Political Declaration of the High-Level Meeting on the Fight Against Tuberculosis

Who adopted this document and its mandates?

A Resolution of the General Assembly, under agenda item 125 Global health and foreign policy, published in 2023.

What subjects does this mandate have?

10 subjects

Declarations (Text)Disease Prevention Epidemics Health Services Hiv/Aids International Cooperation Medical Treatment Public Health Right to Health Tuberculosis

What’s in this document?

1 operative paragraph

Adopts the political declaration of the high-level meeting on the fight against tuberculosis, held on 22 September 2023 in accordance with its resolution 77/274 of 24 February 2023, as contained in the annex to the present resolution.

Political declaration of the high-level meeting on the fight against tuberculosis

Advancing science, finance and innovation, and their benefits, to urgently end the global tuberculosis epidemic, in particular by ensuring equitable access to prevention, testing, treatment and care

We, Heads of State and Government and representatives of States and Governments assembled at the United Nations on 22 September 2023 to reaffirm our commitment to end the tuberculosis epidemic by 2030, and review progress achieved in realizing the 2018 political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis,¹ deeply concerned that some of the global targets set at the United Nations high-level meeting might not be reached, alarmed by the adverse impact of the coronavirus disease (COVID-19) pandemic on access to diagnosis and treatment for people affected by tuberculosis, resulting in increases in illness and deaths, and the persistent crisis of drug-resistant and multidrug-resistant tuberculosis, seize the opportunity that the midterm review of progress on the 2030 Agenda for Sustainable Development presents to intensify leadership and action for a comprehensive and urgent response against the disease, its determinants and consequences at the national, regional and global levels, in order to scale up investments for the tuberculosis response, research and innovation to reduce the number of people falling ill and dying and incurring catastrophic costs from tuberculosis, including by incorporating lessons learned from the response to the COVID-19 pandemic, and achieve the targets agreed in the 2030 Agenda for Sustainable Development and in the End TB Strategy,² and in this regard we:

¹Resolution 73/3.

²See World Health Organization, document WHA67/2014/REC/1, resolution 67.1.

Renew and reaffirm our collective commitment to the 2030 Agenda for Sustainable Development,³ including the resolve to end the tuberculosis epidemic by 2030, as outlined in Sustainable Development Goal 3.3, the Addis Ababa Action Agenda of the Third International Conference on Financing for Development⁴ and the 2018 political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis;

³Resolution 70/1.

⁴Resolution 69/313, annex.

Acknowledge that Millennium Development Goal 6 and associated strategies, plans and programmes for the prevention and care of tuberculosis helped to reverse the trend of the tuberculosis epidemic;

Reaffirm the political declaration of the high-level meeting of the General Assembly on antimicrobial resistance,⁵ the political declaration of the high-level meeting of the General Assembly on HIV and AIDS,⁶ the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases,⁷ and the political declaration of the high-level meeting on universal health coverage;⁸

⁵Resolution 71/3.

⁶Resolution 75/284.

⁷Resolution 73/2

⁸Resolution 74/2.

Recall the first World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response, held in Moscow on 16 and 17 November 2017, and its Moscow Declaration to End TB;

Reaffirm the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and that the fulfilment of the right to health in the context of tuberculosis is closely linked to the right to enjoy and share the benefits of scientific progress and its applications, and note with concern that access to tuberculosis services and to the benefits of research and innovation such as quality, safe, efficacious and affordable tuberculosis diagnostics and treatment, remains challenging, especially for developing countries;

Reaffirm further that health is a precondition for, and an outcome and indicator of the social, economic and environmental dimensions of sustainable development and the implementation of the 2030 Agenda for Sustainable Development and that sustainable development can be achieved only in the absence of a high prevalence of debilitating diseases such as tuberculosis, which requires further multifaceted efforts, including to support developing countries, especially those with a high burden of tuberculosis to ensure they are on track to achieve the Sustainable Development Goals, especially in light of the continuing impacts of the COVID-19 pandemic;

Remain deeply concerned that while it has been 30 years since the World Health Organization declared tuberculosis a global emergency, the global tuberculosis epidemic still is a critical challenge in all regions and affects every country of the world and disproportionately affects developing countries, and that although tuberculosis is preventable and curable, an estimated 10.6 million people fell ill with tuberculosis, of whom 56.5 per cent were men, 32.5 per cent women and 11 per cent children, and approximately 1.6 million people died from the disease in 2021, including approximately 187,000 people with HIV, making tuberculosis one of the leading causes of death worldwide, that 30 high-tuberculosis-burden countries accounted for 87 per cent of those affected, and that one quarter of the world’s population is estimated to have been infected with the bacterium that causes the disease and that millions of people ill with tuberculosis are missing out on quality care each year, including on access to affordable diagnostic tests and treatment, especially in developing countries;

