Stop TB (Interim) Coordinating Board
The first meeting of the Stop TB (Interim) Coordinating Board (the Board) was held at the Rockefeller Foundation Conference Centre in Bellagio, Italy, from 20 to 22 February 2001. Participants from countries with a high burden of TB, Regions, donors, nongovernmental organizations (NGOs)/technical agencies, Stop TB Working Groups, the World Health Organization (WHO), the World Bank (WB), and the Stop TB Partnership Secretariat attended the meeting. After the meeting, the members of the Board made the following statement.
In March 2000, ministerial representatives of 20 countries suffering the highest burden from tuberculosis (TB) issued a challenge in the form of the Amsterdam Declaration to Stop TB (the Amsterdam Declaration). This challenge called for accelerated action to control the global TB epidemic. To date, however, there is little evidence that there has been significant expansion in the use of DOTS. Responding to the challenge from Amsterdam, we, the Stop TB (Interim) Coordinating Board, representing governmental and nongovernmental agencies, developing countries, and technical and donor organizations, have met together in Bellagio, Italy, from 20 to 22 February 2001. We commit to work together in voluntary partnership to achieve the targets for global TB control endorsed by the World Health Assembly in May 2000. To this end we have taken the following actions: A.) The Stop TB Partnership and the Board will operate by consensus among the members. We agreed on our mission, vision, and priorities and we finalized the mechanisms for governance. B.) The Stop TB Partnership Secretariat, hosted by WHO, will coordinate the development of a strategic plan for the partnership, building on the work done in preparation for the Global TB Investment Plan (GIP). C.) We finalized the scope, operations, and governance of the Global TB Drug Facility (GDF) as follows:
D.) We will mobilize partnerships and resources, and exploit opportunities to strengthen the Stop TB Partnership, supporting global, regional, and national TB coordination. E.) We approved the workplan and budget for the Stop TB Partnership Secretariat. We believe that a firm foundation has now been laid for an accelerated response to the Amsterdam Declaration through collective and coordinated action, and encourage all partners to join this global movement to Stop TB. |
Stop TB (Interim) Coordinating Board
M e e t i n g R e p o r t
I. Background
Since the launch of the Stop TB Initiative in November 1998, collaboration among the TB community has evolved into a broad movement with a global partnership now over 75 partners strong.
Further to the completion of a consensus-based approach to developing a governance mechanism for the Stop TB Partnership in late 2000, the organization of the first meeting of the Board was a high priority.
The Rockefeller Foundation kindly agreed to host this meeting, which also provided an opportunity to discuss and finalize the operations of a Global TB Drug Facility jointly developed by the Stop TB partners in response to the call from ministers of the 20 countries with the highest burden of TB made in the Amsterdam Declaration of March 2000.
The first meeting of the Board was held at the Rockefeller Foundation Conference centre in Bellagio, Italy, from 20 to 22 February 2001, with participants from high TB burden countries, regions, donors, NGOs/technical agencies, Stop TB working groups, WHO, The World Bank, and the Stop TB Partnership Secretariat (see Annex 2).
II. Objectives
The meeting had four stated objectives:
1.
III. Opening
Francis Omaswa, chairing the first meeting of the Board, opened the meeting and initiated a round of introductions of participants. The agenda and objectives were adopted (see Annex 1). Jaap Broekmans, European Region representative, was appointed vice-chair of the meeting.
Gro Harlem Brundtland, the Director-General of WHO, welcomed participants to the meeting via a recorded video-statement.
IV. Progress in the Global Partnership to Stop TB
Presentation
Jacob Kumaresan presented a summary of progress made in the partnership, highlighting developments over the past year since the Amsterdam Ministerial Conference on Tuberculosis and Sustainable Development (the Amsterdam conference).
Discussion
TB control is the most rapidly achievable of the three major diseases of poverty (HIV/AIDS, TB, and malaria). The Board noted with concern, however, that acceleration in DOTS expansion has not occurred to date, without which it will be impossible to achieve targets for global TB control by the year 2005. The Board therefore endorsed the call for accelerated efforts to expand DOTS, and noted that only through collective action will the global targets be achieved by 2005.
