Investing in global health: Tackling tuberculosis
26 October 2023
By Maya Tabaqchali, Sustainable Portfolio Manager
Please note: This article is designed to be thought leadership content to offer big picture views and analysis of interesting issues and trends that matter to our clients and the world in which we live. It is not designed to be taken as expert advice, investment advice or a recommendation and any reference to specific companies is therefore not an opinion as to their present or future value or broader ESG credentials. Reliance upon any of the information in this article is at the sole discretion of the reader. Some of the views and issues discussed in this article may derive from third-party research or data which is relied upon by Barclays Private Bank and may not have been validated. Such research and data are made available as additional information for the reader where appropriate.
Deaths from tuberculosis, one of the world’s largest infectious killers, are rising after more than a decade of being in decline, as the COVID-19 pandemic reversed years of progress1. Here we discuss the scale of the challenge, and some of the emerging technologies that could help eradicate this devastating disease (and others).
Tuberculosis (TB) is an infection that multiplies in crowds, spreading through the inhalation of tiny droplets lingering in the air2. Outbreaks are difficult to contain, requiring contact tracing, isolation and vaccination programmes. While much of this will sound familiar to us all, having lived through a global pandemic in recent years, unlike its SARS-CoV-2 cousin, this pernicious pathogen has been a persistent feature of life for centuries3.
Mycobacterium tuberculosis, the bacterium that causes TB, launches its first attack on the lungs. A mild fever is often the first sign, followed by the unwelcome arrival of a painful cough and a shortness of breath. If undefeated by the immune system, it can cause pervasive lung damage – and ultimately spread to the skeletal system, the kidneys and intestines, and then finally the brain4.
Source: UN Sustainable Development Goals Report 2022
Reversing 14 years of progress
In 2015, the United Nations (UN) set a target to end the tuberculosis epidemic by 2030, as part of the ambitious Sustainable Development Goals (SDG) agenda5. We are now halfway through this timeline and yet further away from reaching the goal than when we started. The last decade had seen monumental progress towards the eradication of TB, with 2019 marking an all-time historic low in global TB mortality. However, in 2020, the spread of COVID-19 consumed global health resources, diverted scientific and political attention, and paved the way for TB to make its comeback6.
The latest annual TB report published by the World Health Organisation (WHO) estimates that TB killed 1.6 million people in 2021, a death toll last seen in 2005, effectively reversing 14 years of progress7. The 2020 survey results of Global Fund-supported programmes across 106 countries showed that, since the emergence of the COVID-19 pandemic, 80% of TB programmes worldwide reported disruptions in services as a result of lockdowns and supply chain difficulties8. A delay in TB diagnosis can lead to an increased severity of the disease, while interruptions to TB treatment can lead to the deadly development of drug-resistant strains – both of which further compound the problem9.
While the impact of TB is currently felt most acutely in lower-income countries, which account for 80% of cases, as people migrate and wars displace refugees, strains of TB, in particular the highly drug-resistant variants that are immune to vaccines, are beginning to emerge in the West10.
Source: World Health Organisation 2000-2021
Can we save the SDGs?
The trifecta of the COVID-19 pandemic, a devastating war in Ukraine and a deepening climate emergency has reversed years of global sustainable development across the SDGs more broadly. The UN’s Sustainable Development Goals 2022 report revealed that more than four years of progress against poverty have been erased, with millions more people now living in extreme poverty and suffering from increased hunger compared to pre-pandemic levels11.
The report also showed a stark worsening of inequality both within and between nations, with women disproportionally affected by the increased burden of unpaid work. Additionally, we’re witnessing the highest number of conflicts concurrently since the creation of the UN, with two billion people estimated to live in conflict-affected regions12. And all the while, climate change is acting as a “crisis multiplier”, further escalating poverty, hunger and inequality13.
Despite the scale of the challenges, the solutions humanity so desperately needs could still be in reach, thanks to the transformative potential of science and technology. Indeed, we witnessed extraordinary innovation as the world grappled with an unprecedented global health emergency. Despite the typical vaccine production timeline being between 10-15 years, we saw the development of multiple high-quality COVID-19 vaccines in the record-shattering time of less than one year.
While mRNA vaccinology may seem like it came out of the blue, like the emergence of many ground-breaking discoveries of recent years, it really owes its success to decades of foundational research. If the pandemic showed us anything, it’s that patient, forward-thinking investment into the world’s most innovative companies can work.
