Vaccines (and novel treatments) for Tuberculosis are being worked on, it’s just a very challenging disease (there was a recently reported one from GSK using a recombinant protein with three-year coverage that had ~50% efficacy). Some of my colleagues are working on viral vectors for treatment and vaccination of TB, especially in children. The WHO publishes a Global TB report every year, which includes updates on vaccine development.
I would say it is also somewhat complicated by location. The incidence is low enough in the United States, for example, that the strategy focuses on public health control strategies (Vaccination can also interfere with testing and BCG isn’t as effective for the adult form anyway) and treatment. So there is less federal support for vaccine development compared to other control strategies.
This issue isn’t exclusive to human tuberculosis, either. M. bovis and M. avium psuedotuberculosis also have similar challenges with prevention and control in food animal species.
A good book to read is “Everything is Tuberculosis “ by John Green. (Among other things, he wrote A Fault in Our Stars) He’s been researching and advocating for wiping out tuberculosis for a while. Good read for a layman and gives some history and what can be done with treatments available today.
In simple terms, there havent been a better option.
So while it is fantastic for children, and not that great for adults, it’s still the best option we have, with it being cheap to produce, wide spread, making it very available, but a replacement must be both as safe or safer, and have a greater effectiveness.
And while there has been development, TB as a disease is… Strange, due to the immune response is poorly understood, due to a variety of reasons, an example is that the vaccine have different effectivity depending on who gets the shot where.
As far as I understand it, TB requires a strong T-cell response, which is harder to do, since they are also harder to study, more so since TB can exist in you latent for days, weeks, months, years, and inducing a immune response in a latent disease is… Very Difficult.
And there are what a few dozens developed, I know only of two of them to any degree of familiarity, and even that is surface level, one one them is an adult BCG vaccine, as in its more effective in adults, but its not really a replacement since it still uses the BCG as a base.
Now, the BCG vaccine was made from a cow with TB, but that was cow TB, and there is an attempt to use the same TB humans get, but the problem there is that it wont work for immunocompromised people, which animal-based vaccines avoid, but has chances of being way better, but studies gonna take quite some time, mostly due to red tape.
However I see more in, well it’s not a vaccine per say, but ya know how some people are immune or resistant to this and that disease due to genetics? But yeah, dna markers or whatever its called, figuring out how to share that would be absolutely huge, since that would mean a breakthrough in straight up curing several diseases, HIV being the big one, then there is Malaria, Norovirus, prion disease, cholera, hepatitis b, adn even covid-19.
So while the norovirus aint all that bad compared to the others, ya know, being just a stomach virus, being able to cure one, or at least immunize against it, would be HUGE.
TB researcher here. TB is fascinating because it acts both as an infectious disease and an autoimmune disease in ways. The people with the worst disease either have (a) no immune system and can’t respond to the bug, or (b) a strong healthy immune system which kills most of the bugs but also destroys a lot of normal tissue.
So stimulating the immune response against TB in the case of B may not actually help the patient and in fact may make disease worse. My lab worked on a class of drugs called “host directed therapy” for TB, which are treatments targeted toward modifying the immune response to the bacteria.
It is a super fascinating and challenging disease for sure.
TB is a tough pathogen to target since it evades the immune system in ways we still don’t fully understand.
We also lack clear markers to guide vaccine development.
Animal models often fail to predict how vaccines will work in humans.
Finally, clinical trials need to be large, long, and done in high-burden settings, which makes them expensive and logistically challenging particularly given that TB research has long been underfunded compared to other global health priorities.
Comments
Vaccines (and novel treatments) for Tuberculosis are being worked on, it’s just a very challenging disease (there was a recently reported one from GSK using a recombinant protein with three-year coverage that had ~50% efficacy). Some of my colleagues are working on viral vectors for treatment and vaccination of TB, especially in children. The WHO publishes a Global TB report every year, which includes updates on vaccine development.
I would say it is also somewhat complicated by location. The incidence is low enough in the United States, for example, that the strategy focuses on public health control strategies (Vaccination can also interfere with testing and BCG isn’t as effective for the adult form anyway) and treatment. So there is less federal support for vaccine development compared to other control strategies.
This issue isn’t exclusive to human tuberculosis, either. M. bovis and M. avium psuedotuberculosis also have similar challenges with prevention and control in food animal species.
A good book to read is “Everything is Tuberculosis “ by John Green. (Among other things, he wrote A Fault in Our Stars) He’s been researching and advocating for wiping out tuberculosis for a while. Good read for a layman and gives some history and what can be done with treatments available today.
https://www.johngreenbooks.com/everything-is-tuberculosis
In simple terms, there havent been a better option.
So while it is fantastic for children, and not that great for adults, it’s still the best option we have, with it being cheap to produce, wide spread, making it very available, but a replacement must be both as safe or safer, and have a greater effectiveness.
And while there has been development, TB as a disease is… Strange, due to the immune response is poorly understood, due to a variety of reasons, an example is that the vaccine have different effectivity depending on who gets the shot where.
As far as I understand it, TB requires a strong T-cell response, which is harder to do, since they are also harder to study, more so since TB can exist in you latent for days, weeks, months, years, and inducing a immune response in a latent disease is… Very Difficult.
And there are what a few dozens developed, I know only of two of them to any degree of familiarity, and even that is surface level, one one them is an adult BCG vaccine, as in its more effective in adults, but its not really a replacement since it still uses the BCG as a base.
Now, the BCG vaccine was made from a cow with TB, but that was cow TB, and there is an attempt to use the same TB humans get, but the problem there is that it wont work for immunocompromised people, which animal-based vaccines avoid, but has chances of being way better, but studies gonna take quite some time, mostly due to red tape.
However I see more in, well it’s not a vaccine per say, but ya know how some people are immune or resistant to this and that disease due to genetics? But yeah, dna markers or whatever its called, figuring out how to share that would be absolutely huge, since that would mean a breakthrough in straight up curing several diseases, HIV being the big one, then there is Malaria, Norovirus, prion disease, cholera, hepatitis b, adn even covid-19.
So while the norovirus aint all that bad compared to the others, ya know, being just a stomach virus, being able to cure one, or at least immunize against it, would be HUGE.
TB researcher here. TB is fascinating because it acts both as an infectious disease and an autoimmune disease in ways. The people with the worst disease either have (a) no immune system and can’t respond to the bug, or (b) a strong healthy immune system which kills most of the bugs but also destroys a lot of normal tissue.
So stimulating the immune response against TB in the case of B may not actually help the patient and in fact may make disease worse. My lab worked on a class of drugs called “host directed therapy” for TB, which are treatments targeted toward modifying the immune response to the bacteria.
It is a super fascinating and challenging disease for sure.
TB is a tough pathogen to target since it evades the immune system in ways we still don’t fully understand.
We also lack clear markers to guide vaccine development.
Animal models often fail to predict how vaccines will work in humans.
Finally, clinical trials need to be large, long, and done in high-burden settings, which makes them expensive and logistically challenging particularly given that TB research has long been underfunded compared to other global health priorities.
This being said, there are numerous vaccines in the pipeline and hopes that one/some of them will soon become available: https://newtbvaccines.org/tb-vaccine-pipeline/