Unfortunately, the recent history of the tuberculosis (TB) pandemic has in large part been defined by neglect—inadequate funding for research and control, and insufficient political will to drive the policy changes to support a global response commensurate with TB’s threat to health, security, and global development.

Decades after WHO’s 1993 declaration of TB as a global health emergency, the United Nations General Assembly held the first-ever High Level Meeting (HLM) on Tuberculosis, themed “United to End TB: An Urgent Global Response to a Global Epidemic.” This was only the fifth HLM dedicated to a specific health issue in the history of the United Nations General Assembly.

In the run up to the meeting, TB stakeholders and advocates mobilized to help set the agenda and priorities, which included securing adequate financing to develop new tools to prevent, diagnose, and treat TB, addressing and overcoming antimicrobial resistance, ensuring universal access to TB treatment, and improving collaboration to improve the global response. Such priority-setting was laid out in statements like TB Alliance’s call to action.

The HLM itself proved to be an opportunity to shine light on the devastating impact of TB and the need for a more robust and urgent response, including increased investment in the development of new and improved therapies. Heads of state and other esteemed stakeholders underscored the importance of new TB research.

“We are also giving high priority to product innovation. Faster and more effective prevention, diagnosis and treatment that is gender-responsive and accessible to all is vital to outpace the TB epidemic. With Australia’s support, the TB Alliance introduced the first child-friendly, properly-dosed TB treatment for children in a pilot program in Papua New Guinea. This innovation has the potential to be a game changer in our fight against TB”.
– Marise Payne, Minister of Foreign Affairs, Australia

“The key to achieving the End TB strategy and Sustainable Development Goal of ending TB by 2030, therefore lies in the not-for-profit product development partnerships – PDPs – such as the TB Alliance.”
– Ciarán Cannon, Minister of State at the Department of Foreign Affairs and Trade, Ireland

At the time of the meeting, a $1.3B funding gap existed between annual contributions to TB R&D and what was needed to meet the goals of Stop TB’s End TB strategy. It was determined that the gap could be closed if each country invested 0.1% of their gross domestic expenditure on research and development (GERD) in TB research.

Ultimately, the Political Declaration issued at the HLM included commitments from 120 countries to accelerate progress against TB. This declaration included commitments to close the TB research funding gap, acknowledge the importance of developing new tools to prevent, diagnose and treat TB and expand access to TB drugs among other key interventions to improve the global response to the TB pandemic.

While the HLM placed unprecedented political attention on TB, many of the commitments made in the Political Declaration remain partially or substantially unfulfilled. Notably, the funding shortfall in TB research persists.

The recent impact and mobilization of funding and political will in response to COVID-19 speaks to the potential of national governments to marshal resources and facilitate the rapid development the technologies needed to effectively fight back against pandemics.

TB Alliance’s statement on the HLM set forth an expectation that it would “look back at this meeting’s outcome as the moment when world leaders marshalled the political will and resources needed to finally end TB and leave no one behind.” With close to 1.8 million people dying of TB in 2020, that expectation remains unmet.