Marking the beginning of a new chapter in the fight against TB, the world is on the brink of what could be one of the most important advances in public health since the discovery of antibiotics against TB.
In TimesLIVE, Health Minister Aaron Motsoaledi and Shenaaz El-Halabi, WHO country representative, South Africa, unpack the major implications of the vaccine following the first national TB vaccine preparedness workshop hosted by South Africa.
They write:
After more than 100 years of relying on the BCG vaccine, which protects young children against TB, but does little to prevent the disease in adults, we are closer than ever to introducing the world’s first effective TB vaccine for adolescents and adults. This could become a reality as early as 2028.
For a country that continues to carry one of the world’s highest burdens of TB, this is not only scientifically exciting, it’s a matter of national urgency. The WHO estimates that a TB vaccine that is 50% effective could prevent up to 76m people from developing TB and 8.5m deaths globally over 25 years.
These are not abstract numbers, but represent real lives and will have an immeasurable economic and social impact.
The Covid-19 pandemic taught us many things about urgency, innovation and partnership. In South Africa, we mobilised rapidly, drawing on both public and private sector strengths to secure and distribute vaccines.
But one of our most important lessons was that scientific progress alone is not enough. Trust, clear communication, early community engagement and vaccine access are just as critical.
As we look ahead to a future TB vaccine for this new population, we must ensure that our readiness includes not only the technical systems, but also the preparedness for policy, financing and procurement, as well as the social infrastructure needed for confidence, acceptance and uptake.
This time, we have a window, however brief, to prepare intentionally and inclusively. That is why we brought together policymakers, scientists, regulators, civil society and community leaders for this event in Johannesburg.
Our aim was to begin building the foundation needed to ensure South Africa is ready to evaluate, approve, communicate and ultimately deliver a TB vaccine when the time comes.
This national workshop was the first in a series of engagements to strengthen TB vaccine decision-making and delivery systems in South Africa.
The event focused on:
• Assessing South Africa’s readiness for future TB vaccine introduction, including health system, regulatory, policy, financial and community-facing aspects;
• Identifying critical knowledge and evidence gaps that must be addressed now to enable timely and informed decision-making when an effective vaccine becomes available;
• Fostering collaboration across government, scientific and community stakeholders to prepare the regulatory, policy and programmatic pathways needed for vaccine introduction;
• Engaging in critical conversations about financing and prioritisation – including where the resources for TB vaccine introduction might come from – and which populations should be prioritised based on need, risk and potential impact;
• Beginning to outline national priorities and recommendations that can inform a future road map for effective TB vaccine adoption and scale-up in the context of other TB prevention tools; and
• Moving from political will to implementation readiness, including commitment from the government to introduce, finance and roll out novel TB vaccines to those who need it the most. South Africa’s leadership in this space will provide momentum to the collaboration with WHO to bring global solutions to the G20 ministerial event in November.
This workshop was not the final word. Rather, it was the first of many steps we must take as a country to ensure that when science delivers safe and effective TB vaccines for adults and adolescents, we are ready to offer them to the people who need them most.
When asked about the potential impact of a TB vaccine, Professor Lee Fairlie, South African co-principal investigator of an efficacy trial for a prominent TB candidate, recently noted: “If successful, these new vaccines will be a game-changer for TB prevention, especially in communities of highest need. Reducing or eliminating the need for TB preventive treatment, often in capacity-constrained environments where adherence is challenging, would be revolutionary.”
Her words remind us that the opportunity before us is not just scientific. It’s human, social and profoundly transformative, if we get it right.
The trial, with roughly 60% of its 20 000 participants enrolled from South Africa, is not only a testament to our scientific leadership, but also to the critical contribution of communities who continue to shoulder the burden of TB and show their willingness to be part of the solution.
Introducing a TB vaccine for adults and adolescents would be a transformative step forward; one that builds on the momentum of our national TB strategic plan (2023-2028), supports the integrated vision of the national strategic plan for HIV, TB and STIs, and brings us closer to achieving the goals of the WHO end TB strategy.
But success will require more than science.
It will demand planning, policy coherence, community engagement and sustained investment in the mechanisms that will make vaccine access possible.
Since the expanded programme of immunisation was introduced in 1974, vaccines are estimated to have saved 154m lives.
However, vaccines do not save lives on their own – vaccination does. And vaccination requires trust, information and systems that leave no one behind.
We gathered in Johannesburg for this workshop with humility, urgency and hope. Hope that we can finish what BCG started a century ago, urgency to build a path that allows us to act swiftly when the time comes, and humility to know that we will only succeed if we listen to and work with those most affected.
This is the beginning. The first of many steps and many more conversations to come.
TimesLIVE article – SA moving closer to producing adult TB vaccine (Restricted access)
See more from MedicalBrief archives:
Landmark TB vaccine trial kicks off in SA
SA in five-country trials for drug-resistant TB treatment
TB diagnoses reached record high last year – WHO report
Century-old BCG vaccine prevents TB in children, not adults – Boston meta-analysis