The second United Nations high-level meeting on TB: new global pledge to end the TB epidemic
On 22 September 2023, at the second United Nations (UN) high-level meeting on the fight against tuberculosis (TB), world leaders adopted a historic declaration with commitments to ambitious and comprehensive time-bound targets and actions. These targets and actions aim to enhance equitable access to TB services, protect human rights, address TB determinants, reduce vulnerability, accelerate research and innovation, and mobilize sufficient resources to support these endeavours (1).
The declaration builds on progress against commitments made in the 2018 political declaration of the first high-level meeting on TB (2); it establishes more ambitious targets and commitments to rapidly overcome the adverse impacts of the COVID-19 pandemic on TB services and fast-track progress towards the Sustainable Development Goals (SDGs).
Highlights of the commitments made by all UN Member States in the 2023 political declaration are shown in Table 1 and Table 2. These include commitments to universal access to TB services in both high and low burden countries, with time-bound targets of reaching, with health services, at least 90% of people with or at risk of TB between 2023 and 2027; to increased investments in the TB response (including for research and innovation); and to fast-tracking the development and availability of new tools to prevent, diagnose and treat TB, particularly new TB vaccines. Finally, a follow-up meeting was agreed by Member States for 2028, to review progress achieved towards ending TB.
| Indicator | Global target | ||
| TB treatment coverage (percentage of the estimated number of people who develop TB disease each year who are provided with quality-assured diagnosis and treatment) | 90% by 2027 (equivalent to up to 45 million people globally in the 5-year period 2023–2027, including up to 4.5 million children and up to 1.5 million people with drug-resistant TB) | ||
| Coverage of TB preventive treatment (percentage of people at high risk of developing TB disease who are provided with TB preventive treatment) | 90% by 2027 (equivalent to up to 45 million people globally in the 5-year period 2023–2027, including 30 million household contacts of people with TB and 15 million people living with HIV) | ||
| Coverage of rapid diagnostic testing for TB (percentage of those diagnosed with TB who were initially tested with a WHO-recommended rapid molecular test) | 100% by 2027 | ||
| Coverage of health and social benefits package for people with TB | 100% by 2027 | ||
| Availability of new TB vaccines that are safe and effective | Rollout initiated, preferably within 5 years | ||
| Annual funding for universal access to quality prevention, diagnosis, treatment and care for TB | US$ 22 billion by 2027, US$ 35 billion by 2030 | ||
| Annual funding for TB research | US$ 5 billion by 2027 | ||
| Topic or theme | Commitments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Provide comprehensive care to all people with TB | Strengthen the provision of comprehensive care for all people with TB, with particular attention to people who are vulnerable or in vulnerable situations (e.g. people with HIV, people with TB-associated disabilities, older people, migrants, refugees, internally displaced people, and pregnant and lactating women), using specific models of care such as nutritional, mental health and psychosocial support, social protection, rehabilitation and palliative care. Scale-up comprehensive efforts to close longstanding gaps in the prevention, diagnosis, treatment and care of children. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Address the crisis of drug-resistant TB | Work towards the achievement of universal, equitable and affordable access to WHO-recommended diagnostics and drug susceptibility tests, and all-oral shorter-duration treatment regimens for people with drug-resistant TB, complemented by monitoring and management of side-effects, together with care and support to improve treatment outcomes. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Build on interlinkages across the global health agendas of TB, UHC and PPPR, to strengthen the TB response | Establish TB services as essential elements of national and global strategies to advance UHC, address antimicrobial resistance and strengthen PPPR. Integrate systematic screening, prevention, treatment and care of TB, and related health conditions, within primary health care, including community-based health services. Invest in public health infrastructure and the health workforce. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Address TB during health and humanitarian emergencies | Safeguard TB services as essential health services during humanitarian and health emergencies. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Strengthen the engagement of civil society and communities affected by TB | Intensify national efforts to create enabling legal and social policy frameworks to combat inequalities, and to eliminate all forms of TB-related stigma, discrimination and other human rights barriers and violations. Strengthen the meaningful engagement of parliaments, civil society, and TB-affected local communities, including young people and women, in all aspects of the TB response, to ensure equitable and people-centred access to TB services, with increased and sustained investments, especially in community initiatives. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Enable and strengthen TB research | Create an enabling environment for TB research and innovation across Member States and partners. Strengthen research capacity and collaboration through TB research platforms and networks across the public and private sectors, academia and civil society. Accelerate the research, development and roll-out of safe, effective, affordable and accessible vaccines, preferably within the next 5 years, including through leveraging global collaboration mechanisms and WHO initiatives such as the accelerator council for new TB vaccines. