[Jim Dobbin in the Chair]
Let me start in the past. In 1821, Maria Brontë died of consumption. Two of her daughters died of the disease in infancy and her four older children—Bramwell and his famous sisters, Anne, Emily and Charlotte—also died of it. According to the history books, they became
“ill from dampness and terrible living conditions”.
Consumption, or tuberculosis, is a disease that many people believe belongs to the past. Nothing could be further from the truth. TB kills more people in the world today than any other infectious disease. Every day, 3,800 people die from it. Sunday is world AIDS day, so it is worth remembering that TB is the leading killer of people living with HIV. At least one third of the 35.3 million people living with HIV worldwide are infected with latent TB. People co-infected with TB and HIV are about 30 times more likely to develop active TB disease than people without HIV. Given the devastating synergy that exists between the two infections and the impact that they have on people living in the developing world, it is absolutely vital that resources are stepped up now so that we not only effectively tackle TB-HIV co-infection but ensure that the health-related millennium development goals are achieved. The Department for International Development is about to launch its policy review paper on HIV/AIDS. I hope that it will make clear the importance of linking the approaches to TB and HIV, and that it will have clear commitments to tackle those diseases.
In the UK, we can be tempted to believe that TB no longer poses a threat to public health. There is a widespread belief that the BCG vaccine is effective and that today TB only affects other countries. However, in a connected world of global travel, TB is never far away. That came home to me forcibly when an English student returned from foreign travel with the disease and subsequently infected other students attending the college of which I was principal. Students and staff found dealing with the anti-TB drugs to be an ordeal. For a standard, non-drug-resistant case, the treatment regime can require a six-month course of a cocktail of four drugs. Those “front-line” drugs are more than 40 years old now and have unpleasant side-effects. It was a challenge for me as college principal, working with the local NHS, to get people to take the drugs they had to take. It must be an even bigger challenge to help patients in the developing world who not have access to the type of care and support offered by the NHS.
The stigma attached to the disease here was a barrier to patients accessing treatment. In sub-Saharan Africa, the stigma is even greater. Dr Simon Blankley, a Voluntary Services Overseas chest physician working in Uganda, reported that patients could often be locked away in cupboards or forced to leave their villages, and that health care workers were worried for their own health when TB patients were admitted to wards. TB needs to be tackled in a sustainable way that reassures people and builds community resilience. Dr Blankley was able to use a team of VSO volunteers to provide education and reassurance, and to get TB patients in and around Kampala to complete their eight-month course of treatment. The team’s work drastically increased completion rates. He then expanded the work, adding work on TB to the community health education that was already in place. That sustainable approach can be replicated elsewhere.
Dr Mario Raviglione, director of the global TB programme at the World Health Organisation, said just last month, when he launched the WHO’s global TB report in partnership with the all-party group on global tuberculosis, that
“at the current rate of progress, we will not be rid of TB for over a century.”
The efforts of the global health fund and its partners have made fantastic progress against TB, HIV and malaria, and the Government are to be applauded for their recent pledge of up to £l billion for the fund. However, we need absolute urgency, unremitting determination and co-ordinated effort to tackle TB.
I congratulate the hon. Gentleman on securing this debate. I also warmly applaud the Government on the contribution and the commitment that they have made to the global health fund, which continues the work of the previous Government.
The hon. Gentleman mentioned the HIV position paper, which in fact was published only moments ago. He may be disappointed to note that the Government appear not to be putting quite as much emphasis on ensuring that they make the connection between HIV and TB. Will he insist that the Government continue a commitment to TB REACH and other programmes that address that serious problem?
Thank you, Mr Dobbin, and I thank the hon. Gentleman for his contribution. I am sure that the Minister will reflect on his point when he responds to the debate. It reinforces the point that I made earlier about the importance of the Government taking the opportunity to co-ordinate their efforts in relation to both HIV and TB, and the Minister will have heard those points.
Is my hon. Friend aware that 750,000 TB cases—the most lethal ones—come from South Africa’s gold mines, and contribute 9% of the global total of TB cases, which are often linked to HIV? If so, does he agree that it is vital for the British Government to talk to British-owned companies that are mining gold in South Africa to try to resolve that terrible epidemic?
I thank my right hon. Friend for that intervention. He is absolutely right that the Government have a leadership role to play both globally and in relation to British companies involved in South Africa and elsewhere. I am sure that the Minister will also pick up on that point when he responds to the debate.
Dr Raviglione said that it would take more than a century to get rid of TB. Waiting a hundred years to get rid of this disease is just not good enough. Dr Raviglione also drew attention to the shameful fact that one in every three TB cases on the planet is not properly diagnosed or treated, which equates to 3 million people every year going undiagnosed, the majority of whom will have infectious pulmonary TB. Many of them are estimated to have drug-resistant strains. That is 3 million people a year going undiagnosed for the past six years—that is not good enough, either. Until everyone in the world with TB is diagnosed and correctly treated, we will never succeed in bringing the global TB epidemic under control and it will continue to blight our world, ruining millions of lives every year.
TB has killed more people than every other pandemic in history combined, by a margin of several hundred million. It is a global disease of the here and now. It affects every country, and every country must have a role to play in tackling it. It requires global leadership from our Government and every other Government. Tackling it requires support and investment through multilateral organisations such as the global health fund, as well as through targeted interventions. We need important technical and co-ordinating agencies, such as the WHO’s global TB programme and the Stop TB Partnership, to work together to enhance co-operation and cohesion across the world’s responses to TB. We need the brightest and the best of the scientific and business communities to work with high-burden countries, in order to step up the fight against this disease and save as many lives as possible.
Consumption, or TB, is a disease of the present. It is a scourge on our humanity and deserves the full force of all our efforts. Although new tools to tackle HIV and TB are badly needed, if we scale up the use of the tools that are already available we have the opportunity to save an additional million lives in the next few years.
I hope that the Minister, when he responds to the debate, will take the opportunity to reaffirm the Government’s commitment to ensuring full replenishment of the global health fund; to continuing to fund TB REACH to a level that allows it to carry on supporting new and innovative projects to find “the missing 3 million”; and to continuing to push for the development and uptake of better diagnosis, treatment and prevention treatments for TB, in a way that can be sustainable.
Finally, let us recognise the work done by all those people across the globe on the front line of the fight against this terrible disease. Their effort is a call to arms for us and a call for us, as policy makers, to step up to the mark and provide them with the tools and the wherewithal to eradicate TB and place it firmly in the past.
