Stop TB executive worries over 'accountability' as high-level meeting draws near

MANILA — The high-level meeting on tuberculosis in New York on Wednesday will give the infectious disease a rare political moment in the spotlight. But one key issue hangs over the TB community: How can leaders be held accountable to their promises?

Much of the summit’s outcomes were already decided in advance. The draft political declaration — which contains some specific actions that governments have agreed on to reduce the global burden of TB and end its spread by 2030 — was finalized a week ago.

In the declaration, government leaders committed to diagnose and treat 40 million people with TB by 2022, including those suffering from drug-resistant TB; accelerate the development of tools that are accessible and affordable; mobilize funding reaching $13 billion a year for TB by 2022; close funding gaps in annual TB research; and promote access to affordable medicines, reaffirming the World Trade Organization’s “trade-related aspects of intellectual property agreement,” or TRIPS, which allows countries to implement policies that place public health above patents.

Language linking the use of the TRIPS flexibilities to human rights “could have been stronger,” and the target deadlines for making available various TB diagnostic tools and treatment could have been more specific, according to Lucica Ditiu, executive director of the Stop TB Partnership.

But what worries her most heading into the meeting is accountability. When the declaration is adopted on Wednesday — campaigners say it is unlikely it will be renegotiated — the critical next step is ensuring stakeholders have access to an open and solid platform through which they can check progress on the targets — what has been achieved or not, and why.

“I think a big part [of our key asks] is there. I would even dare to say a very big part of it is there,” she told Devex last Friday, as she waited for her flight from Geneva to New York to attend the summit.

But “the one that I’m most worried [about], to be honest, is on accountability,” she said. “I have friends outside [the global health bubble] and they are asking me like, ‘why are you so excited about the declaration? What’s different this time?’”

The ‘metric’ of political commitment at the summit

Concerns over member states’ accountability stems in part from the makeup of government leaders attending. While members of the TB community are encouraged and grateful for the participation of someone as high profile as Bill Gates, the real celebrities are the heads of states, particularly those from countries with populations with heavy burdens of TB. Their presence at the summit serves as a “metric” of political commitment, said Ditiu.

But as of Tuesday, the list of leaders attending was nowhere finalized.

Ditiu said that of the 34 heads of state confirmed last week, “a big part of them are coming from small countries,” she said. “It’s very nice we have heads of states. But we need the ones where there’s huge burden [of TB, and] a lot of them are absent.”

Brazil, Russia, India, China, and South Africa cover 60 percent of the burden of TB, and almost 60 percent of multidrug-resistant TB. Yet, as Devex reported last week, only South African President Cyril Ramaphosa is confirmed to attend the event among the BRICS countries. Ditiu said Indian Prime Minister Narendra Modi won’t be attending, as he was preoccupied with the launch last weekend of India’s biggest health insurance scheme.

Other high-burden countries without heads of state representation include Pakistan, Thailand, and the Philippines.

“It’s scandalous, not for Stop TB, not for WHO — but for their own citizens, especially countries with high burden [of the disease],” Ditiu said.

Some leaders have delegated the task to their health or foreign ministers, but Ditiu argued addressing TB requires a multisectoral approach.

“I think we have a lot of agitation in the TB community around this topic,” Ditiu said. “If [the leaders] are in New York for UNGA, and they don’t show up for the TB event, then we have a problem.”

The ‘real work’ is yet to come

Some see the high-level meeting as the culmination of a year’s worth of advocacy work. But for the TB community, Ditiu says the “real work” starts on Wednesday, Sept. 27 — the day after the summit.

“It’s terrifying because we are all a bit exhausted with all the preparations,” she said. But now, the TB community needs “to buckle up,” she advised.

After UNGA, there are several important upcoming meetings, including the 40th celebration of the Alma-Ata Declaration — which was a commitment by health experts and world leaders to achieve universal health coverage through primary care — in Kazakhstan on Oct. 25-26, when Ditiu said TB advocates need to ensure TB remains on the agenda.

Apart from upcoming events, Ditiu said there are two important things for advocates to do: Develop a roadmap of advocacies to ensure TB remains high on the political agenda of governments and in global health, and work with countries and partners such as the Global Fund and WHO to ensure scale up of TB in country programs.

“If we want to reach anything, the acceleration needs to happen now,” said Ditiu.

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