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House of Commons Hansard
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Global Fund to Fight AIDS, TB and Malaria
12 January 2016
Volume 604

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I beg to move,

That this House has considered the Global fund to fight AIDS, TB and malaria.

The debate was chosen by the Backbench Business Committee after a submission by the chairs of three all-party parliamentary groups. I have the privilege to co-chair the APPG on tuberculosis; and my hon. Friend the Member for Finchley and Golders Green (Mike Freer), who chairs the APPG on HIV and AIDS, and my hon. Friend the Member for Stafford (Jeremy Lefroy), who chairs the APPG on malaria and neglected tropical diseases, are here today because we are concerned to ensure that there is a continuing fight against three diseases that between them have accounted for, and continue to account for, millions of deaths every single year.

I would like to start by talking about the continuing need to fight these diseases, focusing particularly on tuberculosis, because that is the disease in which I have a particular interest. It continues to kill 1.5 million people every year in spite of the fact that the millennium development goal to halt and reverse the spread of the disease, as well as of HIV and malaria, by 2015, was met, with the prevalence of tuberculosis having halved.

Tuberculosis continues to kill a very large number of people every year. Indeed, the latest figures published by the World Health Organisation indicate that it is now the world’s deadliest disease, surpassing the mortality caused by HIV, although there is a significant issue of co-infection in relation to HIV/AIDS. Some 400,000 people a year die of tuberculosis related to AIDS. Despite the huge progress that has been made on AIDS—progress, however, that did not meet the millennium development goal—the disease continues to kill 1.2 million people a year, and despite the great progress on malaria, it continues to kill 600,000 people a year.

The first point to make is that despite the global effort to counter these dreadful diseases, they remain very significant killers, and continuing action will be needed if they are to be eliminated. It was a fine thing that the world came together in September to agree the new sustainable development goals to replace the millennium development goals, and that objective 3.3 of those goals is to end the three diseases by 2030—in just 15 years’ time. However, the current trajectory of tuberculosis suggests that we will not end the disease in 15 years’ time. We will end it in 200 years’ time, which means that there will continue to be a large number of deaths every year, and indeed an ongoing cost, unless we take firmer action now to beat the disease.

The second reason why it is important to tackle the diseases in question, quite apart from the humanitarian cost, the loss of life and the suffering caused, is that their prevalence has an impact on economic growth. If we want to see the economic development of countries—the continuing development of middle-income countries and the acceleration of development in lower-income countries—it is essential to ensure that there is a healthy population, and it is a condition of economic growth that the population can work and has access to healthcare. These diseases place a burden on the population that impedes economic growth. The circle that needs to be squared is how we support countries in the development of their health systems to produce a healthy population that, in turn, helps to generate economic growth.

The third reason why it is important to tackle these diseases is on the grounds of what one might describe as broader security. For instance, we see the growing risk of drug resistance in the case of tuberculosis, which is a transmissible disease that is easily carried and spread—a disease that knows no borders. The growing risk of drug resistance is linked to the old-fashioned regimes used to treat tuberculosis and to the fact that there has not been a sufficient focus on drug development since the disease resurged. That poses a risk not just to the countries involved but to countries around the world.

The UK Government have taken particular interest in drug resistance. The Prime Minister has led a focus on it through the antimicrobial resistance review, which is chaired by Lord O’Neill. The threat of drug resistance poses a huge risk to the global economy, amounting to billions of pounds of potential cost. By 2050, about a quarter of that cost might be incurred due to drug-resistant tuberculosis if we do not take action.

On all three grounds—humanitarian, economic growth and security—there is an argument for continuing action to tackle these terrible diseases. The question, then, is what the right mechanism to do so is. More than a decade ago, the world came together in the belief that it was important to set up a new means of fighting them. What was then described as a “massive effort” was launched under the auspices of the United Nations, and it became the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In the 10 years that followed the launch of the Global Fund in 2002, the world’s economies have committed more than $22 billion to the fund. In turn, it has developed 1,000 programmes in more than 150 countries to tackle these diseases. The Global Fund now estimates that since its inception, it has saved 17 million lives and is on course to have saved some 22 million lives by the end of the year. That is more than 2 million lives saved annually as a consequence of the effort that was put in place in 2002 under the Global Fund. It has put more than 8 million people on antiretroviral treatment for HIV and treated more than 13 million people for tuberculosis and more than half a billion people for malaria—a quite staggering effort. As a consequence, it has contributed to a decline of a third in the deaths from these three diseases in the countries where it operates.

