ZERO-DRAFT MOSCOW DECLARATIONFirst WHO Global Ministerial Conference
Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response
Moscow, Russian Federation, 16-17 November 2017

MOSCOW DECLARATION
Preamble:We, Ministers of Health and from across Government recognize tuberculosis (TB) is the biggest infectious
disease killer in the world today. It kills children, women and men – 5000 each day – and leaves no country
untouched. The disease disproportionately attacks the poorest, most vulnerable and the marginalized, due tooperational, economic and social conditions. Tuberculosis and its drug-resistant forms pose a health security
threat. It is central to the Anti-Microbial Resistance (AMR) agenda. It demands an urgent response that
includes national, cross-border and global collective action.
With the United Nations Sustainable Development Goals (SDGs) and the WHO End TB Strategy, we havealready committed to end the TB epidemic by 2030. We know that universal health coverage, sustainable1
financing for multisectoral action , rapid scale up of innovative approaches and tools, and discovery of newand better tools for prevention, diagnosis and treatment of TB will be fundamental to transform the fight.
We also recognize the urgent need for committing immediate, intensified, innovative and multisectoral actions
to rapidly accelerate progress in both research and implementation and to enlisting our heads of state andmore global leaders in this response, including through the UN General Assembly (UNGA) High-Level Meeting
on TB in 2018.

Commitments and calls to action:
We commit ourselves to implementing the following priority actions through equitable, ethical and humanrights based approaches and call upon WHO, other UN organizations and all partners to provide support
necessary for success.

1) Advancing TB response within universal health coverage, AMR and SDG agendas
We commit to: Setting up, by 2018, a national Inter-Ministerial Commission on TB to be convened by
Ministry of Health in partnership with civil society and with the Head of State as thepatron, to drive multisectoral action for TB care and prevention and address TB
determinants2.
 Fast-tracking universal access to health care through all state and non-state careproviders by adopting WHO-recommended TB diagnostics, drugs, technologies andstandards of care3, and ensuring attention to high-risk-groups and vulnerable populations
such as migrants, refugees and prisoners.
 Addressing MDR-TB as a national public health crisis through an emergency response
linked to the AMR agenda.
 Eliminating, by 2020, the excess deaths4 due to TB among people with HIV and achieving
synergies in managing TB and noncommunicable diseases.
We call upon: WHO, other UN agencies and partners to coordinate and provide support at national,
regional and global levels to implement commitments in this declaration through policy
guidance, technical assistance, surveillance, monitoring and evaluation, and advocacyand resource mobilization.
 WHO, the Office of the United Nations High Commissioner on Human Rights and otherpartners to support the development of a Charter on equitable, ethical and human rightsbased response to TB.
 WHO, bilateral and multilateral funding agencies and other partners to urgently support
countries addressing MDR-TB.
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2) Increased and sustainable financing
We commit to: Working across ministries to mobilize the domestic financing needed to accelerate
progress towards universal health coverage and social protection.
 Providing domestic financing for national TB budgets in line with suggested 30-60-90
minimum benchmarks for low, lower-middle and upper-middle income countries,respectively.
 Identifying and implementing the actions required to eliminate catastrophic costs5 topatients and their households, including social protection and human rights policies.
We call upon: Global health financing partners including the Global Fund to fight AIDS, TB and Malaria,
bilateral agencies, the World Bank, and regional development banks to pursue andadvocate for additional financing including through blended financing6.
 WHO, academic, technical, civil society and other relevant partners to continue efforts to
help countries develop and pursue investment cases7 while supporting increased
absorption capacity8.

3) Scientific research and innovation
We commit to: Increasing national investments in financial and human resources for TB research,
addressing regulatory impediments, and enhancing in-country TB research capacity.
 Working across ministries, donors, the scientific community and the private sector, tocreate new mechanisms for funding TB research, establish national research networks, anddevelop national research plans to expedite action on priority research
We call upon: Donors, partners and the scientific community to establish a Global Coalition for TB
Research to promote research, broaden funding sources and optimize research
investments based on international consensus and support national efforts to invigorate
TB research.

Multisectoral Accountability Framework
We recognize the need for a multisectoral accountability framework to end TB, which is both political andtechnical. This framework is critical to creating an enabling operational environment for multisectoral action,
fast-tracking priority interventions, monitoring overall progress, and accelerating advocacy at all levels withindifferent sectors, all of which is necessary to achieve committed milestones and the targets to end the TB
epidemic.
We recognize that this framework must encompass tracking of progress towards the high-level targets set
within the SDGs and established by the World Health Assembly as part of the End TB Strategy, and associatedoperational indicators and targets defined by WHO. It must also include measurable indicators, timelines andresponsibilities for the implementation of commitments and calls in this Declaration. Furthermore, given theintersectoral nature of the response, indicators and targets established within other relevant SDGs need to bemonitored to allow a better assessment of progress in countries. A reporting and review process for thisframework needs to be defined.
We call upon WHO and partners and commit ourselves to develop this multisectoral accountability frameworkin advance of the UNGA High-level Meeting on TB in 2018.
Using this multisectoral accountability framework and working with other UN agencies and partners, we
further call upon WHO, to prepare the first annual “Multisectoral Accountability Report on TB” in 2019, andcommit ourselves to contribute to its preparation.

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1Multisectoral action: Preventing TB or minimizing the risk of TB certainly requires not only actions by thehealth sector (such as achieving universal health coverage and control of communicable and non-communicablediseases that are major risk factors for TB) but also by other development sectors (such as poverty reduction,improved food security, better living and working conditions).
2

TB determinants: Conditions that favour transmission of TB or make people vulnerable to get TB are called
TB determinants. The important social determinants of TB include poverty, undernutrition, and poor living andworking conditions. Communicable and non-communicable disease and other conditions that increaseindividual risk of getting TB are called risk factors. These include HIV/AIDS, diabetes, silicosis, tobaccosmoking and harmful use of alcohol.
3Standards of care: WHO-recommended standards of TB care and prevention for optimum delivery of TB careand prevention
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Excess deaths due to TB among people with HIV: Individuals with TB are twice as likely to die if they also
have HIV. In 2015 33% of people who had HIV and TB died, compared with 15% of those who had only TB.
5Catastrophic costs: The catastrophic costs due to TB measure the total economic burden on TB patients andtheir families. These include: payments for care (e.g. diagnostic and treatment services, and medicines),
payments associated with care seeking (e.g. travel costs) and the “opportunity costs” associated with careseeking (e.g. lost income). These are determined by undertaking surveys of TB patients in health facilities.
6

Blended financing: Complementary use of grants (such as from the Global Fund or other donors) and nongrant financing from private and/or public sources (such as a World Bank loan) on terms that would make aprogramme financially sustainable.
7

Investment case: The Investment Case is a description of the transformation that a country wants to see tomeet the targets and milestones towards ending to the TB epidemic, and a prioritized set of investments
required to achieve the results.
8Absorption capacity: Capacity of a country health system to put significantly increased flow of resources toefficient use, which depends generally on governance, institutional capacity, ownership, and social and politicalstability.

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