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Promote access to affordable medicines | Promote equitable access to affordable, safe, effective and quality medicines, such as generics, vaccines, diagnostics and health technologies, including through the Stop TB Partnership/Global Drug Facility, to ensure availability and access to quality-assured and affordable commodities recommended by WHO. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Strengthen multisectoral accountability | Support the WHO multisectoral accountability framework for TB by strengthening high-level multisectoral accountability and review mechanisms, in line with national contexts, defining the roles and responsibilities of relevant sectors and stakeholders with the meaningful engagement of people and communities affected by TB. Develop and implement ambitious, costed national TB strategic plans or health strategies with a multisectoral approach. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
b) Requests
| Topic | Request | |||||
| Role of WHO | WHO is requested to continue providing global leadership to support Member States to build a resilient response to TB as an integral part of the UHC agenda, and to also address the drivers and determinants of the epidemic, including in the context of health and humanitarian emergencies, with multisectoral engagement, the provision of normative guidance and technical support, and through monitoring, reporting and review of progress, and by advancing the TB research and innovation agenda | |||||
| Report and review progress | The UN Secretary-General, with the support of WHO, is requested to report, as part of his annual SDG report, on the global effort to end TB The UN Secretary-General, with the support of WHO, is requested to present a report to the UN General Assembly in 2027, on the progress achieved towards realizing the commitments made in the 2023 political declaration on TB Heads of state and government are requested to undertake a comprehensive review of progress at a UN high-level meeting on TB in 2028 | |||||
The commitments in the declaration present an important opportunity to galvanize the political will and efforts required to achieve the goal and targets of the End TB Strategy (3).
Information about the roadmap up to the UN high-level meeting on TB and the role of the World Health Organization (WHO) in the preparatory process is summarized below.
Appointment of the cofacilitators for the intergovernmental process (October 2022)
The President of the seventy-seventh session of the UN General Assembly, His Excellency Csaba Kőrösi, appointed the Republics of Poland and Uzbekistan as the cofacilitators of the second UN high-level meeting on TB. Their remit was to coordinate the intergovernmental process for the comprehensive review of progress, in the context of the achievement of targets set in the 2018 political declaration and the 2030 Agenda for Sustainable Development, and on that basis to facilitate negotiation of a new political declaration on TB (4).
Scope, modalities, format and organization of the high-level meeting (February 2023)
In December 2022, the cofacilitators introduced a draft resolution on the scope, modalities, format and organization of the high-level meeting; this resolution was negotiated and adopted in February 2023 (5). In the resolution, Member States decided that a high-level meeting on TB would be held on 22 September 2023, with the theme of “Advancing science, finance and innovation, and their benefits, to urgently end the global tuberculosis epidemic, in particular, by ensuring equitable access to prevention, testing, treatment and care”. To ensure a successful review of progress by Member States, the resolution also requested WHO to support the UN Secretary-General in developing a comprehensive progress report, which was subsequently developed and published (6).
Launch of the WHO Director-General flagship initiative “FIND.TREAT.ALL. #EndTB” 2023–2027 (March 2023)
In the lead-up to the second UN high-level meeting on TB, WHO’s Director-General launched a new flagship initiative, which called on world leaders to (7):
- commit to established targets that include providing quality-assured treatment, within the next 5 years, to at least 90% of people who develop TB;
- ensure that all those treated are tested with WHO-recommended diagnostics and that at least 90% of people at high risk of developing TB are provided with preventive treatment; and
- comprehensively address the health and social drivers of the TB epidemic through universal access to health care and social benefits packages.
The initiative also stressed the importance of safe and effective new TB vaccines to fast-track progress, with a view to license at least one new effective TB vaccine within the next 5 years.
Informal briefing for Member States (March–May 2023)
WHO organized an informal technical briefing for the Permanent Missions and Observers to the UN in New York, and a follow-up briefing for the Permanent Missions and Observers to the UN in Geneva. In the context of several other important high-level events scheduled for September – on pandemic preparedness, prevention and response (PPPR) and universal health coverage (UHC), and the high-level political forum on sustainable development – WHO used this opportunity to demonstrate linkages and complementarity across the three health-related agendas and SDGs. In particular, WHO noted efforts to end TB reduce inequities within and between countries, strengthen health systems, and thereby serve as a foundation for UHC and PPPR.
