To end TB, time for us to own our disease response and financing for health

In most countries with a high burden of tuberculosis, domestic health budgets and traditional donor funds have been used to fund TB care and prevention. Going forward, a new approach to financing health and therefore TB care and prevention is needed. To keep our citizens healthy and productive, we must pivot to increases in domestic funding, and innovative, domestically anchored financing models that are resilient, equitable, efficient, and scalable. The global health financing architecture is undergoing a profound transformation, marked by a steady decline in traditional donor assistance, and this change presents a significant challenge but also a strategic opportunity to show ownership, strengthen national health systems, and to contribute to changes into multilateral engagement. In a world full of conflicts as well as competing political and economic crises, health must be prioritized and invested in, by countries themselves and through global solidarity across nations and across public and private entities. Within health, prioritizing the fight against TB is a good way of ensuring that we care about the health of the poor and those that are most disadvantaged. Ending TB is a solvable problem TB is one of the oldest infections that humans have experienced. It has killed over 1 billion people in the last two centuries. It is airborne and a risk to us all. TB is present across the world but is concentrated among the poorer nations and poorer communities within richer nations. Globally, TB still claims 1.25 million lives a year — more than HIV/AIDS and malaria combined. More lives can be saved from TB than any other infectious disease, yet in 2023, the world mobilized barely $5.7 billion for TB services, a quarter of the $22 billion annual commitment endorsed by leaders at the 2023 United Nations high-level meeting on TB. Research and development for new tools to fight TB fared no better, drawing $1.2 billion against a need of US $5 billion. That gap is not a statistic; it is people — our people — who die, or remain undiagnosed, untreated or pushed into poverty by a curable disease. The return on investment is compelling: Every dollar spent on TB yields up to $46 in economic benefit through lives saved, productivity restored, and health-system efficiencies gained. Being able to innovate and be ahead of the curve on financing health and TB is not a buzzword; it is the missing piece of the global TB response. Our four nations — spanning Africa and Asia, lower-middle-income and upper-middle-income economies, island and continental settings — represent a significant diversity of TB’s toll and the full potential of modern financing. If we can chart this course together, the rest of the world can follow. In this context, through our collective experience and vision, we suggest the following actions that are extremely relevant in the global response to TB but also to improve the overall health of our people: 1. Make universal health coverage and health insurance truly universal Indonesia’s BPJS Kesehatan, the Philippines’ UHC law, South Africa’s forthcoming National Health Insurance and Nigeria’s state-level insurance schemes are proof that social health insurance is scaling up. But coverage must include the full TB package — from digital X-ray screening and molecular testing to multidrug-resistant treatment — so patients never have to choose between cure and catastrophe. Payment mechanisms need to incentivize early diagnosis and treatment completion. We want to see global and national UHC and insurance stakeholders prioritizing TB coverage as a tracer indicator for success of UHC. Since TB care touches multiple dimensions of health care, the level of TB care can help measure how well health systems deliver essential, equitable, and integrated health services overall. 2. Tax what makes us sick; invest in what makes us healthy The Philippines’ 2012 Sin Tax Reform Law generated billions of pesos for health by raising tobacco and alcohol excises while curbing consumption. The logic is simple: If a product fuels disease, its profits should help pay the bill. We endorse the World Health Organization’s 3 by 35 initiative to increase the price of all unhealthy products, including tobacco and alcohol by at least 50% by 2035 and earmark the additional revenue for primary health care services, including TB. 3. Engage with development banks for results-based financing Indonesia has the experience of an ongoing results-based World Bank loan for TB of $300 million which was blended with a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria to buy down the interest. This innovative financing that blends loans incentivized with grants has helped Indonesia to increase its domestic fiscal space for financing health and TB. This model was also successfully implemented in India. We are encouraged by recent discussions facilitated by the Stop TB Partnership with the World Bank and the Asian Development Bank to scale up this model of financing to several other high TB burden countries. 4. Swap debt for health In 2024, Indonesia converted €75 million of bilateral debt from Germany into domestic spending on TB, malaria, and local medicine production. Mongolia, Cameroon and the Democratic Republic of Congo have done likewise. Debt-for-health swaps free fiscal space without adding new liabilities. Critically, they align with global calls for debt relief and pandemic preparedness, making them politically appealing to creditors and debtor nations alike 5. Leverage private-sector resources Private sector industries and businesses must contribute to the global and national TB responses. There are several ways this can be achieved. South Africa’s private mining industry collaborated with government health services to cut TB incidence among miners through a public-private partnership that combined onsite screening with workplace infection control. Nigeria’s Private Sector Health Alliance has pledged $25 million — to be matched by the government — to strengthen TB services nationwide. Several countries are planning large scale screening and testing programs for TB where private sector employers can contribute by doing employer-led screening and testing of their own employees and their families. 6. Tap the funds in climate finance Climate change is increasing the TB incidence as it worsens risk factors such as overcrowding and malnutrition. Inversely, certain TB treatment tools are climate-friendly. For example, new portable diagnostics devices and shorter drug regimens that cut TB transmission shrink carbon footprints by reducing travel and energy use. As climate funds, from the Green Climate Fund to multilateral development banks, pivot toward health adaptation, TB programs that lower emissions, improve resilience, and strengthen airborne-disease preparedness qualify as climate solutions. 7. Reduce the price of tools used for screening and testing for TB In our countries, screening and testing for TB is a major cost driver of the TB response. In recent years, while the cost of diagnostics has reduced, there is further scope for cost reduction and research and development of breakthrough, low-cost testing technology. The use of AI in diagnosis holds promise, as does downsized and portable screening and testing equipment and more affordable molecular tests. The current situation created by cuts from traditional funding partners is an opportunity that must be used. It is time for countries to own their epidemics, their responses to epidemics, the funding, and the solutions. We think that going ahead, we should: 1. Prioritize domestic resource mobilisation in our national health budgets. 2. Convene finance, climate, and development ministers to increase funding for the TB response, integrate TB into wider development financing, debt-relief, pandemic preparedness, and climate-adaptation packages. 3. Engage with multilateral development banks to prioritize health and financing for TB. 4. Invite a larger and more ambitious response from the private investors and philanthropic partners to codesign impact-linked instruments — including social impact bonds — that reward measurable health gains. But no country can do this alone. We urge the Group of Seven advanced economies, the Group of 20 major economies, multilateral development banks, and global health funds to match our ambition by: 1. Ending the artificial wall between pandemic preparedness and routine TB responses, acknowledging that the next airborne pandemic will likely emerge where TB, another airborne disease of pandemic proportion, remains entrenched. 2. Incentivizing technology transfer, so the diagnostics, vaccines, and treatment regimens of tomorrow are manufactured nationally, regionally, and are affordable everywhere. 3. Establishing a TB innovative financing facility to blend grants with concessional lending. We invite our fellow ministers, parliamentarians, business leaders and citizens to join us. Let us turn promises into payments, gaps into guarantees, and the world’s oldest epidemic into history.