This is what a Political Declaration on TB should look like...

It remains impossible to get our heads around how little those folk who are unlucky enough to be infected with TB (who also uncoincidentally are predominantly poor) really matter to the authorities (whether at national or global levels) who are entrusted with their protective welfare.

Here’s why we say this.

Five years ago in 2018, a special High Level Meeting on TB was convened at the UN. At this meeting a cluster of targets and commitments were unanimously agreed by all heads of member states in respect of TB. Five years later, and those targets have been appallingly missed, some of them massively, but this year a further meeting is scheduled for September to review ‘progress’. So what can we expect?

What the 'Zero Draft' for the next political declaration on TB is revealing

Currently sensitive negotiations are being conducted to try and develop a 'zero draft' consensus policy statement from which some sort of unanimous political declaration can be formally agreed at the upcoming special meeting. Some of what we have now learnt about this draft is deeply disturbing (what follows relates to what we know about a three-day negotiation meeting held over the period June 20th and July 3rd).

1. We have learnt that negotiations generally broke down before the meeting was concluded.

2. Bizarrely, there was an astonishing request to delete the word "urgently" in reference to strengthening the response to reducing TB deaths, with those requesting this deletion using the argument that things are moving fast enough already in strengthening this response. In fact the estimated annual death toll from TB isn’t currently reducing at all… it’s been rising and (given the epidemiological characteristic of TB trends which shift extremely slowly by standards of other infectious diseases) it probably will continue to do so for several more years if the appropriate ‘urgent’ action isn’t committed to and undertaken. This request for the deletion of "urgently" was, it should be added, largely opposed but nevertheless the word was still not agreed to be left in.

3. Of very significant concern, there was also a significant number of proposed changes in existing wording which, if included, will inevitably weaken the potential impact of any new political declaration. As an example, the vital words "commit to" in relation to TB targets are being pushed towards being weakened into phrases like "strive to promote" or "strive to further". Dear God! In other words, there is actual evidence here of a lack of intention among those drafting this text to actually commit their leaders to anything at all!

4. There was also a change, we understand, that was seriously being considered in respect of the highest level of accountability for achieving (or failing to achieve) any commitments that might reluctantly end up being made - pressing for switching away from identifying "Heads of State” or “Heads of Government" as being responsible (and it was these who committed to the 2018 Declaration) downwards to the more evasive and nebulous "highest level as appropriate or Ministry of Health". Can we conclude from this intended shift of responsibility that Heads of States aren’t expecting much in the way of successful achievements from this new High Level Meeting? Or that they don't feel they should take any responsibility for any of the 2 million-odd vulnerable human beings who die from TB each year (most doing so unnecessarily and as a result of serial shameful neglect)?. Or both, maybe? From a ground level perspective, it certainly looks like some Heads of State are keen that their hands should be washed of any responsibilities for avoidable TB deaths, or at best are intending simply to look away.

5. There does at least appear to be good news in that numerical targets for reductions are said to be now being ‘embedded’ in the proposed texts…except for one astonishing thing: that the wording being proposed to be used before each numerical target is reported to be being pushed to be “up to” rather than “at least’ or “minimum”. From any plausible humanitarian perspective, employing a prefix like “up to” in relation to a target is obviously implicitly self-limiting and what's more renders any such target generally meaningless if not nonsensical.

6. Relating to the vital issue of accelerating the research, development, roll-out of safe, effective, affordable and accessible pre- or post-exposure vaccines, a group of countries actually asked to delete the chronological qualifier that this should be achieved "within 5 years" citing that this would be an impossibility. We don’t know which countries these were (if we did we would name them), but we have to wonder whether or not they noticed anything at all about the recent research, approval and roll-out of COVID vaccines (researched, developed and rolled out within a single year after identification of the pathogen and what's more rolled out globally) Of course, we accept that there was gross inequity in this final roll-out for many reasons, along with some uncertainty persisting about their true protection and long-term safety, but there has nevertheless already been significant work completed on new TB vaccines for well over a decade already. Furthermore, the WHO itself claim that this 5 year target is quite reasonable given the more promising vaccines under research in the existing pipeline – in fact they think that this target is even possible within 3 years, not 5. Furthermore, the WHO point out quite correctly that there is no point doing vaccine development and approval at all if there is no serious aspiration for a rapid rollout.

What does this all add up to? It adds up to a growing probability that the 2023 Political Declaration on TB will be a sham that will amount to a further betrayal of millions of vulnerable human beings who will in turn become millions more TB casualties in the coming years.

In the vast majority of cases TB is treatable, and what's more treating such drug-susceptible TB is cheap and well-proven to be socio-economically very cost-effective. Furthermore, the incidence of TB is definitely reducible with only a little more political will. Both of these two claims, moreover, can be fully substantiated from the content of the previous 2018 Declaration, but they will only ever be actually realised if there is a real intention to change things - in this instance to catch up on those 2018 targets (and more) given that they were so tragically missed. Replacing them, or manipulating them, with disingenuous and evasive language and thus weakening them will do nothing but create more death and destitution.

It's that simple, and it’s that serious. What's more, COVID-19 has shown us just how high leaders can jump if they see it as being expedient.

So here’s what’s now needed as a minimum (i.e. this is the least high they should be jumping in September):

a) Clear, measurable ambitious targets on diagnosing and treating people with both TB and MDR-TB, along with sufficient provision of preventive therapy, along with a particular focus on high-risk groups, including children and people living with co-morbidities (all broken down and committed to by each individual nation). And these targets should build on commitments as agreed by the General Assembly in the 2018 Political Declaration on TB and the Stop TB Partnership’s Global Plan to End TB 2023-2030, and should not be weakened or watered down in any way.

b) The inclusion of clear financial targets for both the TB response and for research which will articulate the overall funding need, and highlight the responsibility of each country to deliver its fair share of the global funding need, as well as recognize with dedicated financial support the critical role of affected communities and civil society in the TB response. And once again, these targets cannot be less or the same as those committed to in 2018: since they have been so abjectly missed over the last five years they should logically be increased very significantly.

c) And these targets need to be committed to and met. Provisions for a proper accountability framework that includes annual reporting from the Secretary-General to monitor and evaluate progress towards ending TB and of investments in TB R&D is paramount, and should promote and support community led monitoring, which is ultimately essential for any successful accountability with such responsibility remaining the respective Heads of States.

Nothing else we will do now.