India Needs Innovative Strategies to Eliminate TB

India Needs Innovative Strategies to Eliminate TB

Context

  • TB continues to kill more people annually than any other infectious disease, surpassing even COVID-19 at its peak.
  • There is still no effective vaccine for adolescents and adults more than a century after the first TB vaccine.
  • India carries one of the world’s highest TB burdens with incidence ranging between 200 and 300 per 100,000 population.
  • Elimination requires reducing incidence to 10 to 20 per 1 lakh, a threshold that demands sustained public health investment.

Understanding the Disease

  • Once exposed, individuals may remain asymptomatic for years or develop subclinical disease with minimal symptoms.
  • Pulmonary TB (PTB) is the infectious form driving transmission while Extrapulmonary TB (EPTB) affects other organs and is harder to diagnose.
  • EPTB is the hidden burden of the epidemic which is frequently missed and associated with significant suffering and mortality.
  • A single vaccine preventing all forms of TB is unrealistic given the diversity of disease pathways.

PreVenTB Trial: A Breakthrough

  • ICMR conducted the PreVenTB trial across 18 sites in India involving more than 12,700 household contacts of TB patients.
  • Two vaccines were evaluated i.e. VPM1002 developed by SIIPL and Immuvac developed by Cadila, in a real-world high-risk population aged six years and above.
  • Key Efficacy Findings:
    • VPM1002 showed 50.4% efficacy against EPTB, a statistically significant and clinically meaningful result.
    • 64.6% efficacy of VPM1002 in children aged 6 to 14 years against all forms of TB.
    • Immuvac showed over 60% efficacy against EPTB in children aged 6 to 10 years.
    • No other TB vaccine trial till date has studied efficacy against EPTB or included it as an efficacy endpoint.

Way Forward

  • India needs a layered approach combining early detection, preventive therapy, targeted vaccination and nutritional supplementation.
  • Targeted deployment of VPM1002 and Immuvac among household contacts and school-age children can deliver immediate tangible benefits.
  • Waiting for a perfect vaccine will delay progress indefinitely when robust real-world evidence already exists today.
  • TB elimination requires sustained public health investment and political commitment not just scientific breakthroughs.
About TBTuberculosis (TB) is a bacterial infectious disease caused by Mycobacterium tuberculosis, mainly affecting lungs.TB spreads through airborne droplets when infected persons cough, sneeze, or spit infectious particles.TB is preventable and curable with timely diagnosis and proper antibiotic treatment adherence.Two types include Pulmonary TB affecting lungs and Extrapulmonary TB affecting other organs.Treatment and Drug ResistanceStandard TB treatment lasts 4–6 months, requiring strict adherence to avoid relapse and resistance development.Multidrug-resistant TB (MDR-TB) shows resistance to isoniazid and rifampicin, requiring second-line drugs.Extensively drug-resistant TB (XDR-TB) is more severe with limited effective treatment options available.New regimens like Bedaquiline-based oral therapy improve treatment success and reduce patient burden.
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