What the UN's first TB declaration should have said

UN TB Summit 2018
Thursday, 27 September, 2018 - 13:00

The ink's mostly dry on the 16-page declaration, which you can check out below, but activists are expecting countries, including the United States, to capitalise on the meeting to make some major announcements.

It's finally here. After months of negotiations, at least one international spat and what we are sure are countless of track changes later the world finally has its first United Nations declaration on TB.

Heads of state, including our own President Cyril Ramaphosa, will ratify the declaration this week at the UN's first high-level meeting on TB in its 73-year history.

And boy, has TB bided its time. TB is single deadliest infectious disease today, World Health Organisation figures show.

The ink's mostly dry on the 16-page declaration, which you can check out below, but activists are expecting countries, including the United States, to capitalise on the meeting to make some major announcements.

We're just hours away from the official signing of the TB declaration. The document is a product of more than  two months of heated negotiations , meaning the words on the page changed quite a bit to accommodate even issues you wouldn't normally think impact an infectious disease — such as trade. (See more on that  here and some useful background on  trade and access to medicine here)
Here what we know was ultimately cut from the final version:

What’s left unsaid: Some of the others issues that didn’t make it into the final draft

  1. National targets, including specific goals for high-risk populations such as prisoners, miners or children
  2. Commitments to putting national targets on paper in the form of strategic plans
  3. Timelines for new innovations such as shorter, pill-based regimens for all forms of TB, rapid tests and vaccines
  4. An independent accountability mechanism outside the UN system — possible including the World Health Organisation — to ensure future engagements from heads of state
  5. National R&D funding targets. Dubbed the “Fair Shar Targets” this would have ensured that .1% of national research funding would have gone to TB

But there's more, say activists from advocacy organisations such South Africa's Section27, Kenya Legal & Ethical Issues Network on HIV and AIDS and the Treatment Action Campaign.
Here's what they think the declaration should have said:

Tuberculosis is a global emergency that kills over one and a half million people every year. It is the leading killer of people with HIV. Yet, collectively we have failed to respond effectively to TB because it mainly affects poor people including criminalised and marginalised communities such as people who use drugs, prisoners and their communities. We recognise our collective and individual failures. With this declaration, we make it clear that the old ways are not and never were good enough.

1. We commit to putting the money needed for TB research and for TB programmes on the table.

2. We commit to implementing and aggressively scaling up access to the latest evidence-based health technologies and policies in our countries. In short, we commit to ensuring that every single person who has TB receives the best available testing, treatments, and support – irrespective of their ability to pay or in which country they may live. In pursuit of this goal, we place human rights, and particularly the right to health, ahead of private interests and short-term political considerations.

 In particular, we will take the following concrete steps:

3. Implement all World Health Organization (WHO) guidelines relating to the diagnosis, prevention, treatment and care of TB immediately but no later than six months after publication of such guidelines. We will ensure the rapid rollout of lifesaving new diagnostics such as  LAM testing, and better and safer medicines such as bedaquiline. We commit to stop using medicines that do not work or worsen health outcomes for people with TB.

4. Establish ambitious national coverage and mortality reduction targets that ensure a bold scale-up of national efforts to address TB. These targets must be reflected in national strategic plans developed by countries in order to ensure effective accountability. These targets should include a) a reduction in mortality by 75% by 2025; b) a reduction in new infections by 50% by 2025; c) that 90% of people with TB will be diagnosed using WHO recommended rapid diagnostics by 2023; and d) that 90% of people with TB are able to access treatment by 2023 including newer, better and safer regimens for people with drug-resistant TB.

5. Commit to raising the money needed to close the funding gap to ensure a comprehensive response to the TB crisis, as outlined in the  WHO Global Tuberculosis Report 2018. In 2018, investments in TB prevention and care in low- and middle-income countries fell US$3.5-billion short of what is needed. The annual gap will widen to US$ 5.4 billion in 2020 unless additional funding is committed. We will work collectively to establish an equitable funding formula for additional funds needed based primarily on countries’, including donor countries’, ability to pay.

