UN declaration reaffirms global promise to end TB by 2030

Tedros Adhanom Ghebreyesus

Heads of state gathered at the U.N. General Assembly for a high-level meeting on tuberculosis Wednesday morning, marking just the fifth time that a health topic has been discussed at the General Assembly. Officials discussed tactics and signed a declaration to accelerate efforts to end the global epidemic of TB, the world’s leading infectious disease killer.

“Today is a historical day in our battle with this ancient disease,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said. “Enough is enough. It is time to end TB and to do that we must reach everyone with quality care.”

At the meeting, representatives adopted a declaration to “reaffirm” their promise to build a TB-free world by 2030.

“[We] pledge to provide leadership and to work together to accelerate our national and global collective actions, investments and innovations urgently to fight this preventable and treatable disease of tuberculosis,” the declaration read.

The declaration promises $13 billion a year by 2022 for TB prevention and care and $2 billion for research. It commits to driving universal access to treatment, securing sufficient and sustainable financing, intensifying research and innovation and prioritizing human rights issues.

“These are bold promises,” Tedros said. “WHO is committed to working with every country, every partner and every community to get the job done.”

The meeting was a held a week after WHO released its 2018 TB report. According to the report, global estimates show nearly 10 million people developed TB in 2017. The disease caused an estimated 1.3 million deaths among people without HIV and an additional 300,000 deaths among patients with HIV. According to the report, the TB incidence rate is falling about 2% each year, not enough to meet some rapidly approaching goals.

“TB is preventable, treatable, and curable and yet it claimed 1.6 million human lives, including 300,000 people who live with HIV,” Maria Fernanda Espinosa Garces, president of the General Assembly, said. “Further and unfortunately, multidrug-resistant TB (MDR-TB) remains a serious health crisis around the world, and this, my friends, is unacceptable.”

According to the WHO report, 558,000 people developed drug-resistant TB in 2017, including 82% who were estimated to have MDR-TB. Globally, 3.6% of new cases and 17% of previously treated cases had drug-resistant or MDR-TB, with 160,684 cases detected in 2017 — an increase from 153,119 in 2016.

The first milestone in the commitment to end TB by 2030 is to reduce the number of TB cases per year by 4% to 5% and reduce the case fatality rate by 10% by 2020.

“This is a moral and political responsibility,” Garces said. “We must move forward with deeds. We must fulfill the commitments we have undertaken.”

“We have before us the opportunity for a clear win — a chance to save the lives of millions, to preserve billions in resources, to demonstrate the success of the Sustainable Development Goals, and to reaffirm the utility, efficacy and necessity of multilateralism and the U.N. system,” she added. “Let us not miss this opportunity.”

Recent studies covered by Infectious Disease News have addressed TB treatments, investigational vaccines and patient care.

In August, WHO announced changes to treatment guidelines for MDR-TB. The new guidelines prioritize oral drugs and minimize injectables, which can cause adverse events that ultimately lead to the interruption of treatment.

Results from a phase 2b trial showed that a vaccine candidate provided 54% protection against active TB disease in adults. An accompanying editorial noted that further research is needed before the vaccine could become a licensed product but said the study is an important step in developing an effective immunization against TB.

A study in India, the country with the highest TB burden in the world, showed that suboptimal care could hinder efforts to eliminate TB. Standardized patients visited health care providers portraying different TB case scenarios and were given a wide range of inadequate care, revealing that there is no consistent common practice and a problem with unnecessary prescription of anti-TB drugs and antibiotics.

Tedros said the fight against TB will be successful only with support, increased investments, new medicines, vaccines, diagnostics and accountability.

“TB is a fearsome disease, but there are many others. The best way to protect the people we serve from all threats is to invest in stronger health systems built on primary health care,” Tedros said. “Now, it’s time to deliver. There has never been a better time to make TB history.” – by Caitlyn Stulpin

Disclosures: Garces and Tedros report no relevant financial disclosures.