UN High-Level Meeting Research Articles

TB prevention activities in the WHO European Region.

TB preventive treatment (TPT) is the primary available healthcare intervention to reduce the risk of progression from TB infection to TB disease. The WHO Regional Office for Europe established the European Prevention and Systematic Screening Initiative to End TB (PASS) to scale up activities related to the programmatic management of TPT. In the absence of a system to measure and monitor preventive activities, a baseline assessment survey was carried out to provide a reference to monitor the scale-up of the intervention. This was a semi-structured survey including 52 questions that was developed, implemented in the WHO-hosted LimeSurvey data form and sent to focal points in the 55 countries and territories in the European Region between September and October 2023. The questions covered TPT, systematic screening and infection prevention and control. A total of 28 questionnaires were returned, corresponding to an overall 51% response rate. Most national policies for TPT and TB screening are in line with the latest WHO guidelines. However, implementation of TB screening, prevention, and infection control activities is lagging. Results are presented separately for high-priority and low-priority countries. The survey identified several important areas that the PASS initiative will focus on to accelerate efforts towards reaching the targets set at the 2027 UN High-Level Meeting on TB for preventive therapy in the European Region. This will require a massive scale-up of efforts and larger investments, as well as coordinated approaches and interventions across the 'cascade' of prevention, from the identification of target populations to the completion of treatment.

A successful UN High-Level Meeting on antimicrobial resistance must build on the 2023 UN High-Level Meeting on tuberculosis

A successful UN High-Level Meeting on antimicrobial resistance must build on the 2023 UN High-Level Meeting on tuberculosis

Needed: a financing breakthrough at the UN High-level Meeting on Universal Health Coverage

Needed: a financing breakthrough at the UN High-level Meeting on Universal Health Coverage

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Shaping Global Health Law through United Nations Governance: The UN High-Level Meeting on Pandemic Prevention, Preparedness and Response

Shaping Global Health Law through United Nations Governance: The UN High-Level Meeting on Pandemic Prevention, Preparedness and Response

Oral health problems are global and need to be addressed in the USA

Oral health problems are global and need to be addressed in the USA

"A Promise Unfulfilled": Stakeholder Influence and the 2018 UN High-Level Meeting on NCDs Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases".

In recognition of the global burden of non-communicable diseases (NCDs), the past decade has seen three United Nations High-Level Meetings (UN HLMs) on NCDs. Yet progress in terms of political or financial commitments has been very slow. At the 2018 meeting, a political declaration was approved but featured language that had been watered down in terms of commitments. In "Competing Frames of Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases," Suzuki et al analyze the documents that were submitted by Member States, non-governmental organizations and the private sector during the consultation period and conclude that the private sector and several high-income countries (HICs) appeared to oppose regulatory frameworks for products associated with NCDs, that wealthier countries resisted financing commitments, and that general power asymmetries affected the final document. This comment supports their findings and provides additional considerations for why the NCD response has yet to produce significant commitments.

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Building a tuberculosis-free world while responding to the COVID-19 pandemic

ERRATUM

Journal of the International AIDS SocietyVolume 23, Issue 2 e25464 ErratumOpen Access ERRATUM This article corrects the following: New opportunities in tuberculosis prevention: implications for people living with HIV Lucia González Fernández, Esther C Casas, Satvinder Singh, Gavin J Churchyard, Grania Brigden, Eduardo Gotuzzo, Wim Vandevelde, Suvanand Sahu, Sevim Ahmedov, Adeeba Kamarulzaman, Alfredo Ponce-de-León, Beatriz Grinsztejn, Susan Swindells, Volume 23Issue 1Journal of the International AIDS Society First Published online: January 8, 2020 First published: 20 February 2020 https://doi.org/10.1002/jia2.25464AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the article 1, the following errors were published in the text on e25438. In the Introduction, the renewed targets to provide TB preventive therapy (TPT) to 30 million people should be by 2022 instead of 2020. The sentence reads: In 2018, the UN High-Level Meeting (UNHLM) on Tuberculosis galvanized the global efforts to prevent TB by setting renewed targets to provide TB preventive therapy (TPT) to 30 million people by 2020 including six million PLHIV [6,7]. The sentence should have read: In 2018, the UN High-Level Meeting (UNHLM) on Tuberculosis galvanized the global efforts to prevent TB by setting renewed targets to provide TB preventive therapy (TPT) to 30 million people by 2022 including six million PLHIV [6,7]. There were minor typesetting errors throughout the article and have been corrected in the online version of the article. Reference 1González Fernández L, Casas EC, Singh S, Churchyard GJ, Brigden G, Gotuzzo E, et al. New opportunities in tuberculosis prevention: implications for people living with HIV. J Intern AIDS Soc. 2020; 23:e25438. Volume23, Issue2February 2020e25464 ReferencesRelatedInformation

