World Leaders Reaffirm Commitment to End Tuberculosis by 2030, as General Assembly Adopts Declaration Outlining Actions for Increased Financing, Treatment Access

GA/12067
26 September 2018
High-Level Meeting on Fight to End Tuberculosis, AM & PM Meetings

World Leaders Reaffirm Commitment to End Tuberculosis by 2030, as General Assembly Adopts Declaration Outlining Actions for Increased Financing, Treatment Access

World leaders in the General Assembly today reaffirmed their commitment to end the global tuberculosis epidemic by 2030, unanimously adopting a political declaration committing them to accelerate national and collective actions, investments and innovations in fighting the preventable disease.

Through the Declaration ‑ titled “United to End Tuberculosis:  An Urgent Global Response to a Global Epidemic” and adopted at a high‑level meeting on the issue ‑ Heads of State and Government recognized that TB disproportionately affects developing regions and countries.  They pledged to provide leadership, acknowledging that multidrug-resistant strains can reverse gains made in combating the disease, which remains among the top 10 causes of death worldwide.

By other terms, they committed to promote access to affordable medicines, including generics, and to provide 40 million people access to diagnosis and treatment by 2022.

Given the strong association between tuberculosis and HIV, leaders also committed to fostering coordination between programmes for both diseases, as well as with other health programmes and sectors to ensure universal access to integrated prevention, diagnosis, treatment and care.  Expressing their commitment to community‑based health services, they pledged to strengthen capacity building in low‑ and lower‑middle‑income countries, and foster public‑private cooperation in pursuing the development of newly approved medicines.

On the question of funding, Heads of State and Government committed to mobilize “sufficient and sustainable” financing from all sources for universal access to quality prevention, diagnosis, treatment and care.  In so doing, they aim to increase overall global investments for ending TB at least $13 billion annually by 2022 and seek $2 billion for closing the estimated $1.3 billion annual funding gap in tuberculosis research.

Further, leaders requested the Secretary-General, with support from the World Health Organization (WHO), provide a progress report in 2020 on global and national progress to achieve agreed upon TB goals within the context of achieving the 2030 Agenda for Sustainable Development.

Describing the global situation, General Assembly President María Fernanda Espinosa Garcés (Ecuador) said tuberculosis claimed 1.6 million lives in 2017, despite being a preventable, treatable and curable disease.  TB offers an opportunity to actually strengthen health‑care systems, she said, noting that often the poorest, most vulnerable and marginalized are those who suffer.

Echoing those remarks, United Nations Deputy Secretary‑General Amina J. Mohammed called TB the world’s greatest infectious killer, stressing that the voices of affected communities ring clear in the Organization.  Poverty and conflict fuelled the spread of the disease.  Yet, the fight against it remains drastically underfunded.  She called for greater investment in health, as well as system‑wide approaches that promote the well‑being of entire communities.  Civil society actors must remain engaged with the United Nations to ensure progress is expedited.

Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, said TB is among the top 10 causes of death, with the rise of antibiotic resistance making the threat more dangerous.  In early 2018, WHO launched an initiative to treat all 40 million people in need of care by 2022, the success of which rests on unwavering support and high‑level political commitment, as well as increased investment, especially in science and research, and keeping all relevant actors accountable for their promises made.  The Political Declaration sets ambitious but achievable targets and WHO is committed to working with all partners to “get the job done”.

Aaron Motsoaledi, Minister for Health of South Africa and Chair of Stop TB Partnership, said TB is fundamentally an issue of social justice:  a litmus test of the world’s commitment to fighting poverty ‑ one that it is failing.  Drug‑resistant TB has become the major cause of deaths related to microbial resistance, and new TB victims are not being found at high enough rates.  He urged the international community to mobilize every available resource, energy and dollar necessary to fight TB.

Veronika Skvortsova, Minister for Health of the Russian Federation and Chair of the World Health Organization Global Ministerial Conference on Tuberculosis, said it was important to have a specific image of a person suffering from TB in one’s mind when considering the availability of vaccines and treatment.  Serious political commitment had yielded a breakthrough in the Russian Federation.  Over the last 10 years, the TB rate had dropped by 42 per cent, and the mortality rate by 60 per cent.

