Ahead of the United Nations High-Level Meeting on Tuberculosis (TB) on September 26 during the UN General Assembly, we sat down with the UN’s Special Envoy for TB, Dr. Eric Goosby, to talk about what the global TB landscape looks like, what we can expect out of the high-level meeting, and what the UN is doing to help create a TB-free world.
Q: What does the global TB landscape look like in 2018?
EG: There is much work to be done on the TB front. According to the recently released World TB Report, TB remains the leading infectious disease killer. There were an estimated 10 million cases and 1.6 million deaths caused by TB in 2017.
We are still missing 40% of these cases, meaning that 4 million people who have TB are not being detected and treated, and pose a great risk of transmission. TB is the leading cause of death among people with HIV and is the deadliest disease among the global threat of antimicrobial resistance.
Despite these challenges, we have a chance now to rapidly accelerate progress to fight TB. The UN High-Level Meeting on TB can be a real turning point in our efforts to build a TB-free world. World leaders will make commitments on how they will tackle TB in each of their countries. Then, our job is to hold them accountable.
Q: We know that TB is the leading cause of death from infectious disease around the world. What is it going to take to help control this epidemic?
EG: To control the epidemic, we must break the chain of transmission through early diagnosis and getting patients on treatment quickly.
Even better would be to eliminate transmission by preventing people from becoming sick with TB. For this, we need to address the massive pool of people infected with TB – estimated to be nearly a quarter of the world’s population, or 1.7 billion people.
Our roadmap to find, diagnose, and treat people with TB disease and TB infection is clear. We need strong health systems, effective patient access, and the removal of financial barriers. This doesn’t happen at a meeting in New York – it happens on the ground in countries. Governments must be at the heart of this action and develop strong national TB plans that address the challenges faced by their populations. To support these efforts, we need multisectoral action that mobilizes resources among funders and includes the voices of civil society.
Q: This is the first-ever UN high-level meeting on TB. How will this meeting impact people affected by TB?
EG: This is a historic moment for TB. We have engaged with parliamentarians to build an understanding of the problem and raise the profile of TB in key countries. We also see strong commitments in the declaration of the UN High-Level Meeting on Tuberculosis.
The key to translating these words to impact on the ground will be the powerful combination of political will and engagement. More than ever before, we are in the position to leverage this momentum, and we must continue to hold our governments responsible for commitments they make. World leaders must return to their countries after the High-Level Meeting and take action on TB to support the health of their populations.
Moreover, we have witnessed extraordinary work by civil society in helping to urge heads of state to engage in supporting the declaration and tailoring action plans for their countries. Foundations, civil society, donor nations, faith-based organizations, and our world’s youth all have an active role to play in reaching our Sustainable Development Goal of eliminating TB by 2030.
Q: What is most needed to end TB?
EG: Ending TB demands financial support and resources to take action on the heads of state’s commitments. This equates to more than $10 billion dollars annually; however, we are currently missing nearly half of the funds for TB research and delivery. We must address these funding gaps, and in particular, invest in developing new tools for prevention, diagnostics, and treatment.
Moreover, at the heart of all these numbers, we need to remember patients and their families, many of whom experience tremendous suffering, financial hardship, and even death due to tuberculosis.
Finally, we need political will – and accountability when our leaders take action.
Generating political will is not a passive effort. It involves a lot of hard work. Getting in front of heads of state and telling them that they need to do something because TB is ravaging their countries is not easy. I’ve done it. I know.
But we all know that a successful high-level meeting means that we need to get heads of state to take responsibility for the health of their people and to step up to the plate and commit.
We must make sure that the words we hear from our country leaders translate into action.
And, equally important, we must hold ourselves accountable for keeping the pressure on. Accountability is the key to unlocking the stranglehold that TB has had on the world since the time of the ancient Egyptians. We must not allow ourselves to start strong in our efforts to build a TB-free world only to stop when the obstacles become too overwhelming.
We’ve done that for too long. It’s time to say: “No more. No longer.”
No one is immune to TB. TB is preventable. TB is treatable. TB is curable. Now, we must all be held accountable.
Dr. Eric P. Goosby is the UN Secretary-General’s Special Envoy on Tuberculosis, a Professor of Medicine and the Director of Global Health Delivery and Diplomacy Institute for Global Health Sciences at the University of California, San Francisco, and a U.S. Ambassador-at-Large (ret.).