Health and finance ministers from 20 countries bearing 80% of the world's tuberculosis (TB) burden have met in Amsterdam to sign a declaration pledging to increase treatment regimes in their respective countries to curtail the spread of the disease. Efforts are to be coordinated through a new secretariat located within the World Health Organization (WHO) in Geneva called Stop TB. But despite the public demonstration of unity, with delegates from all 20 countries signing the declaration, Stop TB executives could not agree on how the initiative should be governed.

Convened by the WHO and the World Bank, the Tuberculosis and Sustainable Development conference was dedicated to galvanizing political commitment to fighting TB. Delegates agreed to increase DOTS coverage to 70% by 2005. However, Stop TB director Arata Kochi, who is on secondment from the WHO, estimated that to achieve such expansion would cost $200 million per year, and at present, the initiative has only $125 million in the bank.

The declaration also called for the creation of a Global Fund for Tuberculosis, which will invest in research into new diagnostics, drugs and vaccines. James Orbinski of Médecins sans Frontières pointed out that no new vaccine has been developed since 1923 and no new drugs have been developed since 1963. William Foege, representing the Gates Foundation, pledged $25 million to the development of new drugs for TB, and backed the role of the WHO in leading the initiative: “If we want them to provide the required leadership, we must provide them with the required budget.”

However, the fact that Stop TB operates within the WHO's institutional framework is a cause for concern for some partners who feel that the initiative cannot move quickly because of the WHO's bureaucracy. Members of the Stop TB committee met with Brundtland at the end of the meeting to discuss a draft document defining its governing structure. The outcome of this closed meeting was that the legal structure of the WHO will not allow its participation in a partnership that is not run under WHO policies and procedures.