Tuberculosis (TB) kills more people each year than any other infectious disease. More than 2 billion people are currently infected and the World Health Organization estimates that in 2024 alone, 10.7 million people fell ill from TB and 1.23 million died of it. After a long downward trend since the U.S. committed to eliminating TB in 1989, the incidence in the U.S. is rising. The U.S. Centers for Disease Control and Prevention reported over 10,000 cases in 2024, a nearly 8% increase over 2023. This reflects a global trend, triggered by the damage to health systems, diagnosis and treatment caused by the COVID-19 pandemic.
But today, World TB Day, Fred Hutch Cancer Center scientists are optimistic. Several promising vaccines are in late-phase clinical trials and recently developed preclinical models of TB disease point toward new avenues for treating it. Our understanding of the bacterium and our responses to it are deepening every day.
“The way I frame it, almost all TB in the world could be prevented,” said Dr. Adrienne Shapiro, assistant professor (Allergy and Infectious Diseases), who works to develop, test and implement TB and HIV prevention strategies as the associate medical director of the Seattle Vaccines Trial Unit (VTU) and also treats patients, including people with TB, at Harborview Medical Center. “Every person with TB disease represents a missed opportunity for preventing TB.”
And even so, only about half the people at risk for a TB infection in Washington state get screened, she said. Of people with a positive TB test, fewer than 50% get preventative treatment. These missed opportunities dog TB treatment around the world; many people present so late in the course of their disease that drugs can no longer help them.
Because we do have cures. We have an antibiotic cocktail, colloquially dubbed RIPE, that can cure TB disease and antibiotics that can cure latent TB and completely prevent progression. Six vaccines are being tested for efficacy and effectiveness in Phase 3 clinical trials, eight are being evaluated for efficacy and safety in Phase 2 trials, and another four are in (or moving into) Phase 1 trials that assess safety and immunogenicity. More candidates are in preclinical testing.
