Vaccine Development, Refugee Screening, & Sustaining Support for TB Programs
TB Tidbits News Scan, July 31, 2023
On The Heels of Historic Commitment to Vaccine Development, Partnership Questions Remain Unresolved
On June 28th, The Bill & Melinda Gates Foundation announced their commitment to help fund the Phase III trial of the M72 TB vaccine, making it the organization’s largest ever investment in a single product. The $400 million expenditure is essential to ensuring that the third phase of the vaccine trials is sufficiently supported. Even if the vaccine clears its Phase III trial, however, success is not guaranteed. While nonprofit donations will cover the trial's funding and logistics, securing regulatory approval and operationalizing drug distribution will require support from a commercial partner. Indian pharmaceutical firms could become commercial partners for the M72 vaccine, given their track record of investing in vaccines for low and middle-income countries, though no firms have stepped forward to date.
Rethinking Ukrainian Refugee Screening
Although Ukraine has consistently reported a high number of TB case in recent years, the Ukraine-Russia conflict, which has resulted in a staggering 8 million refugees since 2022, has exacerbated the challenge. Yet, despite the likelihood that many of these Ukrainian refugees could bring the disease with them into other countries, in April of 2022, the European Centre for Disease Prevention and Control (ECDC) and the WHO released a joint statement concluding that universal TB screening of incoming Ukrainian refugees was not recommended.
Challenging this guidance, in 2022, the French TB control network (CLAT) began actively screening migrants arriving from Ukraine. As part of this initiative, they conducted a survey to gauge the number of TB positive cases recorded amongst people arriving in France between February and October 2022. Survey data revealed a TB positive rate of 116 per 100,000 among the screened population, which is higher than the average within Ukraine. These findings call into question the previous ECDC/WHO recommendation and suggest that universal screening of Ukrainian refugees arriving in European countries may be warranted.
Recent Outbreak Demonstrates the Importance of Sustaining Support for TB Programs
Five Inuit communities in Northern Quebec's Nunavik region are experiencing TB outbreaks, with 58 cases already reported in 2023. Historically, Inuit communities have struggled with Tuberculosis. Most recently, in 2022, an outbreak was identified in Nunavut, another Inuit region in Canada. But outbreaks have plagued Inuit communities for decades. In fact, TB was the leading cause of death among the Inuit in 1952, infecting about one third of the population in the 1950s. Many Inuit who had TB during this period were sent to sanatoriums in southern Canada for treatment. The 1970s saw a mass campaign to combat the disease, with healthcare providers visiting Inuit communities to provide screening and treatment; when the rates of infection began to decline, however, the campaign was discontinued and, unfortunately, TB rates in Inuit communities began to rise again.
In 2018, average annual TB rates among Inuit were 290 times higher than non-indigenous Canadians. While broader social determinants of health are a major contributing factor to the outbreaks and higher rates of infection, actions taken by public health officials can have an impact of reducing the prevalence and burden of the disease. The lessons from Inuit history demonstrate the importance of sustaining support for continuous screening and treatment programs, even as infection rates are in decline.