The importance of the fund to beating these diseases is illustrated particularly in the case of tuberculosis. The Global Fund provides three quarters of the funds that are committed to beating TB globally. In the absence of the Global Fund and its continuing ability to raise resources to beat TB, how would we continue to ensure that resources were deployed to beat this terrible disease, particularly given the ambition in the sustainable development goals to eliminate it in just 15 years?

The first reason why the Global Fund is the right mechanism to continue to tackle the diseases is that it is an established organisation that has experience in marshalling the resources that are needed. The second is that it encapsulates the important principle of partnership between donor countries—western countries with sufficient resources to contribute to the fight against these diseases—the Governments of the countries affected and civil society and the private sector.

The principle upon which the Global Fund was established is that it does not implement programmes to beat these diseases itself. It provides funding for those programmes and presides over them, but the ownership of the programmes is vested in the countries affected. The fund helps to mobilise and unlock domestic resources in the high-burden countries themselves. The principle of partnership between donor countries and the affected countries, and partnership among those who have a role to play in beating these diseases, is incredibly important and underpins the whole of the Global Fund’s work.

The third reason why the Global Fund is the right mechanism to continue this work is its accountability. It is clearly immensely important to the public’s view of international development money that it is spent properly, with accountability and transparency so that we know that resources are deployed properly. It has been a key principle of the Global Fund since its inception that there should be proper accountability in what was described at the beginning as a programme of “tough love” to ensure that the affected countries themselves are contributing to beating these diseases.

Fraud has surfaced over the life of the Global Fund, and I think it is true to say that the fund revealed most of those instances itself. They are part of the problem that any international aid agency has when it operates in countries where fraud can be a problem. The fund’s accountability mechanisms, which have been strengthened, are part of how we will address such issues. Some of the ongoing media criticism of the Global Fund has been misplaced. There is a misunderstanding of the fund’s success in ensuring that resources are implemented properly.

What are the issues for the Global Fund going forward? The fund is an immensely important mechanism in the fight against these diseases, but it has always been beset by external challenges. The terrible tragedy of 9/11 diverted the world’s attention from the need to maintain support for the Global Fund, and then the world financial crisis severely affected the willingness of donor countries to contribute. Some of the most important contributors to the Global Fund—relatively wealthy western countries—have faced a challenge to their own finances and have scaled back their commitment to the fund. That is a serious mistake for the west to make, despite the great challenges that every country faces because of the downturn. It remains important to continue to invest in beating these diseases, for the reasons that I have set out.

We now enter the replenishment phase that the Global Fund goes through every three years. It estimates that the combined external funding required to beat the three diseases, in line with the sustainable development goals, will be a staggering $97 billion over the next three years, 2017 to 2019. Those resources will be provided by the affected countries themselves and the countries that will be contributing to the fund. That requires the Global Fund to raise some $13 billion over the period, which is slightly less than the $15 billion that it was proposed the fund would raise in the last replenishment period, but it should be noted that the fund did not raise sufficient resources to meet that target. The fund estimates that that additional resourcing over the three-year period will save another 8 million lives, avert up to 300 million new infections and, crucially, support $41 billion of domestic investment, which represents an increased rate of growth. It will generate economic growth of some $290 billion, which underlines my point that such investment in beating these diseases ultimately does not impose a cost on the economies that are required to find the money; it actually helps to generate economic growth.

The UK has a proud record of supporting the Global Fund. In particular, the UK contributed up to £1 billion over the last three-year replenishment period, which made it the third largest contributor among donor countries. That was made possible by the Government’s commitment to meeting the international target of spending 0.7% of gross national income on international development, at a time when other countries have scaled back their spending. However, it would be helpful if the Minister responded to some points about how the Government made their commitment.