Editorial Vol.17(1)

On 26th September 2018, Heads of States of different countries gathered at the United Nation General Assembly for the first-ever UN High-Level Meeting (HLM) on tuberculosis (TB) to accelerate efforts in ending TB. The theme of the meeting was “United to end tuberculosis: an urgent global response to a global epidemic”. This was a landmark opportunity to marshal the political will and resources to end TB. Together we can defeat TB and overcome antimicrobial resistance by closing the funding gap for TB research and product development through equitable approaches, securing universal access to new medicines and fostering global collaboration.
 TB is an infectious disease with high mortality, the most common form of antimicrobial resistance and leading cause of death in people living with HIV/AIDS. World Health Organization declared TB as global emergency. Still, TB is second leading cause of death worldwide. A good percentage of people in the developing countries continue to suffer from this menace because of poverty, gender inequality, vulnerability, discrimination and marginalization. Millions of people with TB do not have access to quality care, including affordable diagnostic test and treatment facility and is a precarious challenge to end TB globally, as well as in SAARC Region.
 It is estimated that one quarter of the world’s population is infected with TB bacteria. SAARC Region has 36% of the global TB burden with 3.7 million new TB cases and 0.5 million death. Moreover these morbidity and mortality occur mainly in the economically productive age groups of 15-49 years. In order to eliminate TB from the SAARC Region before the global target, the SAARC TB and HIV/AIDS (STAC) has revised “SAARC Regional Strategy on Elimination of Tuberculosis (2018-2023)”.
 This year the world TB day theme was “Its time”. So it is time to involve policy makers to advocate and take active participation in the TB control programmes. The affected and infected people with this disease can bring positive changes by combining their voices towards the elimination of the disease. Now it is time to intensify advocacy, social mobilization, partnership, research and inter-sectoral efforts to achieve the global target of ending the TB epidemic by 2030.
 Chief Editor Director, STAC

Enlightenment of the United Nations high-level summit on non-communicable disease prevention and control on the development of public health system in China

The Third UN High-level Meeting on Non-Communicable Diseases was held on September 2018. The conference carried out a series of activities on the theme of "Time To Deliver", and adopted the 2018 Political Declaration on Non-Communicable Diseases. The new "5×5" strategy for non-communicable diseases prevention and control was clearly put forward, slow progress of non-communicable diseases prevention and control was criticized and the seven major challenges hindering the progress of non-communicable diseases prevention and control was analyzed, the main role and responsibility of governments at all levels in coping with the challenges of non-communicable diseases was reiterated, and put forward clear requirements. The declaration also reiterates the importance of strengthening public health measures. The meeting and declaration aroused strong repercussions and were regarded as a milestone to promote the global prevention and control of non-communicable diseases, and also brought a series of important inspirations for the development of public health in China in the new era. In order to cope with the heavy burden of non-communicable diseases in China, we must give full play to our institutional advantages, mobilization advantages and organizational advantages, adhere to prevention-oriented, emphasize the role of professional public health institutions, and consolidate and strengthen the disease control system and capacity building.

Screening for tuberculosis: time to move beyond symptoms

To accelerate progress in ending the global tuberculosis epidemic, the first UN High-Level Meeting on tuberculosis, held in 2018, resolved to close the case detection gap by 2022. However, diagnosing an additional 4 million cases of tuberculosis annually, on top of what is currently being detected, requires the immediate and expanded scale-up of systematic tuberculosis screening, followed by confirmatory testing for all individuals who screen positive. Although new confirmatory tests that are substantially more sensitive than smear microscopy are available (eg, Xpert and Xpert Ultra MTB/RIF), annual reductions in tuberculosis incidence (1·5% per year) are still far from the 4–5% annual decline needed to meet global tuberculosis elimination targets. To realise the full potential of sensitive confirmatory tests in achieving these ambitious goals, attention must now be focused on the step in the tuberculosis diagnostic cascade that misses the most patients with tuberculosis; namely, the continued reliance on symptoms to select patients for confirmatory testing.

NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4-a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030-will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010-2016 rate of decline in NCD mortality. Most of these are high-income countries with already-low NCD mortality, and countries in central and eastern Europe. An additional 50 (27%) countries for women and 35 (19%) for men are projected to achieve such a reduction in the subsequent decade, and thus, with slight acceleration of decline, could meet the 2030 target. 86 (46%) countries for women and 97 (52%) for men need implementation of policies that substantially increase the rates of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women in 15 (8%) countries and men in 24 (13%) countries. NCDs and age groups other than those included in the SDG target 3.4 are responsible for a higher risk of death in low-income and middle-income countries than in high-income countries. Substantial reduction of NCD mortality requires policies that considerably reduce tobacco and alcohol use and blood pressure, and equitable access to efficacious and high-quality preventive and curative care for acute and chronic NCDs.