I congratulate the hon. Member for Scunthorpe (Nic Dakin) on securing this debate. I am delighted to be taking part in it, particularly as I have resumed the co-chairmanship of the all-party group on global tuberculosis, now that I am free to do so. It is, quite properly, a cross-party co-chairmanship, which reflects growing concern in the House about what is often a “Cinderella” disease—one that is not talked about as much as some other diseases that are still claiming lives today.
We are, properly, concerned about the terrible tragedy in the Philippines and the loss of thousands of lives and we are, properly, marking world AIDS day on Sunday and the millions of lives that have been claimed by that disease. There is a strong overlap, as the hon. Gentleman pointed out, between HIV and tuberculosis, which many still believe is essentially a disease of the past. Indeed, before I became involved in this movement, I thought so too. In the 19th century, tuberculosis—consumption—was regarded sometimes even as a romantic disease, as featured in many operas of that era, yet one in four people in Europe were dying of consumption at that time. It was only with the advent of modern medicine—antibiotics—and the west’s attack on poverty in the late 19th and early 20th century that the disease was brought under control.
There are some sobering observations to make about the rate at which TB—which, as the hon. Gentleman said, has now resurged here, as a disease of the present—is being tackled, compared with the rate at which the west dealt with it in that era. At the current level of progress that the west in making in dealing with a disease that is still claiming 1.3 million lives a year—unnecessarily, because in the main it is easily and cheaply curable—we will have to rapidly step up the efforts that are being made, because the incidence of this disease is currently declining by 2% a year. If we continue at this rate, it will take more than a whole lifetime—a whole generation—and it will be more than 100 years before we tackle this disease properly and get it under control. That will mean that millions of lives will needlessly be lost.
On top of that, there is a growing threat—one that now amounts to a serious issue for this country as well—of drug-resistant TB, the emergence of which is entirely a reflection of the ancient way in which we treat this disease. Were it not for the fact that people with TB require lengthy treatment with antibiotics, because the drug regimens are old-fashioned and no new drugs have been developed, and were it not for the prevalence of counterfeit drugs and the inadequacy of health regimes, drug-resistant TB might not have developed with such ferocity. However, it is now a serious matter of concern, and not just in developing countries, where people unlucky enough to be diagnosed with drug-resistant TB—and few are—almost always face a death sentence. Acquiring drug-resistant TB in a developed country with an advanced health system would still require an expensive and extremely painful course of treatment over months and years.
While the right hon. Gentleman is elaborating on the complications that follow diagnosis, does he agree that there is a shocking compounding of the problem worldwide, because in some countries lung cancer is being diagnosed to a considerable degree in people who are subsequently diagnosed with TB?
The hon. Gentleman raises an interesting point. The starting position has been that we need the means to diagnose this disease.
Let us face up to the fact that if the resurgence of this disease had been in the west, it would already have been tackled by now. The pharmaceutical companies would have had a commercial interest in developing better diagnostics and tools, better drugs and, indeed, a vaccine. Another common misconception is that a vaccine is available to deal with TB, but only the BCG vaccine exists, and that is generally ineffective for most forms of TB and works for children for a limited time. Had this disease resurged in the west, by now we would already have these things, but we do not, because the drug companies did not have a commercial interest in developing them, essentially because the disease was found in developing countries without the economies or the wherewithal to pay for these new tools.
There can be no better example of the necessity for intervention by wealthy western Governments, who have the resources to ensure that such a disease can be tackled, not just in the interests of ensuring that lives can be saved—there is a profound moral reason to tackle this anyway—but in the west’s interests in securing the economic development of high-burden countries that are afflicted with this disease, which is a tremendous brake on economic development. Of course, TB is a disease that knows no borders, and with migration, and so on, we face the prospect of it resurging in our country. We have higher rates of TB in this country now—although they are low by comparison with high-burden countries in the rest of the world—than in the rest of Europe. We have failed to reduce rates in the past 10 years, as compared with the United States, for example, which has got on top of the problem. This is a pressing public health issue in this country.
There are lots of reasons for western Governments to be concerned about this issue. Therefore, I strongly endorse what my hon. Friend the Member for St Ives (Andrew George) said about the UK Government’s recent commitment, which has not been sufficiently noticed, to replenish the global health fund. That is a fantastic commitment, not just because of the absolute sums pledged to the global health fund—which is an effective means of tackling TB and is responsible for 80% of the funding for TB programmes across the world—but because it sends a powerful message, ahead of the replenishment summit next Monday, to other potential donor countries about the value of stepping up our efforts at this time.
The west faces a choice. We have the opportunity, with the potential emergence of new treatments, diagnostics, and so on, to get on top of this disease. If we relax our efforts and fall victim to the idea that, at a time of austerity, the west might pull back from some commitments that it is making, our efforts to tackle TB would go into reverse. This is an important moment to step up to the plate. Britain has done so admirably. I commend the work of the Secretary of State for International Development and Ministers in making that commitment, and I encourage other countries to do the same.
Again, I congratulate the Government on their efforts regarding the global health fund, which sets the tone, but is my right hon. Friend and co-chair of the all-party group aware that just before this debate the Government published the HIV position paper, which appears to suggest that the UK’s contribution to eradicating TB can largely be delivered through the global health fund, whereas for HIV it can also be delivered by a significant strategy pursued by the Department?
I hope the Minister has noted my hon. Friend’s point, because TB control programmes rely on funding from the global health fund. We need to send that message to the global health fund as it determines resource allocations and to other countries as they consider replenishing their support.
My final point is that although the Government’s support for the global health fund is welcome, it is important to understand that that is not the only thing we need to do if we are to get on top of TB globally. Setting aside the action that needs to be taken domestically—Health Ministers are making progress on what needs to be done through a TB control programme—we cannot rely on the generous commitment to the global health fund for the international effort that is needed.
I want to raise the cause of an important programme run by the Stop TB Partnership called TB REACH, which addresses the problem of the missing 3 million cases to which the hon. Member for Scunthorpe referred. Until we find those who are affected by TB, we have no chance of treating them or getting hold of the disease. The power of TB REACH is that it funds innovative programmes on the ground that are finding new ways to go out and identify the missing 3 million cases. TB REACH has been robustly evaluated and shown to deliver value for money. It is relatively cost-effective, but its funding is coming to an end. TB REACH was largely set up with funding from the Canadian Government and now does not have sufficient funding to identify all the necessary cases. TB REACH has helped to identify some 500,000 cases in the past year, and it needs to do more. If we are serious about the level of the challenge we face, it would be worth while for the Government to seriously consider contributing to the ongoing work of TB REACH to ensure that the programme can survive.
