A Campaign to Rally Energy, Funding, and Political Will to End TB
Tuberculosis (TB) is one of the world’s deadliest infectious diseases, but has long been neglected by governments, funders and global health actors. For more than a half century, we’ve been fighting TB with the same outdated resources, strategies and long, toxic courses of treatment that left patients with lasting side effects.
Thanks to decades of investment in scientific research, we now have newer, safer, and more effective regimens – but very few people around the world have access to them. The 1/4/6×24 Campaign aims to change that. The Campaign’s name comes from its central demand: that countries and other duty bearers take action to implement the shortest available regimens – one month or once-weekly for TB prevention, four months for drug-sensitive TB, and six months for drug-resistant TB — by the end of 2024.
1 = One-month and once-weekly TB preventive treatments, 1HP and 3HP (one month of daily, or three months of weekly isoniazid and rifapentine).
4 = Four-month treatment regimens for drug-sensitive TB, 4HPMZ for adults and adolescents (four months of isoniazid, rifapentine, and moxifloxacin with pyrazinamide for the first two months) and 4HRZ[E] for children with non-severe TB (four months of isoniazid, rifampicin with pyrazinamide, and in certain circumstances with ethambutol, for the first two months).
6 = Six-month treatment regimens for drug-resistant TB, 6BPaL[M] (six months of bedaquiline, pretomanid, linezolid, with moxifloxacin depending on drug-susceptibility).
x 24 = by the end of 2024!
The 1/4/6×24 Campaign draws inspiration from the legacy of the late Partners in Health (PIH) co-founder Dr. Paul Farmer, who stressed the so-called “five S’s” that countries must have in place to deliver equitable care to the poorest people: stuff, staff, space, systems and support. 1/4/6×24 also nods toward the WHO and UNAIDS 3×5 Initiative, which aspired to put 3 million people living with HIV in low- and middle-income countries on ART by 2005 – a step towards the ultimate goal of universal access to HIV treatment and prevention. Similarly, 1/4/6×24 serves as a collective demand to build the momentum we need to course correct the global fight to end TB.
Check back here for additional campaign materials and updates, and information on how to get involved!
- Statement about the 1/4/6×24 Campaign launch event held at the 2022 International AIDS Society Conference in Montreal, Canada (July 31, 2022).
- Global List of Asks and Actors for the 1/4/6×24 Campaign, outlining advocates’ expectations and laying out key action steps and research priorities.
- Brochure for general readers explaining 1/4/6×24 and why it matters.
- Press release about the 1/4/6×24 Campaign Call to Action at the USAID TB Symposium in Washington, D.C. (October 27, 2022)
- Template Advocacy Letter to support community and civil society organizations to engage national policy makers on the need to update national guidelines and mobilize resources to ensure the 5 S’s necessary for 1/4/6×24
- November, 2022 TAGline article: Introducing 1/4/6×24: A Campaign That Draws Inspiration from the Past to Change the Trajectory of the Future Fight to End Tuberculosis
- Community Campaign Training Materials to support national workshops to train civil society and community allies on 1/4/6×24 as a basis for national campaign advocacy strategy development.
- Nature Medicine Correspondence detailing the 1/4/6×24 Campaign and actions needed to scale up implementation of the shorter, safer 1/4/6 regimens (January 10, 2023).
- GFAN Advocacy Guides to 1/4/6×24 to support advocacy for the prioritization and inclusion of 1/4/6 regimens in national strategic plans and Global Fund funding requests.
- Aidspan article with information and links to resources to support advocates to push for prioritization and inclusion of 1/4/6 regimens in national strategic plans and Global Fund funding requests (March 8, 2023).
- How-to Guide: Make your own pill burden display for in-person events to show the dramatic reduction in the number of pills one needs to complete treatment with 1/4/6 regimens compared to the older, longer, and more toxic regimens.
- World TB Day press release detailing 1/4/6×24 Campaign Coalition demands and why 1/4/6×24 is needed to get back on track to ending TB by 2030 (March 20, 2023).
