.
The killer is not an exotic new superbug, or recently-emerged virus, but one of the world’s oldest pandemics, caused by a bacterium which has plagued humanity for an estimated 40 millennia.
Locked in a constant arms race against human immune systems, the bug has in that time evolved into a stubborn, stealthy and difficult-to-stop killer.
Some 10.6m people fell ill with tuberculosis, or TB, in 2022 and 1.5m people died, which is an average of 2.5 deaths per minute.
At the height of the Covid-19 pandemic, tuberculosis was temporarily eclipsed as the biggest infectious killer in the world, but has now reclaimed its top slot.
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The second obstacle has been a lack of funding. As recently as the 1970s and 1980s, there was complacency that BCG and existing drugs were enough to beat TB. That changed with the HIV/AIDS epidemic. As patients’ immune systems were weakened by the new disease, there was a surge in TB.
In South Africa alone, between 1990 and 2019, nearly nine million people developed TB, and 2.1 million lives were lost. HIV caused 55 per cent of those TB cases and 69 per cent of the TB deaths.
Yet the fact that the disease mainly affects developing or middle income countries has meant it has been low priority for donors or pharmaceutical companies in the developed world.
“TB is a disease of the socio-economically dispossessed,” says Willem Hanekom, AHRI’s executive director and principal investigator for the South African trial.“Soci-economic compromise results in immune compromise: the stress, the poor nutrition. That’s why TB is extraordinarily common there. TB is not that common in people who are well fed and happy and well resourced.”