Peng Liyuan, First Lady of China and World Health Organization Goodwill Ambassador for Tuberculosis and HIV/AIDS, said via video message that for a decade she has visited TB‑affected communities to raise awareness, change behaviour and encourage action.

Nandita Venkatesan, tuberculosis survivor from India, said TB had robbed her of eight years of her life, her hearing, family time and four years of employment.  She spent 18 months of college life braving medication side effects and finding solace in education.  She urged world leaders to act now, imploring them to ensure victims have access to up-front testing, treatment and education.

The high‑level meeting also featured two panel discussions:  one on TB prevention, diagnosis, treatment and care, and the other on financing.  Bill Gates, Co‑Chair of the Bill and Melinda Gates Foundation, and Aisha Buhari, First Lady of Nigeria and Joint United Nations Programme on HIV/AIDS Special Ambassador and Ambassador of the Stop TB Partnership, delivered keynote addresses.

Opening Remarks

MARÍA FERNANDA ESPINOSA GARCÉS (Ecuador), President of the General Assembly, said tuberculosis claimed 1.6 million lives last year, despite it being a preventable, treatable and curable disease.  Aside from the moral failings of that mortality rate, the economic losses are staggering, she said, estimating that the TB cost to the global economy could hit $1 trillion by 2030.  By investing now, lives can be saved and economic losses can be eliminated.

Tuberculosis offers an opportunity to actually strengthen health‑care systems, she said, noting that often the poorest, most vulnerable and marginalized are those who suffer.  Ways to empower those affected and improve their resilience must be pursued.  Funding and research for tuberculosis must be dramatically scaled up, she went on to say, noting the $5 billion gap this year.  Today’s Political Declaration titled “United to End Tuberculosis:  An Urgent Global Response to a Global Epidemic” sets a road map to accelerate the World Health Organization (WHO) End TB Strategy and the Moscow Declaration to End TB, in line with the 2030 Sustainable Development Goals.  The goal is to treat 40 million affected people and provide 30 million with preventable treatment, she concluded, calling for the mobilization of $13 billion annually by 2022 for implementation, and $2 billion for research.

AMINA J. MOHAMMED, Deputy Secretary‑General of the United Nations, said tuberculosis is the world’s greatest infectious killer and that the voices of affected communities ring clear in the United Nations.  The disease does not exist in a vacuum, with poverty and conflict fuelling the spread of the disease.  To end the epidemic, there is a need for better health and welfare systems.  The rise of drug-resistant tuberculosis requires increased investment in science and research, she stressed.

The fight against tuberculosis remains drastically underfunded, she said, calling for greater investment in health.  System‑wide approaches must develop health infrastructures to promote the health and well‑being of entire communities.  Two thirds of all tuberculosis cases occur in just eight countries and more work is needed to ensure nobody is left behind.  She said the Political Declaration was ambitious but progress was possible through increased funding and cooperation.  She urged civil society actors to remain engaged with the United Nations to ensure progress is expedited.

TEDROS ADHANOM GHEBREYESUS, Director General, the World Health Organization, said this is a historic day in the fight against tuberculosis, a disease that thrives where there is poverty, malnutrition or conflict.  Tuberculosis killed 1.6 million people in 2017, making it the world’s biggest infectious killer and one of the top 10 causes of death.  The rise of antibiotic resistance is making the threat more dangerous, he said, stressing the need to reach all those affected by the disease with quality care.

In early 2018, WHO launched an initiative to treat all 40 million people in need of care by 2022.  He said the success of the initiative rests on unwavering support and high‑level political commitment, increased investment, especially in science and research, and keeping all relevant actors accountable for the promises they have made.  The Political Declaration sets ambitious but achievable targets and WHO is committed to working with all partners to get the job done.  He stressed that the best way to protect people from tuberculosis is to invest in stronger health systems and that the Global Conference on Primary Health Care to be held in Kazakhstan next month is a vital opportunity to recommit to primary care as the backbone of every health system.

