Four years ago, a disease that rarely made headlines — Ebola — raged in West Africa. There was no vaccine, treatment or cure. Though the initial response was slow, the international community ultimately mobilized resources, developed scientific innovations and promised to make sure a tragedy on the same scale would never happen again.
Today, Ebola is back, but the story is changing. The Democratic Republic of the Congo, where I started my career as a physician, is facing the second of two threatening Ebola outbreaks this year, but this time we're better prepared to respond thanks to new tools, including new vaccines. My company, Johnson & Johnson, is among those that accelerated the development of a vaccine and stands ready to deploy it when needed.
Ebola, and HIV before it, shows what can be accomplished once a disease is catapulted to the top of the global agenda. So it is puzzling to me why a far deadlier disease — tuberculosis — has never received this sort of attention and focus from the global community.
TB represents one of the greatest public health emergencies today, and we need to start treating it like one. TB infects a quarter of the planet's population and, to many people's surprise, claims more lives every year than HIV/AIDS — the latter being a testament to the global HIV response. Growing drug resistance has made addressing TB even more challenging, and drug-resistant TB is now the leading cause of deaths due to antimicrobial resistance.
An outdated and inadequate toolbox is largely to blame for the unacceptably high toll of TB. Many of the medicines used to treat TB today are old, ineffective and have harmful side effects. We don't yet have diagnostics that can quickly detect TB, and we desperately need an effective vaccine.
Advancing innovation for TB is inherently difficult and entails risk. Biologically, TB is a complex disease and there is limited scientific understanding of how it develops and how drugs can stop it. TB innovation is also challenging because it primarily impacts people in low-income countries, meaning there have been limited commercial markets — and few financial incentives — for companies to make the necessary investment in new innovations.
The good news is that the tide may be turning. Wednesday, I will join world leaders gathering in New York for a high-level meeting on TB at the United Nations, the first-ever meeting of this kind for the disease. Encouraging the innovation that is so desperately needed must be central to these discussions.
By working in new ways and with new urgency, progress on TB is possible. At Johnson & Johnson, we have been infused with that sense of urgency for over 20 years, investing significantly in the development of a medicine for a form of TB resistant to at least two of the drugs most commonly used to treat TB. This medicine, when it was approved in 2012, was the first TB drug with a novel mechanism of action made available in 40 years.
And just this week, we announced a 10-year initiative to continue investing in TB, in three key ways: continuing to broaden access to our novel MDR-TB medicine, supporting efforts to find the 4 million cases of TB that go undiagnosed every year, and advancing the development of innovative next-generation TB medicines that are urgently needed.
Yet, as the initial Ebola response has demonstrated, the scale of innovation needed to stop a disease threat requires commitment and engagement from across all sectors and disciplines. For TB, it is crucial to prioritize the creation of a robust and sustainable innovation environment, including new incentives and funding mechanisms. Such an environment would bring more of the private sector on board and dramatically accelerate the development of new TB drugs and other innovations for patients.
As needed as new tools are, they can only be effective if systems are in place to deliver them to patients. It is crucial to invest in strengthening regulatory, delivery and health systems around the world. By working together and investing across sectors, gaps can be filled and capacity built.
Inspiring examples come from the leadership of countries most seriously affected by TB. Across the globe, new innovations are having the greatest impact in countries where TB is a national political priority and there is a budget allocation to match.
For example, in July, South Africa became the first country in the world to recommend an injection-free treatment regimen for MDR-TB. This decision, backed by new data, demonstrated the country's strong commitment to ensuring patients received the best care possible. Countries like South Africa are on the cutting edge, setting a high bar for deft, emergency-level TB response. They know that millions of lives are at stake.
The Ebola response set an important precedent. In just a few years, the world has made incredible strides to create new tools, and communities at risk for the disease are seeing the benefits. We must work together to ensure the same is true for TB. I am confident that, with investment, energy and creativity, the world can develop and deliver the innovations we urgently need to get us on the most effective path to make TB history.
—Paul Stoffels, M.D. is the vice chair of the executive committee and chief scientific officer at Johnson & Johnson.