Recognize that tuberculosis affects populations inequitably and contributes to the cycle of ill health and poverty, that malnutrition and inadequate living conditions contribute to the spread of tuberculosis and its impact upon the community, and that tuberculosis is fundamentally linked to a majority of the leading development challenges addressed by the 2030 Agenda;

Recognize that tuberculosis disproportionately affects people in vulnerable situations in all countries, that the epidemic is driven by both health and social and economic determinants, such as poverty, undernutrition, HIV, housing conditions, mental health, diabetes, tobacco use, harmful use of alcohol and other substance abuse, including drug injection, incarceration, history of incarceration and other congregated settings, as well as occupational risks, such as among miners and health-care workers, that people with tuberculosis and their families face financial hardships before, during and after seeking care, and that these determinants and socioeconomic consequences of tuberculosis are exacerbated by or arise through health and humanitarian emergencies, armed conflicts, displacement, climate change and disasters, and therefore affirm that the response to tuberculosis needs to be people-centred, community-based, gender-responsive, with full respect for human rights, and integrated across relevant health and other sectors;

Recognize that structural inequity, stigma, racism and discrimination, including against women, inadequate investment in, and inequitable access to tuberculosis prevention, diagnosis, treatment remain key roadblocks to ending the tuberculosis epidemic, that people with tuberculosis may suffer from stigma and all forms of discrimination and that barriers to the enjoyment of human rights need to be addressed through comprehensive political, legal and programmatic actions;

Note the multidirectional relationship between tuberculosis, mental health conditions, social and economic determinants, including stigma and discrimination, that can lead to greater morbidity and poorer treatment outcomes, that the prevalence of depression is as high as 45 per cent among individuals with tuberculosis, and that this needs to be addressed through integrated programming;

Recognize the profound socioeconomic challenges and financial hardships faced by people affected by tuberculosis, including in obtaining an early diagnosis, in being subject to extremely long treatment regimens, with drugs that could involve severe side effects, as well as in securing integrated support, including from the community, and therefore affirm that all these people require integrated, people-centred prevention, diagnosis, treatment, management of side effects, and care, as well as psychosocial, nutritional and socioeconomic support for successful treatment, including to reduce stigma and discrimination;

Acknowledge that strong and resilient public health systems are an essential pillar of the tuberculosis response, including health workforce capacity-building for public and private sector care, and recognizes that women health workers make up 70 per cent of the global health workforce and 90 per cent of the front-line health workforce, but hold only 25 per cent of senior leadership positions in health, and resolve to address the 24 per cent pay gap compared to men across the health sector, and to provide better opportunities and working environments for women to ensure their role and leadership in the health sector;

Also acknowledge that investments in building robust, integrated and resilient health systems, including in tuberculosis prevention, detection and treatment services and research and development infrastructure and community responses can advance universal health coverage and contribute to effective pandemic prevention, preparedness and response, and recognizing the opportunity for further coordination for global health policies that the 2023 health-related General Assembly high-level meetings present;

Recognize that tuberculosis can cause infertility, maternal and perinatal mortality, that tuberculosis treatment can reduce obstetric complications, and that addressing this requires universal access to integrated tuberculosis care for women and girls across the life course, in order to obtain the highest standard of health, and that these must not be interrupted in times of emergency;

Reaffirm the importance of collaboration and cooperation at the global and regional level, in particular across the health, finance, trade and development sectors, in order to enhance collective actions to end tuberculosis;

Commend the progress achieved in saving 74 million lives across all countries between 2000 and 2021 through provision of tuberculosis treatment for people with tuberculosis and antiretroviral therapy for people with HIV co-infected with tuberculosis, and regret that only some progress has been achieved towards targets and commitments agreed in the political declaration of the 2018 high-level meeting of the General Assembly on the fight against tuberculosis;

Note with concern that the COVID-19 pandemic continues to have a damaging impact on access to tuberculosis prevention, diagnosis, treatment and care and the burden of tuberculosis disease and that progress made in the years up to 2019 has slowed, stalled or reversed, and global tuberculosis targets are off track, and that the number of people diagnosed with tuberculosis and notified to public health reporting systems fell by 18 per cent from 7.1 million in 2019 to 5.8 million in 2020, followed by a partial recovery to 6.4 million in 2021, and that as a result of these disruptions, the number of people who died from tuberculosis increased in 2020 and 2021 compared to prior years, and the number of people who fell ill from tuberculosis increased in 2021;

Express deep concern that in 2021 only 61 per cent of people with tuberculosis, including 38 per cent of children, were diagnosed and treated for tuberculosis, that only 38 per cent of people with tuberculosis were diagnosed with World Health Organization-recommended rapid molecular diagnostics, and, as a result, between 2018 and 2021:

