The Stop TB Partnership on Wednesday, July 6, 2022, unveiled a costed plan for the world to end tuberculosis (TB), the second leading infectious disease killer in the world, after COVID-19.
The “Global Plan to End TB 2023-2030” (or “Global Plan”) outlines the priority actions and estimated financial resources needed to end TB as a global health threat by 2030. It also lays out how, from now up to 2030, a global investment of $250 billion could save millions of lives through early diagnosis and treatment of 50 million people with TB; the development, approval and distribution of a new TB vaccine; and the redoubling of efforts so that emerging crises like the COVID-19 pandemic or conflicts, like the ongoing war in Ukraine, do not derail TB programmes.
The total amount of funding needed to support the Global Plan’s ambitions is the equivalent of every person in the world donating $4 per year for the next seven years. The economic return on this investment would amount to $40 for every $1 invested – and as much as $59 for every $1 invested in low- and lower middle-income countries. If, instead, the status quo is maintained, TB is expected to continue to kill between 4,000-5,000 people every day, an additional 43 million people will develop TB and the cost in human life and disability would translate to a global economic loss of $1 trillion.
“The COVID-19 pandemic delivered a crystal-clear wake-up call: that we cannot ignore a disease just because it has been relegated only to the poorest parts of the world,” said Dr. Paula Fujiwara, who led the task force in charge of the development of the Global Plan.
“With our attention diverted – along with the absence of financial commitments – TB has strengthened its grip on our planet. But we can regain control and meet our commitments to end TB by 2030 as long as we assert our political will now,” Dr. Fujiwara added.
The Global Plan maps out how to end TB as a public health challenge by 2030 – the year by which governments around the world committed to achieving the United Nations Sustainable Development Goals (SDGs). SDG three is to “ensure healthy lives and promote well-being for all and all ages,” and one of the targets includes ending the TB epidemic. This goal was the focal point of the 2018 United Nations High-Level Meeting (UNHLM) on TB, where member states embraced several global commitments that the world currently is not on track to meet, especially because of the setback to the global TB response due to the COVID-19 pandemic.
“The global community’s response to the COVID-19 pandemic was to plow money and resources into developing diagnosis tools, treatments and vaccines at lightning speed,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. “TB afflicts 10 million people every year, claiming one and a half million lives, and yet the global response has been tepid at best. A similar airborne infectious disease, TB remains neglected, even though it is a health threat for every single person. It is in the interest of all of us to end TB.”
The Global Plan highlights the need to invest in a new TB vaccine, approve it by 2025, and make sure that resources are available so that it can reach adults and adolescents in countries where TB is most prevalent. The only TB vaccine currently available is the BCG vaccine, which was approved more than a century ago and has a very limited impact on disease prevention.
“The proposed investment of $10 billion in new TB vaccines, a new tool we all are waiting for, is 10 times less than what was injected in the research and development for COVID-19 vaccines. It should be possible to have the TB vaccine, isn’t it?” said Dr. Ditiu.
Because future pandemics are also likely to be caused by airborne respiratory infections, the Global Plan positions TB prevention at the centre of pandemic preparedness and response efforts.
“From COVID-19 to any number of crises – including needless wars, mass migrations, famines and other natural disasters – the global community has a long list of excuses for letting TB linger,” added Dr. Ditiu. “Today, the Global Plan outlines how we can end the disease: invest in the science and make sure everyone can access the results, especially those from impoverished regions where TB is most entrenched.”
Between 2023 and 2030, the Global Plan calls for the mobilization of $249.98 billion, diversifying the sources of financing from domestic budgets of governments, external donors, development banks, social health insurance, philanthropy, the private sector, and innovative sources of financing. Of this, $157.2 billion is for TB prevention and care, $52.6 billion for vaccination once new vaccines are available, and an additional $40.18 billion to accelerate the development of new TB medicines, treatment regimens and diagnostics.
The funding needs detailed in the Global Plan are essential to recapture lost progress due to COVID-19 and accelerate progress towards ending TB – previous reports from the Stop TB Partnership noted that COVID-19 had cost the world 12 years of progress against TB. As a result, the action steps in the Global Plan would speed up research and development, scale-up access to modern tools and make up for years of shortfalls in TB funding. Additional funding needs are also outlined for community-level services, efforts to protect the rights of people with TB and support for a stigma-free and gender-responsive approach to TB care and prevention.
