Global TB Funding Must Increase to Meet 2030 Target Despite COVID-19 Disruption

Yogyakarta, March 30, 2022 – The Ministry of Health of the Republic of Indonesia, alongside the Stop TB Partnership Indonesia (STPI) and in observance of World Tuberculosis (TB) Day, hosted the first HWG meeting with a Side Event on Tuberculosis entitled “Financing for TB Response: Overcoming COVID-19 Disruption and Building Future Pandemic Preparedness”. The event took place from March 29-30, 2022 at the Hyatt Regency Hotel Yogyakarta.

This side event, as part of the HWG discussion within the Sherpa Track, aimed to encourage an increase in funding for TB response and enable G20 stakeholders to provide key input to advance TB response into the upcoming G20 High Level Conference communique from the Head of States.

The Minister of Health of the Republic of Indonesia H.E. Budi Gunadi Sadikin stated in his keynote speech that when entrusted with the 2022 G20 presidency, Indonesia has been working hard to promote the strengthening of the global health architecture and ensure a more resilient TB program in the future. Only through increased funding, expansion of existing collaborative networks, and multilateral partnerships can the international community develop effective and efficient TB diagnostics, vaccines, treatment, and surveillance systems.

“Through this effort, we will not only provide the care that TB patients and their families need most, but we will also achieve the outcome we all desire: a world free of TB,” concluded Mr. Sadikin concluded. Increasing funding and resources for TB response will support efforts to restore public health and, in turn, boost economic growth.

WHO Director General Tedros Adhanom Ghebreyesus, The Global Fund Executive Director Peter Sands, USAID Assistant Administrator for Global Health Atul Gawande, and World Bank Vice President for Human Development Mamta Murthi also gave keynote speeches to open the discussion Side Event – which was followed by speeches from the G20 representatives.

“The fight against COVID-19 has taught us that we can deal with the pandemic through joint efforts and rapid response. A similar approach is also necessary for us to be able to manage the TB epidemic. Commitments must be made not only at the global and national levels but also the regional level. We are currently facing a lot of challenges with funding as well as our fund management system,” said Meirinda Sebayang, a DR-TB survivor, Chair of Jaringan Positif Indonesia, and Member of the Stop TB Partnership Board Communities Delegation in her speech.

The two-day side event was divided into 4 sessions with 29 speakers from various global and national organizations and institutions.

1. Session 1: Current Efforts and Financing Towards Ending TB Are Not Sufficient to Meet 2030 Target

Currently, global TB response falls way short of the 2030 TB SDGs target, which aimed for a 90% reduction in TB deaths and an 80% reduction in TB incidence. To eradicate TB at the same time as COVID-19, greater investment is needed in the diagnosis and treatment of all types of TB. This also includes the development of early detection and prevention systems, new tuberculosis vaccines, and more patient-friendly medicines.

Stop TB Partnership Executive Director Lucica Ditiu, who moderated the discussion, explained, “TB is a disease that existed long before COVID-19. However, COVID-19 has worsened the TB situation. Interestingly, 50% of TB cases occur in G20 countries, so if all G20 countries can eliminate TB in their respective countries, then we only need to focus on the other 50% of cases. TB is a curable disease; we just lack the resources and attention to address it properly. We need to give TB the same kind of attention we give to COVID-19, especially since the two diseases have similar symptoms and conditions. Therefore, we have a moral responsibility to eradicate TB in our own countries.”

2. Session 2: Alternative and Innovative Approaches to Expand the Financing to End TB

The COVID-19 pandemic has shown that endemic health crises such as tuberculosis still exist around the world. In the Asia Pacific, TB caused more than 60% more deaths than COVID-19 over the past two years. In addition, 60% of TB cases globally came from six countries with the highest TB burden. This situation calls for a renewed focus on TB response. We have witnessed first-hand the success of governments and the private sector in the fight against COVID-19. The fight against TB now requires a similar approach.

The session led by the Special Staff of the Minister for Public Health Services at the Ministry of Health Prastuti Soewondo, S.E., M.PH., Ph.D. urged world leaders to be able to mobilize four times more resources than ever before for TB – $9.8 for TB treatment and prevention and $2.4 billion for TB research and development annually. This is a necessary step to take because health is an important factor in determining economic growth.

Funding for TB response requires a multisectoral and systematic effort in order to invest more rationally and closer in line with the burden and impact of this epidemic on public health and the economy. G20 countries need to build effective partnerships with all relevant stakeholders, including TB survivors, members of parliament, civil society, technical and multilateral institutions, the private sector, development banks, and philanthropy organizations.

1. Session 3: Development of Airborne Infection Defence Approach (AIDA)

The pandemic has managed to capture global attention, and we all know that the response to COVID-19 requires a lot of resources, including those originally allocated to the fight against TB.

As the pandemic presents an opportunity to improve tuberculosis treatment and management, countries around the world can enhance their knowledge and assets to strengthen their response to TB and protect their communities from future airborne infections.