First, some conditionality was placed on the investment, so that only if other countries raised a certain amount of money would the full UK commitment be met. There is a question about whether that really produces an incentive for countries to fulfil their contribution or whether the real effect is simply to reduce the UK’s intended commitment. I hope the Government will consider that closely when they review their commitment for the next cycle. For all the reasons that I have set out, I hope the Government will now consider making a similarly significant investment in the Global Fund going forward. We are talking about substantial sums, and they should not be committed lightly. The Government need to assure themselves that the money is being spent properly, and it is encouraging that the Department for International Development’s 2011 multilateral aid review, and its 2013 update, assessed the Global Fund as providing very good value for money. Other studies have underlined the effectiveness of how the Global Fund spends its resources.

If the world community’s support for the Global Fund were scaled back, it would raise serious questions about whether we mean what we say when we sign up to international agreements to beat diseases such as HIV/AIDS and malaria. There is no point in the world coming together and setting an ambitious target to eliminate such diseases in 15 years if those targets are not only not met but not met by a country mile. That would undermine the whole process of international agreement that brings countries together to say, “We will work together to tackle these diseases.” It would place the sustainable development goals in a different position from the millennium development goals, which, at least in part, were met in relation to the diseases in question. There would be an ongoing humanitarian cost, as lives would be lost. There would be a continuing risk of the development of drug resistance, which would not be addressed properly. In relation to diseases such as TB, it would raise the question, “If the Global Fund, the principal agent by which this disease will be tackled, does not have the resources to do so, where are those resources going to come from?”

The UK Government are doing a great deal to fight these diseases in addition to their Global Fund commitment, and I was delighted by the Chancellor’s announcement in the autumn statement of the Ross fund, which, in partnership with the Bill & Melinda Gates Foundation, will ensure that £1 billion is invested over a three-year period in a new fund to develop the new drugs and vaccines that will be needed to address the world’s deadliest diseases, including malaria and tuberculosis. That is exactly the kind of focus that we need on new tools to beat those diseases. Only if such new tools are developed will the diseases be tackled properly, particularly tuberculosis, so that is immensely welcome.

However, I want the Government to appreciate that unless they and their fellow major donors continue to contribute to the fund, the progress that we have made in beating diseases such as tuberculosis, which has already been too slow, will fall further behind target. That would be a serious matter, which is why this debate is so important, coming at the point when the new round of replenishment is being considered. It is why voices are needed to discuss the value of Britain’s international aid contribution and the importance of investing in the global fund. Of course there are issues to discuss about the fund’s effectiveness and operation, and other Members might discuss them, but the overall picture is that it has made a vital contribution to saving millions of lives. If we want to continue to do so and to beat these diseases once and for all, it is essential that Britain maintains its contribution to the Global Fund.

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Order. If I put a four-minute time limit on speeches and there are no interventions, we will still not have enough time to get everyone in. I will start the list of speakers and go in the order in which Members submitted their request to speak. If those speaking keep their contributions short, we will be able to get everybody in. I will set a time limit of three and a half minutes, and if everyone is brief and no one intervenes, we might make it. Without wasting any time, I call Pauline Latham.

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It is a pleasure to serve under your chairmanship, Ms Dorries, for the first time not just during this Parliament but since I have been here. I congratulate my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) and colleagues on securing the debate, because the issue is incredibly important at this time. He talked about the generalities of the funding, but I will focus on a specific case, because although the Global Fund is fantastic, its eyes and ears cannot be on every single problem in the world.

I recently returned from northern Uganda, where I visited Gulu and Pajule in Pader, which are experiencing a huge problem with a malaria epidemic. Even the in-country director of the Malaria Consortium, the organisation I travelled with, was shocked at the level and scale of it. Women and children are dying in huge numbers, including babies aborted and stillborn during pregnancy after their mothers contracted malaria. Hospitals there are completely overwhelmed. The best hospital that I visited—the Lacor hospital, a private, non-profit Ugandan hospital whose mission is to guarantee affordable medical services, particularly to the most needy—was admitting up to 500 children into a 100-bed area, meaning that children were sleeping three or four to a bed and under the bed. Their parents were there as well. It is causing huge problems.

That is a really good hospital: it has bedsheets, which are pretty rare in many hospitals there. I saw one child of about three who was fitting badly due to cerebral malaria. I suspect that that child is no longer alive. The mother and other mothers were all attending around the bed, plus the doctors and nurses. That institution is doing the best that it can in incredibly difficult circumstances. Another hospital I visited, a state hospital, had no bed nets or sheets, and the mattresses were so decrepit that no one over here would put a dog on one, never mind lie on it themselves. Most facilities that I saw had no water. How can anybody recover when basic hygiene is not available to the doctors and nurses?

