Tuberculosis is the deadliest infectious disease in the world. A third of the world’s population is chronically infected. Around ten million people become ill with active TB every year, with around a million deaths.

Because our immune system has found a way to contain the bacteria. It forms a so-called granuloma, a sort of wall around the pathogen. When a person’s immune system is weakened – for example by pour nutrition, stress, cancer, or HIV – the granuloma can rupture and the person becomes seriously ill. If the bacteria reach the airways, the patient coughs them out and can infect others.

With treatment, people with active tuberculosis are usually no longer infectious after about eight weeks. However, the therapy generally takes six months to eliminate all the bacteria trapped in the body.

Above all, drug resistance. We’re currently seeing an increase in resistance against one of the most important drugs, bedaquiline. If this loses its effectiveness, we’ll have a huge problem on our hands. In all likelihood, we only have a few years left to prevent this resistance from spreading globally.

Our drug targets multidrug-resistant tuberculosis (MDR-TB), against which the principal standard antibiotics are no longer effective. Shortly we will be starting Phase 3 of the pivotal trial for our drug. If successful, we would be the first university in the world to gain approval for a new antibiotic against tuberculosis since the discovery and first use of penicillin over eighty years ago.

Bringing a new drug to approval usually takes 10 to 15 years and requires very specialized expertise, which universities normally don’t develop. By contrast, we want to prove that universities can do translation – that is, the transition from discovery to patient – which is where a large part of the value added resides.

Politically, there’s support for being independent from industry for applications that won’t become blockbusters; that is why we receive financial backing from, among others, the Free State of Bavaria, the German federal government, and the European Commission.

For a globally leading university, the advantages are clear. It strengthens the location and burnishes the global reputation of the university if we create a new treatment for the deadliest infectious disease in the world. By conducting drug development by ourselves, we save at least half of the costs while still being just as fast. Moreover, we stay committed for the long term, while industry often focuses on areas with broader commercial potential, so diseases like tuberculosis may receive less attention.

I would say our chances are currently about 50:50.

Definitely. We are already using our knowledge about translation to advance other drugs and vaccines – for example, in cooperation with TUM and Helmholtz Munich.

Tuberculosis is always treated with a combination of several drugs, usually four at a time. This is necessary to prevent resistances from arising. As a result, new drugs always have to be tested in combination. We managed to bring all pharmaceutical companies and developers of new tuberculosis drugs together on the UNITE4TB platform. In our studies, we test seven competing drugs in parallel. This is something entirely new!

We have around 4,000 cases of tuberculosis per year. This corresponds to about five cases per 100,000 inhabitants. Some 75 percent of those affected were born abroad. A country with a particularly high percentage of cases of multidrug-resistant tuberculosis is Ukraine. As much of the medical infrastructure there has collapsed, we can well surmise that numbers have only increased.

Upon arrival, there is screening. However, many of the refugees only contract the disease during their flight, and so it can often take several months before it can be securely diagnosed. As such, it would substantially improve diagnosis if we gave the people who come here another health checkup after 6 to 12 months. But the law does not provide for this. Nevertheless, I can assure you that contracting TB in Germany is extremely unlikely.

The current vaccination offers only around 30 percent protection. Above all, it prevents severe forms of the disease in children. A phase-3 study for a new vaccine is currently underway. A vaccine that offered 80 percent protection could be a breakthrough. Even then, however, we’d still need drugs. After all, there are currently 1.7 billion people who are infected and in need of treatment.

We will not achieve that. Other crises keep intervening. Like the coronavirus. During the pandemic, many screening programs were discontinued. This presumably set us back by years.

Our funding is secured. But naturally the competition for research funding intensifies when American researchers are applying for European grants as well. Programs for treating and caring for patients in Africa are coming under pressure. We depend on this cooperation. But every crisis also holds an opportunity. Perhaps countries in the Global South will assume more responsibility for their own healthcare in the future.

Drug development is extremely arduous. It’s a bit like climbing Kilimanjaro. On the final 1,300 meters of the ascent – that is to say, from 4,700 meters upward – everything becomes difficult: less air, altitude sickness, exhaustion. This is precisely the phase we’re in now. Our heads are buzzing. I scarcely think of anything else.