AARON MOTSOALEDI, Minister for Health of South Africa and Chair of Stop TB Partnership, recalled, on the heels of the Nelson Mandela Peace Summit, that Mr. Mandela was himself a survivor of TB and would have reminded the international community that true prosperity is not possible when TB continues to bring agony and death to millions.  Two years ago, he highlighted the continued absence of TB from high‑level political discussions on antimicrobial resistance.  Ending TB will require the highest political priority.

Tuberculosis is fundamentally an issue of social justice, he said, calling it a litmus test of the world’s commitment to fighting poverty, one that it is failing, to date.  He went on to highlight the challenges, including the fact that drug‑resistant TB has become the major cause of deaths related to microbial resistance, and that new TB victims were not being found at high enough rates.  He called on the international community to mobilize every available resource, energy and dollar necessary to fight TB.  In addition to the five tasks laid out in the Political Declaration, he wished to add two personal tasks, he said:  first, that all Heads of State speak spontaneously about TB, and, second, that they be clear that the cost of ignoring TB is much more expensive than the price of ending it.

VERONIKA SKVORTSOVA, Minister for Health of the Russian Federation and Chair of the World Health Organization Global Ministerial Conference on Tuberculosis, said it was important to have a specific image of a person suffering from TB in one’s mind when considering the availability of vaccines and treatment.  She highlighted the importance of serious political commitment, saying that such an approach had allowed the Russian Federation to achieve a breakthrough on TB treatment.  Over the last 10 years, the rate had dropped by 42 per cent, while the mortality rate had dropped by 60 per cent.

The Russian Federation continues to coordinate with the United Nations on these efforts.  The incorporation of rapid diagnosis tools to treat drug‑resistant forms of TB is a vital precondition to fighting the disease in the future, she said, stressing that success will require all efforts to be pooled.  The Moscow Declaration, an example of such coordination, served as a basis for today’s meeting.  Coordination with WHO is crucial, she said, welcoming efforts by WHO Director General in the TB fight.  Despite the difficulties, it is possible to solve this problem, she concluded.

PENG LIYUAN, First Lady of China and World Health Organization Goodwill Ambassador for Tuberculosis and HIV/AIDS, speaking via video message, said that, for a decade, she has visited communities afflicted by tuberculosis as a means to raise awareness, change behaviour and encourage action.  This year, she visited Hubei in central China where she shared tuberculosis‑related knowledge with teenage students and taught young children the importance of good hygiene. 

She shared the story of Shili, a community health worker from Sichuan who, following a massive earthquake in 2008, walked miles to establish contact with her 540 tuberculosis patients and deliver drugs to those cut off from medications.  Ms. Liyuan thanked the 700,000 volunteers from China’s tuberculosis programmes whose awareness‑raising efforts reached 75 per cent of the country’s population.  Fighting the disease is an important part of poverty‑reduction programmes, she said, adding that the WHO strategy to end tuberculosis must be a call to action.

NANDITA VENKATESAN, tuberculosis survivor from India, said TB had robbed her of eight years of her life, her hearing, family time and four years of employment.  She spent 18 months of college life braving medication side effects and finding solace in education.  After having been cleared by a doctor, the disease returned more acutely, this time resistant to drugs.  Her condition deteriorated, she went through countless treatments, surgeries, injections and medication and suffered debilitating side effects and was eventually bedridden at age 23.  Eventually, she lost her hearing, a devastating side effect of her treatment.

She urged world leaders to act now, stressing that the Political Declaration would make a difference and imploring them to ensure victims would have access to up-front testing, treatment and education.  Investment in health infrastructure and in research for TB drug regimens were required.  She also advocated for the institutionalizing of counselling and peer-to-peer support systems, as TB is a mental battle as much as a physical one.

The General Assembly then adopted the Political Declaration titled “United to End Tuberculosis:  An Urgent Global Response to a Global Epidemic”.

