Science Translational Medicine
07 October 2020 Vol 12, Issue 564
Potential impact of tuberculosis vaccines in China, South Africa, and India
By Rebecca C. Harris, Tom Sumner, Gwenan M. Knight, Hui Zhang, Richard G. White
Science Translational Medicine07 Oct 2020
Tuberculosis vaccines should aim to protect infected populations against disease, but other vaccine types may be of use in high-transmission settings.
Inferring TB vaccine impact
There are multiple tuberculosis vaccines in development, although which vaccines are the best candidates to move forward is a matter of debate. Harris et al. used transmission models calibrated to age-specific demographic and epidemiological data from China, South Africa, and India to investigate the potential long-term impact of tuberculosis vaccines with different features, including results from recent clinical trials. They estimated that vaccines preventing disease, rather than infection per se, would have the greatest impact in these countries with high tuberculosis burdens. Their findings may aid prioritization and future trial planning of tuberculosis vaccines currently in development.
More effective tuberculosis vaccines are needed to help reach World Health Organization tuberculosis elimination goals. Insufficient evidence exists on the potential impact of future tuberculosis vaccines with varying characteristics and in different epidemiological settings. To inform vaccine development decision making, we modeled the impact of hypothetical tuberculosis vaccines in three high-burden countries. We calibrated Mycobacterium tuberculosis (M.tb) transmission models to age-stratified demographic and epidemiological data from China, South Africa, and India. We varied vaccine efficacy to prevent infection or disease, effective in persons M.tb uninfected or infected, and duration of protection. We modeled routine early-adolescent vaccination and 10-yearly mass campaigns from 2025. We estimated median percentage population-level tuberculosis incidence rate reduction (IRR) in 2050 compared to a no new vaccine scenario. In all settings, results suggested vaccines preventing disease in M.tb-infected populations would have greatest impact by 2050 (10-year, 70% efficacy against disease, IRR 51%, 52%, and 54% in China, South Africa, and India, respectively). Vaccines preventing reinfection delivered lower potential impact (IRR 1, 12, and 17%). Intermediate impact was predicted for vaccines effective only in uninfected populations, if preventing infection (IRR 21, 37, and 50%) or disease (IRR 19, 36, and 51%), with greater impact in higher-transmission settings. Tuberculosis vaccines have the potential to deliver substantial population-level impact. For prioritizing impact by 2050, vaccine development should focus on preventing disease in M.tb-infected populations. Preventing infection or disease in uninfected populations may be useful in higher transmission settings. As vaccine impact depended on epidemiology, different development strategies may be required.