The 2023 United Nations High-Level Meeting on Tuberculosis: an opportunity to advocate for social science research, by Yuliya Chorna
March 24, World Tuberculosis (TB) Day, offers an opportunity to raise awareness about TB and mobilize political commitments to invest in the global TB response. This year, World TB Day serves as a lead-up to the 2023 United Nations High-Level Meeting (UN HLM) on TB.
Eliminating TB has been prioritized in the context of the 2030 agenda for the UN Sustainable Development Goals (SDGs), specifically SDG 3.4. Until recently, however, TB has not attracted political attention at the level of the UN General Assembly. The first-ever UN HLM on TB in 2018 came as a breakthrough, resulting in a landmark political declaration encompassing new global commitments and targets to end the TB epidemic. The second UN HLM on TB, scheduled for 22 September 2023, will compel Heads of State and governments to review the progress achieved since then, and mobilize political and financial commitments to accelerate action in responses to TB, nationally, regionally, and globally.
This meeting is critical in the wake of the devastating impact of the COVID-19 pandemic on health systems and on TB programs in particular. Despite commendable advances in new TB diagnostics and more safe and effective TB treatments, as depicted in the latest Global TB Report, a staggering 10.6 million people fell ill and 1.6 million people died of TB in 2021. Global spending on essential TB services declined from US$6 billion in 2019 to US$5.4 billion in 2021, far below the global target of US$13 billion committed at the first UN HLM. People affected by TB also continue to face substantial financial barriers to access diagnostic and treatment services, and to support themselves and their families while receiving care for TB.
The theme of the 2nd UN HLM on TB is “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.” Social scientists have made a tremendous contribution to the growing recognition of TB as a disease linked to social determinants and inequities. They have uncovered critical insights into the lived experience of TB, intersecting challenges to service delivery and access, and nuanced understanding around the contextual drivers of success (or failure) of technological innovations and biomedical interventions. Despite this recognition and some momentum towards multisectoral actions in the TB response, TB discourse, policy and practice still retains a predominant biomedical focus. The value of social science insights to uncover drivers of TB, and qualitative research in particular to inform the development and evaluation of emerging tools and approaches, merits space within the mainstream technical discourses invoked by those who lead decisions in the TB response. This includes guideline setting entities such as the World Health Organization (WHO), financers of the TB response – notably the Global Fund, tool developers such as biotech and digital companies, government agents such as national TB programs and, increasingly, civil society and community partners. The 2023 UN HLM on TB offers a window of opportunity to alter normative discourses in TB and stimulate steady changes in subsequent responses.
The UK Academics and Professionals to End TB is a group of academics and clinicians from universities, hospitals and other institutions, that campaign, advocate and educate the general public, public servants and politicians to improve policies on TB and devote more resources to TB research. While they are UK based, their mandate extends beyond. The initiative was engaged in the 1st UN HLM on TB. For this 2nd UN HLM on TB they are reappealing to appointed TB facilitators – H.E. Krzysztof Szczerski, Permanent Representative of Poland and H.E. Bakhtiyor Ibragimov, Permanent Representative of Uzbekistan to the UN – with the ask to ensure that scientists and health care workers are included in all processes of the UN HLM.
As a social scientist in-training, an active member of the Social Science & Innovations for Tuberculosis (SSHIFTB) global network of TB social science scholars, and an advocate of people affected by TB, I stand in support of this initiative. I argue that there is a space for all actors engaged in the TB response to build on global momentum to address TB, and that the academic community should not only be included in the processes and opportunities at the UN HLM on TB but further, that their intellectual strength be channeled to influence the political decisions that get made at the highest level.
As of now, a 2023 UN HLM on TB’s Scope and Modalities Draft Resolution has been submitted by the President of the UN General Assembly. This document specifies format and organization of the 2023 UN HLM on TB, and outlines that the meeting should result in the issue of a concise and action-oriented Political Declaration, agreed upon in advance through intergovernmental negotiations and consensus. The Resolution recognizes that TB remains an urgent global health and development challenge. It calls for the need “to address persistent challenges and gaps in TB research and development, including the development of safe and effective vaccines, diagnostics, medicines and essential health technologies, and their components, as well as equipment, in order to mount an effective tuberculosis response”. Although the Resolution underscores that TB response should be driven by scientific evidence and data, it is critical that the added value of social science research in informing the equitable and people-centered development and rollout of these modalities be specified in the text of the political declaration.
On 8-9 May 2023, a Multi-stakeholder Hearing on TB will be held at the UN Headquarters in New York. Registration for the Multi-stakeholder Hearing on Tuberculosis in preparation for the 2023 UN General Assembly high-level meeting on TB is now open. The deadline to register is 7 April 2023. The Hearings will feature two panels covering themes aligned with the scope and modalities document of the UN HLM on TB and could well serve as a platform to channel the message on the relevance and added value of social science research. It will also provide for a useful networking opportunity between academics and other TB constituencies. The Hearings will bring together representatives of the Member States, observers of the General Assembly, parliamentarians, representatives of local government, relevant UN entities, civil society organizations, non-governmental organizations, academia, professional associations and the private sector and broader communities.
The format of the Hearings will include an opening segment, two interactive panel discussions and a closing segment. Two interactive panels will cover such topics as “Accelerating multisectoral actions to ensure equitable high-quality people-centred tuberculosis care and addressing determinants of tuberculosis in the context of universal health coverage”, and “Scaling up adequate and sustainable national, regional and international financing to ensure equity in tuberculosis service delivery, innovative strategies, as well as for the research and development of new diagnostics, vaccines and medicines”. I have no doubt, that social scientists can bring important angles to the specified themes through their participation in the Hearings.
I urge my fellow social science researchers to engage in the UN HLM on TB, either directly through attendance or through the many platforms which seek for stakeholders’ feedback to generate inputs on the priorities for a Political Declaration. I hope you are inspired and can be engaged through the following resources:
- The scope and modalities resolution on the 2023 UN High Level meeting on TB: https://digitallibrary.un.org/record/4002360?ln=en
- WHO flyer on the UN High Level Meeting on TB: https://www.who.int/publications/m/item/united-nations-high-level-meeting-on-the-fight-to-end-tuberculosis-flyer
- Stop TB Partnership: https://www.stoptb.org/advocate-to-endtb/united-nations-high-level-meeting-tb
- UK Academics and Professionals to End TB: https://www.ukaptb.org/letter-to-un-general-assembly
- The 2023 TB HLM Affected Communities and Civil Society Coordination Hub: https://www.globalfundadvocatesnetwork.org/tb-hlm-engagement-platform/
This essay is an original contribution by Yuliya Chorna, Doctoral Student of the Program in Social Anthropology, York University; SSHIFTB Member; Dahdaleh Global Health Graduate Scholar; and Member of the WHO Civil Society Taskforce on TB. Email email@example.com