Panel I

The General Assembly then held a high‑level panel discussion on “Accelerating comprehensive response through access to affordable prevention, diagnosis, treatment and care to end the tuberculosis epidemic, including multi‑drug‑resistant tuberculosis, taking into consideration co‑morbidities and the linkages to relevant health challenges on each country’s path towards achieving universal health coverage, taking note of and building on the efforts concerning an accountability framework to drive multisectoral action, as envisaged in the Moscow ministerial declaration”.

Moderated by Isaac Adewole, Minister for Health of Nigeria, and David Sergeenko, Minister for Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia, it featured presentations by Henrietta Fore, Executive Director, United Nations Children’s Fund (UNICEF); Fazle Hasan Abed, Founder and Chairperson of BRAC; Jeremiah Chakaya Muhwa, President of the International Union against Tuberculosis and Lung Disease; and Khuat Thi Hai Oanh, Executive Director, Supporting Community Development Initiatives.

Mr. ADEWOLE said that for too long, persons affected by tuberculosis have lived on the margins of society.  Fortunately, the tides are changing for the better and all stakeholders must ride the momentum to expand preventive care.  Nigeria has developed a comprehensive tuberculosis response mechanism that offers preventive measures, diagnosis, treatment and care.  All hands must be on deck to end the plight of tuberculosis and to debunk the myth that it is a disease of the poor.

Mr. SERGEENKO said tuberculosis was the main cause of death for people with HIV/AIDS.  While substantial innovations have come about in testing and medications, real and significant gaps exist in implementation processes.  Georgia’s experience is a model for public‑private partnerships as the country pursues care approaches that include detection of missing tuberculosis cases.  The fight against tuberculosis requires strong political support to strengthen health systems and conduct relevant research.

BILL GATES, Co-Chair of the Bill and Melinda Gates Foundation, delivering a keynote address, said progress has been made in the fight against TB, with countries tripling the number of patients receiving good care since 2000.  But progress has stalled and the world is not on course to end TB by 2030, thus failing to meet that Sustainable Development Goal.  One of the biggest challenges is to find the missing TB cases, with 40 per cent going undiagnosed or unreported every year.  In the near term, it is possible to accelerate progress and close the gaps at every stage, he said, noting that India has more TB cases that any other country yet the Government’s increased TB budget and political commitments had led to real progress.  South Africa and China are implementing national strategies to close the gap, as well, he said, and other countries can follow suit.

Better tools are also needed, he said, adding that early research progress should be turned into a vaccine, and a drug regimen that can cure TB in two months must be created, as should an affordable diagnostic system to identify lost cases.  The private sector has the skills to help with the research and development, he said, pointing to the TB drug accelerator as an example of the private sector working with Government to make progress.

As 2030 approaches, progress is falling short of the TB Sustainable Development Goal, he said.  The Gates Foundation will partner with the global TB community to fund TB research and treatment delivery.  High‑burden countries must commit to the fight, while donors must increase funding.  All countries together with the private sectors must commit to ensure the accessibility of vaccination, early detection and treatment, he concluded.

HENRIETTA FORE, Executive Director, United Nations Children’s Fund, said special attention must be paid to children in the fight to eradicate TB.  Ninety six per cent of the children who die from the disease never accessed treatment, she said, adding that undiagnosed, unreported, untreated cases are particularly common in children.  Symptoms are often misdiagnosed as malnutrition, as many local health systems are not trained to identify them in children.  Change in health systems at a community level are needed to solve this problem, she said, recommending an acceleration in training community health workers, awareness — especially in remote communities — and innovation and diagnosis.  A scaling up of simple interventions would be helpful, she said, such as requiring health‑care workers to test children who are living with an adult with TB.  Investment will be required, she said, urging the international community to commit to ending TB.

Mr. ABED said that, as treatment improved, tuberculosis became a disease of poor countries and financing for research dried up.  The issue is exacerbated by a shortage of effective delivery mechanisms, including incentive schemes that account for the challenges faced by tuberculosis patients.  One of the largest barriers to treatment is the fact that most people fail to stick to the long regimen required.  In response, BRAC has developed responses that hold patients accountable for their own treatment.  It now provides tuberculosis services on a larger scale than any other non‑governmental organization in the world.  He closed by saying only collective action can end the tuberculosis epidemic and by calling for renewed funding for innovative delivery methods.

