TB war needs backers without profits as sole focus

TB vaccine expert Professor Willem Hanekom said the world would never control the disease without manufacturing partners not focused entirely on profits.

Hanekom is an executive director at the Africa Health Research Institute (AHRI) and co-national principal investigator with Professor Lee Fairlie from the University of the Witwatersrand Reproductive Health and HIV Institute (Wits RHI) in a search for a new vaccine.

Hanekom gave a public lecture recently at the Nelson R Mandela School of Medicine entitled Defeating SA’s Biggest Killer: The Quest for a New TB Vaccine.

He said what could be the first new TB vaccine in 100 years was currently undergoing clinical trials.

He said the M72 vaccine had the potential to be a game-changer for TB control globally.

One of the things that set it apart was the fact it could be used in adolescents and adults, not restricted to infants.

He said he was optimistic about the vaccine, but was concerned about its availability. “This is critical work: it is clear from modelling studies that if we do not have an effective vaccine that prevents TB in adolescents and adults ‒ as BCG (the Bacillus Calmette-Guérin vaccine) does in babies – we will not control the TB epidemic,” said Hanekom.

He said there was a significant population for which they did not have any data, such as elderly people at high risk: “People exposed to dust in the mines and those living with HIV without getting treatment.”

He also said they did not have money to develop the number of candidates needed to ensure success.

“We need more candidates. We need resources in the TB vaccine space to be able to develop many vaccines,” he said.

Hanekom said the traditional big-name manufacturers focused on profit margins and interventions that applied to “high-resource evaluations where they can make profits” and they were exploring the possibility of working with manufacturers from developing countries.

Specialist pathologist (forensic) and lead researcher at AHRI, Professor Threnesan Naidoo, said their research programme had uncovered the entire clinical continuation of TB, including active and post-infection.

“We have been fortunate in KwaZulu-Natal to get the tissue from patients with their consent and work with it,” he said.

Although the tissue is not easily available Naidoo said it was necessary to study it.

He said the Albert Luthuli Hospital had “an innovative programme where patients with advanced TB undergo surgery to remove the affected lung with great success. These patients do very well”.

The patients underwent surgery when TB was at such an advanced stage that the damaged lung had to be removed or the volume of blood being coughed up was life threatening.

He also said TB could affect other organs and that people could be infected multiple times.