Stop TB Partnership Deputy Executive Director Suwanand Sahu recommended that the G20 recognize that TB is a massive threat to global health and attempt to integrate TB response into Pandemic Preparedness and Management. G20 countries are also expected to create more opportunities to further discuss the technical aspects of the “Airborne Infection Protection Approach” as a way to effectively manage other respiratory infectious diseases.

To help prevent future pandemics, Dr. Erlina Burhan, MSc, Sp.P(K), Pulmonologist and a Board Member of Stop TB Partnership Indonesia, deemed it necessary to improve strict management of public health, promote a clean and healthy lifestyle, and upgrade existing health and surveillance infrastructure to be able to predict potential pandemics. At the same time, the pharmaceutical industry needs to focus on providing a platform for competitive innovation and continue ongoing research to discover more effective and patient-friendly medicines.

“We need to scale up collaboration to be able to deliver a massive 3T (Testing, Tracing, and Treatment) effort, as we did with COVID-19. The fact is that the COVID-19 vaccine can be found in just a year while the development of the TB vaccine has stalled. For 94 years, we have had no success in finding a new tuberculosis vaccine,” said. Dr. Erlina.

1. Session 4: Financing to End TB in 2030 – How the G20 Led Success Will Look

The last session discussed the global commitment to immediate tuberculosis eradication. Efforts to end TB will require significant investment in research and development, innovative approaches both in terms of research methodologies and active community case finding, as well as decisive political actions to meet the budgetary commitments required to eliminate TB.

Prof. dr. Adi Utarini, M.Sc., MPH, Ph.D., a Member of the National Research and Innovation Agency, invited all parties to seek innovative approaches, translate political commitments into real action, and find leadership benchmarks that can help us effectively manage the TB epidemic.

During the session, Prof. Tjandra Yoga Aditama, Director of the YARSI University Graduate Program, revealed seven things necessary to overcome the global underfunding of TB treatment, among them the need to quadruple the TB budget – including each country's domestic budget with advocacy and political commitment – and to explore the potential role of the private sector and philanthropy organizations.

The speakers emphasized the need for G20 member countries urgently recreate the use of COVID-19 digital technology in responding to the TB crisis. TB-related investments are cost-effective and will ultimately benefit everyone. It also serves as the foundation of a universal health insurance strategy.

Despite these high-level commitments, current TB response investments ($5.3 billion in 2020) are still well below the $13 billion needed to achieve the global targets set by the END TB strategy and the United Nations summit on TB. In 2020, global spending on TB services fell for the first time since 2016, to US$ 5.3 billion (down 8.7% between 2019 and 2020). If the world does not meet the global END TB target by 2030, there will be 31.8 million deaths from the disease and $18.5 trillion in economic losses over the 2020-2050 period.

Tuberculosis has existed for 140 years, but the lack of resources and global solidarity in the prevention and control of the disease makes it the world's second top infectious killer, claiming close to 4,100 lives a day: it is the leading killer of people with HIV and a major contributor of antimicrobial resistance-related deaths. Approximately 1.5 million people died from TB in 2020 (including 215,000 among HIV-positive people).

The current trajectory of efforts is insufficient to meet the END TB target for 2030 and will result in preventable morbidity and mortality. Therefore, increasing investments in TB diagnostics, treatment, and prevention is critical for future pandemic preparedness.

Given the role that G20 countries play in addressing economic and public health challenges, the momentum of Indonesia’s G20 Presidency – as one of the countries with the highest TB burden in the world – is seen as a strategic advantage. Indonesia will be able to lead discussions on increased funding for TB response and demand commitments from the G20 heads of state.

Continuing the two-day seminar, the Indonesian Presidency urged the G20 countries and several other invited countries to develop a “Call to Action on Financing for TB Response”. The document, which will be developed during Indonesia's G20 Presidency in 2022, is expected to generate a concrete collective view that will help promote higher, more effective, and more efficient investments in ending TB.

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About Substansi TBC Kementerian Kesehatan Republik Indonesia

Substansi Tuberkulosis Kementerian Kesehatan Republik Indonesia is the implementing organization for the national TB prevention and response program. Operating under the Ministry of Health of the Republic of Indonesia, its main mission is to eliminate tuberculosis by 2030. By emphasizing the key messages of TOSS TBC (Find Tuberculosis, Treat Until Cured), TB elimination and health improvement goals will be substantially achieved by empowering the community to transform behaviors as well as facilitating social change and advocacy across all sectors.

About Stop TB Partnership Indonesia

Stop TB Partnership Indonesia (STPI) believes that the eradication of tuberculosis (TB) in Indonesia will be achieved if it is based on a strong partnership between the Government, the private sector, and the community. STPI began as a partnership forum and became a foundation in 2018. STPI has initiated cross-sectoral lobbying for national TB policies, built a governance model for cross-sectoral TB management in various districts and villages, and advocated for TB issues on social and mass media. STPI continues to host its forum activities to provide a platform of communication for over 120 TB-related organizations and individuals in Indonesia.