An emotional Amina Mohammed, Deputy Secretary-General of the United Nations (UN), revealed that her father had died of tuberculosis (TB) as she thanked advocates for their work to secure the adoption of the UN political declaration on TB at the high-level meeting (HLM) on Friday.

Urging UN member states to devote the necessary resources to ending one of the world’s oldest and deadliest infectious diseases, Mohammed said that her commitment to ending TB was personal.

“My commitment is my personal story: losing my father to TB at 50, 37 years ago this week,” said Mohammed, blinking away tears. 

“Today we have the tools to diagnose and treat TB, and what we need right now is a vaccine. Let’s end TB now. It is possible.”

Earlier, she described TB as “a major cause of global antibiotic resistance” and “a global health security threat” aggravated by” armed conflicts, economic upheavals and climate disasters”. 

“We must work to address the main drivers of TB: poverty, undernutrition, a lack of access to health services, the prevalence of HIV infections, diabetes, mental health and smoking,” said Mohammed.

The UNHLM on TB Political Declaration was just adopted in UNHQ. Congratulations! #UNGA ⁦@StopTB⁩ it means a lot for people affected by TB across the world. pic.twitter.com/M69k5Bq3vo

— Suvanand Sahu (@SahuSuvanand) September 22, 2023

Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General, joined TB activists chanting “Stop TB” before addressing the HLM.

None of the targets set by the previous HLM on TB in 2018 have been met, largely due to the COVID-19 pandemic, said Tedros.

Member states committed to treating 40 million people for TB between 2018 and 2022, but only 34 million people were reached (84% of target), said Tedros.

However, the biggest failure involves the target of treating 1.5 million people for multidrug or rifampicin-resistant TB  – with slightly over half this target reached (55%). 

While we have new and powerful tools we didn’t have five years ago including a rapid TB test that gives results in two hours and effective treatment “one important thing that we do not have is a new vaccine”, said Tedros.

The BCG vaccine given to infants was developed over 100 years ago and is inadequate for protecting adults and teens.

“That is why the WHO has established the TB Vaccine Accelerator Council to develop, licence and ensure equitable use of a vaccine,” said Tedros, adding that the council had met for the first time this week.

Some new wins for TB

“This declaration contains clear targets for the fight against TB. The TB community should be proud of their amazing work done to secure these targets. However, we know commitments alone aren’t enough and declarations will gather dust without further action,” said Lucica Ditiu, executive director of the Stop TB Partnership.

“In 2018 member states promised to provide $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?”,

The declaration offers a number of new wins for patients, notably “specific, measurable and time-bound targets to find, diagnose, and treat people with TB with the latest WHO recommended tools, as well as time-bound and specific targets for funding the TB response and R&D,” according to a civil society analysis of the TB declaration,

Another big win for the TB community is stronger language around a commitment “to strengthen financial and social protections for people affected by TB and alleviate the health and non-health related financial burden of TB experienced by affected people and their families” and to ensure that by 2027 100% of people with TB “have access to a health and social benefits package so they do not have to endure financial hardship because of their illness”.

There is also the explicit recognition that it is a human right to enjoy the benefits of scientific progress.

But some key targets have also been watered down, such as the erosion of language around gender and human rights with  none of the key asks related to ensuring that all national TB responses are “equitable, inclusive, gender-sensitive, rights-based and people-centred” being secured.

The Stop TB Partnership said that it was working on translating the global targets and commitments to national level commitments,  and ensuring that civil society and TB communities have the resources and tools to ensure leaders follow through on their commitments.”

Future disruptions?

The three political declarations on health adopted this week – on pandemics, universal health coverage and tuberculosis – will be referred to the UN General Assembly for formal ratification, said UNGA president Dennis Francis. It is possible that the 11 member states including Russia, Syria and Venezuela that disputed consensus had been reached on these declarations in a letter sent to the UN Secretary General earlier this week will object then.

“Our delegations oppose any attempt to pretend to formally adopt any of the draft outcome documents in question, during the meetings scheduled for 18, 20, 21 and 22 September 2023, respectively,” the 11 warned.

“In addition, we reserve the right to take appropriate action upon the formal consideration of these four draft outcome documents in the coming weeks, after the conclusion of the High-Level Segment of the 78th Session of the General Assembly, when they must all be considered by the General Assembly in accordance with its rules of procedures.”

However, none of the 11 contested the adoption of the declarations in the HLMs despite some of them speaking during the proceedings.