Only 26.3 million people, including 1.9 million children and 649,000 people with drug-resistant tuberculosis, were reported to have been provided with tuberculosis treatment, which translates to 66 per cent of the 40 million target;

And only 12.5 million people, including 10.3 million people living with HIV, 1.6 million children under the age of 5 who are household contacts of people affected by tuberculosis and 0.6 million other household contacts of people affected by tuberculosis, were provided with tuberculosis preventive treatment, which translates to 42 per cent of the 30 million target agreed in the 2018 political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis;

And that close to half of the people diagnosed with tuberculosis and their families experienced financial hardship because of tuberculosis;

Welcome the commitment and support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, through the seventh replenishment held in September 2022, which will help to sustain support for tuberculosis programmes;

Recognize the need to mobilize sufficient and sustainable financing for universal access to quality prevention, diagnosis, treatment and care of tuberculosis, from all sources, with the aim of increasing overall global investments for ending tuberculosis, and to align with overall national health financing strategies, including in developing countries, to raise domestic revenues and provide international financial support, including at bilateral, regional and global levels, towards achieving universal health coverage and social protection strategies, in the lead-up to 2030;

Welcome progress in reaching 10.3 million people living with HIV with tuberculosis preventive treatment between 2018 and 2021, surpassing the target of reaching 6 million people between 2018 and 2022 set at the 2018 high-level meeting of the General Assembly on the fight against tuberculosis, with a total of 16 million receiving tuberculosis preventive treatment since 2005 when the policy was introduced, which translates to 42 per cent of people living with HIV having benefited from tuberculosis preventive treatment by 2021, although this remains far from reaching the 90 per cent target by 2025, agreed in the political declaration of the high-level meeting of the General Assembly on HIV and AIDS;

Note with concern that, although people living with HIV are about 16 times more likely to fall ill from tuberculosis compared to people without HIV and that tuberculosis remains the leading cause of severe illness and death of people living with HIV, almost half of people with HIV-associated tuberculosis are not diagnosed and treated for tuberculosis, and also note that in 2021, testing for HIV among people with tuberculosis increased to 76 per cent compared to 64 per cent in 2018 and that 89 per cent of people living with HIV who were diagnosed with tuberculosis were on antiretroviral treatment in 2021;

Acknowledge that ending tuberculosis requires accelerating progress towards universal health coverage, particularly through strong and sustainable primary health care, with multisectoral approaches that address tuberculosis determinants, that engages people affected by tuberculosis and civil society, and reaches people with tuberculosis, or at risk of tuberculosis, with equitable and affordable access to high-quality services, close to their everyday environments, enabling them to fully enjoy the benefits of scientific advances, and free of financial hardship;

Acknowledge that drug-resistant tuberculosis is a key component of the global challenge of antimicrobial resistance, and express grave concern that the scope and scale of multidrug-resistant and extensively drug-resistant tuberculosis illness and mortality place an additional burden on health and community systems, especially in low- and middle-income countries, and thereby pose a critical challenge that could reverse the progress made against the disease, against antimicrobial resistance and towards the Sustainable Development Goals, and that there is a profound gap in access to quality diagnosis, treatment and care for those affected, and there is still a low treatment success rate for those who are treated, and therefore acknowledge that it is necessary to ensure global collaboration, sustainable and sufficient political buy-in and financial investment from all sources, strong and resilient health systems, and additional investment in research, development and innovation, recognizing that innovation has the potential to benefit society at large;

Express concern that close to half a million people annually develop tuberculosis that is resistant to at least rifampicin, the most effective first-line drug, of whom only one in three accessed treatment in 2021 and of these, 40 per cent had poor health outcomes for reasons including gaps in access to World Health Organization-recommended diagnostic tests and treatment, inefficient service delivery models, medication side-effects, lack of access to treatment support, comprehensive social protection and care and acknowledged lack of attention and care to the needs of tuberculosis survivors for post-treatment follow-up, particularly drug-resistant tuberculosis survivors;

Remain deeply concerned that financing for tuberculosis prevention, diagnosis, treatment and care is inadequate, that overall total annual funding was consistently less than half of the 13 billion United States dollars a year target set at the 2018 high-level meeting of the General Assembly on the fight against tuberculosis, that domestic funding declined during the COVID-19 pandemic, while acknowledging that investment in care and the prevention of tuberculosis brings some of the largest gains in terms of lives saved and economic benefits from development investments;

Stress the importance of domestic and international funding for the tuberculosis response, particularly in high-burden countries, and note that overall international funding has stagnated since 2018, and stressing therefore the importance of adequately replenishing voluntary international financing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, other sources of financing, including official development assistance, as well as innovative financing to support comprehensive national tuberculosis strategies as an integral part of costed national health strategies, multilateral efforts and other initiatives, to end tuberculosis;