Offline: NCDs, WHO, and the neoliberal utopia

The WHO Independent High-Level Commission on Non-Communicable Diseases presented an important opportunity. Yet, by common consensus, it failed to deliver. The Guardian newspaper reported that, “An independent panel advising the World Health Organisation has stopped short of recommending taxing sugary drinks to reduce obesity after failing to reach a consensus.” WHO scrambled to reassure critics that the agency “still supported taxing” sugar-sweetened beverages. The Commission was left unhappily advocating a set of recommendations substantially weaker than those already existing. Dr Tedros, WHO's Director-General, rejected the Commission's conclusions. “WHO's position cannot change because of this report”, he commented. Critics called the Commission's findings “scandalous”, “startling”, “vague”, “absurd”, “limp”, “lacklustre”, “disappointing”, “unfortunate”, and “sugar-shy”. Overall, the Commission left global health advocates underwhelmed. As one Commissioner wrote to me, “You win some…”. His implication? We lost this one. Although the Commission was certainly disappointing in several ways—and the Commission co-chairs pointed these deficiencies out themselves—such negative interpretations are unfair and mistaken. The Commission was direct in the scale of the challenge it sees ahead. Despite myriad well-intentioned declarations, conventions, commitments, roadmaps, goals, and targets, commissioners underlined a “lack of adequate global progress”, concluding without equivocation that SDG 3.4 (to reduce premature mortality from NCDs by one third) “will not be met”. As a result, their recommendations were not only directed at the usual suspects—ministers of health and the broad global health community. Instead, they appealed to Heads of State. It was they who needed “to accept primary responsibility for taking action”. The Commission went beyond the traditional 4x4 NCD agenda (four main diseases, four main risk factors). It widened its circumference of concern to include mental health, dementia, and air pollution, emphasising the importance of taking a life-course and gendered approach. The Commission pulled no punches about the obstacles to progress: lack of political action, damaging commercial and market forces, no money, and zero accountability for promises easily made and later broken. Now turn to the recommendations. Heads of State need to take responsibility and set priorities. Achieving universal health coverage will be critical. Effective regulation is essential. Although no sugar-sweetened beverage tax was proposed specifically, the Commission did recommend that “fiscal [ie, tax] incentives and disincentives should be considered to encourage healthy lifestyles by promoting the consumption of healthy products and by decreasing the marketing, availability, and consumption of unhealthy products”. Commissioners called for “evidence-based fiscal measures” to reduce the use of unhealthy foods and beverages. The Commission demanded a huge scale-up in financing, proposing new NCD-specific financial instruments, such as a multidonor trust fund. And finally, the Commission called for the creation of an independent accountability mechanism—a Countdown 2030 for NCDs—to monitor and review progress, and to call out those who failed to act on their prior commitments. When you look at the totality of the Commission's proposals, it is far too harsh to call it a failure. On the contrary, it has set a high bar to judge progress in countries and has provided an ambitious manifesto for the UN High-Level Meeting on NCDs, to be held later this year. There are two further important reasons why the Commission should be judged a success. First, it flushed out the chief opponent of political progress—the US Government. As Jamey Keaten and Maria Cheng reported for the Associated Press, it was the US representative on the Commission, Eric Hargan, who “torpedoed” efforts to add a recommendation on taxing sugar-sweetened beverages. Now we have a target: the US administration, which has adopted an anti-science position on fiscal interventions and whose raison d'être is to defend health-harming industries. Second, the controversy over the Commission's report highlights the context of the debate about NCDs—namely, the pervasive and escalating dangers of neoliberalism. We should thank the Commission for so expertly clarifying the terms on which the struggle against NCDs must now be fought.

The Lancet Commission on tuberculosis: building a tuberculosis-free world

The Sustainable Development Goals have prioritised ending the epidemic of tuberculosis by 2030. We are therefore at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000. 1 WHOGlobal tuberculosis report 2017. World Health Organization, Geneva2017 Google Scholar We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline. 2 Frick M Gaudino A Harrington M et al. Pipeline report: HIV, TB, and HCV; drugs, diagnostics, vaccines, preventive technologies, research toward a cure, and immune-based and gene therapies in development. Treatment Action Group, New York2017 Google Scholar Yet tuberculosis remains the leading source of infectious disease deaths globally, responsible for 1·7 million deaths in 2016. 1 WHOGlobal tuberculosis report 2017. World Health Organization, Geneva2017 Google Scholar The UN's High-Level Meeting on Tuberculosis, due to take place in New York, USA, later in 2018, represents a unique opportunity to secure a commitment from heads of state and governments for a coordinated global response to end the epidemic. The Lancet Commission on tuberculosis aims to identify decisive global and country-specific actions necessary to ensure the success of that response. These recommendations will address the following priorities.

