After months of tense negotiations, uncertainty and hard work on all sides the moment arrived – the 26th September 2018 marked the first ever United Nations High Level Meeting (HLM) on tuberculosis (TB). It offered an unprecedented opportunity for Heads of Government to step-up and commit to global action to end TB. Never has it been more urgent – TB is the 7th largest global cause of death with 1.3 million deaths from TB last year and multi-drug resistant TB on the rise.
The UN meeting took place in New York and civil society pushed hard for the attendance of Heads of Government from across the world who gave statements and show their support for taking forward the commitments outlined in the first ever Political Declaration on the Fight Against TB.
So, was it all worth it?
A UN political declaration is always a tense compromise across 193 member states and the TB outcome document was no different. The document should have been much stronger in many places but it did set a minimum level of commitments from which we can build a stronger global TB response. STOPAIDS Director Mike Podmore said “We welcome important commitments in the political declaration to develop community-based health services through approaches protecting equity, ethics, gender equality and human rights and to find the missing people with tuberculosis. But there are numerous key gaps it doesn’t address that we must fill to ensure we make real progress against this deadly disease, such as the need to double current investments in TB and the need to scale up treatment to reach not only 40 million, but 80 million people by 2022 . We must have leadership from the UK government and other key member states to go beyond the commitments in the Declaration to help realise an end to TB.”
In the run up to the HLM, STOPAIDS has been working closely with UK based member organisations such as RESULTS UK to engage the UK government, as well as working with the global TB community to develop global TB community positions and influence the member state negotiations taking place around the Political Declaration. We attended and spoke at the UN civil society hearing in June and co-led engagement with the UK government and parliament around the UK government’s negotiating positions.
We collaborated with global partners to secure some key wins in two focus advocacy areas for us: Ensuring access to affordable medicines and addressing the needs of transitioning countries.
Access to Medicines
TB is primarily an airborne infectious disease that usually attacks the lungs, but can occur in any part of the body. TB can affect anyone, anywhere, but it disproportionately impacts hard to reach groups include people who use drugs, prisoners and people living with HIV. While progress has been made to secure access to affordable antiretroviral drugs for treating HIV, people living with HIV are still dying from preventable and curable co-infections, like TB. Worldwide, TB is the leading cause of death among people living with HIV and causes one third of all HIV-related deaths.
We continue to lack the tools we need to prevent, diagnose and treat TB effectively and the medicines we do have are unacceptably expensive. Delamanid is one of the first two new anti-TB compounds to have become available in over four decades. This drug could save the lives of patients with multi-and extensively-drug resistant forms of TB. However it costs $1700 per six-month treatment, a price which is unaffordable to many health systems – particularly in low and middle income countries. In 2016, 1.7 million people died of TB and 95% of these deaths occurred in low or middle-income countries.
The Political Declaration coming out of this HLM became a battleground for securing access to medicines. Civil society, including STOPAIDS, worked closely with key member states who were willing to fight for the inclusion of language to affirm the right of countries to use flexibilities in international trade law to access the medicines they need and language that recognises the importance of using progressive, delinked models of research and development to develop new medicines, diagnostics and tools to treat TB. The hard work paid off and language was included that reaffirms countries’ rights to use TRIPS flexibilities to protect public health and that recognises the importance of delinking innovation funding from high prices of medicines (although the word delinkage isn’t actually mentioned).
Sustainability and Transitions
Access to medicines wasn’t the only area of concern for STOPAIDS in the earlier drafts of the Declaration where language was entirely omitted on the need to both recognise the challenges being faced by countries experiencing transitions away from donor funding, and the need to provide them with targeted support around issues such as ensuring the procurement of medicines, as well as the sustainability of treatment and other key TB services. STOPAIDS played an integral role in raising the importance of the inclusion of such language at the civil society hearing in June where, following concerted advocacy, we engaged several member states who then suggested text which has now been included in the Political Declaration.
On both access to medicines and sustainability and transitions STOPAIDS is pleased that some of the needed language has made it into the final draft of the Political Declaration but recognises that there is a still a long way to go in the TB response and that all countries will need to go beyond the ambition of the Declaration to secure real progress. You can read more about our position on the Political Declaration in this global statement written by the Affected Communities and Civil Society Platform which we have signed on to.
The UK Government has signed on to the final Political Declaration and must now consider how to implement the commitments within it. At the United General Assembly Meeting that followed the HLM Secretary of State for International Development Penny Mordaunt MP announced £7.5 million new UK aid support for the TB Alliance to develop shorter, simpler treatments that are affordable to the poorest countries in the world. This is a welcome commitment, we’ll be watching to ensure the UK makes good on this promise and working to understand more about how this investment is underpinned by the principle of delinkage.
Going forward, STOPAIDS recommends that the UK government should:
- Continue to actively support countries attempting to use the full range of TRIPS flexibilities to access medicines
- Invest in delinked models of research and development to drive the production of new diagnostics, vaccines and treatments for TB
- Continue to invest in the critical role that multilaterals play in fighting tuberculosis, particularly the proven impact and results of organisations such as the Global Fund to end AIDS, TB and Malaria and Unitaid.
- Ensure all bilaterally and multilaterally funded programmes working on TB and/or HIV provide routine HIV testing to all patients with presumptive and diagnosed TB and routine screening for TB symptoms of all people living with HIV and AIDS, which is essential for ensuring early detection.
- Prioritise the needs of those most likely to be left behind in the fight against TB and HIV, particularly supporting the role of civil society in delivering services for people affected by TB and holding governments to account.
- Provide targeted support and resources according to the health and development needs of individual countries.
We will be holding UN member states to account for the commitments they made at the UN HLM on TB and look forward to continuing to work closely with the UK government and our members the fight to end AIDS and TB.
Jenny Vaughan, STOPAIDS Advocacy Officer