Tuberculosis Kills As Many People Each Year As COVID-19. It’s Time We Found a Better Vaccine

A TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By External Source
Jan 15 2021 – In July 1921, a French infant became the first person to receive an experimental vaccine against tuberculosis (TB), after the mother had died from the disease. The vaccine, known as Bacille Calmette-Guérin (BCG), is the same one still used today.

This first dose of BCG was the culmination of 13 years of research and development.

BCG remains the only licensed vaccine against TB and 2021 marks its 100th anniversary.

Today, all eyes are on the rollout of the COVID-19 vaccine. But while the number of people who died from COVID-19 in the last year is shocking, TB kills about the same number of people — about 1.5-2 million — each year, and has done so for many decades.

In fact, it’s estimated that over the last 200 years, more than 1 billion people have died from TB, far more than from any other infectious disease.

 

If we have a vaccine, why do so many people still die from TB?

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It’s transmitted when a person with active TB coughs up aerosol droplets, which are then inhaled by someone else.

There are about 10 million cases of active TB annually, and it’s estimated up to 2 billion people are what’s known as “latently infected”. That means they are not sick and do not transmit the disease, but in about 10% of these people the disease reactivates.

In most TB endemic regions of the world, BCG is given to infants shortly after birth. The vaccination prevents childhood versions of TB and saves thousands of children’s lives annually.

However, the efficacy of BCG wanes over time. In other words, it stops working. Protection against TB is often lost by adolescence or early adulthood.

Importantly, BCG doesn’t prevent active lung TB in adults, the most important driver of ongoing transmission and cause of death.

The World Health Organization has a goal of TB elimination. To do that, we need to find a TB vaccine that also works in adults.

 

Why hasn’t BCG been replaced with a more effective TB vaccine?

Over the last decades only about 15 new TB vaccine candidates have entered clinical trials (versus 63 for COVID-19 in one year).

Worryingly, many of the most advanced TB vaccine candidates work no better than BCG.

Because the current TB vaccine candidate pipeline is relatively small, these setbacks and trial “failures” mean BCG may remain the gold standard for many years to come.

Despite being 100 years old, exactly how BCG vaccine works is largely unknown. It’s unclear why BCG usually only confers protection against childhood versions of TB or why protection wanes in adolescence.

Given those uncertainties, we can count ourselves lucky the bureaucratic hurdles for vaccine development were significantly lower in the 1920s.

If BCG were developed today, it would probably never be used; the current complex regulatory framework for vaccine development and licensing would likely not allow the use of a vaccine for which nothing or little is known about how it works.

The reasons BCG hasn’t been replaced with a more effective TB vaccine include:

  • the decline of TB in many Western countries in the 20th century
  • limited interest from pharmaceutical companies to invest in TB vaccine development
  • the fact TB research and pre-clinical vaccine development is logistically challenging and requires special biological containment facilities
  • the short-term and fiercely competitive environment for government and philanthropic research funding makes it difficult for academics to commit to TB vaccine research as a career path.

 

Where there’s a will, there’s a way

The pace of COVID-19 vaccine development shows what’s possible when the political will, pharmaceutical interest and funding is there.

While TB is no longer widespread in Australia, it is an issue in remote Indigenous communities.

Papua New Guinea, Australia’s closest neighbour, has high rates of multi-drug resistant TB and low BCG coverage rates. TB has been introduced into Australia via the Torres Strait, with a high proportion of cross-border diagnoses in North Queensland and over-representation of Indigenous children.

Resistance to current TB treatments increases steadily. Treatment of multi drug-resistant TB is hugely expensive and can take up to two years, requiring multiple antibiotics and close monitoring.

Now is the time to put financial and political will into finding a more effective TB vaccine.

2020 taught us pathogens can cause enormous harm to societies and economies. Investment into infectious disease research and vaccine development represents a fraction of the economic cost of a pandemic.

Tuberculosis is a global threat and a public health concern on a scale similar to COVID-19. The development of a new and effective TB vaccine is crucial if TB is to be significantly reduced, let alone eradicated.