Mr. CHAKAYA MUHWA said that some 120 Kenyans die from tuberculosis every day and that, in his native village, people continue to die of the disease.  Poverty was the major driver of tuberculosis, he said, assuring that the disease can only be tackled in partnership with the health sector.  There must be a revolution in prevention with a focus on children and people with HIV.  Data collection related to tuberculosis is lacking in many countries.  He called for efforts to increase demand for tuberculosis treatment services in conjunction with health‑care providers, also urging greater efforts to engage with relevant stakeholders.  He suggested March be designated as “TB Prevention Month” to increase the effectiveness of outreach.

KHUAT THI HAI OANH, Executive Director, Supporting Community Development Initiatives, said the global response to TB has been too slow, citing the high number of lost cases and mortality rates.  Drug‑resistant TB remains a crisis while treatment has not improved.  While better diagnosis, vaccines and treatment are needed, they are useless if they cannot reach victims.  A connection to the people who are left behind is the element missing in the fight against TB, she said, calling for the engagement of lost cases.  Indeed, such cases must be treated as stakeholders in the fight, not simply as victims, and investment in these lost communities with hidden TB cases will be needed.  Strong community systems will not only help end TB, but also help achieve other Sustainable Development Goals, she pointed out.  Global solidarity is needed for global benefit.

In the ensuing discussion, the representative of Canada said tuberculosis remains a major public health concern among Inuit populations.  Native communities face housing shortages and have a lower life expectancy than other Canadians.

Speakers assured the scourge of tuberculosis will only be addressed through cooperative efforts.  The representative of the United States said ending the tuberculosis epidemic requires a global strategy based on innovative care that is rapidly implemented into international strategies.  Key to these endeavours is addressing the HIV/AIDS pandemic.

The representative of Bangladesh said treatment for tuberculosis is completely free as the country makes progress towards achieving universal health care access.  The representative of Brazil said that, as a high‑burden tuberculosis country, it provides universal health services for the disease.

A number of representatives, including of Suriname and Turkmenistan, said their national tuberculosis strategies are in line with the WHO’s “End TB Strategy”.  Speakers also stressed that funding for tuberculosis‑related programmes remains insufficient, with the representative of Madagascar stating that significant gaps remain in the provision of services.

The representative of Venezuela said unilateral coercive measures levelled against his country were forcing it to focus on bilateral partnerships to foster tuberculosis research and called for increased South‑South cooperation.

The representative of Slovakia asked the panellists what tuberculosis treatment priorities exist in their respective regions.

The representative of the African Union said the continent, the world’s fastest‑growing region, is on track to achieve its shared health goals.  He called for shared responsibility in ensuring affordable access to tuberculosis‑related care and urged the private sector to invest in new technologies.

A speaker representing affected communities and civil society organizations called for acknowledgement that public‑private partnerships do not replace the role of Governments in providing affordable medicines, and for use of terminologies that recognize the rights of people affected by tuberculosis.

Also speaking in the discussion were representatives of Germany, Ukraine, Italy, Morocco, China, Senegal, Malaysia and Bolivia.

Panel II

The Assembly then held a high‑level panel discussion on “Scaling up sufficient and sustainable national and international financing and implementation for service delivery, innovation and research and development to identify new diagnostics, drugs, vaccines and other preventive strategies” co‑chaired by Nila Moeloek, Minister for Health of Indonesia, and Molwyn Joseph, Minister for Health and Environment of Antigua and Barbuda.  The discussion featured presentations by Annette Dixon, Vice‑President for Human Development of the World Bank Group; Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria; Lelio Marmora, Executive Director, Unitaid; and Nick Herbert, Co‑Chairman of the Global TB Caucus.