Earlier this year I was a member of the parliamentary delegation that visited TB REACH in Awasa, in Ethiopia. TB REACH is doing outstanding work to find those missing people. I concur with the right hon. Gentleman and add my support. Hopefully the Government can find money to put into TB REACH, as it is not funded through the global health fund.
I am grateful to the right hon. Gentleman, because that is precisely the point I am trying to make. I understand that TB REACH has helped to identify some 750,000 cases of TB and prevent those people from becoming infectious, as they would otherwise have continued to infect others.
The budget of TB REACH is relatively small. It is asking for $40 million a year. In the overall scale of the interventions that the west is now making to control the major diseases of HIV, malaria and TB, the funding is relatively small, although obviously it is not insignificant. The programme is worth while; I therefore ask the Minister to address that point. I have just written to the Secretary of State for International Development and hope to meet her to discuss TB REACH at this important moment, as the programme’s future is being considered.
I am grateful to the Government and to hon. Members on both sides of the House for the interest they have shown in TB. A few years ago, very little interest was shown in the disease, despite the huge interest shown in other international development issues. That has changed. I believe that the work of the all-party group has helped, as have the many non-governmental organisations that are supporting us—in particular, Results UK has played an important role in raising the profile of TB. We have a moral imperative to tackle the disease, and doing so is within our reach. It is now essential that we step up the efforts to ensure that it is not another 100 years before we beat a disease that the west once thought it had beaten.
It is a pleasure to serve under your chairmanship, Mr Dobbin.
In the last three Westminster Hall debates that I have attended—on the privatisation of the east coast main line, the privatisation of blood products laboratories and free schools—I have found myself at loggerheads with Government Members. Unusually, however, today I find myself nodding in agreement with the excellent contribution of the right hon. Member for Arundel and South Downs (Nick Herbert). I pay tribute to my hon. Friend the Member for Scunthorpe (Nic Dakin) for securing this timely, important and significant debate.
I echo the right hon. Member for Arundel and South Downs in paying tribute to the work of the all-party group on global tuberculosis and its members and officers, including the hon. Member for St Ives (Andrew George), who has been an absolute stalwart of the group for a number of years.
I will concentrate on one aspect of this terrible condition that is close to my heart. As Members know, I have the pleasure of representing Easington in east Durham. Easington is a coal mining constituency with a long and distinguished history as one of the great heartlands of the north-east coalfields. I thought it would be poignant in this debate to reflect on why our pits were closed and why Britain now imports more than two thirds of the coal burned in our power stations, when once we imported none.
The UK coal industry was modern, efficient and very health conscious. My right hon. Friend the Member for Neath (Mr Hain) spoke about the incidence of TB among South African miners, which is relevant. I have just come from the annual general meeting of the all-party group on coalfield communities, where we talked about the problems that we face in coal mining communities, the physical legacy of pollution and the ill health associated with mining. That is another reason why this debate is close to my heart.
Although, by its very nature, mining will never be completely safe—it is an extractive process—our mines were about as safe as they could be, and the health, safety and well-being of miners was paramount. There are those who would argue that that drove up costs.
Today, much of the world’s coal production has been offshored and outsourced to countries where health and safety standards are minimal and labour is cheap. There is still blood on the coal, but nowadays it is more likely to be the blood of miners in Colombia, China or South Africa. The price of the irresponsible pursuit of profit and cheap labour is the health and safety of mineworkers worldwide.
Mining is one of the biggest employers of men in South Africa. Tens of thousands of those miners are migrant workers, from neighbouring countries such as Mozambique, Lesotho and Swaziland, who work and live in crowded townships in mining areas. As has been said, diseases such as malaria, TB and HIV/AIDS are rife. South Africa’s mining industry has been the subject of intense international and national media scrutiny due to the recent industrial unrest. Members will be aware of the appalling shooting of striking miners by armed police in scenes reminiscent of the worst days of apartheid. Mining is one of the driving forces of the South African economy; it contributes some 20% of the country’s gross domestic product and is a major employer.
What has not been subject to the same degree of media attention is the devastation caused to miners and their families by TB. The disease remains the leading cause of death in South Africa today. One third of all cases in sub-Saharan Africa have a link to the mines. TB is an airborne disease, spreading through the air when people who have it cough or sneeze, and it is often fatal if left untreated. Rates of TB among South African mineworkers are estimated to be as high as 7,000 per 100,000. That huge figure is 28 times the World Health Organisation’s definition of a health emergency and is the highest such figure in the world.
As we have heard, TB is closely linked to HIV, which is also a challenge in the mines. It is estimated that people with HIV are 21 to 34 times more likely to develop active TB. As we approach world AIDS day, it is important to reflect on that and on the interactions between the two. Such high HIV infection rates, coupled with cramped living conditions and exposure to silica dust, which damages miners’ lungs, creates a perfect breeding ground for the disease. The effects are devastating not only for the families of the many miners who die from TB, but also for communities, companies and Governments.
From a commercial point of view, the disease dents productivity—the issues I am raising are relevant to the British mining companies involved in South Africa—puts a drain on health budgets and spreads far into the rural areas that miners migrate from. Migration also means that the problem is not exclusive to South Africa, which is one reason why sub-Saharan Africa is not on track to meet the target of reducing deaths from TB by half by the expiration of the United Nations millennium development goals in 2015.
I apologise for not being here earlier; I had other business and could not get here any quicker.
The hon. Gentleman mentioned world figures for TB, but the exact number of TB sufferers is not known and many of them cannot be found. How does he think we can best address that problem?
I am grateful to the hon. Gentleman for that relevant point. An estimated 3 million people with TB in southern Africa have not been reached, but programmes, such as TB REACH and those supported by the Department for International Development, exist to identify those people and to secure treatment for them. My point is about the incidence of known TB among miners in South Africa.
TB is curable with drugs, and the costs are relatively modest. Spending £15 a person should be easily affordable. Global underinvestment and indifference mean that the disease killed an estimated 1.3 million people globally in 2012. The failure to deal decisively with TB has allowed drug-resistant strains of the airborne disease to develop, which are much more difficult and significantly more expensive to treat.
