Time for high-burden countries to lead the tuberculosis research agenda

At long last, tuberculosis (TB) is getting the political attention that it deserves, being the leading infectious killer of humans today.In 2016, there were 10.4 million estimated new TB cases, with over 1.7 million deaths [1].The G20 declaration of July 2017 included TB in the context of the need to respond to the antimicrobial resistance threat, following the group's meeting in Hamburg, Germany [2].In November 2017, for the first time, a WHO Global Ministerial Conference on TB was held in Moscow, Russia, culminating in the Moscow Declaration to End TB [3].This year, in September, the United Nations General Assembly (UNGA) will hold the first-ever high-level meeting on the fight against TB [4].While the political attention brings much needed hope, other developments provide cause for worry.The United States government, the largest funder of TB control and research, is rapidly scaling back on overseas aid, slashing billions from global health and humanitarian assistance [5].Canada, despite its progressive policies, is spending substantially less on international aid than comparable G7 countries [6].And while there are considerable uncertainties, Brexit could have a major impact on European Union international development and humanitarian policies and is expected to challenge the EU's role as the world's leading donor [7].The case for funding global health in general, and TB in particular, in this political climate will lack for attention as long as wealthy donor countries focus their priorities on populist and nationalist demands or short-term outcomes of a transactional nature.It is therefore critical for countries most affected by TB to step up, show leadership, and invest in TB control as well as research.Take the case of Brazil, Russia, India, China, and South Africa (BRICS), which together account for 46% of all incident cases of TB and 40% of all TB-related mortality [1].With strong, if uneven, economic growth in BRICS, and their growing stature and leadership in the political arena, these countries are well placed to lead the charge against a disease that is a leading killer of their citizens and a huge drain on their economies [8].In fact, investments in TB control can lead to a huge return on investments for these countries [9].Commendably, there are signs of the BRICS stepping up to deal with TB, commensurate with their disease burden and economic and scientific prowess [8].The BRICS Leaders Xiamen Declaration (2017) specifically mentioned the need to improve surveillance of TB and also agreed to set up a TB research network [10].In fact, the BRICS are now major producers of TB research [11].While the US remains the top producer of TB research in the past 2 decades, India and China have emerged as the second and third leading producers of TB research in recent years [11].Further, bibliometric analyses show that the average year-on-year increase in TB publications from the BRICS countries was, in the past decade, nearly double the overall year-on-year increase across all countries [11].

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