There are also huge pressures on hospitals when families go there too, because they must feed the families as well as feeding and looking after the patients. There is no patient confidentiality, because the patients’ families are there, and when patients are three to a bed, other families listen in as well, but the doctors and nurses say that they desperately need the families to come, because they do not have sufficient staff. It seems to me that the system in Uganda is failing to provide adequate healthcare.

Wherever we went and whatever health facility we visited, the statistics were the same, because spraying had stopped. Residual indoor spraying stops the epidemic, which has now gone through the roof. In one place, the number of cases had decreased to 33 a month by last April, but by May, it had rocketed to 1,500. No health facility, however well prepared, could cope with such a jump. Stock-outs of drugs are not unusual. The director-general of health told us that there was no problem, but she was discussing statistics that were a year out of date.

Hospitals treat 100% of patients with fever in malaria-type facilities, despite the fact that probably only 85% of them actually have malaria, which is not helping the issue of drug resistance. The problem is that drugs are funded, but diagnostic tests are not.

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Order. I am sorry, but I must call the next speaker.

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I am pleased to follow the speeches that we just heard, which set out clearly the need for action to ensure the delivery of sustainable development goal target 3.3 to end AIDS, tuberculosis and malaria. We need the political will to do so, and we are already beginning to see it in this Chamber.

The fund does not implement programmes but raises and invests $4 billion a year to support programmes run by local experts in communities most in need. Countries therefore take the lead in deciding where and how best to fight disease, as well as how to work with international partners. That enhances countries’ ownership and, as the right hon. Member for Arundel and South Downs (Nick Herbert) ably sketched, it increases domestic resource mobilisation through counterpart financing, which is important. I saw for myself on a visit to Cambodia with Results UK how our leadership, through the Global Fund, empowers directors in the countries by allowing them to sort things out themselves. It is a powerful model.

Using a country’s health and wealth to determine funding is indicative of the Global Fund’s model. It sees health as key to improving economies, and as a country’s wealth increases, its reliance on international support should decrease. With that in mind, the UK Government should press the Global Fund board, of which the UK is a member, to introduce a transition strategy to ensure that, when recipient countries move away from the Global Fund, they are still supported sustainably. For example, statistics show that 94% of gene expert diagnostics for TB and two thirds of second-line TB drugs within the World Health Organisation Europe region are provided through the Global Fund. It is imperative that those recipients continue to receive Global Fund support so that people who fall ill have access to diagnosis and treatment.

In short, the Global Fund should remain global, and support should be provided to middle-income countries to transition sustainably. Successive UK Governments have supported the Global Fund, and we can all be extremely proud of that, but the UK kept its contribution during the last replenishment in 2013, hoping that others would respond to the challenge of meeting the target. We have heard from the right hon. Member for Arundel and South Downs that that does not appear to have worked as a strategy, so I hope the UK Government will revisit and reconsider it.

The rationale given for the cap was that it would incentivise others to donate. Ahead of the replenishment, have the Government conducted any assessment of whether it has done so? It has been suggested that the cap has served only to limit our own contribution. The UK Government should commit to that important global initiative, on which so many people’s lives rely. That is clear and unambiguous. The Government should take steps other than a cap to ensure contributions by other donors. The UK should maintain its leadership role, continue to show strong support for the Global Fund and push for the $13 billion ask to be met by making its own substantial contribution, leveraging other donors to invest and expanding the donor base. By doing so, the Minister and his colleagues will show the word leadership that we have shown in the past and match it, which is something of which we can all be proud.

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Thank you, Ms Dorries, for chairing the debate. It is the first time, I think, that I have served under you. I congratulate my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) on securing this incredibly important debate. Before I go any further, I must declare an interest. Last summer I went with Results UK down to Zambia, where we saw for ourselves some of the issues related to HIV and to TB, both of which are important. TB has a tendency to break down the immune system, which makes people much more susceptible to HIV. I am also the chairman of the all-party parliamentary group on Zambia and Malawi, and the vice-chairman of the all-party parliamentary group on Zimbabwe. After visiting Zambia, I went to Zimbabwe to see what was going on there.

