Education; vaccine research key to solving tuberculosis

“Since 2021, TB rates have increased significantly, all the efforts worldwide that we had achieved in the last decade or so…was kind of reversed in just a couple of years of COVID.”

There is hope, however, and in northern Saskatchewan, which has roughly 10 times more cases than the national average, tuberculosis is decreasing.

“If you look at the country as a whole, it doesn’t have a huge TB burden, there are about 2,000 cases,” Dhar said

“If you look at it in terms of population-wise, these are often concentrated in the northern communities.”

World Tuberculosis Day was March. 24, which commemorates Dr Robert Koch’s1882 discovery of mycobacterium tuberculosis, the bacteria that causes the illness.

According to Tina Campbell, TB advisor with Northern Inter-Tribal Health Authority (NITHA), once the TB team were able to get back into the communities, they were able begin actively looking for people.

“Contact tracing for TB is very unique and it’s a really specialized skill that you kind of develop over time,” she said.

“There’s different ways that you need to ask questions, something could mean completely different if you ask, ‘Who lives in your house’ to one person as opposed to another person,” she added, noting a variation might be “Who sleeps in your house?”

Physically being in the community was the key.

“Kind of put yourself in there as well and getting to know the dynamics of every community ‘cause every community is also different,” Campbell said.

“We’re proud to have the response that we’ve had over the last couple of years with the resources that we’ve had ‘cause everywhere else is short staffed – our program is not any different than that.”

Combatting the disease is tricky: while the Bacille Calmette-Guérin (BCG) vaccine is still in use in roughly 180 countries worldwide, it was also first administered in 1921 and it comes with its own set of problems.

“The vaccine only protects against the childhood form of TB,” Dhar said, noting it has almost no efficacy against the adult form.

Another issue with the current treatment is highly toxic and comes with a litany of adverse side effects. In addition, the treatment takes roughly six to nine months – the latter of which is Dhar’s area of expertise.

“I’m trying to understand from the bacteria point of view – what is it about the bug that makes it so difficult to treat,’ he said.

“At the same time, I’m trying to discover new compounds and new targets, which will help us achieve the treatment in a shorter duration.”

Currently, there are about 15 new potential treatments in trials but so far, none can match BCG. Dhar said that has spurred the researchers on and the challenge is to create a treatment that is only one month.

“The bug is quite smart and has learned to live with the human for thousands of years,” he said, noting there are roughly 200-400,000 cases worldwide of a multi-drug-resistant form, due to the length of time, not all people who start the treatment will complete it.

“It has thwarted whatever we’ve thrown at it.”

According to Campbell, when they leave a particular community, it’s sometimes difficult because the nursing station has other areas of responsibilities like immunization programs and prenatal programs.

“A lot of people need to be educated on TB and what to look for and how to respond and who to refer to and where to go,” she said.

“If you need a question about TB, I think we need to continue to push that education on other healthcare practitioners.”

Campbell explained that part of that education needs to include awareness that if a patient comes in with a cough, and they’ve ruled out pneumonia, other respiratory illnesses, testing for TB, which can affect any organ, would be prudent.

“If they’re from this region or do they have a TB history, just always enquiring about that as well,” she said.

“Also, knowing about your own history, ‘cause there are quite a few people that still live with the diagnosis of tuberculosis and maybe were diagnosed back in the ‘60’s, ‘50’s and were never treated for latent TB,” Campbell added referring to the dormant form that effects 25 per cent, or two billion of the world’s population.

It’s also extremely slow growing, it takes 24 hours to double and it’s a containment level three pathogen, so researchers have to work in a restricted environment.

Since the BCG was first used, Dhar said it’s not for lack of effort that new drugs and vaccines haven’t been found, it’s just that the bug is challenging and if people are able to complete the treatment, the cure rates are 85 to 90 per cent.

When the world came together not only identify a new coronavirus but to develop a vaccine and implement it within a year, Dhar said it gave researchers hope.

“From my working experience, I would have never imagined that,” he said.

“Once you go through the clinical trials, most of these processes takes 20 and 30 years at least. So, that was really a game changer.”

Should the world turn that effort towards eradicating tuberculosis?

“If everyone puts in their necessary push behind it, it can be done,” said Dhar.

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julia.lovettsquires@pattisonmedia.com

On BlueSky: juleslovett.bsky.social

by Julia Lovett-Squires

Education; vaccine research key to solving tuberculosis

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