Co-authored by: Elizabeth Lovinger, U.S. and Global Health Policy Director, Treatment Action Group and Jenni Maple, Associate Director of Advocacy, IAVI

There are many problems without solutions. Tuberculosis isn’t one.

Tuberculosis (TB) is one of the oldest, deadliest pandemics. It’s also the leading cause of death among people living with HIV (PLHIV) who are at 20 times higher risk for developing TB. HIV and multidrug-resistant TB (MDR-TB) are a particularly deadly combination. Even with early diagnosis and treatment, PLHIV with MDR-TB are more likely to die.

But we know how to end these pandemics. 

At this fall’s United Nations High-Level Meeting on TB (HLM), the U.S. has an opportunity to make bold commitments toward ending the disease as a global health threat. In so doing, it can also help reduce the number of TB-related deaths among PLHIV.

At the 2018 HLM, the U.S. launched the Global Accelerator to End TB, increasing the capacity of governments, civil society, and the private sector and accelerating progress. It also made a commitment, through the Strategic Plan for Tuberculosis Research, to expand resources and expedite development of tools to combat TB.

U.S. leadership helps develop effective solutions, expand treatment access, and increases attention and investment from other countries. Without such leadership at this year’s HLM, preventable illness and death from TB will continue to exact a terrible toll.

Research and development related to TB has been under-resourced. In 2021, for the first time in history, funding levels reached $1 billion. While significant, world leaders pledged double this amount at the last HLM. The Stop TB Partnership called for states to mobilize $5 billion a year for TB research, including $1 billion/year just for vaccine development. 

For 50 years, we’ve been fighting TB with the same outdated tools: ineffective vaccines and long, toxic courses of treatment. Decades of investment in scientific research have provided newer, safer regimens. For example, a simpler, shorter, highly effective treatment regimen for latent TB is available in rifapentine-based regimens (“3HP”).  We can treat drug-sensitive/drug-resistant TB with four- and six-month regimens, respectively, but significant scale up of treatment coverage is needed.

The current vaccine is over 100 years old. Encouragingly, five candidate vaccines are ready for late-stage clinical trials. Increased investments are required to move these studies forward and help get new TB vaccines developed and deployed this decade. Doing so is essential to achieving the 2030 World Health Organization End TB goals.

The right to science — ensuring that everyone shares in scientific advancement — must be embedded into the framework for action to end TB. Those most vulnerable to the disease must participate in vaccine studies. They must be involved in the process and able to access beneficial outcomes.

The World Health Organization estimates that, between 2000 and 2021, 74 million lives have been saved through TB diagnosis and treatment. U.S. leadership, through the Global Fund to Fight AIDS, Tuberculosis and Malaria — to which the U.S. is the largest donor — USAID, and the President’s Emergency Plan for AIDS Relief (PEPFAR) have been critical to achieving this progress.

The Global Fund provides 76% of all international financing for TB, investing $8.5 billion in programs to prevent and treat TB and an additional $5 billion in TB/HIV programs. These investments have helped decrease TB deaths by 21%. In 2021 alone, the Global Fund helped ensure that 283,000 HIV positive people with TB were on antiretroviral therapy.

USAID leads the U.S. global TB efforts and is a key implementer of PEPFAR programs. It addresses the challenges facing people living with HIV who contract TB by, for example, initiating them on TB preventative treatment, ensuring that people with TB are tested for HIV, and linking people with HIV and TB to antiretroviral regimens.

In turn, Global Fund and PEPFAR integrate HIV prevention, testing, care, and treatment into TB services. These initiatives help strengthen health systems, and reduce the burden of TB and HIV co-infection. These programs have been effective in expanding the uptake of 3HP, ensuring that well-defined budgets for the treatment regimen in its country operating plans. The U.S. has a long history of addressing — and reversing — global health threats. This leadership is more important than ever. Ending TB is not a scientific challenge, but one of resources and political will. And when a solution exists, there is no excuse for not doing everything we can to achieve it.