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www.thelancet.com Vol 392 October 6, 2018 1183 Tuberculosis experts have labelled the first ever UN High-Level Meeting on the world’s biggest infectious disease killer a “disappointment”. On Sept 26, heads of state and political leaders gathered at the UN General Assembly in New York to adopt a political declaration, “United to End Tuberculosis: An Urgent Global Response to a Global Epidemic”, which commits to accelerating action to tackle the disease by 2030. There was widespread hope the meeting would represent a historic milestone in the fight against a disease that killed 1·6 million people last year. But fewer than 20 heads of state turned up for the meeting. Leaders from some high-burden tuberculosis countries, including India and Russia, and donors that had promised to help fund the response were missing. “I thought this was going to be a historic moment, but I felt nothing historic”, Lucica Ditiu, executive director of the STOP TB Partnership, said. Ditiu said it was “completely unacceptable that no head of state, no head of government, not even one” from the European region, which is battling an epidemic of multidrug-resistance, came to the meeting. Sharonann Lynch, tuberculosis and HIV adviser for Médecins Sans Frontières’ Access Campaign, said the turnout for the meeting was “pathetic”. “Tuberculosis once again faces a lack of high-level engagement and attention. It is just a sorry reflection of a lack of political will”, she said. “So much for smashing the status quo on tuberculosis. All we are left with is a bumper sticker slogan that everyone gets to repeat.” WHO’s Global Tuberculosis Report 2018 was a sobering reminder that global efforts to control the epidemic are not on target to achieve the goal of ending the epidemic by 2030. In 2017, an estimated 10 million people were newly infected with tuberculosis and 4 million remained undiagnosed and untreated. Almost half a million people had developed multidrug-resistant tuberculosis.