Massive new TB vaccine trial secures $550m in funding from two philanthropic organisations

29 Jun 2023

A massive and much-anticipated Phase 3 trial of an experimental tuberculosis vaccine is set to proceed after funding was secured from two large philanthropies. If the trial’s findings are positive, the vaccine is likely to become the first new TB vaccine in more than 100 years to be widely used.

Funding for the Phase 3 trial of an experimental tuberculosis (TB) vaccine has been secured from two large philanthropies, Wellcome and the Bill & Melinda Gates Foundation.

On Wednesday, they announced they would invest a combined $550-million into the trial — around $150-million from Wellcome and the remaining $400-million from the Bill & Melinda Gates Medical Research Institute, a nonprofit subsidiary of the Bill & Melinda Gates Foundation.

The vaccine, called M72/AS01E or just M72, made headlines in September 2018 when it was found to offer 54% protection against pulmonary TB disease in a Phase 2B trial. That trial, of around 3,300 people, was conducted in South Africa, Zambia, and Kenya. Final results from that study were published in the New England Journal of Medicine in 2019 — efficacy in these final results was down to around 50%.

Medicines and vaccines are typically only brought to market once safety and efficacy have been confirmed in a large Phase 3 trial. In this case, the Phase 3 trial is set to have around eight times as many participants as the Phase 2B trial.

26,000 study participants

“Conducted in collaboration with an international consortium of TB clinical investigators, the trial will enrol approximately 26,000 people, including people living with HIV and without TB infection, at more than 50 trial sites in Africa and Southeast Asia,” Wellcome and the Bill & Melinda Gates Foundation said in a statement announcing the trial.

They said the trial would “assess the candidate vaccine’s efficacy at preventing progression from latent TB infection to pulmonary TB”.

In an online media conference on Wednesday, Trevor Mundel, the president of Global Health at the Bill & Melinda Gates Foundation, clarified that while most study participants would be people with latent TB infection, 4,000 people without TB infection would also be recruited. This is because establishing evidence of the vaccine’s safety in people without latent TB infection will be important if the vaccine is to be rolled out in areas with high background rates of TB without first having to test everyone for latent infection.

“You’d want to be comfortable with vaccinating everyone in the community,” he said, “So we need to have that safety data in the uninfected as well in order to be able to have that usage, which will be the easiest way to use the vaccine at the end of the day.”

Mundel said that the study was scheduled to start early in 2024 and was expected to last for four to six years. Exactly how long the study will take will depend largely on how long it takes for 150 study participants to develop active TB — the number required for the study to have sufficient statistical power. By comparison, recruitment for the Phase 2B trial started in 2014 and the first findings from that study were published in 2018.

According to the statement, additional details about the trial design and participants will be announced in the coming months.

Given that the Phase 2B trial was partially conducted in South Africa and the country has substantial TB clinical trial capacity, it is almost certain that some of the 50 trial sites will be in South Africa — although specific trial sites have not yet been announced.

As pointed out in the statement, the only TB vaccine in use today, Bacille Calmette-Guerin (BCG), was first given to people in 1921. It helps protect babies and young children against severe systemic forms of TB but offers limited protection against pulmonary TB in adolescents and adults. If the findings from the Phase 3 trial of M72 are positive, M72 will become the first new TB vaccine in more than 100 years to be proven safe and effective.

According to the most recent figures from the World Health Organization (WHO), around 304,000 people fell ill with TB in South Africa in 2021. While TB rates are declining, they are declining relatively slowly and, according to the most recent WHO World TB Report, a major technological breakthrough such as a new vaccine will be needed if ambitious TB control targets are to be met.

Announcement welcomed

“We’ve waited a long time for this study, so are happy to see the Bill & Melinda Gates Foundation and Wellcome taking up this important task,” said Patrick Agbassi, chair of the Global TB Community Advisory Board, in a comment included in the Wellcome/Bill & Melinda Gates Foundation statement.

“The question now becomes how we can enrol 26,000 people most quickly and ensure that all populations at risk of TB will ultimately be able to benefit from access to what could be the first new TB vaccine in over 100 years. A robust community engagement programme will be key, as will taking on studying this vaccine in younger adolescents, pregnant women, people with prior history of TB, and other key groups often underrepresented or left out entirely of TB trials and the benefits of scientific progress.”

Mark Harrington, the executive director of New York-based advocacy organisation Treatment Action Group (TAG) said, “TAG welcomes this historic investment in TB vaccine development by Wellcome and the Bill & Melinda Gates Foundation. A Phase III clinical trial of the M72/AS01E TB vaccine candidate is a long-awaited milestone. We hope this funding commitment sparks governments and other funders to substantially increase investments in the TB vaccine pipeline, which contains a number of promising candidates in addition to M72/AS01E but faces a dire financial shortfall.”

“This Phase III trial,” Harrington said, “will take several years to complete. We encourage the Gates Foundation, Wellcome, GSK, country governments, and other partners to use this time to lay the groundwork for eventual vaccine adoption by ensuring the availability, affordability, and acceptability of M72/AS01E should it prove safe and effective.”

Initial development of M72 was driven by the pharmaceutical company GSK with support from several governments, philanthropies, and research organisations. The vaccine contains the M72 recombinant fusion protein, which the Wellcome/Bill & Melinda Gates Foundation statement explains is derived from two Mycobacterium tuberculosis antigens (Mtb32A and Mtb39A) combined with the GSK proprietary Adjuvant System AS01E. According to the statement, GSK will continue to provide the adjuvant for the vaccine’s further development and potential launch. DM

NOTES: (1) The Bill & Melinda Gates Foundation is mentioned in this article. Spotlight receives funding from the Bill & Melinda Gates Foundation, but is editorially independent — an independence that the editors guard jealously. Spotlight is a member of the South African Press Council. (2) A representative of the Global TB Community Advisory Board is quoted in this article. Spotlight editor Marcus Low was previously a member of the Global TB Community Advisory Board.

This article was published by Spotlight — health journalism in the public interest.

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South Africa

26,000 study participants

Announcement welcomed