Reaffirm the central role of the World Health Organization as the leading agency on health in providing technical advice, guidance, direction and support on tuberculosis prevention, diagnosis, treatment and care, and urgently support its Global Tuberculosis Programme, to end tuberculosis worldwide;

Commend progress achieved so far in tuberculosis research and innovation of new tests, drugs and regimens that informed World Health Organization guidance,⁹ including on the use of shorter-duration tuberculosis preventive treatment with less pill burden, shorter-duration regimens for the treatment of drug-susceptible tuberculosis for adults and children, and more effective all-oral shorter-duration regimens for the treatment of drug-resistant tuberculosis, including formulations appropriate for children, and note that although 26 high-tuberculosis-burden countries are using World Health Organization-recommended rapid molecular diagnostic tests and 126 countries have introduced all-oral regimens to treat drug-resistant forms of tuberculosis, supply and access to some drugs central to these regimens is not yet universally available;

⁹See World Health Organization guidance, available at https://tbksp.org/en/guidance-books-solr.

Recognize that reaching the 2030 global tuberculosis targets requires, inter alia, technological breakthroughs by 2025, so that the annual decline in global tuberculosis incidence can be accelerated to an average of 17 per cent per year, and research and development is critical to achieving that goal;

Recall with concern that no new vaccines for prevention of all forms of tuberculosis have been licensed for over 100 years, that safe, effective, affordable, accessible and preventive vaccines for people of all ages which can be administered before or after exposure are essential to accelerate the decline in illness and mortality and reduce antimicrobial resistance, and acknowledge the importance of global collaboration and increased investment to fast-track progress and ensure equitable access and maximal return on public investment in scientific progress;

Recall with concern that the utilization of World Health Organization-recommended rapid molecular diagnostics remains far too limited, and that in 2021, only 38 per cent of the 6.4 million people newly diagnosed with tuberculosis were initially tested with World Health Organization-recommended rapid molecular diagnostics, and acknowledging that the limited utilization of these rapid tests underscores the urgent need for enhanced global collaboration to facilitate their wider use to ensure more timely and accurate tuberculosis diagnoses, while further research on point-of-care tests is urgently required;

Express concern that financing for tuberculosis research and innovation is only half of the 2 billion United States dollars a year target agreed in the 2018 political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis, and underscore that enhanced, sustained and equitable financing is required for the development and evaluation of better tools and strategies to ensure tuberculosis prevention and care for all, including to address social and economic determinants of the disease, as called for in the global strategy for tuberculosis research and innovation,¹⁰ taking into account that an additional investment in research, development and innovation has the potential to benefit society at large;

¹⁰See World Health Organization, document WHA73/2020/REC/1, resolution 73.3.

Recognize the importance of national systems that monitor the availability, accessibility, acceptability, affordability and quality of tuberculosis care at their respective national level;

Welcome the roll-out of the World Health Organization multisectoral accountability framework for tuberculosis as requested in General Assembly resolution 73/3 and World Health Assembly resolution 71.3, and emphasize the continued importance of multisectoral action and accountability, as appropriate, across the health and nutrition, finance, labour, social protection, education, science and technology, justice, agriculture, the environment, including air quality, housing, trade, development and other sectors, in order to ensure that all relevant stakeholders pursue actions to end tuberculosis and leave no one behind through whole-of-society and whole-of-government approaches;

Recognize that equitable, affordable and sustainable access to high-quality tuberculosis diagnostics, vaccines and medicines, including for preventive treatment, are essential to end illness, suffering and prevent further loss of life from tuberculosis, and further recognize the role played by relevant international organizations and initiatives, such as the Stop TB Partnership/Global Drug Facility, working to improve access to high-quality and affordable medicines, including appropriate formulations of medicines for children, and diagnostics to test, prevent and treat tuberculosis for populations in need;

Recognize that active and meaningful engagement of civil society, people and communities affected by tuberculosis, and health-care workers, is vital to improve access to tuberculosis prevention and care, relevant health information and education, and contribute to the promotion and protection of the human rights of people affected by tuberculosis, including through planning, implementation, monitoring, evaluation and accountability, as appropriate and at all levels, of the tuberculosis response and in research, development and delivery of tuberculosis services;

Commit to protect and promote the right to the enjoyment of the highest attainable standard of physical and mental health, and the right to enjoy the benefits of scientific progress and its application in order to advance towards universal access to quality, affordable, inclusive, equitable and timely prevention, diagnosis, treatment, care and awareness-raising related to tuberculosis, and address its economic and social determinants;