To my mind, there are a number of incredibly important issues. Yes, it is vital that we continue to put investment, through the Global Fund, into sorting out some of the health issues, but we also need to concentrate more on education, so that people are in a better position to look after their own economy and sort themselves out. The issue that is about to strike in a big way, I think, is that of famine. I am interested in knowing what the Government plan to do, because we are probably looking at there being some kind of famine in southern Africa, and that matter needs attention as well.

The Global Fund is important and, as members of the all-party group, we saw for ourselves just how important it is that investment is going into hospitals and healthcare units in Zambia. The British Government have been criticised somewhat for putting money into overseas aid development, but I point out that many asylum seekers might have TB. Trying to ensure that we deal with TB at source prevents problems from coming into this country and having an impact on our national health service.

I would be grateful if the Minister could explain the Government strategy for dealing with the potential of famine in southern Africa, so that we can ensure that later this year we do not see on our television screens a mass of starving children and adults.

I am acutely aware that others want to speak, so I will now keep myself to myself.

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I appreciate being called in the debate, Ms Dorries, and I also declare an interest. I remain an ambassador for the Scottish Catholic International Aid Fund—SCIAF.

When I became an ambassador, I got the chance to visit Kenya and Tanzania—back in 2006—before the big change to cheap access to antiretrovirals. I saw people languishing and I saw women in their fifties and sixties looking after the children of their children—sometimes 10 or 11 of them. In my local work I have established a youth group, and through the charity ZamScot we are building a school in a children’s centre in Lusaka. The centre rescues young boys who have grown up on the streets as AIDS orphans and sends them to primary school. They have often been on the streets since they were toddlers, and they finally go to school at the age of 12 or 13.

Along with other hon. Members, last autumn I had the opportunity, through Results UK, to visit Ethiopia. People who might have HIV—or even AIDS—are now on antiretrovirals and are looking after their families by taking part in growing their own food. That shows the difference that the world has been able to make by taking the decision to make the drugs available. The decision has transformed sub-Saharan Africa, and it has shown what the world can do when countries get together.

The trip to Ethiopia was about polio, a disease we are close to eliminating. The last remaining area with polio is on the border of Afghanistan and Pakistan. It has taken 30 years to get to that point, but it is incredible to think that polio might disappear in the next few years. Something can be done, and we have to keep on doing it.

The two things that require consideration are, first, the 10% limit, and whether it really leveraged anything or whether diplomatic pressure and sheer embarrassment would be more powerful, and, secondly, the transition in middle-income countries. It is important that such countries get at least a three-year warning and that, in our arrangement with them, we work towards a Government institution taking over. Often, non-governmental organisations do a lot of the work, and as we see ourselves moving towards a transition with a country we need to start pushing it to have proper institutional structures. Some 75% of HIV cases are in middle-income countries, and if we pull back, we will see that change.

In 2013, the United Kingdom stepped up in an incredible way, and we must not take our foot off the gas. It was the structures that had been developed through efforts to eliminate polio that spotted Ebola in west Africa. As the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, we need to protect ourselves—and not just our NHS—from multi-resistant TB coming in. There are selfish reasons for acting, but we can also develop the world economy, the African economy and the developing economy by allowing countries to have healthier populations.

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The latest figures released by UNAIDS show that nearly 16 million people now access antiretroviral therapies—ARTs—compared with fewer than 1 million just 10 years ago. In 2014, there were 2 million new HIV infections, compared with 3.4 million in 2001. That shows progress, but about 22 million people living with HIV still do not access ARTs and an incredible 19 million are simply unaware of their status.

If the aim of ending AIDS as a public health threat by 2030 is to be achieved, the bulk of the progress must be made in the next five years, to bend the curve of the epidemic towards manageable levels. The joint United Nations programme has accepted and released fast-track targets. These are that 90% of people living with HIV know their status, 90% of those people are accessing treatment and 90% of those on treatment are virally supressed. That would significantly reduce the number of onward transmissions. The challenge of achieving universal access, however, remains ahead of us.

