The UN High Level Meeting (UNHLM) on tuberculosis (TB) – a potential turning point to end the world’s leading infectious killer

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TB is preventable and curable. Yet it still kills more people globally than any other infectious disease, and the decline in incidence is too slow and off-track to end the disease by 2030, as envisaged in the Sustainable Development Goals. The WHO estimates that in 2017 10 million people developed the disease and 1.6 million died of it [1].  Of high concern, drug-resistant forms of TB account for nearly a third of all deaths owing to antimicrobial drug resistance in humans. The airborne nature of TB’s spread makes it a serious global health security threat.

The currently available tools for fighting TB are not reaching all people in need, due to lack of resources, low political ambition, huge care access barriers and national health systems that were not built with the ever-increasing seriousness of a TB pandemic in mind. Another significant factor is a historical lack of innovation and R&D in TB. Better tools are desperately needed but over the last several decades the research community has left TB behind. To come on track to end the disease, TB needs more attention from world leaders, greater ambition at country level, more allocation of resources, new approaches to reach all in need of prevention and care with the best tools available, a human right and equity-based approach, and research to develop better diagnostics, drugs and vaccines.

To change the status quo and to draw the attention of world leaders to the global issue of TB, in September 2018 the United Nations (UN) General Assembly in New York assigned one full day dedicated to a High-Level Meeting (HLM) on TB with Heads of States and Governments, or their representatives, in attendance. This was the very first HLM on TB – an unprecedented and historic event in the global fight against TB. When this meeting was initially proposed by the Stop TB Partnership Board and by its Chair H.E. Motsoaledi, Minister of Health of South Africa, many did not believe that this could ever happen. But the argument and the gravity of the data was too compelling for the UN to ignore, and it also benefited from the support of several countries as well as high-level individuals, such as the First Lady of Nigeria.

For myself, after the initial euphoria of the UNHLM on TB being accepted, there were highs and lows during the run up, the meeting per se and the political declaration that resulted.

First among the highs was the civil society hearing that preceded the UNHLM and highlighted to country missions in New York the sufferings and aspirations of people affected by TB and what could be achieved if there is a paradigm shift in the approach to fight TB. The heartfelt testimonies from TB survivors, and subsequent deliberations in this hearing greatly influenced the political declaration.

Second among the highs was seeing the strong commitment and inclusiveness of the two countries who were the co-facilitators of the UNHLM – Japan and Antigua & Barbuda. It was hugely encouraging to see what can be achieved by this inclusiveness and partnership spirit.

Third, the entire process led to a strong political declaration that has key measurable targets and commitments. The political commitment calls for doubling of resources for implementation, tripling of resources for research, concrete numbers of people to be treated for TB, including drug-resistant TB, children and preventive TB treatment [2,3].The global targets are broken down into country targets and can be found on the Stop TB website [4].

Amongst the lows, first was the deadlock that happened between countries on a few clauses in the draft political declaration, particularly the one pertaining to intellectual property rights – this was about the degree to which drug patents can be protected versus the prices of treatment regimen. The resolution of this took time and effort, diverted attention from other equally important issues for deliberations, and for some period divided countries and stakeholders.

Second, although all member states of the UN participated and more countries wanted to make statements than time permitted, the actual number of Heads of State in attendance was disappointing.

The positive outcome of the UNHLM in my view was in two areas: awareness and commitment. The awareness about the global TB pandemic has now gone beyond health ministries of countries, to offices of Heads of States and Governments, other Ministries, the media and into the public domain. Awareness levels have also increased within development agencies, and civil society enthusiasm for action has increased. High level governance and authority in countries has also understood the true impact of TB, the lack of progress and the subsequent significance of the global impact should this status quo remain. The commitments made by countries is now reflected in a strong political declaration.

Where do we go from here? In my view, a strong increase in resources, bold action to fulfil the commitments made at the UNHLM and a mechanism to hold world leaders accountable are the three most important follow up action to the UNHLM. To what extent and at what speed these actions will unfold will determine to a large extent whether or not the UNHLM was a historic turning point in the fight to end the TB epidemic. Funding for TB needs to increase from the current levels of 6–7 billion per annum to over 13 billion per annum, and quickly. Additionally, TB research funding needs to go up from US $0.7 billion per annum to US $2 billion per annum. Millions of people in need of care for TB, drug-resistant TB and latent TB infection cannot access diagnostics due to various socio-economic barriers and are currently ‘missing’. They need to be reached immediately with the best quality services. Progress on the UNHLM targets and commitments need to be monitored and reported in a manner that Heads of States can take notice and act, and civil society can hold their leaders and authorities accountable.

The upcoming World TB Day on 24th March 2019 is the first since the UNHLM on TB and is an opportunity to fast-track the follow-up actions from the political declaration. The Stop TB Partnership has worked with partners across the world to set a very apt theme for the World TB Day 2019: “Its time….” [5].  Countries, partners, civil society and individuals can add call to action slogans to this text according to their context and their dreams. On this World TB Day of 2019 my call to action would be “It’s time for resources, action and accountability, as follow-up actions from the UNHLM”.

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References
  1. WHO 2018. Global tuberculosis report 2018. Geneva: World Health Organization (2018).
  2. A/RES/73/3 (2018). Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/73/3 (Accessed on March 1, 2019).
  3. Stop TB Partnership. UNHLM on TB Key Targets for 2022. 2018. http://stoptb.org/assets/documents/global/advocacy/unhlm/UNHLM_Targets&Commitments.pdf (Accessed on March 10, 2019).
  4. Stop TB Partnership. UN High Level Meeting on TB: key targets and commitments for 2022 and outlined in the UN declaration on TB. http://stoptb.org/global/advocacy/unhlm_targets.asp (Accessed on March 10, 2019).
  5. Stop TB Partnership. World TB Day 2019: theme and infographics http://stoptb.org/events/world_tb_day/2019/ (Accessed on March 10, 2019)
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