The search for better vaccines against TBBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m92 (Published 15 January 2020) Cite this as: BMJ 2020;368:m92
- Barry R Bloom, Joan and Jack Jacobson research professor of public health
- Harvard T H Chan School of Public Health, Boston, MA, USA
Tuberculosis (TB) now causes more deaths than any other infectious disease, including AIDS and malaria, with the greatest toll in low and middle income countries. The World Health Organization estimates that there are annually about 10 million new cases and 1.5 million deaths from TB.1 Multidrug resistance is increasing. Although deaths from TB have fallen substantially over the past 20 years, incidence has been declining only glacially.
The general strategy to control TB has for many years been based on four premises: that people who have TB will be sick; that they will seek and get medical care; that they will be diagnosed and given proper treatment; and that in six months they will be cured. Each of these premises, which are reasonable for developed countries, is challenged in high burden developing countries. For example, in many countries the cascade of care is such that fewer than half of patients with drug sensitive TB are cured; for patients with multidrug resistant TB the …