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The Kansas City TB Outbreak Shows The Value Of U.S. Government Health Funding
Feb. 19, 2025
McConnell, Martinez-Wright, and Lovinger work for Treatment Action Group.
An ongoing tuberculosis outbreak in the Kansas City metropolitan area straddling Kansas and Missouri has made headlines across the country, a rare feat for an infectious disease too often ignored in the United States. While previous reports describing the outbreak as "the largest in U.S. History" were quickly debunked, it is one of the bigger TB outbreaks within a one-year period over the past several decades: Since January 2024 in Wyandotte and Johnson counties, there have been 67 cases of active TB (symptomatic disease that can spread by air and can be fatal if left untreated,) and 79 cases of TB infection (asymptomatic and non-infectious, but which can eventually turn into active disease.) Two deaths have been linked to the outbreak.
As longtime TB researchers and activists, we seldom see this much attention paid to TB in the United States, let alone in the Midwest, where all three of us grew up. While TB makes more than 10 million people sick each year, fewer than 10,000 of them are in the United States. But the outbreak in greater Kansas City offers a stark reminder of the importance of public funding for TB research and programming — and the potentially deadly stakes of the Trump administration's assault on global and public health infrastructure.
Even though TB is curable and preventable, it remains the world's deadliest infectious disease, killing about 1.25 million people every year. TB mortality is largely due to lack of access to prevention, diagnosis, and treatment. Public investment makes the care and tools that fight TB available to everyone who needs them and saves lives. This includes funding the work of domestic local health departments: More than half the people living with active TB disease linked to the Kansas City-area outbreak have already been cured; the rest are still taking their course of curative treatment. The vast majority of people with TB infection in Kansas and Missouri have also taken TB preventive treatment (TPT), which will protect them from developing active disease. Local health departments traced close contacts of people diagnosed with TB and administered treatment and prevention free of charge. That not only benefits patients themselves, but also their neighbors. The Centers for Disease Control and Prevention TB Elimination Division enhances health departments' capacity to stop domestic TB outbreaks in their tracks.
Just as everyone living in the greater Kansas City area and beyond benefits from TB programming through local health departments, we're also all better off when public health officials have the best possible scientific tools to find, cure, and prevent TB. Since the Treatment Action Group added TB to its mission back in 2002, we've seen global TB advocacy help win major advancements in TB research and development. Just over 20 years ago, we were still using technologies from the 1800s to diagnose TB, and treating it with imperfect drugs discovered back in the 1950s and 1960s. It could take many weeks and several facility visits to even diagnose a case to begin with, people had to stick with arduous medication regimens for extended periods of time and deal with severe side effects, and barely anyone with TB infection underwent TPT because the preventive regimen was as long as treatment for active disease. In other words, the TB interventions we were stuck with were a bit like cutting steak with a butter knife — but with life-and-death consequences.
Today, regimens for TB prevention and treatment are shorter and less toxic than ever before. These strides are largely thanks to public investment in TB research and trials. For example, one clinical trial sponsored by the National Institutes of Health and the CDC showed that TB infection can be successfully treated with 12 weeks of a once-weekly treatment called 3HP — findings that allowed this shorter, gentler regimen to replace the previous nine-month regimen of 270 daily doses. A related CDC trial showed that this 3HP regimen is safe for young children, making TB prevention more accessible for kids. Yet another NIH and CDC trial demonstrated that treatment time for drug-susceptible TB can be cut from six months to four months. For drug-resistant TB, a TAG analysis found U.S. Government investments in R&D for the drug bedaquiline exceeded spending by product developer Johnson & Johnson by several times, ultimately enabling DR-TB treatment to be shortened from 18 months or more to as little as six months.
I saw firsthand in Nigeria that drugs alone can't win the war against tuberculosisThese discoveries would probably never have happened, and countless lives would have been unnecessarily cut short, without U.S. Government spending.
The fact that health departments in Kansas and Missouri had access to these scientific breakthroughs makes TB outbreaks more manageable — stopping the outbreak well short of becoming U.S. History's largest! — and makes getting sick with TB less traumatic and disruptive for people living with the disease, their families, and communities. Ensuring that everyone on Earth has access to the best available tools reduces the TB burden everywhere, ending chains of transmission as quickly as possible.
Make no mistake — we still need even better tools, including a broadly effective vaccine, to end TB for good. The new presidential administration's relentless attack on federal spending related to TB research and science seriously threatens this progress, betraying people affected by TB across the world, and in the heartland alike.
Erin McConnell, born and raised in Kansas City, is a senior TB Project associate at Treatment Action Group (TAG) focused on community engagement in research. Kendall Martinez-Wright, raised in Palmyra, Missouri, is the government relations and policy associate at TAG, focusing on federal legislation and budget for HIV, TB, and hepatitis C programs nationally and globally. Elizabeth (Lizzy) Lovinger, born and raised in metropolitan Detroit, is the U.S. And global health policy director at TAG, where she advocates for the policies necessary to end the HIV, TB, and hepatitis C pandemics.
GSK's TB Vaccine Makes A Big Step Forward Towards Licensing
GlaxoSmithKline has spent 20 years trying to develop an improved vaccine for tuberculosis, and new data for its lead candidate M72/AS01E suggests it is getting closer to a breakthrough in the disease.
A phase 2b trial has found that the vaccine has an overall protective efficacy of 50% three years after immunisation, an advance on the current BCG vaccine which is not very effective and according to GSK "does not provide proven and consistent protection in adults in TB-endemic countries."
The big problem with the BCG shot is that its protection tends to be short-lived. That means it provides limited protection in people with latent TB infection – estimated to be around a quarter of the global population – who go on to develop active TB disease later on.
Meanwhile, the drugs used to treat TB are progressively becoming less effective due to the emergence of resistant strains, so there is an even more urgent need for an effective vaccine. Earlier this year, the WHO warned that multidrug resistant TB could become the dominant form of the infection in Europe as well as the rest of the world.
M72/AS01E still needs further testing and is likely a few years away from being licensed, but the new data adds to optimism that improved protection may in time be available for a disease that kills around 1.5 million people around the world every year.
The three-year data – published in the New England Journal of Medicine and presented at the World Conference on Lung Health this week – builds on an earlier readout from the trial in 2018, which found a 54% success rate after two years.
TB expert David Lewinsohn of Oregon Health & Science University in the US told the BBC that the remarkable finding in the trial is that M72/AS01E is effective in adults who are already infected with Mycobacterium tuberculosis, the bacteria that causes TB.
"As most people who are infected with Mycobacterium tuberculosis do not get TB, we believe that infection confers some degree of protection," he said. "As a result it is really exciting that a vaccine has been shown to improve on this natural immunity."
The trial was conducted in three countries where TB is endemic – Kenya, South Africa and Zambia – and involved 3,573 HIV-negative adults between the ages of 18 and 50 years who received two doses of either M72/AS01E or placebo 30 days apart.
The subjects were followed for three years to see if they developed pulmonary TB disease, the most contagious form. In the final analysis, 13 participants in the vaccine group developed active pulmonary TB compared to 26 participants in the placebo group.
"Without a more effective vaccine, it will not be possible to achieve the WHO target of decreasing the number of new cases by 90% and the number of TB deaths by 95% between 2015 and 2035," said GSK in a statement.
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