Several participants welcomed the commitments and intentions made by the G8 countries related to targets to tackle diseases of poverty, but stressed the need for caution in expecting early follow-up to these commitments. Results and sustainable outcomes from TB action will reinforce the degree of political commitment, which in turn will mobilize financial resources.
To support sustainable results, there is a clear need for clarification of actions required at different levels. Countries have competing priorities within the health sector and need to ensure that TB is part of the priority package. Fostering partnerships with patient groups, family, private practitioners, and professionals will strengthen national coordination. It is crucial to strengthen links with the HIV/AIDS community globally (UNAIDS) as well as locally (TB activists). Other areas that must be addressed include health sector reform, private sector involvement, and integration at the national level.
There is a need to ensure consistency of advocacy approaches and messages across the various working groups of the partnership.
The Netherlands stressed that they attended the meeting as an observer until the representatives from financial donors were officially endorsed by the Partners’ Forum.
Decisions
1.
The Board calls for accelerated efforts on DOTS expansion needed to reach the global targets by 2005.2. Recognizing that TB is not the only problem within countries, the Board will support partnership-building at all levels and with various sectors to integrate and coordinate activities with other disease programmes and initiatives such as HIV/AIDS and Malaria.
V. Progress of Stop TB Working Groups
V.1 DOTS Expansion
Presentation
Mario Raviglione presented the current status of progress in TB control in the high-burden countries following the Amsterdam conference, and the development of the Global DOTS Expansion Plan (GDEP). The GDEP aims to accelerate the expansion of DOTS in order to achieve global targets, building on collaboration among partners and countries.
Discussion
The need for country and regional partnerships, including national/regional interagency committees, was stressed.
The Board endorsed the following steps for DOTS Expansion:
a) Continue to sustain and promote GDEP.
b) Identify the best opportunity to launch GDEP.
c) Mobilize resources to implement GDEP.
d) Ensure that the GDF is an integral part of GDEP.
e) Ensure that the DOTS-Plus for MDR-TB and the TB/HIV working groups work with GDEP.
f) Act now in countries.
V.2 DOTS-Plus for MDR-TB
Presentation
Jim Kim, chair of the Working Group, presented the progress of activities related to MDR-TB and the Green Light Committee (GLC), and the actions needed.
Discussion
The dialogue between DOTS Plus and DOTS Expansion was welcomed by the participants.
Participants expressed a need to include an assessment of effectiveness as well as cost-effectiveness in the pilot-projects, in order to develop sustainable projects.
The Board endorsed the following steps for MDR-TB (DOTS-Plus):
a) Endorse and support pilot projects and the development of recommendations for Member
countries.
b) Support and sustain a strong Secretariat for the GLC.
c) Integrate the Working Group into all TB control activities, especially GDEP.
d) Explore integration between the GLC and the GDF.
e) Provide leadership in advocacy to effectively use the threat of MDR-TB to generate
funds and support for all TB control efforts.
V.3 TB/HIV
Presentation
Mario Raviglione presented a status report on the dual epidemic and the proposed joint WHO/UNAIDS strategy on TB and HIV. The first meeting of the Working Group on TB/HIV will be held in Harare in April 2001.
Helene Gayle presented the activities of CDC’s Global AIDS Programme in the Leadership and Investment in Fighting an Epidemic (LIFE) initiative.
Discussion
Antiretrovirals have a potentially significant role in reducing the burden of TB, but have so far not been included in most TB/HIV pilot projects (including LIFE and ProTest). More discussion is needed in this area.
Existence of an effective treatment against TB should be further advocated within the AIDS community.
The Board endorsed the following steps for TB/HIV:
a) To agree upon the Working Group plan for 2001;
b) To ensure that partners contribute to strategy development and testing;
c). To advocate for the need to address TB/HIV and increase resources to support response;
d) To mobilize additional funds for implementation of ProTest projects;
e). To ensure that resolutions of the Working Group on TB/HIV are mainstreamed into the
DOTS expansion concept.
f) Recommends a representative from UNAIDS to chair the Working Group on TB/HIV.