Although the anniversary of BCG is cause for celebration, it should also serve as a reminder more needs to be done to combat this deadly disease.
The Conversation

Andreas Kupz, Senior Research Fellow, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Legally Speaking, Is Digital Money Really Money?

Countries are moving fast toward creating digital currencies. Or, so we hear from various surveys showing an increasing number of central banks making substantial progress towards having an official digital currency. But, in fact, close to 80% of the world’s central banks are either not allowed to issue a digital currency under their existing laws, or the legal framework is not clear

Can mobile money be categorized as digital money? IOM helped Mohammed Ahmed to set up a shop in Omduram market, near Khartoum, Sudan. The initiative involves the use of mobile money to buy goods. Credit: International Organization for Migration / Yasir Elbakri

By Catalina Margulis and Arthur Rossi
WASHINGTON DC, Jan 15 2021 – Countries are moving fast toward creating digital currencies. Or, so we hear from various surveys showing an increasing number of central banks making substantial progress towards having an official digital currency.

But, in fact, close to 80 percent of the world’s central banks are either not allowed to issue a digital currency under their existing laws, or the legal framework is not clear.

To help countries make this assessment, we reviewed the central bank laws of 174 IMF members in a new IMF staff paper, and found out that only about 40 are legally allowed to issue digital currencies.

Not just a legal technicality

Any money issuance is a form of debt for the central bank, so it must have a solid basis to avoid legal, financial and reputational risks for the institutions. Ultimately, it is about ensuring that a significant and potentially contentious innovation is in line with a central bank’s mandate. Otherwise, the door is opened to potential political and legal challenges.

Now, readers may be asking themselves: if issuing money is the most basic function for any central bank, why then is a digital form of money so different? The answer requires a detailed analysis of the functions and powers of each central bank, as well as the implications of different designs of digital instruments.

Building a case for digital currencies

To legally qualify as currency, a means of payment must be considered as such by the country’s laws and be denominated in its official monetary unit. A currency typically enjoys legal tender status, meaning debtors can pay their obligations by transferring it to creditors.

Therefore, legal tender status is usually only given to means of payment that can be easily received and used by the majority of the population. That is why banknotes and coins are the most common form of currency.

To use digital currencies, digital infrastructure—laptops, smartphones, connectivity—must first be in place. But governments cannot impose on their citizens to have it, so granting legal tender status to a central bank digital instrument might be challenging. Without the legal tender designation, achieving full currency status could be equally challenging. Still, many means of payments widely used in advanced economies are neither legal tender nor currency (e.g. commercial book money).

Uncharted waters?

Digital currencies can take different forms. Our analysis focuses on the legal implications of the main concepts being considered by various central banks. For instance, where it would be “account-based” or “token-based”. The first means digitalizing the balances currently held on accounts in a central banks’ books; while the second refers to designing a new digital token not connected to the existing accounts that commercial banks hold with a central bank.

From a legal perspective, the difference is between centuries-old traditions and uncharted waters. The first model is as old as central banking itself, having been developed in the early 17th century by the Exchange Bank of Amsterdam, considered the precursor of modern central banks. Its legal status under public and private law in most countries is well developed and understood.

Digital tokens, in contrast, have a very short history and unclear legal status. Some central banks are allowed to issue any type of currency (which could include digital forms), while most (61 percent) are limited to only banknotes and coins.

Another important design feature is whether the digital currency is to be used only at the “wholesale” level, by financial institutions, or could be accessible to the general public (“retail”). Commercial banks hold accounts with their central bank, being therefore their traditional “clients.”

Allowing private citizens’ accounts, as in retail banking, would be a tectonic shift to how central banks are organized and would require significant legal changes. Only 10 central banks in our sample would currently be allowed to do so.

A challenging endeavor

The overlapping of these and other design features can create very complex legal challenges—and could well influence the decisions made by each monetary authority.

The creation of central bank digital currencies will also raise legal issues in many other areas, including tax, property, contracts, and insolvency laws; payments systems; privacy and data protection; most fundamentally, preventing money laundering and terrorism financing.

If they are to be “the next milestone in the evolution of money,” central bank digital currencies need robust legal foundations that ensure smooth integration to the financial system, credibility and broad acceptance by countries’ citizens and economic agents.

 


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