IMF analysis reveals 51 countries with moderate-to-high risk of sovereign debt distress and 9 countries in debt distress: unable to fulfill financial obligations to lenders. For many high-TB burden countries, yearly debt servicing now exceeds domestic revenue – forcing countries to cut expenditure on health. Based on a literature review and engagement with World Bank/IMF, this abstract presents a policy analysis of the implications of sovereign debt distress on TB vaccine readiness and proposes debt relief and reform as innovative financial tools for creating fiscal space for government investment in vaccine R&D and implementation