TB at the UN 2023

Marc Lipman and Ibrahim Abubakar attended the recent UNHLM in New York – the second to have a session focused on TB. Here Marc reflects on the meeting.

The UN High Level Meeting (UNHLM) on TB took place during the 78^th Session of the United Nations General Assembly in New York on Friday 22 September 2023. Earlier in the week there had been UNHLMs on Pandemic Prevention, Preparedness and Response (PPPR) and Universal Health Coverage (UHC). Given both the global importance of TB and the devastating impact that the COVID pandemic has had on TB services, the potential existed for the last UNHLM of the week to be the most fruitful.

Looking back this might indeed be the case as, unlike PPPR and UHC, the political declaration adopted following the TB UNHLM contained targets against which global and national progress could be measured, and the TB community came across as intelligent, unified and committed. However, what a country says it will do to eliminate TB and the actions that then follow can be quite different. Indeed there was a fair amount of wiggle room in the declaration as targets were often couched in language that made them aspirational rather than binding. It was noticeable, also, that by the end of the week many if not all national leaders had packed up and gone home, leaving their Health ministers to usher in the political declaration.

The importance of science and research were emphasised. This aligned with the commitment to significantly increased funding. The concern for me is complacency

So what was good? Certainly, the importance of science and research were emphasised. This aligned with the commitment to significantly increased funding directed towards the topical area of vaccines, and the creation of the TB Vaccine Accelerator Council – which, with WHO support, will focus stakeholders such as governments, communities, global agencies and funders on key issues relating to vaccine development, evaluation and implementation. Also, there was a recognition of the societal impact of TB, with emphasis placed on the importance of equity and access for all, and the catastrophic economic consequences of TB.

The concern for me is complacency: as one speaker said during the UNHLM TB session – “In 2023 why do we let 4000 people die each day from a condition that can be easily cured?”. The answer may be that people are so used to the massive amounts of associated chronic disease and death, that despite the considerable personal stigma of TB, it is almost accepted as an inevitable consequence of life in many parts of the world.

The next UNHLM on TB was announced as taking place in 2028. This itself is a success as it was not a given. How we drive and support the agenda going forward is important, and UCL-TB – both through its research, training and education (including its role as a WHO Collaborating Centre for TB Research and Innovation) and also as part of the network of Academics and Professionals to End TB (UKAPTB) – has an important role to ensure that in five years’ time we can feel a sense of achievement rather than gloom about what followed the 2023 UNHLM on TB.