Building better diagnostics
Effectively overcoming the rising number of TB cases, starts with better diagnostics. We need to move from a global public health model that relies solely on passive case finding, where those affected are required to self-report when they have symptoms, to a model of both passive and active case finding, where diagnostic capabilities are taken into the community to seek out those infected. This is far more equitable and allows for earlier detection of TB, which in turn allows for earlier treatment and helps to limit the spread of the disease14.
This kind of community-based active diagnostics has only been made possible in recent years with the breakthrough of portable testing devices. Access to best-in-class molecular diagnostics had previously been limited by the systems needed to run them. However, through the automation of highly complex and time-consuming manual procedures, the most vulnerable populations can now access high-quality, battery-operated devices that can provide accurate and fast diagnosis, even in hard-to-reach areas with limited electrical supply.
Once diagnosed, patients need access to antibiotics capable of fighting the pathogen effectively. This can be difficult, given the prevalence of drug-resistant TB strains that are immune to existing treatments. Typical drug development timelines can also range from between 10-15 years, making it incredibly challenging to respond to the mutating pathogen.
Revolutionising drug development
However, the technological progress unfolding in this area is particularly exciting and has the potential to revolutionise the drug development landscape. Cheap gene sequencing, combined with cheap computing, has enabled advances in mRNA technology, synthetic biology, stem-cell therapy and the development of CRISPR gene editing15. Scientists are able to study the molecular composition of a pathogen and strategically design drugs that target weak points. This expedites the drug discovery process, particularly when using machine learning, and has the potential to be far more effective, and so shortening the time drug regimens are needed.
Vaccines are another area seeing monumental progress. The only licensed vaccine for use against TB today – the BCG vaccine – was first developed over 100 years ago. Although known to provide moderate protection against TB in infants and young children in some countries, it is less effective in areas with high incidence of the disease and it is ineffective in preventing TB in adults16. Building on the success seen during the pandemic, we have entered a golden age of vaccine technology. In the year 2000, we had no new TB vaccines in development, but today there are 14 promising vaccine candidates currently in clinical trials, a number of which the WHO expects to be ready in the coming years17. A new, more effective vaccine that provides immunity to all age groups would be a game-changer for TB eradication, providing the antiviral weaponry we need to contain the spread of multi-drug resistant TB effectively.
In innovation we trust
Eradicating TB is within reach if capabilities are harnessed. To put the global decline in TB incidence back on track, we need better tools for prevention, diagnosis and treatment. Although government action and global co-operation are undoubtedly critical in the sustainable development toolbox, technological advancement is the workhorse that will deliver the solutions humanity needs at this important juncture. We’ve said it before, and we’ll say it again: in innovation we trust.
Related articles
Disclaimer
This communication is general in nature and provided for information/educational purposes only. It does not take into account any specific investment objectives, the financial situation or particular needs of any particular person. It not intended for distribution, publication, or use in any jurisdiction where such distribution, publication, or use would be unlawful, nor is it aimed at any person or entity to whom it would be unlawful for them to access.
This communication has been prepared by Barclays Private Bank (Barclays) and references to Barclays includes any entity within the Barclays group of companies.
This communication:
(i) is not research nor a product of the Barclays Research department. Any views expressed in these materials may differ from those of the Barclays Research department. All opinions and estimates are given as of the date of the materials and are subject to change. Barclays is not obliged to inform recipients of these materials of any change to such opinions or estimates;
(ii) is not an offer, an invitation or a recommendation to enter into any product or service and does not constitute a solicitation to buy or sell securities, investment advice or a personal recommendation;
(iii) is confidential and no part may be reproduced, distributed or transmitted without the prior written permission of Barclays; and
(iv) has not been reviewed or approved by any regulatory authority.
Any past or simulated past performance including back-testing, modelling or scenario analysis, or future projections contained in this communication is no indication as to future performance. No representation is made as to the accuracy of the assumptions made in this communication, or completeness of, any modelling, scenario analysis or back-testing. The value of any investment may also fluctuate as a result of market changes.
Where information in this communication has been obtained from third party sources, we believe those sources to be reliable but we do not guarantee the information’s accuracy and you should note that it may be incomplete or condensed.
Neither Barclays nor any of its directors, officers, employees, representatives or agents, accepts any liability whatsoever for any direct, indirect or consequential losses (in contract, tort or otherwise) arising from the use of this communication or its contents or reliance on the information contained herein, except to the extent this would be prohibited by law or regulation.