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World Tuberculosis Day 2023: The Time to Invest is Now

March 24th marks a significant day in the history of global health; it is the day that tubercle bacillus was discovered, the bacterium that causes an infectious disease that has caused significant morbidity and mortality throughout human history – tuberculosis (TB). It is a day that has become to be known as World TB Day; an opportunity to shed light on the disparities and challenges that people worldwide continue to face today with TB.

Recent calls for action for universal access to short, safe treatment regimens as well as vaccine development intrinsically relate to underlying challenges within the TB space. Despite numerous global commitments to end TB, the level of investment from the private sector, multilateral organizations, and most importantly, countries, is insufficient to reach global TB targets. The shortfalls in TB investment amplify current bottlenecks surrounding various aspects of TB including vaccine development, accessible diagnostics, and equitable care for all, to name a few.

The UN high-level meeting on TB in 2018 saw a collective agreement that US $13 billion was needed annually for prevention, diagnostics, treatment, and care by 2022. However, global TB spending on these essential resources fell from US$6.0 billion in 2019 to US$5.4 billion in 2021, roughly half of what was needed. While most low- and middle-income countries (LMICs) continue to struggle generating the necessary funding, we see high-income countries (HICs) like the United States making efforts to incentivize countries to invest more in TB. Methods used to increase research and development (R&D) funding include international agreements such as the “fair share targets” which underlines a specific level of investment of 0.1% of total national spending on R&D to achieve country specific targets. Methodologies such as the use of “pull funding” to acquire the required financial investment have also been explored by the Centre for Global Development in collaboration with Triangulate Health Ltd and could be beneficial.

The TB epidemic is a multi-faceted problem that necessitates action from all sectors and all actors within the TB space. As we have seen, TB disproportionately affects LMICs, and most specifically, those countries which lack the financial and technological capacity to provide sufficient diagnosis, treatment, and care. There is a sense of congruency between TB and other global health issues such as antimicrobial resistance (AMR) which innately challenges many of those diagnosed with TB.

The work and funding needed to reach global goals by 2030 to end TB have been depicted as the highest return on investment (ROI) out of all SDG indicators most specifically in LMICs. Preparations for a second UN high-level meeting on TB in 2023, offers an opportunity to reinforce the gaps we see specifically in TB financing and garner support at the country level for increased efforts. There is an inherent harmony between increased action against TB and achieving other global health goals including universal health coverage (UHC).

It is no secret that even with the most conservative estimates, the cost of inaction is troubling. Millions more deaths, billions in treatment costs, and billions in lost productivity are only a few of the realities if we do not reach our goal. Despite some challenges, including those related to the Covid-19 pandemic, there is a great reason for optimism, and we need to continue to build and strengthen global efforts as we have seen, underpinning the WHO’s theme of Yes! We can #EndTB!

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