Sponsored by public-private partnerships, new products are entering the market for the first time in decades.

Not much has changed in tuberculosis treatment since this 1930s poster was made.

In the lobby of the offices of the Aeras Global TB Vaccine Foundation in Bethesda, Maryland, the walls are decorated with posters from the 1930s that warn of tuberculosis (TB). In those days, the standard preventive agent was the Bacille Calmette-Guérin (BCG) vaccine, only effective against only some kinds of childhood TB. It's still the only available vaccine—but not for long.

After decades of stagnation in TB research, there are four vaccines in trials, new diagnostic techniques and about seven new drugs on the horizon.

“Working in TB now is a bit of a candy shop,” says Peter Small, who heads the TB program at the Bill & Melinda Gates Foundation, which is credited with revitalizing the field. “There is great science and huge need,” he says.

A third of the world's population has the latent form of TB (in which bugs take up residence in the lungs), but these people don't display symptoms. In those with compromised immune systems, such as HIV-positive individuals, the quiescent bacteria begin actively multiplying. There are 9 million new cases of TB and 2 million deaths each year, many of them in sub-Saharan Africa. Some regions such as Eastern Europe have shown a troubling rise in multidrug-resistant disease.

The standard treatment is a course of four antibiotics for two months followed by two of those for another four months. None of the drugs are ideal, researchers say, because they take too long to kill the bacteria; the strongest of these, rifampin, speeds up the body's breakdown of HIV protease inhibitors, rendering them ineffective.

We badly need new technologies. We need new drugs, we need new vaccines. , Christopher Dye, World Health Organization

“We badly need new technologies,” says Christopher Dye, head of TB Monitoring and Evaluation at the World Health Organization. “We need new drugs, we need new vaccines.”

The darling of the TB community is Tibotec's compound TMC207, which is in phase 2 trials. The compound targets the bugs' ATP synthase, an enzyme they need to store energy, and has proven surprisingly effective in a mouse model (Science 307, 223–227; 2004). “Every-one is amazed at its performance,” says Dye.

Public-private partnerships are also ushering in promising compounds by providing market incentive to manufacturers. For instance, the Tuberculosis Trials Consortium is supporting Bayer's moxifloxacin, a broad-spectrum antibiotic already on the market for bacterial lung infections. The drug, which researchers hope might snare resistant bugs, is being tested in a multicenter trial of 330 people.

The Global Alliance for TB Drug Development has another candidate, PA-824, which might replace two of the standard drugs (Nature 405, 962–966; 2000). The compound, which could shorten treatment time and promises to fight multidrug-resistant TB, is in safety tests.

On the vaccine front, BCG, once reviled by scientists as weak and limited, has staged a comeback. Adrian Hill at the University of Oxford and others have shown that when used as the first in a double whammy of shots, BCG can help produce a robust immune response (Nat. Med. 10, 1240–1244; 2004). Hill's group combines BCG with MVA85A, a virus decked out with the characteristic antigens of Mycobacterium tuberculosis. Phase 2 trials are underway in South Africa.

The first TB additions to the market may actually be diagnostic techniques. The Geneva-based Foundation for Innovative New Diagnostics is championing at least eight new products. The group aims to cut the time required to detect drug resistance, develop more sensitive diagnostic methods and create a cheap test to detect TB in developing countries.