Among the three weapons used in the fight against TB (vaccines, diagnostics and drugs), the most spectacular improvement recently has been in the diagnostic field. Rapid molecular tests are available to identify, within a timeframe of less than 2 hours to 1 day, whether a biological sample includes M. tuberculosis, and whether the strain is resistant to MDR- or XDR-TB defining drugs.
The challenge now is represented by the development of model programmes in former Soviet Union countries, where innovative diagnostic and treatment algorithms (involving new drugs) are being scientifically validated and integrated within a strong public health policy. To pursue elimination, innovative treatment regimens involving new drugs will need to be validated to treat LTBI and TB, and model programmes demonstrating feasibility, efficacy, and cost-effectiveness need to be implemented. This is a preliminary step to the strengthening of the elimination strategy to which Europe has been committed since 1990 but which it has never embarked upon. Pre-registration trials are evaluating the therapeutic impact of new, short-length regimens, as well as the safety, tolerability and efficacy of new drugs for the treatment of MDR-TB.
New vaccines, when available, will increase the chances of complete elimination of TB in Europe. Currently, only a few vaccines are under advanced clinical evaluation. Of particular interest are the listeriolysin-expressing BCG construct, and vaccines that utilise a viral delivery system.
Further advances should allow identification of surrogate markers to better validate the efficacy of therapeutic and preventive products. The present development pipelines for new TB diagnostics, drugs and vaccines are outlined in the WHO Global Tuberculosis Report 2012.