Improve availability, affordability and efficiency of health products by increasing transparency of prices of medicines, vaccines, medical devices, diagnostics, assistive products, cell- and gene-based therapies and other health technologies across the value chain, including through improved regulations and building constructive engagement and a stronger partnership with relevant stakeholders, including industries, the private sector and civil society, in accordance with national and regional legal frameworks and contexts, to address the global concern about the high prices of some health products and in this regard encourage the World Health Organization to continue its efforts to biennially convene the Fair Pricing Forum with Member States and all relevant stakeholders to discuss the affordability and transparency of prices and costs relating to health products;

Recognize the need to strengthen linkages between ending tuberculosis and the 2030 Agenda for Sustainable Development, including towards achieving universal health coverage, through the Sustainable Development Goals review processes, including the high-level political forum on sustainable development, and noting relevant resolutions and decisions made by the World Health Assembly;

Commit to urgently strengthen measures to reduce tuberculosis-related deaths, including among people living with HIV, through comprehensive multisectoral actions, including but not limited to the implementation of the World Health Organization End TB Strategy, that address all determinants and risk factors of tuberculosis and improve health outcomes, and close the large gaps in access to tuberculosis prevention, diagnosis, treatment and care, especially in high-burden countries;

Continue to support the World Health Organization multisectoral accountability framework for tuberculosis by establishing or strengthening high-level multisectoral accountability and review mechanisms, in line with national contexts, defining the roles and responsibilities of relevant sectors and stakeholders with the meaningful engagement of people and communities affected by tuberculosis, and to strengthen national review of progress aligned to agreed national and global tuberculosis targets, including the commitments in the present political declaration, with support from the World Health Organization to enhance efforts in ending tuberculosis;

Commit to develop and implement ambitious costed national tuberculosis strategic plans or national health strategies with multisectoral approaches, including with the active involvement of communities and people affected by tuberculosis, civil society, private sector and other stakeholders to enable universal access to quality tuberculosis services and actions to address all tuberculosis determinants and drivers, such as poverty, undernutrition, HIV, inequalities by social and economic position, as well as inadequate housing and living conditions, barriers to gender equality, and non-communicable diseases, including diabetes;

Emphasize that efforts to increase awareness on tuberculosis must be intensified, including through continuous sensitization, teaching and training of health workers to consider tuberculosis in differential diagnosis, bearing in mind the need to invest in a better public health infrastructure and workforce to improve prevention efforts;

Strengthen support and capacity-building in low-income and lower-middle-income countries, many of which have high rates of tuberculosis combined with health and social protection systems that have limited resources, including to support implementing multisectoral approaches in their response to the tuberculosis epidemic;

Further commit to strengthen notification of all people diagnosed with tuberculosis, by public, private and community-based health-care providers to national health information systems, facilitated by the expanded use of secure, confidential and digital case-based surveillance, with full respect for human rights, in line with the highest applicable standards and data privacy laws, and to improve civil registration and vital statistics registers (CRVS), to allow for tracking of the tuberculosis epidemic, including drug-resistant forms, and its impact, with disaggregation by age, sex and other characteristics relevant to national contexts, and to strengthen national capacity for the use and analysis of such data, including by improving real-time data collection, reporting and automation, to inform and support evidence-based decision-making and strengthen accountability;

Pledge to accelerate progress towards timely, quality, universal access to tuberculosis services in both high- and low-burden countries, as outlined in the End TB Strategy, such that, by 2027:

At least 90 per cent of the estimated number of people who develop tuberculosis are reached with quality-assured diagnosis and treatment, with all those diagnosed having been initially tested with World Health Organization-recommended rapid molecular tests, and supported to complete treatment, which translates to providing life-saving treatment for up to approximately 45 million people between 2023 and 2027, including up to 4.5 million children and up to 1.5 million people with drug-resistant tuberculosis;

At least 90 per cent of people at high risk of developing tuberculosis are provided with preventive treatment, which translates to providing up to approximately 45 million people with tuberculosis preventive treatment, including approximately 30 million household contacts of people with tuberculosis, including children and approximately 15 million people living with HIV, with the vision of reaching more people, including those who live in remote geographical regions or in areas difficult to access, taking into account World Health Organization guidance;

100 per cent of people with tuberculosis have access to a health and social benefits package so they do not have to endure financial hardship because of their illness;

Commit to integrate within primary health care, including community-based health services, the systematic screening, prevention, treatment and care of tuberculosis and for related health conditions, such as HIV and AIDS, viral hepatitis, undernutrition, mental health, non-communicable diseases including diabetes and chronic lung disease, tobacco use, harmful use of alcohol and other substance abuse, including drug injection, as well as a people-centred, approach, to improve equitable access to quality, inclusive, affordable health services with effective referral systems to other levels of care;

