Impossible task for TB response:
achieving 100% of targets with less than 50% of funding

The Stop TB Partnership calls on governments to boost urgently needed funding in TB
and other infectious diseases at UNGA Special Session on COVID-19 in November

14 October 2020, Geneva, Switzerland - Today, the World Health Organization (WHO) launched its annual Global TB Report 2020, but the findings give no cause for celebration.

The Stop TB Partnership is sounding the alarm on the need for urgent funding to effectively combat rising cases of tuberculosis (TB) and other infectious diseases. World leaders must invest in TB prevention, detection, and care, and get back on track to avoid additional suffering and deaths resulting from TB.
 
Progress against the global TB targets, which was already too slow, has been further stalled by COVID-19. Governments must step up now if they are to fulfill the commitments made at the United Nations High-Level Meeting (HLM) on TB in 2018. Two years on, the global TB response is less then 50% funded, with under US$ 6.5 billion available in funding for TB prevention, diagnosis, treatment, and care, despite world leaders having agreed to provide US$ 13 billion per year.
 
At the upcoming United Nations Special Session on COVID-19, due to take place on 5-6 November, world leaders should recommit to fulfilling these important commitments in time for the 2022 deadline.
 
Dr. Lucica Ditiu, Executive Director, Stop TB Partnership, shares her reflections on the Global TB Report 2020 and outlines some of the key lessons that can be learned to strengthen the fight to end TB.
 
Lesson 1: Prioritization
 
An ancient airborne and curable disease, TB remains the biggest infectious disease killer for the ninth year in a row, with 1.4 million deaths in 2019, an average of 4,000 people dying every day due to TB. Even in the context of COVID-19, TB remains the leading cause of death in countries with a high TB burden.
 
Although TB can be prevented and cured, the number of people who die from TB declined by only 100,000 in 2019. Lack of funding and prioritization keep us in the same spot, year after year, so that TB remains a significant threat to global health.
 
TB must be maintained on the political, social, and economic agenda at global, regional, and country levels, with the HLM TB targets as a benchmark. The Stop TB Partnership is calling for follow-up UN HLM on TB in 2023, at which world leaders will need to account for their actions, or lack thereof, in the struggle to end this century-old epidemic.
 
Lesson 2: Funding
 
The global TB response remains chronically underfunded at less than 50%, despite the mobilization of domestic resources in high-burden TB countries and investment by the Global Fund. It will be impossible to fulfil 100% of the UN HLM targets by 2022 with less than 50% of the funds.
 
In 2019, WHO reports, just 33% of people with TB, 50% of children with TB, and 60% of people with Multi-Drug Resistant and Rifampicin Resistant TB are missing out on care. The target to diagnose and treat all people affected by TB disease or infection will remain unfulfilled without sufficient investment.
 
The TB community has worked hard to prioritize, improve efficiency, and achieve better value for money, but the most ambitious national strategic plan, that aims to reach 100% coverage, will never be fully implemented if it is not fully funded.
 
National TB responses should be bold, evidence-based, gender-sensitive, centered on human rights, and address stigma. We need innovative approaches to maximize and better leverage domestic resources. In the coming years, we also need to see increased resources from a more diverse group of external donors, looking beyond the Global Fund, which has carried much of the weight until now, as countries economies will be impacted by the response to the COVID-19 pandemic. 
 
Lesson 3: Integrating TB and COVID-19 response
 
The COVID-19 pandemic has had a drastic impact on the TB response. A modeling study released by the Stop TB Partnership earlier this year showed significant rollback of our achievements, returning us to where we were five years ago. The study highlights the risk of an additional 6.3 million TB cases and 1.4 million TB deaths by 2025.
 
The WHO report presents solid data and profiles of 48 high-burden countries, showing a significant drop in TB diagnosis for the first six months of 2020. An anticipated "bounce back" in the level of TB notifications has not happened in most countries. As such, unfortunately, we expect to see a drop of 20-30% in the notification of TB cases compared with 2019.
 
It is essential for countries where TB is prevalent to ensure the continuation of TB services and prevent disruption in diagnosis and treatment. Redirection of resources and healthcare capacity from TB response to respond to COVID-19 threatens to derail our already-fragile global investments to date.
 
However, we have the potential to make better use of those precious and scarce resources, if we strategically plan for simultaneous TB and COVID-19 interventions, such as case finding and diagnosis. The TB response has learned lessons that can be applied to the COVID-19 response, and vice versa.
 
Health Ministers and others should streamline and integrate the responses and utilize new technologies and platforms for the benefit of both. With worrying backward trends reported, governments need to scale up to catch up.
 
Lesson 4: Data
 
We still do not have the data we need to design timely and informed TB responses. While the WHO Global TB Report provides us with vital data and analysis, it draws on data from 2019, so that we are only just now learning what happened more than a year ago.
 
The lack of real-time data on TB is a significant obstacle to progress in the right to end TB, a problem that is with COVID-19, we have seen how – with adequate investment and prioritization – health data can be collected and shared on a weekly, daily, and even hourly basis.
 
In 2020, when the use of digital technology is booming, we can and must do better. The example of India’s real-time TB data shows us that it is possible to generate and analyze data every day to adapt and adjust the TB response as needed. More countries should follow India's example and develop real-time data collection systems to enable smart programming and course correction.
 
The world is facing unprecedented challenges. But we have no other way to go but straight ahead to achieve our goal of ending TB by 2030. It is not for us, it is not for glory – it is for the millions of people suffering from an entirely curable, airborne disease. If we can learn from our mistakes, if we remain united and committed, we will do it.
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