of AIDS-Free World explored the funding and leadership gap in a little more
detail in a keynote address on the final day of the pre-meeting – and had some interesting
ideas about how to better leverage resources.
“TB is overwhelmingly
funded by the Global Fund; without it, there would be a vacant pipeline. As has
been noted, some 77% of funding for TB in Africa comes from the Global Fund. However,
only about 17% of the Fund’s resources go to TB while 53% goes to HIV and 30%
to malaria. Tuberculosis is the impoverished cousin… One and a half million
[dead from TB] annually, and not a single death necessary.”
If the Global Fund is
not replenished this September, TB will be hard hit.
In addition, the
Global Plan to End TB will require $13 billion a year in funding until 2030 –
but the current funding levels are one-half of that – and as Lewis pointed out
“the replenishment target for the Global Fund is $13 billion over three years.”
Lewis also highlighted
how the leading organisations in the fight to end TB are not powerful international entities, rooted in the
United Nations, with vast budgets at hand – unlike UNAIDS.
“Wouldn’t you say – I don’t think this is
intellectual innocence on my part – that UNAIDS is a logical repository to drive
the response to tuberculosis; if the two are stitched so relentlessly together,
and TB is now a greater killer than AIDS, would you not think that the entity
charged with the international institutional responsibility for AIDS, would be the
protagonist in the fight against TB?”
that it might be difficult to introduce this change into UNAIDS because of its
current structure within the UN and its governance. However, he recommended an
alternative – the United Nations Development Programme (UNDP), which is the
largest and best-resourced UN agency, is in virtually every country and has
strong relations with the government of every country.
“If UNDP were
to decide to exercise significant leadership on TB, it could make a stunning
impact,” he said, pointing out that UNDP has already been involved with TB in
He also believes it
might be possible to set up a new financial machine behind the TB response. He
reminded the audience that an old ally, Jim Kim, President of the World Bank,
had focused significantly on TB from Russia to Peru in his early days at
Partners in Health.
In fact, he reported
that Jim Kim had told him that he’d be willing to sit down with “a
representative group to discuss, concretely, innovative forms of financing to
political pressure will also clearly be needed. Minister Motsoaledi places
great hope in the Global TB Caucus – a body of members of parliament (1400 members from 126 countries) seeking to address TB in
their own countries, regions and globally. Motsoaledi, who co-chairs the group,
said that it had formally endorsed the Global Plan to end TB last year.
One of their first
orders of business ought to be acting upon a Stop TB Partnership and MSF petition that
is being circulated at the conference called Step Up for TB: Sign the Dotted Line. It demands that all countries
upgrade their responses to TB to utilise currently available tools, including
the latest diagnostic technology, medicines, and treatment guidelines within 500 days.
as the Union’s José-Luis Castro stressed, countries also need to address “the root causes
of the TB/HIV epidemic: poverty, malnutrition, poor housing conditions,
injustices from stigma to gender discrimination and the denial of basic human
human rights to health approach may be the best way to move the agenda forward,
according to Mike Frick of TAG who quoted Partners in Health’s Paul Farmer in
his concluding remarks.
need… is an agenda for research and action grounded in the struggle for social
and economic rights, an agenda suited to public health and medicine, whose
central contributions to future progress in human rights will be linked to the
equitable distribution of the fruits of scientific advancement.”
And at the
close of the conference, a delegation of African parliamentarians said that
they were indeed committed to fight for better sanitation and urban policies
that benefit the poor, and a human rights approach to healthcare.
tell if this is just “mosotos” (more-of-the-same – all talk and opinions and
speeches), or if it will indeed be the change needed to truly end TB and AIDS.
But, as Castro concluded, “If we choose to change we have a shot of beating two
of the worst epidemics that humanity has known."