V.4 Global Alliance for TB Drug Development
Presentation
Giorgio Roscigno presented the rapid development of the Global Alliance. One year ago, around this time, various organizations called for the development of a group to enhance the TB Drug Development (the Declaration of Cape Town). In 2000 the Alliance has been constituted and launched (Bangkok) and a president of the stakeholders association has been selected.
Discussion
The progress of the Alliance was commended by all participants.
V.5 Diagnostics
Presentation
Paul Nunn (on behalf of Carlos Morel, Director TDR) presented a report on activities of the TDR-TB Diagnostics Initiative (TBDI). The Scientific Advisory Committee for Evaluation of Novel Drug Susceptibility Testing Methods held a meeting in December 2000. The diagnostics trial network was expanded during the past year.
Discussion
The Board endorsed the following steps for the Diagnostics Working group, and asked the TBDI to:
a) Identify a working group on diagnostics. TBDI has created a coordination mechanism
for stakeholders in TB diagnostics research and development.
b) The Working group should ensure linkage between GDEP, TB programme laboratories,
and clinical diagnostic research activities.
c) The Working group should ensure a coordinated approach to industry.
d) The Working group should respond to the need for improved quality of clinical
trials,
the development of standard protocols, etc.
V.6 Vaccine Development
Presentation
Paul Nunn presented a report on the Initiative for Vaccine Research (IVR), which aims to coordinate vaccine development capabilities of different organizations. The IVR Vaccine Advisory Group will meet in Geneva from 8 to 9 June to review the existing TB Research and Development (R&D) strategy.
Discussion
The Board endorsed the following steps for the Working Group on Vaccine Development:
a) TDR and IVR are requested to coordinate the activities of Vaccine R&D
stakeholders
and to form a Stop TB Working Group on vaccines.
b) Identify a chair for the Working Group on Vaccine R&D.
c) TDR and IVR to make recommendations to nominate representatives from industry
and R&D organizations to the Board.
VI. Global Partnership strategy, future priorities, governance and organization
Presentation
Ian Smith presented a draft document outlining the mission, vision, values, and prioritized strategies for the Stop TB Partnership, together with the specific priorities for 2001. Petra Heitkamp presented the governance mechanism for the partnership and identified the areas requiring further consultation, particularly the nomination process for Board members.
Discussion
The operational structure and governance mechanism for the Stop TB Partnership is designed to develop and coordinate global TB elimination. Participants emphasized that the mission statement needs to specify shared responsibility, which builds on individual accountability and comparative advantages of the partner organizations. Global targets for DOTS expansion must be explicitly included in the mission statement.
The TB community needs brokers between resource supply and need. The Board and Partnership Secretariat will take up this challenge, directly related to resource mobilization, through the work of one or more task forces on advocacy, financing, resource mobilization, and communications.
Policy decisions made by the Board will be respected by WHO. The Partnership Secretariat is accountable to the Board, including approval of the workplan and budget. Funds for Stop TB Partnership activities will be held by WHO, but specified for Stop TB Partnership. WHO is currently exploring new sustainable mechanisms to enhance administrative efficiency.
Decisions
1. The Board revised and endorsed the mission, vision, values and priorities statement, and endorsed the governance mechanisms. The Stop TB Partnership Secretariat will merge these two documents into a comprehensive framework for the Stop TB Partnership.
2. The Stop TB Partnership Secretariat will develop draft terms of references for the task forces on advocacy, resource mobilization and communications, and finance within four weeks for circulation to Board members. Based on these terms of reference, the Board will determine how many task forces are needed.
3. The Taskforce for Child Survival offered to provide financial support for the initial activities in advocacy, resource mobilization, communications, and financing task forces up to US$ 50 000.
4. The Stop TB Partnership Secretariat will draft generic and specific terms of reference for theWorking Groups for circulation to Board members.