Affordable first-line treatments are available in low-income countries in the form of generic drugs, but those drugs are denied to middle-income countries—MICs. MICs are excluded from licensing deals and are forced to buy drugs at inflated prices, making second and third-line ARTs prohibitively expensive. It is estimated that, by 2020, only 13% of those living with HIV will be found in low-income countries. We will be leaving the rest behind. If international donors, including the UK, continue to scale back bilateral overseas development aid for MICs, we will leave the bulk of people infected with HIV with reduced access to treatment, as the countries we were aiding choose not to fill the gap because the groups that are left vulnerable are either marginalised or criminalised. We are leaving those people high and dry.

Multilaterals such as the Global Fund must be allowed to provide critical bridging finance for MICs. We cannot simply pull out and leave Governments to fill the gap when we know they will not do so. As countries transition into the middle-income category, we know that we will withdraw, but we must put some form of package in place to support the transition; otherwise we will not be supporting a successful response to the HIV epidemic.

The UK has championed the inclusion of the principle of “no one left behind”, but we are leaving people behind because of our focus on middle-income countries stepping up to the plate—something they are not doing. We have the influence and the money. When we withdraw—for the perfectly legitimate reasons of trying to persuade middle income countries to bridge that gap and step up—we need to ensure that we provide support. Simply withdrawing leaves too many people vulnerable and exposed. I hope the Minister will commit to looking at providing technical support before funding is withdrawn to ensure that programmes do not collapse after withdrawal and that illegal or marginalised groups are not simply left to their own devices.

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It is a pleasure to speak in this debate, and I congratulate the right hon. Member for Arundel and South Downs (Nick Herbert) on securing it for our consideration. As the Democratic Unionist party’s parliamentary spokesperson on health, and someone who has a particular interest in the issue, I think it is always good to come along and make a contribution. The debate is about the Global Fund to Fight AIDS, Tuberculosis and Malaria, but I am ever mindful that in Northern Ireland we have rising numbers of people with HIV, so there is a problem for us at home, too.

Although much progress has been made in responding to the epidemics, the dual impact of HIV and TB continues to be devastating for millions of people and their families. I have had the opportunity to speak to people with HIV and to the HIV and TB organisations. The combination of both diseases is deadly to those who have them. Of the 1.5 million people killed by TB in 2014, 400,000 were HIV-positive. AIDS-related illnesses claimed 1.2 million lives in 2014, including the 400,000 TB deaths among HIV-positive people. Malaria causes hundreds of thousands of deaths every year, predominantly among young children. I congratulate the Government on how they have responded, because they have done many good things, and their support for the Global Fund is essential in reducing those upsetting statistics. The Global Fund can be part of the drive to eradicate the diseases, but it needs help from Governments across the world.

The Global Fund is also asking the private sector for support. That involves the pharmaceutical companies, and perhaps the Minister can give us some thoughts on the partnerships with them and what they mean. I and other Members have been made aware of the issue of out-of-date drugs being sent to the third world, where people have said, “We would not use them, but we will send them over there.” I have some concern about that, which other Members will share. Can the Minister give us some ideas on that?

We are well aware of the tightening of the purse strings and the finances at home, but we need to be able to respond in a positive fashion. Responding to the Global Fund’s call for additional resources, UNAIDS executive director Michel Sidibé said:

“We have to invest additional resources today to end these epidemics, otherwise the deadly trio will claim millions more lives, as well as costing us more in the long run”.

The Government and the country need to ensure the future success of the Global Fund, so that it can deliver. That of course will not be free, but the Global Fund plan can work to end the pandemic.

The Global Fund has been successful and is ready to continue its lifesaving work, if funded. The statistics on what has happened so far should encourage us, as should what could happen if the Global Fund had more money. Because of the work of the Global Fund partnership, 17 million lives have been saved globally and 8.1 million people living with HIV and AIDS who would not otherwise receive any treatment are receiving antiretroviral therapy. Some 13.2 million people who would not otherwise have been tested for tuberculosis have been treated and 548 million insecticide-treated nets have been distributed by the Global Fund partnership. Those are some of the things that the Global Fund has been able to do, and it could do more if the opportunity was there.

The Global Fund partnership has been working in Nigeria. The number of Nigerians dying of malaria has declined by 60% since 2000, but every year around 250,000 Nigerian children still die from the disease. If we want to do something for more people that is even better, more effective and more long term, we need to ensure that the Global Fund can continue its work. There is a serious return on investment in the Global Fund, but with more funding the partnership can make even greater strides.