Given that one third of deaths among people living with HIV are due to tuberculosis and that HIV is associated with poorer tuberculosis treatment outcomes, recommit to strengthen coordination and collaboration between tuberculosis and HIV programmes, with the support of relevant United Nations specialized agencies, funds and programmes and other stakeholders in the follow-up to the 2021 high-level meeting of the General Assembly on HIV and AIDS to ensure universal access to integrated prevention, diagnosis, treatment and care services, including through promoting testing for HIV among people with tuberculosis and screening all people living with HIV regularly for tuberculosis, especially using diagnostics appropriate for people with advanced HIV disease who are most at risk of dying from tuberculosis, providing tuberculosis preventive treatment, and addressing common social and economic determinants of HIV, tuberculosis and related comorbidities and structural barriers to health services, such as stigma, discrimination and gender inequality, leaving no one behind;

Commit to strengthen comprehensive care for all people with tuberculosis, using specific models of care such as nutritional and mental health and psychosocial support, social protection, as well as rehabilitation, treatment of post-tuberculosis lung disease, and palliative care, paying particular attention to people in vulnerable situations or who are vulnerable to tuberculosis, including women during pregnancy, lactation and post-partum period, children and adolescents, people living with HIV, persons with disabilities, including those with lifelong disabilities due to tuberculosis, Indigenous Peoples, health-care workers, older persons, migrants, refugees, internally displaced people, people living in situations of complex emergencies, stateless persons, people in prison and other closed settings, people living in impoverished areas, people affected by extreme poverty, miners and others exposed to silica, undernourished people, ethnic minorities, people and communities at risk of exposure to bovine tuberculosis, taking into account the higher prevalence of tuberculosis among men and that the gaps in case detection and reporting are higher among men;

Commit to ensure meaningful participation and inclusion of persons with disabilities, including those affected by tuberculosis, through non-discrimination, equality of opportunities, accessibility to all tuberculosis services, and integrated tuberculosis services for persons with disabilities, including comprehensive rehabilitation and social support services for tuberculosis survivors with disabilities in line with the Convention on the Rights of Persons with Disabilities;

Commit to urgently scale up comprehensive efforts to close long-standing gaps in prevention, diagnosis, treatment and care of children with or at risk of tuberculosis, recognizing it is an important preventable cause of preventable childhood illness and death, including among children with HIV and as a comorbidity of other common childhood illnesses, especially pneumonia, meningitis and malnutrition, including by implementing relevant World Health Organization guidance and policies to improve equitable access to screening, prevention, testing and treatment services, particularly to vaccines and formulations of tuberculosis medicines for children, as part of a comprehensive integrated primary health care;

Commit to accelerate progress to end the crisis of the drug-resistant tuberculosis epidemic in the context of broader national, regional and global mechanisms to address antimicrobial resistance, by improving treatment adherence for people with drug-susceptible and drug-resistant tuberculosis, including with support of digital technologies, and by working towards the achievement of the universal, equitable and affordable access to World Health Organization-recommended diagnostics and drug-susceptibility tests, as well as those approved and recommended by national regulatory agencies and all-oral shorter-duration treatment regimens for people with drug-resistant tuberculosis, complemented by monitoring and management of side effects together with care and support to improve outcome of treatment;

Scale up efforts to collect and report antimicrobial resistance surveillance data for tuberculosis, and increase support for the existing surveillance systems, including the World Health Organization Global Project on Anti-Tuberculosis Drug Resistance Surveillance, the Global Tuberculosis Data Collection System and the World Health Organization Global Antimicrobial Resistance and Use Surveillance System (GLASS) in its endeavour to strengthen knowledge through surveillance and research, and look forward to the 2024 high-level meeting on antimicrobial resistance;

Recognize high-level commitments and calls for action against tuberculosis, including its multidrug-resistant and zoonotic forms, made by global, regional and subregional bodies and meetings, and recognize also the value of a One Health approach;

Recommit to promoting access to affordable medicines, including generics, for scaling up access to affordable tuberculosis treatment, including the treatment of multidrug-resistant and extensively drug-resistant tuberculosis;

Strive to ensure that tuberculosis services are essential elements of national and global strategies and efforts to achieve universal health coverage, to address antimicrobial resistance, and to strengthen pandemic prevention, preparedness and response to ensure uninterrupted diagnosis, prevention, treatment, affordable and quality-assured antibiotics, surveillance and research-related tuberculosis activities for all people, while ensuring that the fight against tuberculosis is not devalued as a result of health emergencies;

Commit to invest in tuberculosis services and health workforce, support service providers, ensuring sufficient quantity, adequate levels of training and motivation, surveillance, inter alia, integrated molecular surveillance, information systems, laboratory capacity, community-based care, as well as to consolidate and adopt existing laboratory capacities used during the COVID-19 pandemic to increase the access to diagnostics, to strengthen global health capacities to prevent, prepare, detect, report and respond to threats from future epidemics and pandemics and to avoid adverse impact of future pandemics on tuberculosis;

