October 29, 2024 — Treatment Action Group (TAG) is deeply concerned by the reported decrease in domestic funding for tuberculosis (TB) services announced today in the World Health Organization’s 2024 Global Tuberculosis Report.
TB is the world’s top infectious disease killer, and ending TB requires adequate and sustained funding for prevention, diagnosis, treatment, and care. Eighty percent of funding for essential TB services comes from national budgets, which makes the reported decline in domestic funding particularly alarming.
The fact that the decline appears driven by reduced spending by the BRICS countries (Brazil, Russian Federation, India, China, and South Africa) — countries which account for 49% of the global TB burden and have been heralded as champions of ending TB — only adds to our concern that backsliding in domestic funding gravely threatens progress towards ending TB.
Since a peak of US$6.8 billion in 2019, domestic funding available to TB programs and services in low- and middle-income countries (LMICs) has declined to US$5.7 billion, representing only 26% of the global target of US$22 billion.
Domestic funding has declined even as international funding has been in plateau. Unlike BRICS countries, which are almost entirely reliant on domestic funding for TB programs, international funding remains a critical funding source for other LMICs — making up 54% of funding for high-TB burden countries and 62% of funding available in low-income countries.
However, if domestic funding continues to decline in all LMICs, we risk an overreliance on international funding sources with no promise of increases — underscoring the need to push for bolstered and sustainable domestic funding for TB.
The decrease in domestic funding for TB echoes alarm bells heard in the halls of the World Bank and International Monetary Fund last week: the debt crisis among LMICs threatens investment in health and progress towards Sustainable Development Goals.
The domestic funding decline for TB is part of a larger story about the precarity of essential health services in an international financial system whose rules put countries facing epidemics, such as TB, in impossible situations.
Sovereign debt now consumes 40% of government revenue on average, compared to the mere 10% dedicated to all health services. Currently, 43% of high-TB burden countries are either in or at risk of debt distress, where they are unable to fulfill their financial and debt obligations. Given the reliance on domestic funding for TB programs, ever-increasing debt burdens and the risk of debt distress pose a catastrophic risk to TB services in high-TB burden countries and worldwide.
Beyond the impact of reduced domestic funding for TB programs today, sovereign debt also threatens the future of TB response by limiting countries’ fiscal space to invest in TB innovations and TB research and development. As we enter into an exciting era of development of new TB tools, including a potential new vaccine, we must ensure countries have fiscal flexibility to quickly invest in research and new innovations to realize TB goals.
The 2024 Global Tuberculosis Report reflects the urgency of developing financing models that protect and bolster domestic investment in health and other public services. In the absence of debt restructuring and relief, we worry that domestic investment in TB programs will continue to decline as debt burden continues to grow—threatening the realization of a future without TB.
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Contact: Erin McConnell, erin.mcconnell@