- World TB Day toolkit with links to key 1/4/6×24 resources and a series of sample social media posts and graphics to push for 1/4/6×24 leading up to World TB Day (March 24, 2023) and beyond.
- 1/4/6×24 Videos featuring TB survivors from around the globe sharing their experiences and challenges taking the longer regimens and explaining why scaling up access to the shorter, safer regimens for TB prevention and treatment matters.
- Statement from the 1/4/6×24 Coalition welcoming India’s rejection of Johnson & Johnson’s patent evergreening tactic for bedaquiline (March 28, 2023).
- IJTLD Editorial highlighting Ukraine’s efforts to successfully adopt and implement the shorter, safer 1/4/6 regimens in the midst of a devasting war.
- Lancet Microbe Comment detailing the diagnostic tools, strategies, and actions necessary to close diagnostic gaps for TB and DR-TB and achieve 1/4/6×24 (July 31, 2023).
- 1/4/6×24 Campaign Statement calling on country governments to go beyond the UN High Level Meeting political declaration on TB to deliver the funding necessary to scale up access to the 1/4/6 regimens and supportive diagnostics by the end of 2024 (September 19, 2023).
- Joint Statement by 1/4/6×24 Coalition Members on the role of community activism in delivering recent price reductions of lifesaving tools bedaquiline, 3HP, and GeneXpert TB tests, and what must still be done to reduce prices and increase access to 1/4/6 regimens and supportive diagnostics (November 7, 2023).
- 1/4/6×24 Campaign One-Pager highlighting the recent price reductions of 1/4/6 medicines and supportive diagnostics and the opportunity to take advantage of the Global Fund grant cycle (GC7) to increase uptake of the 1/4/6 regimens — especially the “4” (November 7, 2023).
- Webcast recording from the 1/4/6×24 Campaign Call to Action at the USAID TB Symposium in Washington, D.C. (October 28, 2022)
- Letter from TB CAB and Indian civil society and community based organizations and activists appealing to the Minister of Health and Family Welfare, Government of India to update national guidelines to include the 1/4/6 regimens, advocate for financial and other resources necessary to get in place the staff, stuff, space, systems, and support‖ needed to implement the updated national guidelines by the end of 2024, and include civil society and affected communities in these efforts to reform policies, frameworks, and the standard of care for TB in India.
- Letter from the TB CAB appealing to the Minister of Health in Peru to update national guidelines to include the 1/4/6 regimens, advocate for financial and other resources necessary to get in place the staff, stuff, space, systems, and support needed to implement the updated national guidelines by the end of 2024, and include civil society and affected communities in these efforts to reform policies, frameworks, and the standard of care for TB in Peru. (Letter is in Spanish.)
- Letter from the TB CAB appealing to the Minister of Health in Moldova to update national guidelines to include 1/4/6 regimens, advocate for financial and other resources necessary to get in place the staff, stuff, space, systems, and support needed to implement the updated national guidelines by the end of 2024, and include civil society and affected communities in these efforts to reform policies, frameworks, and the standard of care for TB in Moldova. (Letter is in Moldovan/Romanian.)
- Letter from the Community Research Advisors Group (CRAG) to the National TB Program in Thailand encouraging rapid implementation of the four-month regimen of 1/4/6×24, given the role of the Thai Red Cross AIDS Research Centre and The Research Institute for Health Sciences (RIHES) in, and Thai TB patients’ contributions to, the large phase III clinical trial that validated the 4-month regimen.
- Letter from the Community Research Advisors Group (CRAG) to the Health Department of the Republic of South Africa, requesting that the four-month tuberculosis treatment be made available to communities that participated in Tuberculosis Trials Consortium (TBTC) Study 31/ACTG A5349.
- Letter from the Community Research Advisors Group (CRAG) to the Minister of Health in Peru, calling for the introduction of the four-month regimen from the TBTC Study 31/ACTG A5349.
