NEW YORK ― In the lead-up to the first U.N. high-level meeting on tuberculosis on Wednesday, global health experts said the momentum was different, that a turning point was near in the fight against the disease, the world’s top infectious killer. Despite this new sense of engagement, many experts and advocates were disappointed by a lack of political will at the meeting ― a state of affairs that has continued for centuries.

Tuberculosis ― which kills 1.6 million people a year, or about 3 people a minute ― has long struggled to command the global attention and investment that other health issues, like HIV and cancer, have received. That’s in part because it afflicts primarily impoverished and disenfranchised communities in African and South Asian countries. And it’s particularly heart-wrenching, advocates say, because tuberculosis is treatable and curable but millions continue to die.

“This [meeting] is a long time in coming,” the U.S. Agency for International Development’s deputy assistant administrator in global health, Irene Koek, told HuffPost. “Tuberculosis is a huge issue for millions of people around the world, and it’s never gotten the attention it really needs to be properly addressed.”

So this year’s summit, during the U.N. General Assembly, was considered a massive get ― an opportunity to elevate the fight against tuberculosis. Only four other conditions (HIV/AIDS, noncommunicable disease, antimicrobial resistance and Ebola) have led to meetings at this level in the history of the U.N. The power of those meetings to potentially increase awareness, along with funding and global commitment, was unmistakable. The meetings on HIV/AIDS led to unprecedented funding and awareness, and those on Ebola helped raise billions of dollars to fight the disease.

People who work to eradicate TB hoped the world’s apparent lack of concern would change with this meeting, but they were disappointed with the lack of progress in holding leaders accountable.

We need 3 things to #EndTB:



1. Political commitment from the highest levels & action to back it up;



2. Increased investments, especially in R&D for new medicines, vaccines & diagnostics;



3. To hold each other accountable for the promises we are making today #UNGA pic.twitter.com/8pOnBTbGuT — Tedros Adhanom Ghebreyesus @ #UNGA (@DrTedros) September 26, 2018

The U.N. delegation of countries ultimately agreed to ambitious targets, including a commitment to finding 40 million undiagnosed cases of TB by 2022 and increasing annual investment in TB to $13 billion by that time. But many global experts bemoaned that by agreeing to such ambitious goals without concrete funding commitments or action plans, the lofty declarations could never become reality.

“TB was declared a global health emergency 25 years ago,” Nick Herbert — a U.K. parliamentarian and the head of the TB Caucus, which gathers parliamentarians around the world to the fight the disease — said at the U.N. meeting. “Since then, 50 million people have died. Declarations are not enough.”

And perhaps most dishearteningly for a high-level meeting, only 16 heads of government showed up, and none of them were from Europe or North America, where the bulk of funding comes from.

Lucica Ditiu, the executive director of the international Stop TB Partnership and a key force in the organization of the meeting, was vocal about her disappointment in the showing of political will.

“It’s a long race we are starting. To be honest with you, I expected more spark and more commitment,” she told HuffPost. “I think no one is happy to be held accountable.”

Are we going to continue to let TB get out of hand and sacrifice millions of lives ― or are we going to put in 10 percent of what we spent on Ebola? Willo Brock, spokesperson for drug developer TB Alliance

Dr. Paula Fujiwara, the scientific director for the Union, said she was disappointed by not only the poor showing of heads of government but also by the lack of concrete commitments ― dates, funding, accountability ― offered by the leaders who did attend.

“This is our spotlight and chance to smash the status quo, and it was vacuous and empty,” said Sharonann Lynch, the HIV and TB policy adviser for Doctors Without Borders’ access campaign. “The fact that heads of state couldn’t bother to walk across the hall and make a statement about TB was disappointing.”

Herbert put it in blunt terms during his address.

“The truth is that doctors know how to treat TB, but the world is refusing to pay for it,” he said. “This isn’t a medical problem. It’s a shameful political failure.”

But others cautioned not to read too much into the number of leaders who attended or the dollar amount donated, saying it all boils down to what happens in the next month and years and that TB is now finally on the global radar screen.

“Is where we are right now where we want to be? Not exactly,” said Dr. Hank Tomlinson, the director of global HIV and TB at the Centers for Disease Control and Prevention. “Is where we are at historic? Yes.”

Tomlinson, Koek and other U.S. government officials stressed this was the most excited the TB community has been in years, and they reiterated how it gave them hope for progress against a disease long neglected. Resources are being mobilized, and “the right people are agitated,” Tomlinson said.

