UN pledges on TB met with caution by health community

World leaders must be held to account over renewed commitments to end TB including licensing a new vaccine, the global health community urged following a highly anticipated UN meeting in New York.

There was applause in the conference room at the UN headquarters on Friday (22 September) as leaders approved a political declaration pledging billions of dollars in funding and setting out ambitious targets for the next five years towards ending the global TB epidemic.

However, with goals and pledges set at the previous UN high-level meeting on TB in 2018 having failed to be met, some remained more circumspect.

“I welcome the 2023 Political Declaration, but we are respectfully putting our governments on notice that we will not allow those affected by this ancient plague to be failed again.”

Stephen Mule, Anglophone Africa co-chair, Global TB Caucus

Kenyan MP Stephen Mule, the Anglophone Africa regional co-chair of the Global TB Caucus, a network of political representatives who support efforts to end tuberculosis, said the pledges needed careful monitoring.

“We would be in a very different place” if the 2018 targets had been implemented in full, he said.

“I welcome the 2023 Political Declaration, but we are respectfully putting our governments on notice that we will not allow those affected by this ancient plague to be failed again,” Mule said.

Targets adopted by world leaders over the next five years include 90 per cent of people reached with TB prevention and care services, using a WHO-recommended rapid test to diagnose TB, and providing social benefits to anyone with the disease.

The declaration also commits to licensing at least one new TB vaccine and closing funding gaps for TB implementation and research by 2027.

The only licensed TB vaccine was developed more than a century ago and while it protects young children it does not adequately protect adolescents and adults, who account for most TB transmission.

Ahead of the meeting, WHO director-general Tedros Adhanom Ghebreyesus launched a dedicated TB vaccine council to speed up the development, licensing and deployment of new TB vaccines.

In order to achieve the new goals, member states committed to increase global TB funding from US$5.4 billion a year to US$22 billion a year by 2027, increasing to US$35 billion by 2030.

Countries also agreed a five-fold increase in funding for TB research and innovation, promising to mobilise US$5 billion a year by 2027. This will go towards developing diagnostics and vaccines, as well as treatment courses that are shorter and safer than current regimens.

Previous targets unmet

However, according to WHO, previous TB targets remain unmet, due to disruptions caused by COVID-19 and ongoing conflicts.

Between 2018 and 2022, the goal had been to get treatment to 40 million people with TB, but the figure reached was only 34 million. Only 15.5 million of a targeted 30 million people were able to access preventative treatment.

In 2018, governments had pledged to increase overall global investments for ending TB to at least US$13 billion annually by 2022.

However, in reality funding for TB services in low- and middle-income countries actually fell from US$6.4 billion in 2018 to US$5.8 billion in in 2022, leaving TB programmes with a 50 per cent funding gap, WHO said.

In the same period, annual funding for TB research stood at between US$0.9 billion and US$1.0 billion – half the target set in 2018.

The Stop TB Partnership said the governments needed to be held to account.

“We know commitments alone aren’t enough and declarations will gather dust without further action,” said Lucica Ditiu, executive director of the Partnership.

“In 2018, member states promised to provide US$13 billion a year in annual TB funding by 2022, yet they’re providing less than half that amount.

“Who is accountable for the failure to follow through on this promise?”

She said “strong accountability efforts and tools” were needed to hold leaders and groups to account.

“This starts with translating the global targets and commitments to national level, which Stop TB Partnership is currently working on, and ensuring civil society and TB communities have the resources and tools to ensure leaders follow through on their commitments,” she added.

Madhukar Pai, associate director of the McGill International TB Centre, told SciDev.Net: “I think lack of accountability makes it hard to know if countries will follow up on the declaration.

“Even with a global pandemic, we could not hold countries accountable.

“My only hope is that the TB advocates and civil society members will push for greater accountability by leaders.”

Alex Pym, head of infectious disease for the UK-based health research charity Wellcome, said the commitment to a new vaccine was “promising”.

“For too long, the pace of TB research and innovation has been too slow,” he said, adding that a vaccine plus improved, accessible diagnostics would make a real difference in the fight against the disease.

But, like others, he said: “Now we must see these new ambitious targets being turned into concrete action.”

This piece was produced by SciDev.Net’s Global desk.