- Letter from the Community Research Advisors Group (CRAG) to Dr. Owen Mugurungi and Dr. Fungai Kavenga in Zimbabwe, requesting to make the four-month tuberculosis treatment available in communities that participated in TBTC Study 31/ACTG A5349. (Zimbabwe is one of those countries.)
- Letter from Comitê Comunitário de Acompanhamento de Pesquisas em Tuberculose no Brasil (CCAP TB Brasil) and Brazilian civil society and community based organizations and activists to the Federal Government’s Transition Team, calling on the new government to reinstate the National TB Program under the Ministry of Health and accelerate discussions necessary to update national guidelines to include the the 1/4/6 regimens and robust social policies to support their implementation.
- Letter from TB CAB, Observatorio Social de Tuberculosis en México, and other civil society and community-based organizations to update national guidelines to include 1/4/6 regimens, advocate for financial and other resources necessary to get in place the staff, stuff, space, systems, and support needed to implement the updated national guidelines by the end of 2024, and include civil society and affected communities in these efforts to reform policies, frameworks, and the standard of care for TB in Mexico. (Letter is in Spanish.)
- Open letter from the 1/4/6×24 Campaign Coalition and allies to Johnson & Johnson calling on the company to publicly commit to withdraw and not enforce the fumarate salt patent claims and other secondary patents on bedaquiline, as part of its commitment to the goals of the 1/4/6×24 Campaign (January 13, 2023).
- Open letter from the 1/4/6×24 Campaign Coalition and allies to Cepheid calling on the company to take urgent action necessary to improve equitable access to GeneXpert tuberculosis diagnostics and achieve 1/4/6×24 (February 28, 2023).
- Open letter from the 1/4/6×24 Campaign Coalition and allies to Johnson & Johnson, endorsed by 83 organizations and 106 individuals, reiterating demands that the company publicly commit to non-enforcement and withdrawal of secondary patents on bedaquiline to enable access to generic bedaquiline in all low- and middle-income countries (July 11, 2023).
- Open letter from TAG, Partners In Health, and MSF Access Campaign to Johnson & Johnson requesting detailed responses to questions and concerns regarding the deal with the Global Drug Facility to supply generic bedaquiline to low- and middle-income countries that excludes South Africa, 10 EECA countries, and China (August 1, 2023).
This campaign speaks to governments, normative and regulatory agencies, multilateral agencies, bilateral and other donors, clinicians, nurses, community health workers, TB survivors, civil society, activists, and community groups, and makes specific asks of national governments, international donors, pharmaceutical companies, and other people and institutions in positions of power to affect the course of the TB response. Here we share the commitments on 1/4/6×24 that have been made to date:
- Global Drug Facility, Stop TB Partnership (GDF)
- Global Fund Against HIV, TB, and Malaria
- Médecins Sans Frontières (MSF)
- Partners in Health (PIH)
- Sentinel Project Against Pediatric Drug-Resistant TB
- Stop TB Partnership (STBP)
- United States Agency for International Development (USAID)
- World Health Organization (WHO)
This work is led by the 1/4/6×24 Campaign Coalition, an international network of TB survivors, researchers, clinicians, activists, and civil society professionals who advocate for communities affected by TB. Their institutional affiliations include:
Treatment Action Group (TAG)
Partners In Health (PIH)
Médecins Sans Frontières (MSF)
Global Coalition of TB Advocates (GCTA)
Treatment Action Campaign (TAC)
Global TB Community Advisory Board (TB CAB)
Stop TB Partnership
Survivors Against TB
The Sentinel Project Against Pediatric Drug-Resistant TB
We Are TB
TBPPM Learning Network
Asia Pacific Counsel of AIDS Service Organizations (APCASO)
African Coalition on TB (ACT)
TB Europe Coalition (TBEC)
Lean on Me Foundation
O’Neill Institute for National and Global Health Law at Georgetown University
TB Women Global
Wote Youth Development Projects
Zambia Association for Prevention of HIV and TB (ZAPHIT)