Ms. MOELOEK said tuberculosis is among the top 10 causes of death in the world, with millions dying of the disease each year.  Indonesia was among the high‑burden countries attempting to address tuberculosis with limited resources and geographic and socioeconomic problems.  Indonesia’s decentralized system allows for the emergence of local champions and initiatives to provide care to those affected by the disease.  She acknowledged the relevance of strong cooperation at all levels of Government to ensure an enabling environment capable of addressing the epidemic.

Mr. JOSEPH said Antigua and Barbuda served as co‑facilitator in the preparation of today’s meeting because tuberculosis knows no borders.  Global cooperation is essential to end epidemics and to protect and promote human rights.  He called on all States to ramp up efforts to end tuberculosis at home and abroad, adding that complacency was a bigger threat than the disease itself.  States must feel the urgency of those most affected by tuberculosis, he said, urging speakers to focus on best approaches to drive financing for health.

Ms. DIXON said the human and economic costs of TB disproportionately affect people in the prime of life.  The World Bank’s Human Capital project will focus on country outcomes that are crucial for increasing productivity and growth.  By creating a direct link between growth and productivity, and health and education, the project aims to create domestic demand.  Integrated health service delivery, which addresses various factors affecting people with TB, is needed.  In many countries the private sector has played a crucial role, she said, highlighting the importance of better service delivery and stressing that Government funding should be provided when outcomes are being achieved.  Further, taxes or levees can be earmarked as a way to strengthen the health sector, she suggested, for example on cigarettes, alcohol and sugary soft drinks.  While external financing will remain critical, it should complement, not substitute for, domestic resources.

Mr. SANDS called the TB epidemic a moral issue, as the people dying are mainly poor and marginalized without a voice.  It is also a global health security issue with drug‑resistant TB being the scariest form of antimicrobial resistance.  It is an economic issue as well, affecting people in their prime.  The Global Fund now represents about 65 per cent of the international response to TB, he pointed out, and had launched a catalytic fund to find and treat an additional 1.5 million people by 2019.  But that should only be seen as a first step, he said, urging everyone to agree to a “step change” in the approach to ending TB.  Every country where TB exists must muster the political will and invest the resources needed to meet the Political Declaration’s targets.  More international funding and domestic resources will be needed, as well.  Indeed, finding those being missed will require innovative approaches, including action to address human rights‑related barriers to health.

AISHA BUHARI, First Lady of Nigeria, Joint United Nations Programme on HIV/AIDS Special Ambassador, and Ambassador of the Stop TB Partnership, delivered a keynote address asking how it was possible for a 1,000‑year‑old preventable, curable disease to become the number one infectious killer in 2018.  She noted that the world had achieved great success in ending many epidemics, and wondered what was different about TB.  The key lies in the missing, undiagnosed cases, she said.

To address those issues, she called for greater political commitment and accountability at the national, regional and global levels, as well as more resources for implementation, research and development, and effective partnerships.  She pressed participants to renew their resolve and forge new alliances at all levels to end TB, reaffirming her commitment to work with the Stop TB partnership and all other stakeholders.

Mr. MARMORA said global health priorities must be defined by key partners such as global health stakeholders, national authorities and civil society.  In some cases there is no market for innovative solutions to problems, which calls for well‑targeted catalytic investment.  More must be done to prepare for the introduction of health products in low‑resource settings, with those products adapted to the needs of specific populations and data collected to prove their quality and effectiveness.  He noted that in some cases such products require specific efforts to create demand.

Until a couple of years ago, effective treatment for children with tuberculosis was nowhere to be found, he said.  To fill the gap in global response, Unitaid launched a programme that staked out a market for paediatric tuberculosis treatment that resulted in a new paediatric fixed‑dose combination.  As a result, there is no longer a need to use medications designed for adults when treating children.  Multi‑partnership approaches to development are complex and must be undertaken with the utmost precision, blending technical and political elements, he stressed.

