A delegation of African parliamentarians and global health representatives visited the University of Cape Town (UCT) Lung Institute and the South African Tuberculosis Vaccine Initiative (SATVI) on Friday, 15 May, at the Faculty of Health Sciences. The visit was part of an international gathering of African parliamentarians organised by the Global Tuberculosis (TB) Caucus, with support from the South African National AIDS Council (SANAC).
Researchers briefed delegates on the progress of TB vaccine studies, novel diagnostic strategies aimed at active case finding, and a new TB vaccine candidate developed at UCT.
During his opening remarks, Professor Norbert Ndjeka, the chief director of Drug-Resistant TB, TB and HIV at the national Department of Health, made a call for urgent scientific innovation, noting that without new advances in diagnostics, vaccines and digital technology, ending TB is not possible. “Scientific innovation is not optional – it is essential,” said Professor Ndjeka. “We cannot move forward without it.”
TB kills one person every 25 seconds
Professor Mark Hatherill, the director of SATVI at UCT, presented data showing that TB kills more than one million people every year – an estimated one person every 25 seconds – claiming more lives globally than colon cancer, hypertensive heart disease or road traffic accidents. Briefly displaced by COVID-19 during the pandemic, TB has reclaimed its position as the world’s single deadliest infectious pathogen.
The burden of TB disease falls overwhelmingly on Africa and Southeast Asia. While the global average is approximately 130 people per 100 000 falling ill with TB, that figure is far higher across sub-Saharan Africa. All these countries practise universal Bacillus Calmette–Guérin (BCG) vaccination of infants to prevent childhood TB.
Professor Hatherill noted: “BCG does a great job of protecting young children against the most severe forms of TB. The problem is that protection wears off.” By adolescence, BCG no longer protects against the adult and adolescent forms of TB – the type that transmits to others and drives the global epidemic. What is needed, Hatherill argued, is a new TB vaccine for adults and adolescents to interrupt transmission at its source.
A new generation of vaccines within reach
Associate Professor Angelique Kany Kany Luabeya, investigator on the M72 investigational TB vaccine study, told delegates that for the first time in over a century there is reason for real optimism.
The M72AS01E candidate vaccine has demonstrated 50% efficacy in preventing TB disease – the only TB vaccine to meet the World Health Organization’s (WHO) efficacy threshold, and the benchmark required before a vaccine can be rolled out at scale. Modelling suggests it could prevent up to 76 million TB cases and 8.5 million deaths over 25 years.
SATVI is participating in an ongoing phase 3 trial, which has now enrolled all 20 000 participants across sites in South Africa, Zambia, Malawi, Kenya, Indonesia and beyond – including people living with TB infection, people without TB infection and people living with HIV. Results are expected within two to three years.
“We are almost there,” said Associate Professor Luabeya. “But are we ready, as African countries with a high burden of TB, to roll out this vaccine when it crosses the line?” She urged governments and health systems to act now – strengthening regulatory capacity, local manufacturing, clinical trial infrastructure and community engagement – so the continent is positioned to receive the vaccine without delay.
Beyond the needle
While the M72 vaccine study advances, the UCT Lung Institute is also conducting studies on the MTBVAC investigational vaccine and rethinking how the BCG TB vaccine could be delivered to optimal effect. Professor Keertan Dheda of the UCT Lung Institute shared a pioneering approach to delivering the BCG vaccine through inhalation – administered as a dry powder directly into the lungs, as opposed to the traditional intradermal route. He cited animal studies in primates which show that the inhaled route is highly protective and noted that the Lung Institute was the first institution in the world to test this approach safely in human volunteers.
“If you drive immunity in the lung, maybe that’s the correct way to go.”
“TB is a disease of the lung,” said Professor Dheda. “It makes perfect sense that if you drive immunity in the lung, maybe that’s the correct way to go.” The team is now developing a spray-dried formulation and completing construction of a new aerobiology laboratory at UCT. Dheda noted that the field likely needs two or three effective vaccines, not one. “We need to prioritise and fund these ideas,” he said. “We’re not sure what’s going to work and we need two or three effective vaccines.” Both candidates – being researched at SATVI and the UCT Lung Institute – represent original scientific development from Africa.
Seeing is believing
During a walkabout of the two research group facilities, delegates visited the UCT Lung Institute, where they could observe a mobile TB case-finding unit; a digital stethoscope using artificial intelligence; digital chest X-rays supported by computer-aided detection for TB; and a cough aerosol sampling cascade impactor to capture and quantify live, infectious Mycobacterium tuberculosis.
At the SATVI laboratory, delegates learnt about immune responses associated with protection against TB and the TITAN TB vaccine, a new candidate that is being developed by a consortium of South African scientists.
An African story
Concluding remarks were delivered by honorary Professor Rod Dawson, a pulmonologist and TB drug development specialist at the UCT Lung Institute. He told delegates that the question of what comes after a successful trial is as urgent as the science itself. With two major trials and 40 000 participants between them, the investment has been enormous. Now, policy makers must prepare for the next phase: manufacturing at scale, equitable distribution and delivery, without depending on external partners.
“We are within reach of the first effective TB vaccine for adolescents and adults, a tool that could save millions of lives.”
“How do we supply the areas that need it most and actually do it ourselves?” he asked. Professor Dawson pointed to the UCT Lung Institute as proof of what is possible: founded 20 years ago with 14 staff members, it now employs 220 people and is entirely privately funded, built on scientific excellence rather than dependency.
“I’d love to see African innovations get vaccines made. I’d like to see African innovations get vaccines into the clinics,” said Dawson. “This is an African story.”
Speaking on behalf of the Global TB Caucus, the honourable Stephen Mutinda Mule, member of parliament, Kenya; and the regional co-chair of Global TB Caucus, thanked the hosts and echoed calls for action. “As parliamentarians, we spend most of our time in chamber debating what should be done. What we saw at UCT was a reminder of what is already being done by Africans, for Africa. We are within reach of the first effective TB vaccine for adolescents and adults, a tool that could save millions of lives. We must ensure that when these vaccines cross the finish line, our governments are ready. As parliamentarians we pass the laws, and the budgets, to prepare now so that African innovation reaches African communities without delay.”
The Global TB Caucus delegation comprised parliamentarians from 15 countries across Africa, joined by international health funders and sponsor representatives. SATVI and the UCT Lung Institute continue to lead Africa’s contribution to the global TB vaccine effort.
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