5. The Board recommended the following steps for the nomination of Stop TB Coordinating Board members, to be carried out by specific Board members and the Stop TB Partnership Secretariat:
a High TB burden countries: the Board proposed the two countries with the highest burden of TB (China, India), and two others (Brazil, Nigeria).
b. Regional representatives should be nominated by WHO regional offices in accordance with proposed criteria. In addition, nominations should balance the selection of the high-burden countries.
c. A subgroup of the interim Board (Ernest Loevinsohn, Ariel Pablos-Mendez, Joy Riggs-Perla, Alastair Robb) will propose a mechanism for selection of donor nominees. The Stop TB Partnership Secretariat will send the list of Stop TB donor partners that match the proposed criteria.
d. A subgroup of the interim Board (Helene Gayle, Nils Billo, Alan Hinman, and Jacob Kumaresan) will propose a mechanism for final selection of the NGO / Technical Agency nominee to the Board, including criteria for involvement.
e. A subgroup of the interim Board (Giorgio Roscigno, Paul Nunn, and Jacob Kumaresan) will develop a proposal for involvement of industry-representatives to the Board (taking into consideration the recommendations that will be given as referred to in the discussion of V.6).
f. The Board emphasized the need for additional Board representation from patients groups and from HIV/AIDS organizations, and will further consider whether UNAIDS should be nominated in this latter capacity.
6. The operations of the Coordinating Board were agreed upon, with additional points:
a. Organizations only have one seat on the Board unless nominated otherwise, for
example
the chairs of the working groups.
b. A clear strategy for staggering the terms of office of Board members needs to be
initiated
from next Board meeting onwards.
c. Organizations that fail to attend two consecutive Board meetings will be removed as Board members.
7. The next Board meeting will be held immediately following the Partners' Forum.
VII. Global TB Drug Facility
Presentations
Daniel Kibuga made a presentation on the scope and operations of the GDF, Ernest Loevinsohn on governance of the GDF, and Jacob Kumaresan on the status of the interim GDF. Ernest Loevinsohn and Alastair Robb outlined recent discussions on establishing an umbrella fund for addressing diseases of poverty.
Discussion
The Board commended the progress in the development of the GDF made by the Core Technical Group (CTG) and the Stop TB Partnership Secretariat.
Countries can use the GDF to strengthen their national TB programmes; donors can use the GDF for bilateral support. The GDF should endeavour at all times to strengthen national systems, and not disturb or disadvantage national industries. Local manufacturing could be encouraged through regional tendering. The grant agreement process is vital to ensure that funds are used appropriately.
Donors are unable to provide funds when no institutional arrangements are in place. There is no risk-free option; the issue is to rightly balance the risks. The Board agreed to establish institutional arrangements and move from discussion to action.
Discussions in the G8 during the past year have resulted in commitment of resources. A channel to ensure the flow of resources to countries is being developed (Ottawa Initiative). Resources must be additional to and not substitute for existing aid flows and must "lock in" other commitments from other bilateral agencies, the EU, private sector, etc. Decision-making must be at country level and build on existing mechanisms. The GDF would be one of the channels through which resources from the Ottawa Initiative could flow to support country level TB action.
The CTG has proposed that the GDF be housed in WHO and managed by the Stop TB Partnership Secretariat. The GDF will not enjoy legal status, but will have a memorandum of understanding with the host agency to ensure independence. This arrangement will be for an initial period of two years followed by a review.
Decisions
1. The Board thanks the members of the GDF Core Technical Group, which has now completed its assignment with the finalization of the GDF Prospectus and Governance.
2. The Board endorsed the Prospectus and Governance of the GDF. The Stop TB Partnership Secretariat should incorporate the management and institutional arrangements, revise and finalize the prospectus.
3. The GDF will be housed by WHO and managed by the Stop TB Partnership Secretariat.
4. A representative of the Board, Christopher Lovelace (WB), will lead discussions with WHO on a memorandum of understanding to finalize the institutional arrangements for the GDF, and report back to the Board within three months.
5. The Stop TB Partnership Secretariat will draft criteria for monitoring and evaluation of success of the GDF (including output/impact criteria and process criteria), for submission to the Board.