Mr. HERBERT lamented that TB has been curable for nearly a century, yet today is the world’s deadliest infectious disease.  While welcoming the Political Declaration, he questioned if its promises will be translated into action.  The ambitious target to treat 40 million more patients over the next five years, if met, will “break the back” of the epidemic, and if not, will miss the Sustainable Development Goal addressing TB.  Every nation must accept its fair share of additional funding, he said, pointing out that the Political Declaration lacks a strong or independent accountability mechanism to ensure those commitments.  He called for a high‑level steering group to ensure progress, urging parliamentarians to press their Heads of Government on this issue.  The cost of not acting will be catastrophic, he said, pointing out that TB treatments are the most cost‑effective health interventions and that a small boost in global research and development would produce new tools.

When the floor was open for questions and comments, the United States representative said that the United States Agency for International Development has just launched an innovative global accelerator to end TB, a new business model to catalyse efforts across all sectors.  The accelerator will focus on locally generated solutions and coordinate with faith‑based organizations that often have better access to populations.

The representative of Cameroon recounted his country’s own efforts to end tuberculosis, saying that there is potential for overlap in the diagnosis and treatment of HIV and TB.  He called for broader and more strategic efforts on all levels, including agriculture and sanitation.

The representative of Trinidad and Tobago said small and developing countries lack access to existing TB treatments.  Starting and stopping treatment because of lack of ongoing access to medications leads to multi‑drug resistance, he said, calling for a more equitable approach to treating the disease.

A representative for International Organization for Migration (IOM) called for inclusion of the migrant population when implementing TB treatment and eradication measures.  High costs are often used as a reason for not including migrants in health‑care systems, but preventing illness is less expensive than treating it, she said.

Morocco’s representative said decision‑makers in developing countries do not give proper attention to TB.  The provision of treatment is not enough; decision‑makers, including the ministries of housing and education, must take action.  Civic participation is also needed, as is financing.

A representative of the McGill TB Centre said lack of ambition is to blame for the status of the TB epidemic.  The diagnostic tools date back to the 1920s, he said, calling for a renewed commitment, especially from TB workers.

Niger’s representative also highlighted the overlap between HIV and tuberculosis detection and treatment, recounting his country’s adherence to the WHO strategy.

The representative of the Philippines said that, as his country has the fourth‑highest tuberculosis burden, it sought to make TB sufferers agents of their own health.  They should be treated as stakeholders, he insisted.

Canada’s representative said that creative, gender‑based solutions are needed, as is mutual accountability.

The representative of the Marshall Islands said international funding should flow towards activities.  International efforts often parallel local efforts rather than complementing them.

The representative of the Central African Republic said conditions in post‑conflict regions should not have any bearing on assistance.  Available resources must be better used, he said, suggesting that global funding mechanisms could make resources more accessible.

A representative of Foundation of Innovative New Diagnosis said that without new tools, the 2030 goals would not be met.  Progress has been made, including a new urine lab test that detects TB in HIV patients, however, political ambition and funding are lacking.

A representative of the World Health Organization urged participants to coordinate with the organization on steps to address TB and to support applied health research.

Also participating in the discussion were representatives of Indonesia, Argentina, Armenia and Bolivia.

Closing Remarks

TIMPIYIAN LESENI, tuberculosis survivor from Kenya, said that following her harrowing fight with zoonotic tuberculosis, contracted by consuming cow’s milk, she began an advocacy group through which she spreads knowledge of the disease.  Public health approaches fall short when they forget to recognize the human rights of those affected by tuberculosis.  The Political Declaration adopted today is a mandate, she said, urging all actors to end the stigma and discrimination associated with the disease.  She called for the full integration of tuberculosis prevention, treatment and care into health‑care systems, adding that all care for the disease must be free.  Moreover, community health workers must be empowered as they have first‑hand knowledge of the effects of the disease, she concluded.

Ms. ESPINOSA called the high‑level meeting a success in terms of interest and commitment, given the relatively short time allocated for it.  Thanking the Heads of Government, country representatives and survivors for their participation, she stressed that action must now be taken to implement the Political Declaration.  Participants had made specific recommendations during the meeting, while individual countries had relayed details of their national efforts to combat the epidemic.  She called on leaders and private sector actors to invest and take the necessary actions so “we may be the generation to end TB once and for all”.

For information media. Not an official record.