Commit to build back stronger by learning lessons from the COVID-19 pandemic, including by enhancing the resilience of tuberculosis programmes during health emergencies, implementing resilient and inclusive recovery plans to reach targets and harnessing innovations such as digital technologies;

Support building capacities, skills and expertise and developing local and regional manufacturing capacities for health tools, including in developing countries, while recognizing that the high prices of some health products, and the inequitable access to such products within and among countries, as well as financial hardships associated with high prices of health products, continue to impede progress towards achieving universal health coverage and ending tuberculosis, among other diseases, by 2030;

Commit to mobilize sufficient, adequate, predictable and sustainable financing for universal access to quality tuberculosis prevention, diagnosis, treatment and care within and beyond the health sector to address determinants and drivers of the tuberculosis epidemic, from all sources, with the aim of reaching overall global investments of at least 22 billion United States dollars a year by 2027, and 35 billion annually by 2030 as estimated by the Stop TB Partnership by enhancing global solidarity, and through domestic and international investment mechanisms, including innovative financing mechanism, aligned with costed and budgeted national health plans and strategies to end tuberculosis and its complications or sequelae in collaboration with the World Health Organization and the Global Fund to fight AIDS, Tuberculosis and Malaria;

Continue to promote sustainable, financial and technical support from all sources to developing countries with a view to build capacity, support and strengthen national health systems in bringing epidemics under control, including to prevent and eliminate tuberculosis and in achieving universal health coverage;

Commit to work towards the increase of funding from the bilateral donors and financial mechanisms such as the Global Fund and financing institutions such as the World Bank and the Regional Development Banks, and private sector and innovative financing mechanisms including co-financing schemes and mobilize additional funding;

Commit to give particular attention to high-burden countries, including by supporting efforts in eliminating tuberculosis through prevention efforts and access to quality diagnosis, treatment and care, including access to affordable diagnostic tools and drug treatment, as well as financing innovations, research and development;

Recognize the enormous economic and social impacts and burden of tuberculosis for people affected by the disease, their households, in particular, for migrants and hosting countries and in this respect highlights the need to provide support as well as technical and financial assistance, to host and transit countries for strengthening local and national infrastructures and health systems for effective tuberculosis prevention, treatment and care, with a view to reducing the burden on health systems;

Commit to maximize the potential of innovation to end tuberculosis by 2030, including through international cooperation as well as financing, encouraging greater collaboration between the scientific research and innovation community and tuberculosis stakeholders; committing to scale up promising innovations to the greatest extent possible; and fostering greater engagement from the research and innovation community in high-burden countries at all stages of planning and implementation of tuberculosis programmes and in alignment with national plans and priorities;

Further commit to mobilize adequate, predictable and sustainable financing for tuberculosis research and innovation especially to high-burden countries towards reaching 5 billion United States dollars a year by 2027, for the development of safe, effective, accessible and affordable rapid and accurate point-of-care diagnostics, including for drug susceptibility testing, including for use in community settings; vaccines for all forms of tuberculosis for people of all ages; and shorter, safer and more effective treatment regimens, especially for drug-resistant tuberculosis, including child-friendly diagnostics and treatment, and for implementation science to facilitate the scaling of evidence-based interventions and other newly approved technologies, including digital technologies, while ensuring participation of institutions from all countries, particularly from developing countries, in tuberculosis research and innovation;

Commit to create a research-enabling environment that expedites research innovation, and promotes collaboration in tuberculosis research and development across United Nations Member States in order to develop and introduce new tools to prevent, diagnose and treat tuberculosis in all its forms, and to ensure equitable access to the benefits and applications of tuberculosis research;

Promote increased access to affordable, safe, effective and quality medicines, including generics, vaccines, diagnostics and health technologies, reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) as amended, and also reaffirming the 2001 World Trade Organization Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and note the need for appropriate incentives in the development of new health products;

Commit to create an enabling environment for tuberculosis research, including operational and implementation research and innovation, by developing and implementing sustainable and fully funded national tuberculosis research agendas and strategic plans in line with national priorities, developing or strengthening public-private partnerships and product development partnerships in collaboration with affected communities and civil society, particularly in high-burden countries, where appropriate, strengthening research capacity, legislative and regulatory frameworks where needed so that new tuberculosis diagnostics, medicines and vaccines, for both tuberculosis disease and infection are prioritized;

Commit to increase international cooperation to advance tuberculosis research and innovation, including by fostering and coordinating research and clinical trials, providing funding for collaborative research and clinical trials, supporting transparent and rapid reporting of research and clinical trial results, promoting data-sharing, encouraging open innovation approaches, voluntary licensing and technology transfer on mutually agreed terms;

Further commit to strengthening research capacity and collaboration through improving tuberculosis research platforms and networks across the public and private sectors, noting platforms and networks such as the BRICS Tuberculosis Research Network¹¹ in basic science, clinical research and development, including pre-clinical and clinical trials, as well as operational, qualitative and applied research, to advance effective tuberculosis prevention, diagnosis, treatment and care and actions on the economic and social determinants and impacts of the disease;

¹¹See https://bricstb.samrc.ac.za/.

