Tuberculosis gets some ambitious commitments. But will they be met?

As Dennis Francis, president of the 78th session of the United Nations General Assembly, wrapped up his speech on Friday, he looked at the crowd sitting at the back of the room and pointed at them. “Together, up at the top, we can end TB,” he said, joining the chanting crowd of civil society at the U.N. high-level meeting on the fight against tuberculosis. The meeting was the last of the three high-level meetings focused on health held during UNGA last week. Similar to the others, it ended with mixed reactions as advocates warned that the political declaration lacked or did not fully reflect some key asks from the TB community such as monitoring national strategic plans. In addition, Zimbabwe’s President Emmerson Dambudzo Mnangagwa and Saint Kitts and Nevis Prime Minister Terrance Drew were the only heads of state that attended the meeting. But Lucica Ditiu, executive director of the Stop TB Partnership, told Devex there’s still reason to celebrate. The declaration was adopted, despite earlier objections to some language in the draft. It also contains some concrete deliverables on funding. “I am a believer in things that you can measure because then you can keep people accountable,” she said. “It’s not ideal, it’s not ambitious enough. But it's something we can work with.” The work ahead now is to get governments to follow through on their commitments, something advocates know won’t be easy. A slew of failed promises In the declaration, governments committed to mobilizing at least $22 billion a year by 2027, and $35 billion annually by 2030 for TB. They also committed to mobilize $5 billion a year by 2027 for TB research and innovation. These targets are ambitious, especially given that the funding commitments governments made at the last high-level meeting on TB in 2018 were not met. Less than half of the $13 billion they committed to raise by 2022 was made available. In addition, only half of the $2 billion they committed for annual TB research and development materialized. In 2018, governments set a target of having 40 million people on TB treatment but only reached 34 million. They also set a target of reaching 30 million people with TB preventive treatment but only reached about half this number. These failed promises have created a sense of skepticism about the new declaration, as there are no clear targets or deadlines, for instance, on ending stigma, which prevents people with TB from seeking care and starting treatment. “The challenge for every country is how they are going to and whether they will meet the ambitions that are actually set, or whether these targets frankly are simply numbers written on a piece of paper that nobody will adhere to,” British legislator Nick Herbert said during a panel right before the high-level meeting on Friday. “Do political leaders mean what they say when they say that this disease will be beaten in seven years’ time? Or are we going to find ourselves going up the escalator and down again and be back here in another [high-level meeting]?” he added. The next high-level meeting on TB is set for 2028. Lack of leadership Prior to the meeting, there were already concerns that it may have a low turnout among heads of state. Ditiu said that while there were “amazing people” in the room, she expected more high-level personalities, adding that ministers of health struggle with their health budgets, and TB could benefit from support from finance ministers and heads of state. This is the U.N. General Assembly after all, not the World Health Assembly, she said. “You don't need to torture people for a year with declarations and to bring them to New York if it's a conversation with ministers of health. We have other platforms [for that], obviously, WHA … [but also] our own board,” she said. “It's also disheartening because it gives a signal that TB remains medical and at the level of ministers of health,” she said, adding that TB remains the biggest infectious disease killer. About 1.5 million people die from TB each year, according to the World Health Organization. “If I care about my population, my citizens, if I care about their health, I would be interested to really discuss with other presidents what are we doing about that. Also because it's airborne,” she said. But Ditiu said the high-level meeting isn’t the end of it. They will make the declaration more digestible for governments, and unpack the targets per country, showing heads of states what they committed to do. These then will be monitored by communities and civil society in countries. “We have already a tool called One Impact that is used in already 28 countries to monitor. We will make sure that new things are added to the tool to monitor [these new commitments],” she said.