6. The GDF will be formally launched on World TB Day (24 March 2001).
7. The need for commitment to long-term support for the GDF was discussed and supported.
VIII. Global Investment Plan for TB Elimination
Presentation
Jim Kim and Ian Smith made a joint presentation on the content, development process, and plans for finalization of the GIP, which is being developed jointly by Harvard Medical School and the Stop TB Partnership Secretariat, with funding from the Soros Foundation.
Discussion
The Board endorsed the development process and plan for finalization of the GIP.
In addition to an investment plan, there is a clear need for a strategic plan for the partnership. High-burden countries must be involved in the planning process. It was suggested that the NTP managers' meeting might be used for this purpose. This would ensure that the GIP reflects needs at country level and links with ongoing bilateral activities.
The Board commended the Soros Foundation for their support to the GIP. The recommendations related to the strategic plan would need to be discussed with the Soros Foundation to ensure this fits with their expectations, and final copyright issues would need to be clarified.
Decisions
1. The Board will develop a comprehensive global strategic plan for TB elimination, building on the work already done through GIP (giving further attention to an appropriate name).
2. The Stop TB Partnership Secretariat will take responsibility for development of this strategic plan, through process of consultation with the task force on advocacy, resource mobilization and communication, Stop TB working groups and high-burden countries.
3. The Stop TB Partnership Secretariat will distribute the current version of the GIP to the Board.
4. The Stop TB Partnership Secretariat present options for final development of the plan to the Board, including possibility of combining the investment plan and the strategic plan.
5. The strategic plan and GIP will be presented at the Partners’ Forum to be held in late 2001.
IX. Workplan and budget of the Stop TB Partnership Secretariat
Presentation
Jacob Kumaresan presented a draft workplan and budget for the Stop TB Partnership Secretariat.
Discussion
The Board discussed the workplan as presented by the Stop TB Partnership Secretariat. Staffing issues for the Stop TB Partnership Secretariat will need to be clarified as part of the process in developing the memorandum of understanding for the GDF, with the aim of maintaining a "lean" and efficient Secretariat.
Decisions
1. The Board approved the workplan and budget of the Stop TB Partnership Secretariat for 2001.
2. Additional resources must be mobilized for the additional activities proposed during the meeting.
X. Summary and next steps
With the commitment expressed by partners during the meeting, there is a major opportunity to accelerate action to control TB. The Board emphasized that there is no excuse for further delays in accelerating action to expand DOTS. A clear global strategic plan will support the efforts of countries and national partnerships, and must be developed as a matter of great urgency.
The next Partners’ Forum will be held in late 2001. Several options for hosting the meeting were discussed, including the International Union Against Tuberculosis and Lung Disease (The Union) meeting in Paris in October 2001. The World Bank also offered to explore possibilities for hosting the event. Future meetings of the Stop TB Partners' Forum could be held back- to-back with the Roll Back Malaria Partners' meeting.
Board members committed to attend regional meetings to promote the Stop TB Partnership.
Board members will make strategic visits to strengthen links with current partners and potential partner organizations.
The Board concluded with a statement (Bellagio Statement) outlining the main outcomes of the meeting, to be circulated to all partners.