To end TB, we will need an all-hands-on-deck approach from governments and a diverse range of partners from civil society and affected communities and an increasing investment through mechanisms like Challenge Facility for Civil Society to ensure we can play our role” said Choub Sok Chamreun, executive director of Khmer HIV/AIDS NGO Alliance and Co-Chair of Activists’ Coalition on TB Asia- Pacific (ACT! AP). “We are treading water instead of making waves, and we are losing too many people as a result. It’s time to end TB for good.”
Lucica Ditiu, Executive Director, Stop TB Partnership, said: “The data we have states that out of two people that are sick with untreated tuberculosis, one of them dies.
“I am optimistic that the war against tuberculosis will finally be won by 2030. A lot of optimism comes from what we have seen happening during COVID – it is possible to mobilise the resources – it is possible that researchers will work together and share data to be able to develop new tools in such a short amount of time and it is possible to deploy and to organise amazing efforts at the grassroots level.”
Dr. Mansukh Mandaviya, Minister of Health and Family Welfare Government of India and Chair of the Stop TB Partnership Board and Chair of the Stop TB Partnership Board: “Tuberculosis has been primarily a disease of poverty with developed countries almost eliminating the disease. The real challenge is in developing countries, where priority is still not given. Tuberculosis kills more than 4,100 people a day a globally, we cannot let this airborne, preventable disease continues to take precious lives, despite commitments made irregularly by governments and key stakeholders to increase the resources available to fight this disease.
“Our Honourable Prime Minister Narendra Modi has given a clarion call to the nation (India) to end tuberculosis by 2025, five years ahead of the goal. The TB national project plan for TB eliminations 2022-2025 is an endorsement of our government. He doubled commitments to make India TV free by 2025.”
Dr. Paula Fujiwara, Chair, Stop TB Partnership Global Plan Task Force: “It is possible to reduce annual TB deaths by 90% and treat 50 million people with Tuberculosis, including children and those with drug resistant tuberculosis by 2030.
“TB remains a disease with an excellent return on investment of $40 for every dollar invested, and we will need the nearly $250 billion until 2030, 157.2 billion will be for TB prevention and care. There’s going to be a continued need for research on the development of diagnostics, medications and vaccines, and this increased funding includes the catch up from losses from the COVID-19 efforts.
“The global plan gives us momentum as we move forward to the next UN high level meeting in 2030 and look to reach the SDG goals.”
Mr. Paul Mahanna, Director, Office of Infectious Diseases, USAID, Bureau for Global Health: “We cannot drive change without addressing the significant funding gaps that exist within high TB burden countries that result in lack of access to life saving services and drive individuals, families and communities further into poverty.
“Currently, almost 30% of funding per TB case comes from out-of-pocket costs and on average individuals with TB and their households lose 50% of their annual incomes as they suffer from and get treatment for the disease, even in places where TB services are provided free of charge.”
Mr. Chuob Sok Chamreun, Executive Director of Khmer HIV/AIDS NGO Alliance (KHANA) and Stop Tb Partnership Global Plan Task Force member: “It Is important to involve the civil society and the community in the development of the global plan to end TB. Without them being actively engaged in building, planning, implementing and monitoring, the response will not be successful, and it will be difficult to meet the demand.
“Having the plan alone is not enough and we want a plan that can meet the demands of communities and that really respond to what the people want. Taking the plan into action is really good and working together alongside civil society, affected communities and all other stakeholders will lead to progress.”
Dr. Tereza Kasaeva, Director, Global TB Programme, WHO: “TB is the second biggest infectious disease killer in the world right after the COVID-19. There are huge gaps in enabling access to TB prevention and test services for people with TB as well as lack in financing. We urgently need increased investments actions to get the response back on track to save lives and reach the global TB targets set in the strategy.
“We can see that even despite of all these challenges, that out of six high-burden countries who managed to reach End TB strategy milestones, five are from the African region. So that’s why we have to support these programmes, and these people, and to give more investments. They’re doing an amazing job.”
