Should you be worried about tuberculosis?

One hundred years ago, tuberculosis (TB) was one of the leading causes of death worldwide. Today, while the overall number of cases has dropped, TB has re-emerged as the world’s leading killer from a single infectious agent, overtaking COVID-19 in 2023, according to the World Health Organization (WHO). Despite existing vaccines and therapies, the disease remains a significant public health issue in Europe. The region is falling behind elimination targets, according to a new joint report by the WHO and the European Centre for Disease Prevention and Control (ECDC). 

TB is an infectious disease caused by strains of bacteria from the mycobacteria family. The disease most commonly affects the lungs and can be fatal if not treated. Despite being preventable and curable, Mycobacterium tuberculosis, infects about 25% of the global population, with an average of 5–10% progressing to symptomatic disease. In 2024, that led to 1.23 million deaths in the world. Progress towards elimination remains insufficient. 

In Europe, one in five cases of tuberculosis still goes undiagnosed, representing not only a failure in detection, but a missed opportunity to treat patients earlier, prevent suffering, and stop further transmission. Moreover, drug resistance in the region remains higher than in other parts of the world, according to the new WHO–ECDC report. Multi-drug resistant tuberculosis among new and previously treated cases was 23% and 51% respectively, which significantly exceeds the global average of 3.2% and 16%. The United Nations High-Level Meeting on antimicrobial resistance has recognised drug-resistant TB as a critical component of the global antimicrobial resistance response. These antibiotic resistant variants require longer treatments with more drugs and are associated with lower success rates. 

“There remains a significant unmet need for new tuberculosis treatments in the EU, especially for children,” said Emer Cooke, the EMA’s executive director in Science | Business. 

Eradication efforts are hindered by slow research and innovation, as well as a lack of essential tools, from vaccines to diagnostics and medicines. Only one licensed TB vaccine is currently in use (BCG), and it was developed more than a century ago. “By investing in rapid diagnosis, shorter all-oral treatment regimens and stronger follow-up, countries can reach more people, earlier, improve outcomes and put us back on track toward our targets,” said Hans Kluge, WHO Regional Director for Europe.  

After decades of stagnation, the rise in TB cases is pushing innovation in the sector, and driving the largest TB drug and vaccine pipeline in history. There are currently 29 candidates in clinical development, including 18 next-generation or new chemical entities (NCEs) and eight repurposed drugs. All of these have involved animal research (see table below).  

 

A selection of leading candidates from the TB drug and vaccine pipeline

 

Agent	Type	Trial	Stage	Animal Research
LAI-bedaquiline	Long-acting injection	CTIS2023-508810-41-00	Phase 1	Mice, Mice
TBA-7371	NCE	NCT04176250	Phase 2	Mice,
BTZ-043	NCE	NCT05926466	Phase 2	Mice, Mice
Ganfeborole	NCE	NCT05807399	Phase 2	Mice, Marmoset , animals models, in vivo
Telacebec	NCE	NCT03563599	Phase 2	Mouse, Mice, Rats , dogs, mouse, mouse
SQ-109	NCE	NCT00866190	Phase 2	Mice, Mice, Rabbits,
Delpazolid	Next-generation drug (oxazolidinone)	NCT06114628	Phase 2	Mice, rats, dogs
TBAJ876	Next-generation drug (diarylquinoline)	NCT06058299	Phase 2	Rats, Mice, Mice, Mice, Mice , Mice, mice
Quabodepistat	NCE	NCT07209761	Phase 3	Mouse, Mouse, Marmoset,
M72/AS01E	Adult vaccine (recombinant protein)	NCT06062238	Phase 3	mice, guinea pigs, rabbits and monkeys, Mice, guinea pigs, Mice, guinea pigs, cynomolgus monkeys, monkeys, Mice
MTBVAC	Adult vaccine (attenuated virus)	NCT06272812	Phase 3	Rhesus macaques, mice, guinea pigs, guinea pigs, newborn mice, mice, mice, non human primates, discovery, report, guinea pigs, mice
Immuvac	Adult vaccines (inactivated virus)	CTRI/2019/01/017026	Phase 3	Mice, mice, mice, mice, guinea pigs, guinea pig
Sutezolid	Next-generation drug (oxazolidinone)	NCT06192160	Phase 3	Non human primates, mice, mice , non human primates, mice, mice, mice, summery,   development
Sudapyride	Next-generation drug (diarylquinoline)	NCT05824871	Phase 3	Zebrafish, monkey, beagle, rat, and mouse liver, in vivo, mice ,mice, mice,

doi: https://doi.org/10.1038/d41591-026-00019-1 
 

Animal models are essential tools to mimic the clinical symptoms observed in human TB and to study immune responses to infection and the pathophysiology and pathogenesis of TB. Since Robert Koch in 1882 first used guinea pigs to prove that Mycobacterium tuberculosis  caused TB, various animal models –including mice, rats, rabbits, guinea pigs, cattle, zebrafish, non-human primates, and others –have been used to study various aspects of TB and evaluate new therapies and vaccines. No single model fully represents all aspects of the disease due to considerable differences in disease resistance, susceptibility and route of infection. Nevertheless, together these animal models have significantly contributed to drug and vaccine development, identification of biomarkers, and understanding of TB immunopathogenesis and the influence of host genetics on infection. 

 

Histogram showing proportion of different pre-clinical animal models used in TB research. Search terms either mouse or guinea pig or rabbit or non-human primate (NHP) or Zebrafish with tuberculosis were used for searches on PubMed on March 12, 2018. Source : https://pmc.ncbi.nlm.nih.gov/articles/PMC6094516/  

 

Last edited: 19 May 2026 14:18

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