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It is a pleasure to serve under your chairmanship, Mrs Dorries. I represent a Leeds constituency and we have suffered a lot with the recent floods. I have had a number of letters and emails from people suggesting that the easy solution would be to cut the funding for international development and to put that money into flood prevention instead, but frankly that is a short-term solution that would not help. I want to see all countries succeeding, and to achieve that, they need healthy populations that can then drive healthy economies. That requires long-term thinking and investment.

While I have been a Member of Parliament, I have had the opportunity to visit a number of countries, and like my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) I declare an interest, in that I also went to Zambia in August. The trip was arranged for us to see how the country is addressing serious health challenges, such as TB and HIV. Over the past decade, Zambia has shown strong growth and during the visit we learned that the Government contribution to the health sector has doubled in the past five years, but that the health sector is dependent on other sources of funding, which account for something like 30% to 40% of health spending in that country.

Zambia has a serious AIDS epidemic. Malaria is the leading cause of illness and death. The country has a serious problem with TB, with the risk of co-infection with HIV. Zambia is working hard to tackle those things, offering support and education and raising awareness among those suffering with those illnesses. In 2014, some 64,000 Zambians developed TB, which is a rate of 406 per 100,000. In this country, the rate is 12 per 100,000. That gives us an idea of the scale of the problem they are facing, but they are making great progress.

Two visits particularly stuck in my mind. One was with a young health adviser in a village. His name was Elias. He dressed up smartly for us: he was wearing a waistcoat and tie while we all frankly looked like scruffs. He was educating villagers on the basic standards of living, so that they reduced the risks of infection. The other most notable visit was to the St Luke’s mission hospital in Chongwe district. It receives funding from the Global Fund and is set in a very rural location. We were told that a man had walked for two days with his son to get to the hospital, but sadly got there too late. That shows how far these people have to travel to get the treatments they need. There we met patients who were suffering with TB and HIV, and they were becoming advocates in their communities to address the need for people to get treatment and, more importantly, testing. That is just one example of how much the Global Fund has done.

In Zambia, the Global Fund has diagnosed and treated more than 81,000 TB cases, provided 14 million bed nets and given antiretroviral treatment to some 670,000 people. We should be very proud of what the Global Fund has achieved. It is critical to ensure that healthcare is available to everyone who needs it. It says that the £13 billion it is looking for could generate another £41 billion in additional domestic investments. We have a proud record in supporting international aid, and I hope that when these diseases are eventually eradicated, we as a country can look back and say that we helped to achieve that.

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I thank the right hon. Member for Arundel and South Downs (Nick Herbert) for bringing this debate to the Chamber. I congratulate him on his thorough and eloquent introduction. He was able to lay out all the pitfalls facing us if we have a cut in the Global Fund.

In the summer of 2015, I was also on the same delegation to Zambia as the hon. Members for Plymouth, Sutton and Devonport (Oliver Colvile) and for Pudsey (Stuart Andrew). We went with Results UK. We were able to see at first hand the impact of the Global Fund and the importance of continuing to push to address global health challenges, including infectious diseases.

According to the World Health Organisation, 64,000 Zambians developed TB in 2014. That includes a high level of TB and HIV co-infection, with an estimated 38,000 TB cases reported among people living with HIV. The Zambian Government’s contribution to the health sector doubled between 2011 and 2014. Unfortunately, they rely heavily on external resources, which account for between 30% and 40% of health expenditure in recent years.

On the delegation, I was able to see at first hand the positive impact that the Global Fund has had on healthcare in Zambia. I, too, visited St Luke’s mission hospital in the Chongwe district, which has received Global Fund grants, and was able to speak to patients who had undergone and lived through treatment for HIV and TB. They had become confident advocates, and were proud to be able to stand with us and eat with us, and to explain to us how their lives were before the hospital’s intervention. I know how important the Global Fund is in transforming people’s lives and making a difference to those people in Zambia. Overall, Global Fund-financed projects have treated more than 81,000 new cases of TB, distributed more than 14 million bed nets to protect families from the transmission of malaria, and provided antiretroviral treatment to more than 600,000 people with HIV living in Zambia.