Strategic roundtable on TB (May 2023)
During the 76th World Health Assembly, the WHO Director-General convened a strategic roundtable with the theme of “Ending TB by 2030: Universal access to care, multisectoral collaboration, and innovations to accelerate progress and combat antimicrobial resistance” (8). The roundtable brought together leaders to deliberate on effective ways to strengthen the fight against TB, building on the principle of equitable universal access to TB prevention and care services, and aligning with WHO’s broader agendas of UHC, antimicrobial resistance and PPPR.
Multistakeholder hearing on TB (May 2023)
The President of the General Assembly convened a multistakeholder hearing to ensure an inclusive, active and substantive engagement of stakeholders in preparation for the second high-level meeting on TB, with support from WHO and the Stop TB Partnership. Those taking part included TB survivors and affected communities, representatives of Member States, parliamentarians, civil society organizations, philanthropic foundations, academia, medical associations, the private sector and broader communities. The hearing included an opening segment followed by two thematic panels: fast-tracking multisectoral and multistakeholder action to ensure universal access to equitable, high-quality, people-centred TB services; and mobilizing adequate and sustainable financing for the TB response, research and innovation. The summary of discussions was published by the Office of the President of the General Assembly (9).
Intergovernmental consultations (May–July 2023)
The President of the General Assembly and the facilitators of the second UN high-level meeting on TB developed and made available a public roadmap for the formal intergovernmental consultations (10). In keeping with this roadmap, WHO provided technical support to Member States when requested.
The second UN high-level meeting on TB (22 September 2023)
The second UN high-level meeting on TB took place during the 78th session of the General Assembly on 22 September 2023, following the high-level meetings on PPPR and UHC. During this meeting, Member States reflected on progress achieved and challenges remaining in ending TB through two thematic panels: accelerating multisectoral actions to ensure equitable high-quality people-centred TB care and addressing determinants of TB in the context of UHC; and scaling up adequate and sustainable national, regional and international financing to ensure equity in TB service delivery and innovative strategies. During the meeting, Member States adopted a new political declaration and agreed to convene a third UN high-level meeting in 2028 to review progress.
References
Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations; 2023 (https://www.un.org/pga/77/wp-content/uploads/sites/105/2023/09/TB-Final-Text.pdf).
Resolution 73/3: Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations General Assembly; 2018 (https://www.who.int/publications/m/item/political-declaration-of-the-un-general-assembly-high-level-meeting-on-the-fight-against-tuberculosis).
The End TB Strategy. Geneva: World Health Organization; 2015 (https://iris.who.int/handle/10665/331326).
Letter from the President of the General Assembly – fight against tuberculosis – appointments of co-facilitators. New York: United Nations; 2022 (https://www.un.org/pga/77/2022/10/20/letter-from-the-president-of-the-general-assembly-fight-against-tuberculosis-appointments-of-co-facs/).
Resolution 77/274: Scope, modalities, format and organization of the high-level meeting on the fight against tuberculosis. New York: United Nations; 2023 (https://daccess-ods.un.org/access.nsf/Get?OpenAgent&DS=A/RES/77/274&Lang=E).
A/78/88: Comprehensive review of progress towards the achievement of global tuberculosis targets and implementation of the political declaration of the United Nations high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations; 2023 (https://undocs.org/A/78/88).
World Health Organization Director-General Flagship Initiative to #ENDTB 2023-2027 [website]. Geneva: World Health Organization; 2023 (https://www.who.int/publications/m/item/who-director-general-flagship-initiative-to-endtb).
Ending TB by 2030: universal access to care, multisectoral collaboration, and innovations to accelerate progress and combat antimicrobial resistance [website]. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/events/detail/2023/05/22/default-calendar/strategic-roundtables-seventy-sixth-world-health-assembly).
Summary by the President of the General Assembly of the multistakeholder hearing in preparation of the United Nations General Assembly high-level meeting on the fight against tuberculosis. New York: United Nations; 2023 (https://www.un.org/pga/77/wp-content/uploads/sites/105/2023/06/PGA-Summary-TB-Multistakeholder-Hearings.pdf).
Roadmap for the intergovernmental process of the high-level meeting on TB. New York: United Nations; 2023 (https://www.un.org/pga/77/wp-content/uploads/sites/105/2023/05/Roadmap-for-negotiations-of-PD-of-HLM-on-TB.pdf).