Looking for new funding models to address an ancient problem

A patient talks to a health worker for the detection and treatment of tuberculosis in Lima, Peru. The number of newly diagnosed TB cases has steadily declined since 2000, but the pace is currently so slow that it would take until 2182 to reach the WHO’s targets for ending the epidemic. Photo by: Pan-American Health Organization / CC BY-ND

The global tuberculosis response has consistently suffered funding shortages, which contributed to the disease surpassing AIDS in 2014 as the world’s leading infectious killer. Now — in a bid to end the pandemic by 2035 — a new strategy is looking to alternative funding sources and new spending models that will help officials better take advantage of the available resources.

At least 9.6 million people fell ill with TB in 2014, according to the World Health Organization. And though the disease in its most common form is treatable with a six-month daily drug regimen, it nonetheless claimed the lives of 1.5 million of those patients.

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This high number of deaths continues “even though we have had the disease for such a long time, we know how to cure it — and it’s cheap,” said Lucica Ditiu, executive director of the Stop TB Partnership.

While the number of newly diagnosed TB cases has steadily declined since 2000, the pace is currently so slow that it would take until 2182 to reach the WHO’s targets for ending the epidemic.

Chronic funding shortages are largely to blame, leaving health systems in some of the worst-affected countries without the resources to track and test patients and then maintain their treatment. In 2015 alone there was a $2 billion gap between TB budgets and the amount of available funding — not including research funding shortages.

Funding needs

The new Global Plan to End TB — released in November 2015 by the Stop TB Partnership — calls for an investment of at least $56 billion over the next five years to implement TB programs, alongside $9 billion for research and development. The authors of the strategy predict spending at that level could prevent 38 million people from getting sick and save at least 8 million lives by 2020.

But it will take more than just money.

“Really, it’s political leadership, domestic and international finance and better impact for the money, including getting into the community and letting the communities handle the response,” said Mark Dybul, who heads the Global Fund to Fight AIDS, Malaria and Tuberculosis. But financing remains critical. “It’s actually doing more with more,” he said.

Good news arrived shortly around the release of the new TB strategy in the form of the Ross Fund — a 1 billion pound ($1.46 billion) commitment from the United Kingdom toward researching and developing new drugs, diagnostics and vaccines for the world’s deadliest diseases, including TB.

Tough environment

This new funding channel aside, the global TB community remains circumspect about available international resources. The Global Fund, which provides the vast majority of external TB financing, has entered a replenishment year.

“It’s a tough environment to be raising money,” Dybul cautioned, citing the ongoing refugee crisis and an accelerated climate change response.

Instead of focusing on an overstretched international community, activists are demanding increased investments — especially toward research — from the governments of some of the worst-affected states. This includes the BRICS countries — Brazil, Russia, India, China and South Africa — as well as Indonesia.

Ending the TB epidemic “will take political will from outside of the normal actors in the health and TB world,” said Marcus Low, head of policy for Treatment Action Campaign. He pointed to statistics from the latest Treatment Action Group report on research funding for the disease, which found that BRICS countries suffer 40 percent of the global TB-related deaths, but pay for only 3.6 percent of the research. “There’s a massive disconnect there.”

TAC joined other activist groups in a march through the streets of Cape Town, South Africa, in the midst of December’s World Conference on Lung Health attended by Devex. They ended by presenting South Africa’s Health Minister Aaron Motsoaledi with a list of demands, including a call for all BRICS countries and Indonesia to triple research investment next year and make TB prevention a priority in all high-burden countries.

A new model

6 recommendations for global health actors

Recommendations from the Global Plan to End TB include calls for the global health community to reach at least 90 percent of all people with TB — including at least 90 percent of key populations, who are often the most underserved and at risk — and to achieve at least a 90 percent treatment success rate among those patients. Here are six key steps to help reach these targets:

1. Improve health systems to offer better TB screening — especially among high-risk groups — and earlier diagnosis.

2. Ensure a human-rights based approach to detection and treatment, drawing on rights to health, nondiscrimination and privacy.

3. Integrate communities  — especially those most at-risk — in the response.

4. Provide treatment to all people with TB. Currently, an estimated 3 million people each year go undetected and untreated.

5. Demand greater political and financial commitments to providing resources for TB care and prevention, especially within countries that are most affected by the disease.

6. Intensify research and innovation into new medications, diagnostic tools and interventions and, eventually, a vaccine.

The Global Plan echoes many of these requests, while also laying out the financial incentive for governments to invest — a return of at least $27 for each dollar contributed. What the strategy also offers — for the first time — are detailed models for nine different country settings that could help guide states on investments and policy changes based on their individual situations.

“It is a clear and fairly simple path forward for many countries in many situations,” said Carel Pretorius, who undertook the modeling effort alongside colleagues from the Global Plan Task Force and other experts. “It’s a simple political message to explain what they’re going to need to do to start getting this impact.”

He cautioned that there are some limitations. For instance, the team was not able to model all of the countries, but took a test case from each of the regions and extrapolated to other states that fell within the grouping. They also had to make assumptions about how costs would change over time. These and other simplifying assumptions should ultimately be accounted for when applying results to a country level, he said.

The models offer countries a framework that they can apply as part of an anticipated upgraded response that includes additional funding, renewed political commitment and better engagement with most-affected communities — and that may finally be enough to end the TB pandemic.

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the author

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    Andrew Green

    Andrew Green is a Devex Correspondent based in Berlin. His coverage focuses primarily on health and human rights and he has previously worked as Voice of America's South Sudan bureau chief and the Center for Public Integrity's web editor.