Earlier this year, members of the all-party parliamentary group on global tuberculosis, including me, met the Secretary of State for International Development. I want to echo the words of Government Members and compliment the Minister and the Secretary of State for their commitment on this issue. We met them to put TB at the forefront of their dealings with major Anglo-American mining interests, particularly in the gold mining industry, which has a high incidence of TB as well as high rates of HIV. As my right hon. Friend the Member for Neath mentioned, an estimated 750,000 cases—I had to check that incredible figure, as I thought it was a printing error—of TB each year, 9% of the global total, come from South Africa’s gold mines.
Colleagues who represent former British mining communities, such as my right hon. Friend the Member for Rother Valley (Mr Barron), and I are determined to push the battle against TB up the political agenda here in the UK. Along with the South African mining unions, I want to see the British Government make the British mining companies involved in South Africa sign up to a new protocol launched by the South African Department of Health. That would help ensure that mining companies abide by a legal framework governing the treatment and compensation of occupational TB.
In the past, too many stricken miners simply returned to their towns and villages to die lingering and often painful deaths. In the 21st century, it simply cannot be acceptable that mining companies, or any other employers, should systematically endanger the health of their workers. Rates of TB in the mines have been estimated at 28 times the World Health Organisation’s definition of a health emergency. This is a global health emergency. We need Governments, employers and drug companies to act accordingly.
People do not have to live in a mining constituency to know that keeping the lights on should not come at the expense of the health and lives of South African miners and their families, or those in any other countries. That is simply wrong. Global mining operations headquartered in the UK must accept their social, moral and ethical obligations to address the issue as a matter of urgency.
It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. Discussing the link between tuberculosis and HIV/AIDS is particularly pertinent given our proximity to world AIDS day.
I would like primarily to focus on the need to ensure the consistent global provision of cheap, effective, high-quality drugs. I also want briefly to reflect on the past in a slightly different way from other hon. Members. More than 50 years ago, I actually caught TB, just while I was waiting for my BCG vaccination. If the timing had been otherwise, my life would obviously have been rather different. It is important to reflect on the fact that the BCG vaccination is over 90 years old, and it seems incredible that we do not yet have an effective vaccination. I really want to stress that aspect of the problem today.
I was in the sanatorium for seven months and can still remember the awful drugs, which I think are exactly the same as those given today. Day after day, I received injections and the most appalling tasting medicine. To make things slightly better for us young teenagers, we were given a book to read about how TB was treated in this country at the beginning of the 20th century, which was also pretty awful. Things moved on pretty quickly from the time when I was ill, however, and it was not long before the sanatorium was closed down and TB stamped out. That experience drives my interest in tackling worldwide TB.
It seems incredible that, as we have heard, an estimated 1.3 million people died from TB last year. It is most distressing to think that we are still relying on the same drugs for standard TB. We need rapid developments across the range of drugs. As has been mentioned, drug-resistant TB and extreme drug resistant TB also exist, both of which require a cocktail of drugs with horrendous side effects. The duration and difficulty of treatment represents a major challenge to patients completing treatment and therefore being fully cured. I was fortunate enough to go on a trip with the organisation Results UK to a village in Rwanda to meet patients who could not afford the transport to access the slightly more advanced drugs. There is so much more to be done.
We must also look at diagnosis. For the most part, just as when I had TB, the diagnosis is through sputum smear microscopy, which can take months, does not detect drug resistance and is ineffective at diagnosing TB in children and among HIV-positive patients. A new machine, GeneXpert, can detect some forms of drug resistance and can provide an accurate result in two hours. It has been approved by the WHO and rolled out across the world, but it is heavily dependent on local infrastructure. A point-of-care, cheap, easy-to-use diagnostic remains absolutely vital to achieving the quick diagnosis required to reduce transmission.
I, too, congratulate DFID and the Government on making a real commitment to UK aid overseas and, in particular, on topping up the global fund. However, what we are really saying, beyond congratulating the Government, is that much more needs to be done. Every year, 3 million TB patients globally are not officially treated, so we need other countries to add to the contribution we are making. We need to support important programmes such as TB REACH, which other Members have mentioned. We need the maximum provision of high-quality drugs at affordable prices. The Government must use their connections at the highest level to encourage countries to take a harder line on the quality control of drugs.
Global drug provision remains a challenge. The UK needs to increase the number of countries engaged in pooled procurement programmes such as the Global Drug Facility. That will increase demand and draw together a fragmented market, thus helping to ensure a more economically appealing market for manufacturers and suppliers.
Poor health is a driver and a consequence of poverty; we can look back at our history and see that, and we see it today worldwide. The Prime Minister co-chaired a UN high-level panel on the post-2015 framework, which reported earlier this year. Its report revealed that TB case finding and treatment was the most cost-effective intervention measured, returning £30 for every £1 spent. With its record, the UK is in a unique position that enables it to continue giving leadership and to do much more to tackle this big global problem.
I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on applying for and securing the debate. We have heard some of the dreadful statistics on TB throughout the world, and I want to spend a few minutes looking in detail at the cost of treating TB when it has not been caught first time round.
Last year, there were an estimated 450,000 cases of multi-drug-resistant TB. It is believed that 10% of those involve extensively drug-resistant TB and are, effectively, impossible to treat. Drug resistance is really a man-made problem resulting from the misuse of anti-TB drugs and the poor management of the disease. Drug-resistant TB can be passed from person to person in the same way as TB that is not drug-resistant. Clearly, early and rapid diagnosis and treatment completion are essential to control TB. As many Members, including my hon. Friend the Member for Scunthorpe, have said, TB is the leading killer of people living with HIV/AIDS and accounts for one in five AIDS-related deaths.
Drug-resistant TB develops primarily because it is treated with a number of drugs taken over six to nine months. If medication is taken incorrectly or stopped prematurely, the TB bacteria can re-emerge and become resistant to the drugs used to treat TB. That sometimes happens because of the provision of substandard drugs, because patients do not complete their treatment or because the drugs are available only intermittently.
Multi-drug-resistant TB is a form of TB that does not respond to the standard treatment using first-line drugs and that is extremely difficult and expensive to treat. As I suggested earlier, extensively drug-resistant TB occurs when resistance to second-line drugs develops on top of multi-drug resistance. Drug-resistant TB can take two years or more to treat with drugs that are less potent, more toxic and much more expensive than those used to treat a standard case of TB. The drugs are toxic and are commonly associated with severe side effects, of which permanent deafness is the most common. Almost all of them have limited effectiveness, and most are more than 40 years old, as the hon. Member for Mid Dorset and North Poole (Annette Brooke) said. Fewer than 50% of multi-drug-resistant TB cases are successfully treated and considered cured.
