By Sahera Ramzan
Over the last year, TB-affected communities, civil society, academics and diplomats have been working tirelessly in preparation for the second UN High-Level Meeting on TB, which took place in New York on 22 September, as part of the UN General Assembly. The High-Level Meeting (HLM) represented the biggest political moment for TB, convening heads of state, political leaders, parliamentarians, policy makers and other UN agencies. The objective of the meeting was to review progress since the first TB HLM in 2018 and recommit to goals through the 2023 Political Declaration.
Opening the meeting, the President of the General Assembly asked: “Why have we been unable to defeat a preventable but curable disease that kills over 4,400 people a day?” This very rightly shone a light on the painfully slow progress that has been made to end TB, at the cost of needless human suffering. The President further called on Member States to use all the tools at their disposal to advance science and innovation until we have a vaccine for TB. The UN Deputy Secretary-General emphasised the impact that conflicts, climate disasters and humanitarian crises are having on the transmission of infectious diseases, and how these further perpetuate the cycle of inequality among the most vulnerable in society. She also urged Member States to include TB in their national agendas.
One of the main purposes of the UN HLM on TB was to adopt the 2023 Political Declaration which was approved at the meeting. The process of getting an agreed political declaration was challenging and at times it looked unlikely to happen. After the success of the 2018 declaration, it felt as if once again the TB community was having to make the case for why TB matters. However, the declaration has made some advances since the 2018 declaration. A new target to ensure that 100% of people with TB have access to a health and social benefits package is a welcome inclusion. This commitment will help to reduce the financial hardships people with TB face due to their illness, and will go some way towards helping to reduce inequalities, especially those experienced by vulnerable and marginalised groups. The declaration contains specific, measurable targets on the prevention and treatment of TB, and a recognition of the right to enjoy and share the benefits of scientific progress and its applications, noting that access to diagnostics and treatments remain a challenge in resource-poor settings.
Funding for TB
The 2023 Declaration acknowledged the lack of financial investment for TB and failure to reach the funding targets set out in the 2018 declaration. In response to this, the 2023 funding targets have been greatly increased to accelerate progress to ending TB. But without any accountability mechanisms as to how these targets will be achieved, the challenge is now whether the funding targets can be met. There was a distinct lack of international commitments from Member States at the HLM, with only three countries committing to financial support packages for the global TB response. The UK was one of these countries, announcing a £495 million global health package including funding for TB, health research partnerships and tackling drug-resistant infections. But the wider lack of international support shows the reality of how TB is viewed on the political stage, and why we are still so far behind in ending the epidemic.
Stigma and discrimination
Among the opening speeches, a TB survivor, author and advocate, Handaa Enkh-Amgalan from Mongolia spoke of her battle with TB and the stigma that is still very prevalent with the disease. She urged Member States and stakeholders to look at how we treat TB, to focus on the social aspects such as stigma alongside medical treatments. Handaa spoke of the impact that stigma has on people being able to access TB treatment and care in a timely manner to avoid any further suffering.
The 2023 declaration acknowledged the structural inequity, stigma, racism, discrimination and access to healthcare as major barriers in ending the TB epidemic. Acknowledging these issues is all well and good, but the declaration falls short in holding Member States to account for addressing these issues in national TB plans, to ensure everyone who needs access to TB diagnostics, treatment and care can do so without being stigmatised or discriminated against.
The 2023 declaration made reference to the World Health Organisation’s Multi Stakeholder Accountability Framework for TB (MAF-TB), defining the roles and responsibilities of relevant actors and stakeholders. But the declaration failed to commit to any targets on implementing the MAF-TB at national level and making these publicly accessible. The importance of accountability in the TB response is an area that requires more focus and implementation, with prioritisation at the national level.
Although the 2023 declaration included some positive targets including on progress made on research and development, without universal access to prevent and treat TB disease, the targets remain an aspiration. Provision of health services that are able to respond to the needs of people that are equitable, inclusive, gender-responsive, rights-based and people-centred are essential for the TB response. There is a big gap between the global targets in the declaration and the commitments from political leaders to provide the resources to turn these targets into action. In the absence of robust accountability and monitoring mechanisms, we risk stalling progress even further, placing a heavier burden on already vulnerable populations and exacerbating inequalities.
Strong civil society advocacy
Throughout the challenges of the HLM process this year, the one constant has been the determination and energy from TB-affected communities and civil society from across the world. TB survivors, advocates, academics and policy-makers have shown what global solidarity really means in the fight to end TB, serving as an example to political leaders. The coordinated efforts of the global TB community supported by the leadership from Global Fund Advocates Network and Stop TB Partnership have been the driving force in pushing for an ambitious declaration and global commitments to end TB. The strong presence of civil society and TB affected communities at the HLM sent a powerful reminder that at the political meetings, it is the people that matter, the people that governments are responsible to the people who continue to fight to end TB, and the people that hold their governments to account.
You can watch the full recording of the UN HLM on TB here.