NEW YORK — Tuberculosis took center stage for the first time at the United Nations in September, in the first United Nations high-level meeting devoted to this infectious airborne disease that killed 1.6 million people worldwide last year.
Held on Sept. 26 alongside the United Nations General Assembly in New York, the meeting was intended to unite countries in a declaration of political will to tackle the leading causes of TB’s spread: poverty and instability; insufficient funding; outdated diagnostic and treatment models, and slow development of new technologies.
Tuberculosis can be prevented, treated and cured, yet it is the 9th overall cause of death globally. Shortfalls in reaching people with TB and ensuring they get effective treatment lead to, and are compounded by, the spread of multi-drug resistant TB. Ukraine is one of the world’s highest burden countries of such TB, which does not respond to traditional treatment.
The World Health Organization has set the goal to eradicate tuberculosis by 2030. The political declaration signed at the U.N. meeting in September pledges to diagnose and successfully treat 40 million people with TB worldwide by the end of 2022, and provide prevention for 30 million more.
These goals can’t be achieved without comprehensive state programs and a huge shift in global funding priorities. The biggest international funder of TB program, the Global Fund to fight HIV, TB, and malaria, currently devotes only 18 percent of its overall spending on TB, even though the disease causes more deaths annually than HIV and malaria combined. The declaration calls for doubling global investment in TB care, prevention, and medical research and development.
Despite the declaration, the high-level meeting seemed to indicate that there’s a long way to eradicate TB. The event was touted as a game-changer, but it attracted only 15 heads of state, despite taking place when many more leaders were in New York for the concurrent U.N. General Assembly. Not one country leader came from the European region, where post-Soviet states, including Ukraine, are leading the epidemic.
“It’s as if Europe couldn’t care less,” commented Lucica Ditiu, executive director of the Stop TB Partnership, a key organizer of the meeting. “I am very shocked by probably very limited political commitment or capacity to prioritize TB.”
Ukraine, represented by Pavlo Rozenko, deputy prime minister for humanitarian affairs, was the most high-level European-region delegation there. It was also one of the most democratic, including two civil society members. Rozenko, however, didn’t speak at the meeting, leaving it to acting Health Minister Ulana Suprun.
Suprun’s speech focussed on a “hybrid war on health” being waged by Russia’s spread of anti-vaccine messages. She noted the detrimental effect of the ongoing war in east Ukraine on TB patients without making any commitments to tackling the disease.
Recently, Ukraine has reduced both TB incidence and mortality, with 31,000 cases registered last year. But over a quarter of newly-diagnosed TB cases are drug-resistant forms. Cure rates are the lowest among all multi-drug resistant TB burden countries, at 38 percent.
This year the Ukrainian government pledged full state funding of TB treatment (previously international agencies like the Global Fund covered up to 50 percent of medication costs). In a break between sessions, Suprun said the country offers a good example of the cross-sectoral collaboration needed to tackle TB.
“No one can do it alone,” she said. While medications are purchased with budgetary funds, non-government organizations provide social services to patients who are often people on the margins of society such as the homeless, ex-prisoners or migrants. “Most high-risk groups are not the most trusting of government and government officials, and it’s easier for NGOs to get access to them,” she said.
TB patients in Ukraine, and globally, are isolated from society for months or even years in specialized hospitals and treated as outcasts (although current treatment guidelines recommend outpatient care as soon as patients stop being infectious, usually a few weeks after starting treatment). As a result, many people do not seek treatment or fail to complete treatment courses, which leads to MDR-TB.
Thanks to public campaigns and high-profile events, attitudes are slowly changing. When Olya Klymenko from Kyiv was diagnosed with TB in 2015, she lost her job and found the psychological stigma harder to shake off than the physical side effects of a six-month treatment course. She now heads TB People Ukraine, an organization of TB survivors campaigning for more attention, and less prejudice, around the disease.
“In 2015 they locked me in a ward, and in 2017 I spoke together with the health minister on one stage,” said Klymenko, who was one of the civil society members of the Ukraine delegation. “That’s the result of really hard work to change things by a united command. I do see progress in Ukraine.”
Still, Klymenko could hardly dream that people could say publicly that they had survived TB, and get a round of applause. But that’s what happened at a gala dinner organized by the Stop TB Partnership in central New York before the HLM. Taking part were musicians and celebrities from around the world who themselves, or whose family members, had had TB.
This evening was very amazing for me personally,” said Klymenko. “It made me think of all our patients [in Ukraine] and the stigma and the constant lack of respect there, while here they applauded them. It’s our goal that they should be applauded in Ukraine too because they’ve earned it.”
Among the galas and the speeches, civil society members noted the dearth of concrete commitments of either funding or programming from governments and international agencies. The signed declaration does not include the provision of an independent accountability mechanism, which was initially called for but excluded from the final document. Without such a mechanism, promises can be easily broken.
“The main point is not the meeting itself, but what will be done afterward,” said Anton Basenko from the Alliance for Public Health, who attended the New York gathering as a civil society representative. He compared the event to a 2016 U.N. meeting on HIV, where a declaration signed by governments including Ukraine has brought little change. “Nothing was really done if we look at the country level,” he said. “Nobody knows what this political declaration is. If you ask a government official ‘Do you report, are you accountable?’ they don’t even care about it, it’s just one more U.N. document.”
Civil society, he said, has an important role to play in making sure Ukraine’s contribution to the fight against TB is more than a few speeches. “It also depends on us in civil society and communities, and I hope we can call our government to be accountable for these commitments and the nice words spoken here.”