6. Invest at least 0.1% of our national gross expenditure on research and development (GERD) on TB research starting in 2019 and we will continue with TB research investment at least this level until 2030. It is only through such a concrete, measurable commitment that we will ensure the annual US$2-billion that is required for TB research. We will ensure that TB health technologies developed with public and charitable funds will be equitably and affordably accessible to people with TB globally. We commit to ensuring that publicly-funded TB clinical trials include pregnant women, children, and people taking other treatments for HIV and other diseases and conditions. We commit to ensuring that better, more tolerable treatment regimens and co-formulations are developed at product development stages.

7. Implement the recommendation of the United Nations Secretary General’s High-Level Panel on Access to Medicines and establish, before the end of 2019, a binding convention on the research and development of critically needed health technologies for TB and other areas of urgent public health need. We commit to making annual financial contributions to a fund that will be established through the convention. We commit that no exclusive rights, in the form of intellectual property or any other means, will be granted on any products resulting from research funded through the convention.

8. We will, each country individually, by 2021, adopt, use, and protect the public health flexibilities available under the World Trade Organization (WTO) TRIPS Agreement as clarified by the Doha Declaration on the TRIPS Agreement and Public Health of 2001. We will raise the bar for patentability (excluding new uses, new forms, and new formulations of existing health technologies from patentability) and set up easy-to-use compulsory and government use licensing procedures with wide grounds for the issuing such licenses. Least developed countries will adopt the pharmaceutical transition period until 2033 or such time as they are no longer an LDC in accordance with the extension period allowed under WTO rules. We will, each country, refrain from any and all efforts in trade agreements or otherwise to impose TRIPS-plus measures or to retaliate or threaten to retaliate against other countries for using such measures.

9. We will, all high-TB burden countries individually, ensure rapid registration of TB health technologies. We commit to do this by making better use of the WHO’s Collaborative Registration system in order to speed up national registration processes, and, by facilitating and incentivising broad and expedited registration of TB medicines, diagnostics, and vaccines by originators and generic producers.

10. We will, all high-TB-burden countries individually with the financial support of wealthy countries, fully fund aggressive contact tracing and active case finding campaigns in all high-burden countries to find the “missing people” with TB and ensure that TB is diagnosed and treated earlier, and implement programmes to ensure people are supported through treatment better. This will not only support the health of people with TB but also reduce the spread of TB in our communities. We commit to hiring the adequate numbers of health workers needed to scale up these campaigns in order to reduce TB mortality, and we agree to motivate them with a living wage, the tools and training they need to do their work, and the infection control they require.

11. We will, all high-TB burden countries individually and with the financial support of wealthy countries, conduct annual audits of TB infection control in all healthcare facilities, prisons and other public buildings where people gather in our countries. We commit to making the detailed results of these audits publicly available together with turnaround plans based on the challenges identified to address shortcomings in infection control.
12. Commit to ensuring that community members affected by TB are engaged and participate fully in the development and implementation of TB policies and programming, including through financially and otherwise supporting TB prevention and treatment literacy campaigns and other community mobilisation efforts.

13. We call on Peter Sands, the Executive Director of the Global Fund to Fight Aids, Tuberculosis and Malaria to launch immediately a reprogramming and fundraising initiative to ensure high-TB burden countries modify their Global Fund-funded TB and TB-HIV programs to reflect the newest WHO treatment and prevention guidelines rather than old and outmoded approaches.

14. We call on the US Congress to urgently scale up funding for the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Centers for Disease Control (CDC) to support expansion of life-saving TB and TB-HIV programming around the world, including by scaling up access to GeneXpert, aggressively expanding LAM testing, ensuring access to better and safer TB health technologies, and through funding the bold expansion of contact tracing and active case finding campaigns.

Issued by the Health Global Access Project, Global Tuberculosis Community Advisory Board, Global Coalition of TB Activists, International Treatment Preparedness Coalition, Kenya Legal & Ethical Issues Network on HIV and Aids (KELIN), Section27, Treatment Action Campaign, Treatment Action Group.

This article was written by Bhekisisa Centre For Health Journalism  and first appeared on Bhekisisa website

Article Photo Courtesy: www.media.ip-watch.org

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