A Grand Halt! TB or not TB? That is the Question.

During a long haul flight from Asia to London, I hurriedly prepare for a PhD interview on touch-down. I reason that In-flight entertainment sounds a reasonable sacrifice for these next few hours of my life. Given the 1.4 million lives lost to TB a few years earlier, it sounds more than reasonable. But Iron Man 3 surely!?!?!….

It’s early September a few years back and I’m wedged between two well-sized snorers, who are clearly well versed in how to maximise space when there’s very little of it, on a long haul jumbo from south-east Asia to London. Besides a few small flashing screens I can see, the cabin looks more or less asleep. But here I am, battling with my heavy eyelids and hungry for anything but aeroplane food, as I haphazardly put together a laptop presentation to support my claim of being a worthy PhD candidate for a worthy project on Tuberculosis vaccines.

And when’s the interview????  In about 14 hours, just 3 hours after I arrive in London. The last few weeks have been full-on as I needed to finalise a different project, but there is a tinge of self-annoyance in starting on this presentation so late. It doesn’t matter – I think to myself – the adrenaline will see me through this minor challenge and set me off on a trailblazing career fighting TB.

It didn’t.

The PhD Studentship deservedly went to one of the other 5 shortlisted candidates for a different, non-TB orientated, project. And to think of all those in-flight films I missed out on…. for nothing!

Not quite. I learned a fair few things about Mycobacterium tuberculosis including how the only vaccine available against TB – BCG (the one that gave you the rounded scar on your upper left triceps) – is inconsistent with early age BCG vaccinations waning in adolescence – particularly for TB affecting the lungs, at least in TB-endemic areas. The story is different in the USA however, suggesting environmental influences or a role of host genetics. A much more recent vaccine developed at Oxford, called MVA85A, showed early signs of promise but the Lancet reported an absence of effectiveness against TB in infants.

How on earth then, do we see a grand halt to TB by 2050 as per the aim of Stop TB? There is clearly a lot in the field of immunology that scientists are yet to learn, and I know this personally with TB. The project I was vouching for was to develop a human blood sera assay to screen for handy immune markers in response to a long list of candidate TB vaccines – so this could go some way in explaining why one vaccine seems more effective than others before testing in human clinical trials, thus making the discovery process safer too (and, prospectively reducing need of animal use in TB vaccine research).

So will the world see TB eradicated with assistance of a novel vaccine to work with by 2050? I think that’s still TB decided.

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