On the Cusp of Change: Why TB Advocacy Must Keep Pushing Forward

The same day that he-who-shall-not-be-named was sworn back in to office and began dismantling the United States’ role in global health, I landed in Istanbul, Turkey for a Stop TB Partnership meeting. While the lack of uncertainty brough on by the executive orders and dire warnings from our US colleagues certainly impacted our commentary It was they themselves, who, over the 3 days, brought us back to hope and infused our discussions with enthusiasm.

Perhaps, despite the challenges of this moment, we are at a unique place in the TB. No, we haven’t solved the problems of inadequate diagnostic and treatment tools; and no, we don’t have a better vaccine than the BCG (which is still crucial in preventing childhood TB); but because there have been significant gains made and more importantly, we have broader enablers for success.

We now have better, less invasive, and more accessible ways to accurately test and diagnose TB, including at the point of care. A portable chest X-ray and AI system was recently taken to the Everest base camp. It wasn’t just an impressive photo-op – which, let’s be honest, it totally was – it showed that we now have a chest x-ray tool that can help people living in the most harsh environments. Newer, shorter, and less harsh treatment regimens are becoming the standard of care. The cost of key TB treatments and devices, including GeneXpert cartridges, has dropped —though not as much as needed. These savings, achieved through partnerships with the Global Fund, Stop TB, and others, help us stretch TB funding further while improving results. These innovations have been important – and the sight of even better drug-resistant TB treatments and TB vaccines at stage 3 clinical trials makes me practically giddy and its realistic to hope that we may have a new vaccine as early as 2028. We must start doing the work now —building demand to attract pharma interest, strengthening our fight for lower costs, and getting ahead of the misinformation that often undermines vaccination campaigns.

But maybe as excitingly as the new tools we also have more “enablers” in place than we ever have before. Thanks to initiatives like the Challenge Facility for Civil Society we have more community advocates – very often survivors of TB themselves – who are doing amazing work. (Editor’s Note: sadly, since my time in Istanbul with the actions of he-who-shall-not-be-named the new round of applications for CFCS grants has been halted.) So often we’ve bemoaned the lack of specific data on TB, but we now have much more sophisticated data collection tools, including a TB Key and Vulnerable Populations size estimation tool that is giving us new insight and more accurate information and studies examining determinants of TB. We know that good nutrition is key to treatment success, but new studies are also showing the value of nutrition as a preventative tool. As the analogy goes, if we hope to “turn off the tap” that keeps filling up the bathtub – the water being a steady flow of new TB infections – we have to double up our efforts in the known ways to prevent infection and continue to find means that can help us turn off the tap.

There is no doubt efficiencies can still be gained in health systems and TB interventions through service integration. There is equally no doubt that we’ll have to be innovative – like our  with campaigns to boost available resources or like our Turkish colleagues using funding that was generated by an national entertainment tax was generated by an national entertainment tax. But we’ll also have to stick to the basics and build on the years of advocacy with parliamentarians and national TB programs. The Global Fund shared data in Istanbul showing that TB funding becomes 12-25% more efficient when overall health budgets are optimized. This means that improving broader health spending can make TB funding go further. Additionally, the progress towards Universal Health Coverage (UHC) has largely been driven by investments in infectious diseases like TB, HIV, and malaria. This shows that advocating for TB funding is closely connected to the broader fight for UHC and achieving UHC requires investments in TB.

As always, financing the current efforts to find, treat and care for people affected by TB in a holistic and stigma-free way and to effectively roll-out new tools we will need money. And lots and lots and lots more money.

To borrow a too often used phrase, after this week in Istanbul, it really feels to me as though the fight against TB is on the cusp of a real tipping point. The Global Fund Replenishment this year is crucial for TB financing, as it provides about 76% of external funding and a demand-driven system that TB advocates can use to push for new tools. After years of dogged determination from survivors, community advocates, National TB programme managers, partners like the Global Fund and Stop TB Partnership and so many more, despite the challenges we face, I came out with a lot of optimism that real and significant change is just a few billion dollars and some new tools away and that is so much closer than we’ve ever been that I hope we don’t take our foot off the pedal even if the road looks bumpy and feels unknown.

Katy

Noting, that I currently serve as the Alternate Board Member for the Developed Country NGO Delegation to the Stop TB Partnership board in case any of my enthusiasm could be perceived as a conflict of interest.