Today, the United Nations General Assembly will, for better or worse, shape the next decade of the global response to the world’s deadliest infectious disease. Millions of people will feel the decisions made today. Millions of lives will be won or lost as member states barter and jockey over the content of the Political Declaration of the United Nations High Level Meeting on Tuberculosis. This is not hyperbole but empirical observation: what happens today matters for millions. And as of this morning, things don’t look good.
From time to time, the United Nations General Assembly, the main decision making body of the UN, convenes a “High Level Meeting” on an issue that demands a coordinated global response. At a High Level Meeting, the countries of the world come together and agree to a plan, normally called a “political declaration,” on how to address the issue. The High Level Meeting on TB will take place in September 2018. The political declaration will be decided long before then. And today is the cut off for introducing new text to the draft.
The UN High Level Meeting on TB is long overdue. In 2016, TB killed 1.7 million people and made 10 million more sick. For those who survive, the devastations that TB leaves behind include catastrophic economic consequences, deep stigma, and brutal “side effects” such as permanent, and complete, hearing loss. Yet TB is preventable and, for the most part, curable. It is precisely the type of problem that persists only for lack of coordinated attention.
We could end TB cheaply and quickly. We know how to do it. Amongst the world’s complex challenges, TB is relatively simple and affordable, if not even lucrative, to fix. Proper investment in the TB response could lead to returns to society on the scale of USD$43 for every USD$1 put in.
Yet, at the current rate of progress, we won’t meet targets set by the UN to “end TB by 2030” for another 150 years. And 28 million more people will die from TB by 2030, at a global economic cost of about USD$1 trillion. We also know that we have a narrow window to act—we can either stop the rise of drug-resistant forms of TB now or we can sit by, let the bacteria grow stronger, and watch helplessly as it kills millions in a few years.
The World Health Organization says that we need about USD$13 billion annually till 2030 to end TB. On the global scale, it’s not a lot of money. And in terms of lives saved and economic benefits reaped, it’s the deal of the millennia. But our current level of investment is only about half way there. This is precisely the type of situation a High Level Meeting is meant to fix. All we need is a coordinated push.
And here we are. It is June 18th, 2018. The world faces a disease that kills millions, devastates economies and grows in its threat to life and national security every day. We know how to fix it. It’s cheap to fix it. And we’re not doing it. We’re letting the moment go. Or, rather, governments across the globe and their representatives at the United Nations are letting it go.
We know what an effective political declaration would have: clear commitments to meet measurable targets on financing, research and development, treatment and prevention, and a handful of other key interventions; strategies to tackle the drivers of TB in populations that require special focus such as detainees and mineworkers; an accountability mechanism that can hold countries to meeting the commitments they make; and a firm anchoring in human rights.
The draft political declaration as we know it this morning doesn’t have these elements. All of them have been on the table. All of them have been proposed, briefed, and debated. But they’re not in the declaration.
The TB High Level Meeting is neither the beginning nor the end of the TB response, but it is an important moment of contingency. Today, people over phones and around conference rooms in New York and across the globe will decide the language to be introduced to the Political Declaration of the United Nations High Level Meeting on TB. They can choose to make it a success or let the moment go by. Millions of lives are at stake. The world will soon know, and feel, the choices they make.
