UNITED NATIONS (AP) — Top U.N. officials, health industry leaders and activists demanded Monday that the world invest more to develop new vaccines and tackle a surge in tuberculosis fueled by the impact of COVID-19 and conflicts including Ukraine and Sudan.

At a crowded meeting punctuated by activists chanting “End TB Now," there were speeches from many TB sufferers and a keynote by U.N. Deputy Secretary-General Amina Mohammed, who spoke about how her father passed on tuberculosis to her two-year-old sister: TB claimed his life at the age of 60, but her sister, now 50, is a survivor.

Tuberculosis is the biggest infectious disease killer in the world today, taking the lives of around 4,400 people every day around the world including 700 children, Dr. Lucica Ditiu, executive director of the Stop TB Partnership, said ahead of Monday’s hearing to prepare for a high-level meeting on Sept. 22 during the annual gathering of world leaders at the U.N. General Assembly.

The U.N. deputy secretary-general said global response efforts to tuberculosis have saved 74 million lives since 2000, but over 10.5 million people got the disease and an estimated 6.1 million died in 2021, and it is now the leading cause of death for people with HIV.

The TB epidemic is driven by a host of factors including poverty, malnutrition and HIV and disproportionately affects the most vulnerable in all countries, Mohammed said, stressing that these drivers of the disease must be addressed.

She said $22 billion is needed to provide all people diagnosed with TB access to quality treatment by 2027 along with access to health and social benefits so they don’t suffer financial hardship — and an additional $5 billion a year is needed for TB research and innovation.

“We can develop safe and effective tuberculosis vaccines and simple one-stop shops for quality tests and care,” Mohammed said. “This would be a game changer.”

U.N. World Health Organization Director-General Tedros Adhanom Ghebreyesus said in a video address to the meeting that COVID-19 “turned our world upside-down” for three years, and in addition to the millions of deaths it deprived millions of people of essential health services including for tuberculosis.

“Conflicts across Europe, Africa, and the Middle East have made life-saving services even harder to access for people living with TB,” he said. “These challenges have been a setback in the fight against TB, reversing some of the significant gains we have made over the past 20 years in expanding access to prevention, testing and treatment.”

The WHO chief said the high-level meeting in September must be a turning point in reinvigorating progress in the fight against TB, not only by expanding existing tools but also developing new tools including new TB vaccines. That’s why WHO “has proposed establishing a TB vaccine accelerator council to facilitate the development, licensing and use of new TB vaccines," Ghebreyesus said.

Dr. Özlem Türeci, chief medical officer of BioNTech which developed one of the main COVID-19 vaccines with Pfizer using messenger RNA technology, told the meeting that it started trials of a new vaccine candidate for TB several weeks ago.

The Stop TB Partnership’s Ditiu said a COVID vaccine was developed in less than a year while it has taken 19 years to get three or four other vaccines for TB to phase 3 trials because of a lack of money.

Before COVID, which like TB is transmitted through the air, “we didn’t see very dramatic cases of TB,” she said, “but after COVID we saw a type of TB that we saw in … movies in which people spit blood and they are very weak, and so on.”

Ditiu said the economic impact of COVID and conflicts, first and foremost in Ukraine but now also in Sudan, are having “a huge impact” on efforts to treat people with TB and diagnose new cases.

Ukraine has the highest number of estimated people with TB in the European region – 34,000 – and also a high number with drug-resistant TB, she told a news conference on Thursday.

“It’s remarkable, the fact that the Ukrainian people are actually showing an amazing resilience in doing their best to maintain the services for TB,” Ditiu said. “But obviously a lot of people left the country.”

Nonetheless, she said, major efforts have been made to track down those with the disease, but what worries everyone is to ensure that people in Ukraine have access to treatment.

According to the Stop TB Partnership, which is managed by the U.N. Office for Project Services and aims to achieve a world free of tuberculosis, 18,000 people in Sudan received treatment in 2021.

Ditiu said the situation there for TB sufferers because of the ongoing fighting and collapse of most of the health system is “probably like a ticking bomb.”