Some Promising Momentum

Despite low turnout among government heads, advocates were heartened by the strong presence from the U.S., the top donor country on TB. Health and Human Services Secretary Alex Azar, USAID head Mark Green, CDC boss Robert Redfield and National Institute of Allergy and Infectious Diseases chief Tony Fauci made appearances. Former President Bill Clinton and Sen. Marco Rubio (R.-Fla.) tweeted about the meeting, and 43 senators and 106 members of the House signed letters encouraging increased support for TB efforts.

And even more important, the U.S. promised money, indicating that this is a top priority. Experts agree that to eradicate TB, a rapid ramp-up of investment to fill a $3.5 billion gap for proper prevention and treatment and $1.3 billion for research is desperately needed.

So USAID committed to the new Global Accelerator to End TB, which entails $35 million over several years to build up accountability and data tracking for its projects, on top of $30 million (pending congressional approval) to assist in India’s fight against TB. NIAID launched an ambitious proposal to drastically shore up research and development funding for TB.

“The U.S. government’s initiative is an encouraging step in the right direction,” said Loyce Pace, the president and executive director of the Global Health Council.

The U.K. donated the equivalent of $10 million to the TB Alliance, an organization funding critical advances in drug development for treatment and vaccines.

TB was declared a global health emergency 25 years ago. Since then, 50 million people have died. Declarations are not enough. Nick Herbert, a U.K. parliamentarian and the head of the TB Caucus

Advocates pointed to the growing number of TB survivors who are telling their stories as critical, stressing that successful global health movements, like efforts on HIV/AIDS, all started from such personal advocacy.

And experts pointed to recent technological advancements in the last few days — a vaccine phase three clinical trial that’s showing promise as well as a new testing device. And everyone was excited about encouraging developments before the meeting: the first-time ministerial meeting held in Russia, where President Vladimir Putin committed to fighting the scourge, followed by a game-changing pledge by Prime Minister Narendra Modi of India to end TB by 2025. Russia and India battle some of the most cases of tuberculosis in the world, especially when it comes to drug resistance.

To keep up that innovation, the mobilization of resources is essential, said Willo Brock, a spokesperson for drug developer TB Alliance.

“Are we going to continue to let TB get out of hand and sacrifice millions of lives, or are we going to put in 10 percent of what we spent on Ebola?” he asked.

An Intellectual Property Hang-Up

Before the meeting, however, the fight over the declaration process turned ugly over a dispute between the U.S. and other member countries over intellectual property language, which could affect the affordability of drugs.

This dispute led to a three-month delay in finalizing the declaration language ― leaving less time to focus on the meeting itself. And it wasn’t the only time the U.S. took a stand apart from previously agreed-upon language that other countries considered uncontroversial, drawing criticism that it was standing with the pharmaceutical industry and profits over saving lives.

South Africa, led by its Health Minister Aaron Motsoaledi ― who has been credited with driving the international community to have such a high-level meeting ― broke decades of U.N. protocol to reopen negotiations on the declaration this summer, standing up to the world’s largest TB donor in the process.

While both sides ended up agreeing to a compromise that maintained the status quo on intellectual property rights, the hard feeling continued on the floor Wednesday. Azar made a point to announce, “We cannot cede ground on intellectual property rights,” eliciting audible gasps throughout the chamber.

For some advocates, this protracted dispute may have weakened attempts to build stronger accountability measures and goals.

“There would have been three months of time to think about what to do with the declaration,” Brock said. “The reality is we had it approved last week, which to me was a loss of time and momentum.”

Koek echoed that sentiment.

“There was a lot of time and energy spent worried about that instead of what we need heads of state to commit to, which is what we needed,” Koek said.

What Happens Next

The U.N. special envoy for tuberculosis, Eric Goosby, repeats the same phrase at every meeting about the illness: “TB is a disease we can prevent, we can treat and we can cure.”

At the U.N. this week, he added, “Now we must all be held accountable.”

Which for Herbert sums it all up.

“I don’t want to undervalue today’s meeting and the declaration, which is excellent. It does say all the right things,” Herbert told HuffPost. “I think the issue is the accountability for what the world is committed to. I don’t want to keep coming to conferences and hear the lament that TB is this awful disease, that we don’t get the resources and we don’t get the attention.”

Or as Goosby put it earlier in the day, “There’s a light at the end of the tunnel ― but it is a long tunnel.”