UN High-Level Meeting on antimicrobials—what do we need?

UN High-Level Meeting on antimicrobials—what do we need?

What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually—far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

Measuring progress on NCDs: one goal and five targets

Heads of states and governments made commitments to the prevention and control of non-communicable diseases (NCDs) in the Political Declaration from the UN High-level Meeting on NCDs in September, 2011.1 A key commitment in the Political Declaration calls upon WHO to develop a comprehensive global monitoring framework to assess progress in the implementation of national strategies and plans for the four main NCDs: cardiovascular diseases (CVD), diabetes, cancer, and chronic respiratory diseases.

Abstract SY26-01: Screening and cancer prevention in underdeveloped environments: A global view

Abstract SY26-01: Screening and cancer prevention in underdeveloped environments: A global view

Dietary salt and cardiovascular disease

I take exception to the Comment, “Salt reduction lowers cardiovascular risk…” by Feng He and Graham MacGregor.1He FJ MacGregor GA Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials.Lancet. 2011; 378: 380-382Summary Full Text Full Text PDF PubMed Scopus (276) Google Scholar Both authors are members of the advocacy group World Action on Salt and Health (WASH)—a single-purpose activist organisation whose goal is worldwide salt reduction. Their response to every paper that counters the WASH agenda is immediate and consistently negative, reflecting ideology far more than objective science. Although they might believe their mission to be just, this does not excuse them from declaring a conflict of interest based on intellectual passion.He and MacGregor seem concerned with the timing of any publication that might run counter to the salt-reduction agenda. Colleagues at WASH did not want any publication to interfere with the plan to use the UN High-Level Meeting on Non-communicable Diseases in New York in September as a means to further their goal of worldwide salt reduction. However, even the outcome of the High-Level Meeting cannot trump nature. Modern societies during the past 200 years have never experienced levels of salt consumption as low as those being recommended by WHO—a dietary regimen that would, without doubt, result in chronically increased renin/aldosterone concentrations population-wide.Even the US Institute of Medicine admitted in its “Strategies to reduce sodium intake”2Institute of MedicineStrategies to reduce sodium intake in the United States.http://www.iom.edu/Reports/2010/Strategies-to-Reduce-Sodium-Intake-in-the-United-States.aspxGoogle Scholar that a stepwise approach should be taken and at each step an analysis should be done to check for unintended consequences. In other words, shoot first and ask questions later. Human physiology answers to a far higher authority than WHO, WASH, or the Salt Institute.I am employed by the Salt Institute. I take exception to the Comment, “Salt reduction lowers cardiovascular risk…” by Feng He and Graham MacGregor.1He FJ MacGregor GA Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials.Lancet. 2011; 378: 380-382Summary Full Text Full Text PDF PubMed Scopus (276) Google Scholar Both authors are members of the advocacy group World Action on Salt and Health (WASH)—a single-purpose activist organisation whose goal is worldwide salt reduction. Their response to every paper that counters the WASH agenda is immediate and consistently negative, reflecting ideology far more than objective science. Although they might believe their mission to be just, this does not excuse them from declaring a conflict of interest based on intellectual passion. He and MacGregor seem concerned with the timing of any publication that might run counter to the salt-reduction agenda. Colleagues at WASH did not want any publication to interfere with the plan to use the UN High-Level Meeting on Non-communicable Diseases in New York in September as a means to further their goal of worldwide salt reduction. However, even the outcome of the High-Level Meeting cannot trump nature. Modern societies during the past 200 years have never experienced levels of salt consumption as low as those being recommended by WHO—a dietary regimen that would, without doubt, result in chronically increased renin/aldosterone concentrations population-wide. Even the US Institute of Medicine admitted in its “Strategies to reduce sodium intake”2Institute of MedicineStrategies to reduce sodium intake in the United States.http://www.iom.edu/Reports/2010/Strategies-to-Reduce-Sodium-Intake-in-the-United-States.aspxGoogle Scholar that a stepwise approach should be taken and at each step an analysis should be done to check for unintended consequences. In other words, shoot first and ask questions later. Human physiology answers to a far higher authority than WHO, WASH, or the Salt Institute. I am employed by the Salt Institute. Dietary salt and cardiovascular disease – Authors' replyWe disagree with Rod Taylor and colleagues that normotensive and hypertensive individuals should be treated separately. Blood pressure is a continuous risk factor starting from 115/75 mm Hg1 and the cutoff point (ie, 140/90 mm Hg) for separating hypertensive people from normotensive people is arbitrary. Full-Text PDF