A new era for global tuberculosis: holding leaders accountable for promises

Read the editorial from The Union leadership, highlighting the next steps for leaders in tuberculosis, which was published in The International Journal of Tuberculosis and Lung Disease:

September’s United Nations (UN) General Assembly was a historic moment for tuberculosis (TB). For the first time ever, the UN convened heads of state and government at a High-Level Meeting on the fight against TB, which produced a UN political declaration on TB.[1] Political commitment, with adequate resources, is essential to achieving the End TB Strategy.[2] The world now has a global TB political framework endorsed at the highest levels of government that includes targets to achieve by 2022—a timeframe relevant for currently serving national leaders.

Among other promises, leaders committed to:

  • successfully treat 40 million people for TB, including 3.5 million children and 1.5 million people with drug-resistant TB
  • provide TB preventive therapy to 30 million people, including 4 million children under the age of 5
  • include child TB in the child survival agenda and provide family-based TB care
  • advance all areas of innovation, including supporting the Life Prize and the BRICS (Brazil, Russia, India, China, South Africa) TB Research Network, needed to deliver new tools for TB prevention, diagnosis and treatment
  • support a human rights-based approach to global TB
  • mobilise US$13 billion annually for TB care, and US$2 billion annually for TB research and development.

The greatest drawback of the political declaration is that it created no independent mechanism for holding leaders accountable for success or for contributing the necessary resources. To hold leaders accountable, we suggest that the TB community take the following collective actions:

Launch an advocacy campaign through 2022 that advocates for progress toward national-level targets derived from the declaration’s global targets. The campaign should involve direct political engagement, media relations, smart use of data and compelling storytelling. The growing advocacy networks of TB survivors—including TB People, We Are TB, and TB Proof—should be at the forefront of the advocacy and nurtured until they include engaged survivors in every country.

Engage new partners. The World Health Organization’s 2018 Global Tuberculosis Report shows that undernourishment, human immunodeficiency virus, smoking tobacco, diabetes, and the harmful use of alcohol are underlying factors in half of TB incidence.[3]

We need to make common cause with these communities. Elevate TB prevention as an advocacy priority, starting with rapid, routine screening of household contacts. Only one in four household contacts under five were screened for TB in 2017, and only half of high TB-HIV burden countries are even reporting data on household contacts with HIV who received preventive therapy last year.

Rebrand World TB Day by declaring March TB Prevention Month. Doing so will create more time and opportunities for advocacy and community engagement. Heads of state and government have the most visible platforms in their countries. They also have numerous responsibilities. TB Prevention Month will provide more time for local and national campaigns, community engagement, and participation with heads of state who have just committed to achieving historic gains against TB.

After the UN High-Level Meeting on TB, the global TB community faces an unprecedented opportunity to mobilize political and social action against TB. We must seize it together.

Statement by Dr Jeremiah Chakaya Muhwa, José Luis Castro, Paul M. Jensen, Dr Paula I. Fujiwara 


1. United Nations. Political Declaration on the Fight against Tuberculosis. Co-Facilitators’ revised text, 11 September 2018. New York, NY, USA: UN, 2018. https://www.un.org/pga/72/wpcontent/uploads/sites/51/2018/09/Co-facilitators-Revised-textPolitical-Declaraion-on-the-Fight-against-Tuberculosis.pdf Accessed October 2018.

2. World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. EB134/12. Geneva, Switzerland: WHO, 2013. http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_12-en.pdf?ua¼1 Accessed October 2018.

3. World Health Organization. Global tuberculosis report, 2018. WHO/CDS/TB/2018.20. Geneva, Switzerland: WHO, 2018. http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua¼1 Accessed October 2018.