On costs, multi-drug-resistant TB can be up to 450 times as expensive to treat as a standard case of TB. In all 27 high-burden multi-drug-resistant TB countries, the treatment cost is greater than the annual average income. If multi-drug-resistant TB is not correctly treated and develops into extensively drug-resistant TB, the chances of someone being successfully cured are less than one in 10. The world needs to recognise that. Extensively drug-resistant TB patients are practically impossible to treat, but they often remain infectious and capable of transmitting the disease to others. That scenario is often described as a time bomb.
I am sure that is the case; indeed, the global fund does do that. However, that does not prevent the supply of drugs, even if they are affordable in part, from becoming intermittent. As a consequence, we end up with the more extreme cases of TB.
The UK Government have played a leading role in the response to TB globally, investing in research and development on new tools to tackle TB, supporting efforts to increase the profile of the disease through the Stop TB Partnership and supporting key institutions such as the global fund, which accounts for more than 80% of donor funding to tackle TB in developing countries.
I mentioned in an intervention that I visited Ethiopia earlier this year. I went there with Results UK in the February recess, along with the hon. Member for South Derbyshire (Heather Wheeler), my hon. Friend the Member for Workington (Sir Tony Cunningham) and two Members of the other place. In Addis Ababa, we visited St Peter’s hospital, which is Ethiopia’s national TB referral hospital. With support from the global fund, St Peter’s provides care for TB referral cases and patients with multi-drug-resistant tuberculosis. It also provides care and treatment to people living with HIV/AIDS, which is of course closely linked to TB.
The hospital demonstrated that, with proper funding, low-income countries can use minimal resources efficiently and effectively to respond to the threat of drug-resistant TB. As I said in my intervention on the right hon. Member for Arundel and South Downs (Nick Herbert), we also visited Awasa and looked at the great work TB REACH was doing there to find the missing 3 million cases.
While we were in Ethiopia, we did not look just at TB, although that was our primary aim. We also looked at Ethiopia’s strong planning and innovative response to its human resource crisis. It is using its health extension programme, which quite a lot of our money has gone into developing. Funding to support such successful interventions has been provided by key multilateral organisations, including the global fund and TB REACH. I reiterate that, in addition to what they have done already, the UK Government have put £1 billion over three years into the global fund, and they are much to be credited for that.
Finally, I have travelled the Commonwealth on many occasions over the years. When we were out in Addis Ababa, we had a meeting with DFID—I say this because the Minister is here—and it was one of the most positive meetings I have ever had. The DFID people knew exactly where global fund money and our taxpayers’ money was going: to help people in dire need of an improvement in their health, as well as in their quality of life, through water supplies and things like that. We always hear negative views about what happens to taxpayers’ money when it goes to the developing world, so it is worth putting on record that that was the most positive experience I have had since becoming a Member of the House.
I congratulate the hon. Member for Scunthorpe (Nic Dakin) on securing this debate on tuberculosis, a disease that 8.6 million people catch, and of which 1.3 million people die, every year. It is a huge issue.
I was fortunate enough to join the Results UK delegation to Zambia last year, when we examined the link between HIV and TB. We visited Lusaka central prison. I do not know whether you have ever been to a prison in central Africa, Mr Dobbin, but, a couple of months before we attended, the vice-president of Zambia, Guy Scott, visited another prison and described it as hell on earth. I must say I have never been anywhere like Lusaka central prison. It was shocking.
The prison was built by the colonial authorities in the 1920s to house between 180 and 200 prisoners. Now it houses almost 2,000. We were taken to cells no bigger than my bedroom at home. They were designed to sleep between six and 10 people, but now there are 80 to 100 prisoners locked in those rooms for up to 14 hours a day. I looked at the room and wondered how they even fitted so many people in it. Apparently the sleeping arrangement is to line up 12 people against the wall, who crouch down with their backs to it. They sit down and open their legs and the next 10 or 12 come and lie between their legs, and so on, to cram them into all the available space. Mattresses and blankets are completely lacking. The toilet facilities are completely inadequate for the number of prisoners, and an open drain or sewer, containing a disgusting-looking brown liquid, runs through the middle of the courtyard. Medical facilities are lacking—the site has no health clinic and sick prisoners lack medicine—and so is food. There is one basic meal a day, which is completely lacking in protein. It is fair to say that the conditions in the prison are not conducive to general health.
Catching TB should not be part of someone’s prison sentence, but in that prison it was. At one stage the TB infection rate was almost 100%. TB is one of the fastest-growing epidemics in sub-Saharan Africa’s prison populations. It presents a threat not only to the inmates but to the wider population, because the prisons act as a reservoir for TB. It gets into the wider community through visiting, staff visits and the fact that prisoners who leave have been inadequately treated. TB does not respect prison walls.
There was a bright spot to the visit. We were taken to the prison by the commissioner of prison services, who was very open, and keen for us to see the reality. Several hon. Members have mentioned TB REACH, and we were shown a project that it had set up in the prison together with the Centre for Infectious Disease Research in Zambia. That programme included TB and HIV screening, treatment, and the introduction of isolation cells for prisoners with multiple drug-resistant TB. A prisoners’ drama group had been organised to teach prisoners to look for the signs of TB and understand how important it is for those with the disease to make people aware of it and get the required treatment. The programme was massively successful. The TB infection rate was down to 30%. That is still huge, but it is an awful lot better than it had been a year before.
Early diagnosis and treatment are essential for the control of TB. As we saw in Zambia, TB REACH runs pretty much the only mechanism designed to target and treat the 3 million missing TB victims we have heard about. One of its advantages is that it can react very quickly. It can provide fast-track funding for projects, to get them up and running quickly—often within six months. It is also willing to fund new and innovative approaches. That is important, because organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria will fund projects only if they have been proved successful. They will not finance new ideas or do experimental things to see whether they will work.
We need new approaches. Many places that we visited in Zambia—whether clinics, hospitals, or community groups—were in isolated communities. There is a need for new, mobile technology, and we need to roll out new diagnostic tests. That can happen only when testing and experimentation has been carried out, and when an organisation such as TB REACH is willing to provide funding. We saw that process in action when we visited Kanyama clinic, run by the Zambia AIDS Related Tuberculosis Project. Like my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke), we saw the GeneXpert machine in action.
