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Tuberculosis (TB) research and innovation is essential to achieve global TB targets for reductions in TB incidence and TB deaths. The targets of the WHO End TB Strategy (1), adopted in 2014, required a global rate of decline in TB incidence of 17% per year between 2025 and 2035, compared with a baseline level of 2% per year in 2015. The rate of decline needed to reach 10% per year by 2025 – the fastest achieved at national level, historically. It was recognized that such an unprecedented rate of decline from 2025 would require a major technological breakthrough by 2025, such as a new TB vaccine that is effective both before and after exposure to infection (2). For this reason, “Intensified research and innovation” is the third pillar of the End TB Strategy.
Building on the End TB Strategy, Member States adopted a Global Strategy for TB research and innovation in 2020 (3). This calls for strong and sustained research efforts to accelerate the development of more accurate and affordable rapid point-of-care tests for diagnosing TB infection and TB disease and for detecting drug resistance; shorter, safer regimens for treating TB infection and TB disease, especially drug-resistant TB; a TB vaccine that is effective before and after exposure across a range of age groups; and strategies to optimally scale-up effective interventions.
Between 2018 and 2022, research and development has resulted in changes to WHO guidelines for TB prevention, screening, diagnosis, and treatment. New recommendations include: shorter treatment regimens of 4 months for children and adults with drug-susceptible TB disease and 6 months for people aged 14 and above with rifampicin-resistant and multidrug-resistant TB (MDR/RR-TB) disease, as well as a new 6-month regimen for children and adolescents with TB meningitis; a regimen of one-month for TB preventive treatment; and new tests for TB infection and disease (4).
The 2018 political declaration of the high-level meeting of the General Assembly on the fight against TB (5) included the first globally-agreed funding target for TB research of US$ 2 billion per year, for the period 2018–2022. The political declaration of the second UN high-level meeting on TB, held on 22 September 2023 (6), has established an even more ambitious target: that funding should reach US$ 5 billion annually by 2027.
Although funding for TB research and innovation has been slowly increasing (Fig. 6.1), the latest published data show that only US$ 1 billion was available in 2021 (7). In that year, most of the funding came from the public sector (70%), followed by philanthropy (14%), the private sector (10%), and multilateral agencies (6%). To close the funding gap, stakeholders, including governments, the biomedical industry, and other funders of healthcare research together with civil society, should consider testing and implementing innovative models of financing.