Aaron Oxley

Executive director, RESULTS UK

In 2018, people all around the world joined forces to raise the alarm to world leaders about a disease that kills over four thousand people a day, is increasingly resistant to drugs, and is spread through the air. This was met with surprise – many thought this disease had been beaten decades before.

That disease was tuberculosis (TB) and, in September, world leaders came together in New York to make new commitments to end this ancient, deadly disease, once and for all.

The world’s new commitments

The United Nations High-Level Meeting on TB (UNHLM on TB) was a huge success. With almost 18 months’ hindsight, it’s clear the meeting was a turning point in the fight against the disease, not least because the  new commitments that were made include:

• Successfully treating 40 million people with TB by 2022
• Ending stigma and all forms of discrimination, including removing discriminatory laws, policies and programmes against people with TB
• Delivering new, safe, effective, and affordable tools including drugs, diagnostics, and vaccines for TB
• Committing to dramatically increasing funding to $13 billion per year, with an additional $2 billion for research and development in the fight against TB
• Robust commitments to accountability at the national and global level.

It’s the last of those commitments that, in many ways, was the most important: it meant that world leaders want us to hold them accountable to delivering their promises.

What does ‘accountability’ look like?

Accountability is never just one thing. The World Health Organization (WHO) was tasked with producing an ‘Accountability Framework’ that helps us put the world’s accountability efforts into context. It shows how the WHO’s own powerful monitoring, through the Global TB Report, must be complemented with other monitoring. It must review activities such as the MSF/STBP ‘Out Of Step’ report on countries’ performance in implementing the best TB policies, the TAG ‘Tuberculosis Research Funding Trends’ report to track investments in TB R&D, and accessible country-level monitoring tools that look at the role of communities, rights, and gender.

In September 2020, the Secretary General of the UN will deliver a report on how well countries have progressed towards the commitments they made.

The UN Secretary General must celebrate success and highlight areas for concern in ending TB.

It’s vital that the Secretary General plays a leading role in ensuring accountability for TB commitments by praising countries and leaders who have increased efforts and achieved success. The 2019 Global TB Report saw a dramatic increase in finding and treating people with TB, and we are hopeful of more progress to report in 2020.

But, at the same time, the Secretary General shouldn’t shy away from naming those countries where progress is not being made. Where funding for TB – either in domestic health budgets or overseas aid budgets – is going down, not up. Or, where the level of ambition has not been commensurate with the need, nor with the promises that were made.

He also should make sure that the work of accountability is not seen as a top-down endeavour: it is essential that civil society and communities affected by the disease are empowered and engaged throughout.

Above all, it is vital that the Secretary General’s report does exactly what world leaders called on him to do: make sure that we keep our promises to end TB once and for all.