For hon. Members who do not know what the GeneXpert machine is, the relevant website describes it as follows:
“The GeneXpert System automates and integrates sample preparation, nucleic acid amplification, and detection of the target sequence in simple or complex samples using real-time Polymerase Chain Reaction”.
In basic terms, it is a diagnostic tool that can diagnose TB much more accurately than the use of a microscope, as well as more quickly—often within two hours. It can detect TB in HIV-positive patients too. That of course is a massive advantage in rural clinics, because people can have the test and wait for the result. At the clinic, people from the community were encouraged to become involved as volunteers and to help people by talking them through the process, the results, and what the treatment would entail, and by going out into communities to ensure that they continued taking the treatment in the weeks ahead.
The GeneXpert machine works well in some environments, but it is not perfect. It can be difficult to use in isolated rural areas, because it requires a constant electricity supply, so on our visit we looked at how alternative energy supplies such as solar power could be used to power medical equipment in rural areas.
On our visits to Kanyama clinic and Lusaka central prison we saw at first hand the effect of TB REACH projects—improving TB diagnosis and providing fast treatment. However, as we have heard from my right hon. Friend the Member for Arundel and South Downs (Nick Herbert), the project is time-limited, and new funding is required now that its grant is coming to an end. There is concern about how some of the projects can be integrated into national health care systems. TB REACH grants are for short periods, to get a new technique into use in a locality. For permanent solutions it is necessary to integrate an approach into the relevant national health scheme, or to reach a position where it can be funded by the global health fund or donor countries will be willing to continue to support it.
As we have heard, the majority of the TB burden is concentrated in countries that often receive less donor funding. Whether it is the burden of drug-resistant TB in eastern Europe, TB in prisons in Zambia, or the epidemic, on an enormous scale, in India, domestic Governments must step up their own response. The UK has a unique opportunity to use its global leadership position to call on those Governments to increase their investment in the fight against TB, especially given our strong links to southern Africa and India, which account for the greatest part of the missing 3 million—the ones missed by their health systems. TB is a global disease on which the UK can have an impact.
The Minister and DFID have done a fantastic job and have made Britain a world leader in the battle against malaria. The UK Government should also use their position to become a global leader in the fight against TB, which is another of the top infectious disease killers. Global political commitment to that fight has so far been missing.
It is a pleasure to serve under your chairmanship, Mr Dobbin; I thank you for giving me the time to speak in the debate. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on securing the debate, which is close to my heart, as I am the co-chair of the all-party group on global tuberculosis. I also congratulate and thank the many agencies and non-governmental organisations that work in this field, which have helped to raise the issue and bring it to the top of the world agenda.
There is an urgent need to address TB worldwide, but we must not forget that it is still a big concern in the UK, where the rate of TB cases is the highest in western Europe, with 9,000 cases last year alone. My constituency has the second highest rate in the country—156.8 cases per 100,000 people, roughly six times higher than the UK average and equivalent to the rate in Tanzania. It is important to remember that TB is very much a public health threat in parts of the UK, and that it affects people’s health every day, often with long-lasting consequences.
One of the key barriers to treating and eliminating TB in this country is stigma. TB is an airborne, infectious disease, which is deemed incurable and is associated with poverty. Many people are reluctant to tell their families, partners and community when they have the disease, which means they are much less likely to be treated. In the UK, stigma is a barrier that prevents people from seeking treatment when they start to feel ill. It also makes it difficult for health workers to identify other people who might have been exposed, because patients are often reluctant to admit to the possibility of their having infected others.
We cannot afford to ignore TB. It needs to be prioritised and talked about so that people do not feel marginalised and ashamed. We need to ensure that they are aware that TB can be treated and that they seek treatment when they fall ill.
We have a great health centre in Southall that offers TB screening, diagnosis and treatment. However, a third of patients in the area had a delay of more than three months between symptom onset and diagnosis. Although the proportion of people completing treatment was similar to the London average, slightly more were lost to follow-up.
We need to support social outreach projects in high-risk areas as a means of engaging directly with the community, rather than wait for people to come to the health services. That will help to raise awareness and stymie stigmatising, and will enable us to diagnose and treat TB earlier in at-risk communities. Case finding needs to be an active process to ensure that cases of TB do not fall between the cracks and remain untreated.
On a local and community level, outreach projects are crucial, but it is essential that we also have a national strategy on TB. The all-party group on global tuberculosis led the way in calling for a national strategy on TB. It is encouraging that Public Health England is currently developing such a strategy, which will be published in 2014. The national strategy will drive best practice throughout the UK’s clinical and social care for TB, but we must ensure that it is closely integrated with other Government policies on TB, including those of the UK Border Agency and the Department for International Development.
An interdepartmental ministerial group on TB performed that task at the turn of the century, but unfortunately it produced only one report before folding. That group should be revived. TB affects a wide range of Departments, and efforts must be made to enhance co-operation and co-ordination across their policies and interventions to provide the most effective response to TB in this country. A formalised, recognised structure with appropriate support is the best way to make that happen.
TB has been neglected for too long. It is a disease that people do not talk about and have forgotten, which increases stigma and reduces the likelihood that those in need will receive treatment and care. The UK does not need to commit finances to make a difference to how the disease is perceived, but it does need to show leadership and commitment domestically and abroad. It can do that by reaffirming that TB is a serious threat and a priority, and by committing to a local community strategy accompanied by a national, co-ordinated interdepartmental approach.
It is a pleasure to serve under your chairmanship, Mr Dobbin. I was going to mention your experience, which I am well aware of. Perhaps you should have spoken in the debate, rather than being in the Chair.
I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin)on securing such an important debate. The unity that we have heard in the contributions is telling. We often spend our time disagreeing, but today we have not. That should be a message to everybody who cares about this incredibly important issue.
There have been seven excellent contributions to the debate, and I was struck by the amount of personal experience that we have heard. My hon. Friend talked about his experience as a college principal and the stigma of the disease in this country. The right hon. Member for Arundel and South Downs (Nick Herbert) gave a brilliant contribution about his role in the all-party group. He was rightly frustrated about progress and the wildly different standards across the globe, although we are all equally vulnerable to this terrible disease.
