LHL International support our partners to do advocacy at country- level, sharing results of community- led monitoring and the voices of people affected by tuberculosis. At global level, we take part in large advocacy campaigns and networks, such as Global Fund Advocacy Network (GFAN) and the Nordic Network to sustain and increase political support for the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). We also meet with Norad and Ministry of Foreign Affairs to discuss matters of TB, global health, and pandemic preparedness.
One of LHL Internationals main tasks is to raise awareness about tuberculosis. Through our projects we raise awareness about tuberculosis at community level, to ensure that people with symptoms of tuberculosis seek care, and that they know their rights. We also train health workers, medical doctors, nurses and lab technicians, and community volunteers in tuberculosis.
In Norway, we work to raise awareness and to increase the knowledge about tuberculosis at several fronts:
For decades there has been a major shortfall in the global finances for tuberculosis. Although the world leaders committed to adequately fund tuberculosis during the UN high level meeting on tuberculosis in 2018, less than 50% of funding for both prevention, diagnosis, treatment and care, and for tuberculosis research, have been available.
During the second high level meeting in 2023, the world, including Norway, have aimed to reach overall global investments of at least USD 22 billion a year by 2027, and USD 35 billion annually by 2030. In addition, they agreed to mobilize sustainable financing for tuberculosis research and innovation especially to high burden countries towards reaching USD 5 billion a year by 2027.
Amidst all this the Global Fund to fight aids, tuberculosis and malaria (GFATM), as the largest financing mechanism for tuberculosis, is seriously underfunded. During the seventh replenishment in 2022, they were able to mobilize S$15.7 billion which were short of the 18 billion ask, and the need for 30% increase from all countries. This affects all aspects of tuberculosis programs, but especially access to rapid molecular diagnostics, and social support to people on treatment.
Norway was among the countries that reduced their funding support. The next replenishment will take place in 2025.
We will not stop the tuberculosis epidemic if we do not develop and scale up the use of new tools, and the cost of inaction - status quo - is estimated to be 1 trillion USD and 6,6 million additional tuberculosis deaths.
The development of antibiotics, such as Rifampicin and Isoniazid, contributed greatly to end of the tuberculosis epidemic in Norway around the mid-1900s. And as it happens, it is many of the same drugs that are still being used to treat tuberculosis today. Development and research of new drugs have been slow, and in many places the only diagnostics remains microscopy like it has been since Robert Koch discovered the bacteria in 1882.
Today, the main challenge is drug resistant tuberculosis (DR-TB). Before recent innovations, treatment for DR-TB treatment required 5–7 drugs and more than 14,000 pills over a duration of up to 18 months, or sometimes longer. And of those few who could access diagnosis and treatment, more than 40% were unable to complete the long treatment period, due to severe side effects and costs.
Today most countries use a shorter DR-TB treatment regimen with Bedaquilin which was first approved in 2012. The shorter regimens improve compliance and increase cure rate. A six-month regimen (BPaLM/BPaL) is also now recommended by WHO.
Rapid implementation and scale up of new diagnostics and treatment regimens are a challenge, mostly due to high cost. Intellectual Property Rights (IP) and production monopoly are major barriers, and there has been several advocacy campaigns, such as The Time for $5 https://msfaccess.org/time-for-5 for Gene Xpert, and the demand to reduce the cost of Bedaquilin to a dollar a day for low-income countries. In July 2023 a deal between Johnson & Johnson and Global Drug Facility (GDF) allowed for sale and manufacture of generic Bedaquiline in lower- and middle-income countries. However, for many middle-income countries that are not eligible for procurement through GDF and that does not receive grants from the Global Fund, access to new technology and drugs are scarce.
Today’s tuberculosis vaccine, the BCG vaccine, was developed early in the 1900s. Unfortunately, the BCG vaccine does not provide full protection. While it has been proven that the vaccine effectively prevents serious forms of tuberculosis in young children, it only provides limited protection for adults. This is evident as more than 10 million people develop tuberculosis every year.
To end tuberculosis, it is absolutely crucial that a new vaccine is developed. The political declaration endorsed at the UN high level meeting on tuberculosis in 2023 contains a commitment to develop “vaccines for all forms of tuberculosis for people of all ages” and to “roll-out of safe, effective, affordable and accessible pre and post exposure vaccines, preferably within the next 5 years.” However, governments have for many years failed in financing and supporting research and development of a tuberculosis vaccine, and yet again, they have not committed the necessary funding. There is a need for at least $5 billion a year for tuberculosis research, including minimum $1.25 billion for tuberculosis vaccine research, but the declaration instead put this as a ceiling to reach over time, instead of an urgently needed funding floor.
Beginning of 2024, there is 17 tuberculosis vaccines in the pipeline, out of which 6 are in phase 3 clinical trials. One of them is MTBVAC which previously received some funding from the Norwegian government. At this point Norway is not funding any tuberculosis vaccine research.
For updates on the latest in tuberculosis research, you can go to Treatment Action Groups (TAG) annual pipeline reports.
Universal health coverage (UHC) means that all people have access to the quality health services they need, when and where they need them, without financial hardship. It covers all essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
UHC is key for tuberculosis prevention and care. Every year 3 million people with tuberculosis does not access diagnosis and treatment, most of whom are from key and vulnerable populations and/ or have low socioeconomic status. Many families also face catastrophic costs (> 20% of annual household income), around 32% for those with susceptible tuberculosis, and as high as 81% for drug resistant tuberculosis.
To achieve UHC, we need to invest in people-centered care that are accessible, available, acceptable, and affordable for all people. This includes social protection measures that address both the risk factors and social determinants of tuberculosis, such as malnutrition, and to integrate the management of co-morbidities and side- effects.
To encompass all this, focusing only on health system strengthening (HSS) and primary health care alone will be inadequate. It is necessary to include strong community systems, and to have concurrent tuberculosis-specific priorities and funding. Without that, it will not be possible to stop the tuberculosis epidemic.
