Tuberculosis is among the world’s most devastating infectious diseases, and the World Health Organization has described the spread of its drug-resistant forms as a global health crisis. As the United Nations General Assembly hosts a multistakeholder hearing on May 15 in the lead-up to September’s high-level meeting on antimicrobial resistance, it should take steps to integrate TB as a key strategy in the global response to AMR.
As it stands, drug-resistant TB, or DR-TB, is a leading cause of death among AMR infections globally. In 2022, at least 410,000 people across the world developed multidrug resistant TB, which is a severe form of DR-TB, resulting in 160,000 deaths. TB also has a “one health” dimension, as zoonotic TB affects animals and can be transmitted to humans. An estimated 140,000 people develop zoonotic TB annually, and the bacteria causing this form of TB is naturally resistant to an antibiotic commonly used in TB treatment.
The stakeholder hearing presents a crucial opportunity for U.N. member states to reaffirm countries’ commitment to combating AMR. It is equally critical that the General Assembly addresses DR-TB as a priority within the AMR agenda.
The intersection between TB and AMR
TB and its drug-resistant forms are prime examples of the intersection between AMR and infectious diseases. The spread of multidrug-resistant TB and even more dangerous extensively drug-resistant TBs has exacerbated both the TB pandemic and AMR crisis.
Only 2 in 5 people with DR-TB start treatment, according to WHO estimates, leaving a large number of people untreated. Untreated DR-TB spreads through the airborne route and mortality is upwards of 50%. Most TB drug resistance will emerge when a person with TB receives inadequate, substandard, or incomplete treatment. Where people with TB lack access to people-centered care and adequate nutritional, psychosocial, or mental health support, the risks are greater that treatment will be interrupted, and new resistance will emerge.
Preventing drug resistance in TB is also a priority among mobile populations such as refugees, internally displaced people, and migrant workers, where breakdowns in the continuum of care can lead to treatment interruptions. Even the wealthiest countries that are close to eliminating TB are impacted, especially from a financial perspective, when small numbers of people become sick with DR-TB.
Because of a lack of action, DR-TB has spread to the point where most people with resistant forms of TB acquired it through airborne transmission. In addition to the overall burden of TB globally, the ongoing spread of DR-TB combined with shortfalls in investment to develop new TB treatment regimens makes TB a global health security risk.
About the Stop TB Partnership
The Stop TB Partnership is a unique United Nations hosted entity based in Geneva, Switzerland, committed to revolutionizing tuberculosis space to end the disease by 2030. The organization aligns more than 2,000 partners worldwide to promote cross-sectoral collaboration. The Stop TB Partnership’s various teams and initiatives take bold and smart risks to identify, fund, and support innovative approaches, ideas, and solutions to ensure the TB community has a voice at the highest political levels and that all TB-affected people have access to affordable, quality, and people-centered care.
Key asks for UNGA
It is crucial to address TB and AMR together, and UNGA can pave the way by supporting critical interventions. The following are actions the assembly should endorse.
1. Include TB as a tracer indicator in global and national AMR strategies. This is critical as progress on TB and TB research and development are key indicators of progress on AMR and necessary to guard against the development of drug-resistant strains.
2. Mobilize $22 billion in annual funding for the global TB response by 2027, plus $5 billion in annual investment in TB R&D, as agreed in the 2023 U.N. political declaration of the high-level meeting on the fight against TB.
3. Prioritize vaccine development as a critical strategy in addressing AMR; ensure regulatory frameworks support streamlined development and authorization of drugs and vaccines against AMR infections; and support R&D on human immunology. Member states should embrace artificial intelligence strategies for tracking AMR and identifying viable vaccine targets for AMR.
4. Include TB services as essential elements of national and global universal health coverage strategies and efforts to address AMR, to ensure uninterrupted diagnosis, prevention, treatment, affordable and quality-assured antibiotics, surveillance, and research-related activities. Supporting a one health approach is critical.
5. Commit to providing treatment for up to 45 million people with TB between 2023 and 2027, including up to 4.5 million children and up to 1.5 million people with drug-resistant tuberculosis, as agreed in the 2023 U.N. political declaration on TB elimination.
6. Advocate and commit resources for an AMR response that is human rights-based, gender transformative, stigma-free, and people-centered. This ensures communities, affected people, and key and vulnerable populations are at the center of the AMR response, with resources allocated to support their engagement in AMR programs.
7. An independent panel on evidence for action on AMR should be constituted expediently, with a similar approach as was done for the Intergovernmental Panel on Climate Change. Such a panel as well as any accountability and/or follow-up mechanisms established by the high-level meeting on AMR in September should include TB.
A more robust effort against TB and AMR is crucial to the achievement of the Sustainable Development Goals. Because of its spread and airborne nature, DR-TB is a key driver of AMR globally, making it essential for the TB response to be integrated into the AMR agenda. At its upcoming high-level meeting on AMR, UNGA has a critical opportunity to advance a coordinated response to TB and AMR at the national level.
Visit the Talking TB series for more coverage on how we can eliminate tuberculosis by 2030. The time for a paradigm shift and a renewed focus on funding, research, and global solutions is now. Join the conversation by using the hashtag #TalkingTB.
About the authors
Nick Herbert
Nick Herbert (Lord Herbert of South Downs) is the founder and chair of the Global TB Caucus and has been involved globally in the fight against tuberculosis for nearly two decades. He is a former member of the House of Commons and is now a member of the House of Lords in the U.K. Parliament.
Dr. Lucica Ditiu
Dr. Lucica Ditiu is the executive director of the Stop TB Partnership. She is a Romanian physician, accomplished professional, and leader in the global fight against tuberculosis and other communicable diseases. Ditiu is driven by the firm belief that we should "leave no one behind" and is one of the strongest advocates within the international community in the fight against tuberculosis. A believer in innovation, flexibility, change, breaking the rules and thinking out of the box, Ditiu is dedicated to driving political commitment and engagement to accelerate the efforts to end TB.
Austin Arinze Obiefuna
Austin Arinze Obiefuna is the board vice-chair of the Stop TB Partnership and the executive director of Afro Global Alliance. He also leads the regional TB network Africa Coalition on TB. He is a WHO consultant and a member of the WHO AFRO Regional Green Light Committee. He previously served as the chair of the Global Network of Stop TB Partnerships and represented Africa on the executive board of the International Union Against TB and Lung Disease. He was instrumental in forming the Nigeria Stop TB Partnership and several other TB partnerships around the world.