My hon. Friend the Member for Easington (Grahame M. Morris) spoke from a mining perspective about his experience and that of his constituents. The hon. Member for Mid Dorset and North Poole (Annette Brooke) spoke personally and directly about her experience of the disease. My right hon. Friend the Member for Rother Valley (Mr Barron) brought his considerable health experience to the debate. The hon. Member for City of Chester (Stephen Mosley) painted a serious and distressing picture of what the disease can mean in places in which people are weak and vulnerable, but also talked about what can be done practically. Finally, my hon. Friend the Member for Ealing, Southall (Mr Sharma) rightly spoke about the picture globally and in the UK, and about his experience in his constituency.
Tuberculosis has cast a long shadow over our country; I can recall my grandparents talking about life alongside people with TB. That shadow led to the bright sunlight of our NHS, which we are proud of. TB preys on the vulnerable, the poor and the weak. I will ask questions of the Minister, but it is worth remembering that, as the hon. Member for City of Chester pointed out, we are talking about putting in place systems to protect people.
TB is a horrible, debilitating disease. To add to the picture drawn by my hon. Friend the Member for Scunthorpe, in our own country TB robbed us of John Keats at age 25 and George Orwell at age 46—think about what those two people might have contributed to our country had they not left us at a young age.
The tragedy of the 1 million deaths from TB each year is the fact that it is a curable disease. As other hon. Members have made clear, we face a growing problem of drug resistance, as well as basic issues about resources and infrastructure; those factors are holding back our ability to cut the persistently high mortality rate for the disease.
TB is not solely a problem in the poorest countries; as my hon. Friend the Member for Ealing, Southall pointed out, it is also a problem here in the UK. Although I am responding to this debate as a shadow International Development Minister, tackling TB demonstrates why we must never see development as some kind of offshore policy issue. Real action to tackle TB diagnosis, treatment, drug resistance and co-morbidities across the developing world will benefit the NHS and public health at home, as well as right across the globe.
I was pleased to serve on the International Development Committee in 2012, when we considered the contribution of the Department for International Development to the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the time, the Committee expressed real concerns about delays to DFID funding for that crucial organisation, which is estimated to have saved as many as 8.7 million lives. I am pleased that Ministers took the Committee’s concerns seriously and that next week the UK will be part of the global health fund replenishment. If we are to eliminate TB globally, the fund requires sustained, guaranteed funding. Will the Minister set out how Britain will make sure that there is more long-term stability for such funding?
Although the global health fund is a vital player and the UK’s contribution to it is extremely welcome, it remains the case that DFID does not currently engage in bilateral funding of programmes related to TB. That is despite the fact that, as has already been mentioned, the UN high-level panel on the post-millennium development goals framework, co-chaired by the Prime Minister himself, found that spending on TB diagnosis, prevention and treatment returns £30 of benefits for every pound spent; that surely satisfies the Government’s demands for value for money. Will the Minister tell us more about how DFID keeps under review its potential for funding TB-specific programmes through bilateral programmes?
Clearly, Britain’s strategy for improving prevention, diagnosis and cure of TB in the poorest countries has to go beyond specific funds—here I develop the point made by the hon. Member for City of Chester—in that it needs to be part of a holistic set of policies to build up functioning, universal health services, the lack of which holds back the fight against tuberculosis. Weak health care systems are thought to be a key reason for the estimated 3 million missed diagnoses of TB and increasing mortality rates from the disease. As I mentioned, our own experience of the disease before the days of the NHS should tell us that, if nothing else does.
In the UK we are right to be proud of the NHS, and we should not be shy about promoting through our development work the benefits of universal health care that is free at the point of use. Curbing a disease such as TB, which is widespread and hits some of the world’s poorest people disproportionately, is simply not going to happen if, when we attempt to do so through health systems, user fees are levied. Put starkly, 27 nations are considered to have a high burden of TB drug resistance. In each of those countries, the average cost of treatment exceeds the annual GDP per capita. If the poorest people cannot afford treatment, they will not receive it.
Britain has a good story to tell in this regard: in 2009, faced with concerns about TB diagnosis at home, the then Government took the decision to remove prescription charges for anyone attending a TB clinic. That should be what we advocate and support in every developing nation we work with that has a high TB incidence. Will the Minister put on the record DFID’s position on providing bilateral support for health care systems where user fees are currently charged? What specific work is being done to ensure that TB treatments are available free of charge in the nations with which DFID has a bilateral relationship? It is important to set out that principle.
Once again, I thank my hon. Friend the Member for Scunthorpe for securing such an important debate and bringing his experience to it. I also thank all right hon. and hon. Members who have contributed today.
I thank the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. If I may say so, it has been one of the best Westminster Hall debates I have been to. The speeches have all been passionate and have each come from a slightly different angle. Together, they form a comprehensive picture of the action that this issue requires.
We all know that tuberculosis remains one of the world’s biggest killers. It causes untold suffering and kills more than 1 million people across the world every year. What makes that tragedy much worse is that every single one of those deaths is preventable. The World Health Organisation’s recently launched annual global TB report outlines the progress and challenges in reaching international TB targets. Efforts to tackle TB are having a real effect. The incidence of TB has fallen in all six WHO regions and TB cases have been falling worldwide for a decade. However, the rate of decline remains too slow, at just 2% a year.
Resistance to TB drugs is a growing threat and the risk of resurgence is therefore always present. The figures are compelling: 8.6 million people still developed TB in 2012, and 1.3 million died. TB is one of the top 10 killers of children worldwide—a situation that is wholly unacceptable, as it is wholly preventable. There are wider social and economic costs as well, as TB primarily affects young adults in what should be their most productive years. Right hon. and hon. Members have spoken passionately about the areas for action highlighted in the global TB report.
The UK remains absolutely committed to the global goal of halving deaths from TB by 2015. We are helping people to have effective diagnosis and treatment, including for TB and HIV co-infection and for multi-drug-resistant TB. We are also helping to develop more effective treatment and better vaccines. All that work needs good health systems, so we are helping countries to build effective, efficient and durable health systems to support the delivery of TB programmes. Without such systems, we can have the best intentions, but there will be no means of achieving enough.
What is more, the Department for International Development is tackling the underlying risk factors for developing active TB. TB is a disease of poverty and squalor. Factors associated with poverty, such as malnutrition, overcrowding and poor sanitation, dramatically increase the chance of someone becoming infected and developing active TB. It is no wonder, therefore, that the ghastly prison described by my hon. Friend the Member for City of Chester (Stephen Mosley) —in what I thought was a remarkable speech—is so obviously perilous.