Stop TB (Interim) Coordinating Board presentations available from the Stop TB Partnership Secretariat:
Annex 1: Agenda
Tuesday 20 February 2001
| 15:00 onwards | Registration at the Bellagio Conference Centre and collection of background documents |
| 15:00–18:00 | Reading time for Coordinating Board background documents |
| 19:30 | Dinner |
Wednesday 21 February 2001 Chair: Francis Omaswa
| 8:30–9:00 | Welcome Introduction of participants and adoption of agenda Opening (video) statement by Dr Gro Harlem Brundtland, Director-General, WHO |
| 9:00–10:30 | Progress of the Global Partnership to Stop TB |
| 9:00–9:15 | Update on strategic development of TB control in WHO – J.W. Lee |
| 9:15–9:30 | Update on Stop TB Partnership Secretariat – Jacob Kumaresan |
| 9:30–10:30 | Group discussion and update from countries,
regions, and partners on progress since the Amsterdam conference |
| 10:30–11:00 | Coffee/Tea |
| 11:00–13:00 | Progress in Stop TB Working Groups Update on the progress made in 2000 and outline of accelerated action planned for 2001, including potential synergies among groups working on these issues and other Stop TB working groups DOTS Expansion – Mario Raviglione TB and HIV/AIDS – Mario Raviglione DOTS-Plus for MDR-TB – Jim Kim Global Alliance for New TB Drug Development – Giorgio Roscigno TB Vaccine Development Coalition – Paul Nunn TB Diagnostics Initiative – Paul Nunn |
| 13:00–14:00 | Lunch (on site) |
| 14:00–15:30 | Progress of the Global Partnership to Stop TB and future priorities |
| 14:00–14:30 | continued: Discussion of Stop TB working groups, including potential synergies among groups and support needed from the Global Partnership and Partnership Secretariat |
| 14:30–14:45 | Strategy and future priorities – Ian Smith |
| 14:45–15:30 | Discussion |
| 15:30–16:00 | Coffee/Tea Break |
| 16:00–17:30 | Organization and governance of the Global Partnership |
| 16:00–16:30 | Governance mechanisms – Petra Heitkamp |
| 16:30–17:30 | Discussion of operations of Stop TB Coordinating Board |
| 17:30 | Adjourn |
Thursday 22 February 2001 Chair: Francis Omaswa
| 8:30–8:45 | Review of Day 2 Agenda |
| 8:45–11:00 | Global TB Drug Facility (GDF) |
| 08:45–09:15 | Scope and operations – Daniel Kibuga |
| 09:15–09:30 | Management and governance – Ernest Loevinsohn |
| 09:30–10:15 | Group discussion |
| 10:15–10:30 | Update on Interim Global TB Drug Facility – Jacob Kumaresan |
| 10:30–11:00 | Group discussion |
| 11:00–11:30 | Coffee/Tea |
| 11:30–13:00 | Global Investment Plan (GIP) for TB Elimination |
| 11:30–12:30 | Presentation – Jim Kim |
| 12:30–13:00 | Group discussion |
| 13:00–14:00 | Lunch (on-site) |
| 14:00–15:00 | Workplan and budget of Stop TB Partnership Secretariat |
| 14:00–14:30 | Presentation Partnership Secretariat – Jacob Kumaresan |
| 14:30–15:00 | Group discussion |
| 15:00–15:30 | Summary and next steps |
| 15:30 | Adjourn |
Annex 2: List of Participants
Regional RepresentativesHigh-burden Country Representatives
India - Not able to attend.
Kenya - Dr Daniel K. Kibuga
Pakistan - Dr Javaid Khan
Peru - Not able to attend.
Working Group Chairpersons
WG on Alliance for TB Drug Development - Dr Giorgio Roscigno, USA
WG on DOTS-Plus for MDR-TB - Dr Jim Yong Kim, USA
WG on Vaccines/TB Diagnostics, Dr Paul Nunn, Switzerland
WG on DOTS Expansion/TB & HIV/AIDS - Dr Mario Raviglione, Switzerland
Nongovernmental Organizations and Institutes
Centers for Disease Control & Prevention (CDC) - Dr Helene Gayle - USA
International Union Against Tuberculosis and Lung Disease (The Union) - Dr Nils Billo -France
Task Force for Child Survival and Development (TFCSD) - Dr Alan Hinman - USA
Donors
Canadian International Development Agency (CIDA) - Dr Ernest R. Loevinsohn
The Netherlands Government - Mr Harry van Schooten
US Agency for International Development (USAID) - Dr Joy Riggs-Perla, USA
Department for International Health (DfID) - Dr Julian Lob-Levyt, UK
Rockefeller Foundation - Dr Ariel Pablos-Mendez - USA
Multilateral Agencies
World Health Organization - Dr J.W. Lee, Switzerland
World Bank - Mr Christopher Lovelace, USA
United Nations Children’s Fund (UNICEF) – Not able to attend.
Stop TB Partnership Secretariat
Dr Jacob Kumaresan, Switzerland
Dr Ian Smith, Switzerland
Ms Petra Heitkamp, Switzerland
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