Commit to promote equitable, affordable and timely access to the benefits of research and innovation, tuberculosis vaccines, medicines, including generic medicines, and diagnostics, and through appropriate governance structures that foster local and regional production capacity, research and innovation as a shared responsibility that is needs-driven, evidence-based and guided by the core principles of affordability, accessibility, effectiveness, efficiency and equity by rapid deployment of recently approved tools, diagnostics, new drugs, regimens and methodologies, as they become available, in countries with the greatest need, including through the Stop TB Partnership/Global Drug Facility, to ensure availability and access to quality-assured and affordable tuberculosis commodities, recommended by the World Health Organization;

Continue to support existing initiatives and incentive mechanisms that separate the cost of investment in research and development from the price and volume of sales, to facilitate equitable and affordable access to new tools and other results to be gained through research and development;

Commit to working with the private sector and academia, accelerate the research, development and roll-out of safe, effective, affordable and accessible pre- and post-exposure vaccines, preferably within the next five years, for all forms of tuberculosis for people of all ages, and establish sustainable systems for local, regional and global manufacturing and procurement and equitable distribution of vaccines once they are available, through global collaboration mechanisms, including World Health Organization initiatives such as the accelerator council for new tuberculosis vaccines¹² noting that further details of the programme are being developed;

¹²See https://www.who.int/news/item/17-01-2023-who-announces-plans-to-establish-a-tb-vaccine-accelerator-council.

Commit to intensify national efforts to create enabling legal and social policy frameworks to combat inequalities, in order to eliminate all forms of tuberculosis-related stigma, discrimination, inequality and other barriers, including those negatively impacting human rights, and to adopt equitable, inclusive and gender-responsive approaches, as appropriate, to address barriers to tuberculosis services that reflect the different ways men and women can be affected by tuberculosis and achieve a more effective response and greater results, so that no one is left behind in the fight against tuberculosis;

Commit to strengthen the meaningful engagement of parliaments, civil society, the educational system and tuberculosis-affected local communities, including young people and women, in all aspects of the tuberculosis response, to ensure that the response is equitable, inclusive, people-centred and promotes gender equality and respects human rights, including with regard to policymaking forums, planning, comprehensive tuberculosis care delivery, and national multisectoral accountability and review mechanisms as appropriate, and increase and sustain investment for initiatives, in particular at the community level, and in line with national contexts;

Commit to promote the inclusion of tuberculosis in the curricula of medical schools, public health, nursery, medical technology, nutrition, social work and other related areas of training;

Commit to safeguard tuberculosis services as essential health services during humanitarian and health emergencies and in conflict settings, as displaced people and people affected by such emergencies face multiple challenges, including heightened tuberculosis infection, risk of treatment interruption and limited access to quality health-care services, nutritious food and information that is language- and culture-sensitive;

Commit to strengthen financial and social protections for people affected by tuberculosis and alleviate the health and non-health related financial burden of tuberculosis experienced by affected people and their families;

Request the World Health Organization to continue to provide global leadership to support Member States to build a resilient response to tuberculosis as an integral part of the universal health coverage agenda, and to also address the drivers and determinants of the epidemic, including in the context of health and humanitarian emergencies, with multisectoral engagement, the provision of normative guidance and technical support, and through monitoring, reporting and review of progress, and by advancing the tuberculosis research and innovation agenda;

Request the Secretary-General, in close collaboration with the Director General of the World Health Organization, to strengthen cooperation between Member States and relevant entities to implement the present declaration and accelerate progress towards ending tuberculosis by 2030, including funds, programmes and specialized agencies of the United Nations system, United Nations regional commissions, the Stop TB Partnership, hosted by the United Nations Office for Project Services, Unitaid, hosted by the World Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to promote cooperation among relevant multilateral stakeholders;

Also request the Secretary-General, with the support of the World Health Organization, to report, as part of his annual Sustainable Development Goals report, on the global effort to end tuberculosis, and to present to the General Assembly a report in 2027 on the progress achieved in realizing the commitments made in this political declaration towards agreed tuberculosis goals at the national, regional and global levels, including on the progress of multisectoral action, within the context of achieving the 2030 Agenda for Sustainable Development, which will serve to inform preparations for a comprehensive review by Heads of State and Government at a high-level meeting on tuberculosis in 2028.

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