The Minister is responding systematically to the debate, which I appreciate, but will he turn his attention to the issues I raised about the incidence of TB among miners in South Africa? The hon. Member for City of Chester talked about chronic conditions in prisons; the hostel accommodation for miners, along with the confines of the mines they work in, is causing TB to spread. Will the Minister also comment on the obligations on UK-headquartered mining companies?
The hon. Gentleman has raised a serious point. If he will bear with me, I will come to the issue of South Africa in just a moment. As he and the right hon. Member for Neath (Mr Hain) said, the issue is obvious and compelling, and has to be addressed.
In spite of tough times, the broad picture for the UK is that we are delivering on our promise to spend 0.7% of gross national income on development. This year we will become the first G8 nation ever to do so. We are clear about our responsibility to deliver aid that is transparent, that delivers value for money and that produces the best results for the world’s poorest people. Our support to the Global Fund to Fight AIDS, Tuberculosis and Malaria helps to do just that. Between 2002 and 2012, the global health fund supported the detection and treatment of 9.7 million cases of TB.
To respond to the continuity point raised by the hon. Member for Wirral South (Alison McGovern), who spoke from the Opposition Front Bench, last month the UK Government committed up to £1 billion over the next three years, which is enough to save a life every three minutes. The global health fund allocates 18% of its funds to TB, which equates to £180 million of UK development funding specifically for that disease. Improving basic TB control is critical to prevent the further spread of TB, and includes early detection and diagnosis of people with the illness, ensuring that they get the right treatment and care, and checking that their families and other close contacts do not also have active TB. Also important is the reporting of cases, so that health authorities can better monitor them and improve their services.
Let me turn to the work we are doing through our country bilateral support programmes. DFID is working closely with the Government of South Africa to expand the quality and access of public sector services, including TB control, and is increasing the speed with which new TB drugs are registered. In conjunction with the World Bank, DFID is also engaged in a new partnership with the private sector in South Africa. The partnership has been set up to increase public-private collaboration to reduce the high incidence of TB specifically in miners and in the communities around them. We will continue to focus on that important target group, to which the hon. Member for Easington (Grahame M. Morris) referred. In India, DFID is working with Indian pharmaceutical manufacturers to improve the price and security of supply for high-quality drugs for resistant TB and new low-cost diagnostic products.
Co-infection has been covered thoroughly today. Many countries have made considerable progress in addressing the combined epidemic of TB and HIV. However, there were still 320,000 deaths from HIV-associated TB in 2012. DFID is supporting improved co-ordination and collaboration between TB and HIV services jointly. As part of our commitment to the global health fund, we are pushing it to do more to prevent, diagnose and treat TB and HIV co-infection.
The UK Government are very concerned about the spread of drug-resistant TB, which probably results from the improper use of antibiotics. A patient who develops active disease with a drug-resistant TB strain can transmit that form of TB to other individuals, which threatens the whole global response to TB. Drug resistance increases the cost of treatment and makes it more difficult to ensure that effective treatment is accessible to the poorest. We support efforts to tackle drug-resistant TB through our support to UNITAID, the global health fund and research.
The UK has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. We support a number of product development partnerships that bring together a range of public, private and community organisations. They are designed to develop and deliver new products more rapidly and more cheaply than either the public or private sectors can do alone.
I should mention TB REACH, to which four or five hon. Members referred. The issue is not as straightforward as any of us in public policy would like. We have reviewed the external mid-term evaluation of TB REACH, and the findings suggest that it has successfully funded pilot projects and innovative approaches, which we applaud. The question is whether it will be able to roll them out effectively in the long term and on an adequate scale. We propose that DFID officials should meet the executive director of the Stop TB Partnership to discuss how the global health fund can better support the expansion of proven TB REACH projects. It is important the TB REACH implementers co-ordinate more closely with national TB control programmes—again, that was raised today—and are part of national planning processes. That is crucial to secure longer-term support.
I am grateful to the Minister for responding to our points about TB REACH. Does he accept that although it will no doubt be worth having a dialogue with the global health fund about supporting proven TB REACH projects, further projects will rely on the continued funding of that programme? As my hon. Friend the Member for City of Chester (Stephen Mosley) effectively said, TB REACH funds projects that the global health fund will not fund because they are unproven. TB REACH allows innovation on the ground in such projects. Will the Minister reflect on that and consider my request for a meeting to discuss the TB REACH programme before a final decision is taken about its funding?
I certainly undertake to consider that, but obviously, as I am on my feet at the moment, I cannot give a commitment. We provide core funding to the Stop TB Partnership, some of which is used to support TB REACH continuously. I understand exactly what my right hon. Friend is saying, and I hope that the meeting to which I have referred can explore that point in more detail and address his concerns conclusively.
DFID has also supported the Foundation for Innovative and New Diagnostics—FIND—to develop a rapid molecular test, GeneXpert, to which reference has been made. It can be used by health care workers with minimal training and laboratory facilities. The test is associated with a 40% improvement in case detection rates and can provide test results within two hours. Working through the Stop TB Partnership and UNITAID, the Department has supported the policy development and distribution of GeneXpert, which is available in 29 countries. In August, DFID announced support to nine public-private partnerships, including FIND, the TB Alliance and Aeras. Those partnerships will help to fund crucial work on developing new and more effective tools to prevent, diagnose and treat TB.
We cannot shelter the UK from what is happening around the world. In 2011, nearly 9,000 cases of TB were reported in the UK. More than 6,000 of them were in people born outside the UK. The patterns must be analysed, followed and fully understood. A cross-government approach is also essential. Public Health England has made TB one of its priorities and is working to oversee a stronger national approach.
Resistance to all antimicrobials—the drugs used to prevent and treat bacterial, fungal, viral and some parasitic infections in humans and animals—is increasing, but of greatest concern is the rapid increase in bacterial resistance to antibiotics, including those used to treat TB. In September, the Government published a new five-year antimicrobial resistance strategy, which sets out actions to slow the development and spread of anti- microbial resistance, including strengthened international collaboration. That is why DFID will continue to work with the Department of Health and others to provide national and international policy leadership. We must play our part in ensuring co-ordinated action to tackle TB at home and abroad.
In conclusion, significant progress has been made since 1995 in controlling TB, with more than 56 million cases treated and 22 million lives saved. That progress has been rooted in improved partnership, policy, innovation, and national and international leadership. We have grounds for optimism, but we are not complacent about the significant challenges ahead, in which the UK will continue to play its full part.