I call on the Government and the Minister to end the cap and push for the 2017-19 proposed investment contribution of £13 billion to be met through both our contributions and those of others’. If it is not, I am concerned that all the great work that has been done in places such as Zambia will be eroded.

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I thank my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) for his eloquent speech and for setting out the case so strongly. I declare an interest as a trustee of the Liverpool School of Tropical Medicine, and I have previously done work on artemisinin.

The impact of the Global Fund cannot be underestimated. Since its inauguration, we have seen for malaria alone a reduction in deaths of at least 48%, most of them among children. It is largely through the Global Fund that we have seen the possibility of the mass distribution of insecticide-treated bed nets, which cut in half the chances of children catching malaria. The fund has also supported the use of rapid diagnostic tests, which have made rapid diagnosis possible in rural areas for pretty much the first time. Malaria treatment can therefore begin quickly, before the disease has taken hold.

Five hundred and fifteen million treatments for malaria have been provided, largely of the effective artemisinin-based combination therapies, which were previously much too expensive for most people. The Global Fund has without doubt helped to transform the global malaria situation from one that was becoming out of control in sub-Saharan Africa in the 1990s, to the current situation, where we are speaking with some confidence of elimination—indeed, several countries have become malaria-free.

There have, of course, been problems. The misuse of funds and tools—such as bed nets—and poorly implemented programmes have hit the headlines. However, the Global Fund has always taken such problems seriously and taken action to remedy them. The question is whether the fund is the best way to tackle these diseases in future, and if so, what it needs to change to become even more effective. I am certain that it has a vital role to play. As my right hon. Friend the Member for Arundel and South Downs said, one of the strongest arguments is that it funds programmes developed by the affected countries themselves. Aid-funded programmes have often been criticised for being the pet projects of the donors without reference to those who are supposed to benefit. The Global Fund takes the opposite approach.

It is important that the Global Fund looks hard at how it operates. I shall mention very briefly four things that it should look at. First, it could do more to ensure that its programmes are fully integrated into the health systems of the countries that it supports and strengthens. I would have much more to say on that, but there is not enough time. I would be very happy to speak to my hon. Friend the Minister about that on another occasion.

Secondly, the global community needs to consider the case either for a separate fund for neglected tropical diseases or for including such diseases in the work of the Global Fund, with increased funding. Diseases such as lymphatic filariasis, soil-transmitted helminths, trachoma and so on—there are 17 of them in total—affect 1.4 billion people on the planet.

Thirdly, the Global Fund needs to report more regularly and more strongly on the work that it does. I was perplexed that the fund did not respond more strongly to adverse reports in the press last year of malaria bed nets being misused. They were indeed being misused, but it was in only a tiny minority of cases. It is vital that corruption and the diversion of funds are investigated and offenders caught, and the Global Fund does that, as it did in Sierra Leone in 2014. At the same time, it needs constantly to point out just how many lives continue to be saved every year as a result of its work across the three diseases. I would like to see quarterly, not annual, reporting.

Fourthly, the Global Fund needs to keep a very close eye on the fight against resistance to antimalarial drugs and the insecticide on bed nets, and allocate money accordingly. The same goes for multi-drug-resistant TB, which my right hon. Friend the Member for Arundel and South Downs mentioned. If not checked, such resistance threatens the substantial gains made over the past 15 years. The importance of the Global Fund to the battle against malaria cannot be overestimated. We were losing that battle but we are now, I hope, on the winning side.

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It is a pleasure to serve under your chairmanship, Ms Dorries. I congratulate the right hon. Member for Arundel and South Downs (Nick Herbert) on his eloquent opening speech, along with all the chairs of the all-party groups who successfully bid for this debate. Once upon a time I was involved in the campaign for the South Downs national park, and a very beautiful part of the country it is too.

A number of Members have made a lot of excellent points. The importance of the issue to the House is shown by the fact that so many Members wanted to speak. Thanks to your skilful action, Ms Dorries, they have been able to contribute to the debate. I pay tribute to Members for their contributions and for the expertise that they have shown, not least the hon. Member for Stafford (Jeremy Lefroy).

We often hear in Westminster Hall debates, and in political discourse more generally, that any given political change is possible or achievable and all that is lacking is the political will. The Global Fund to Fight AIDS, Tuberculosis and Malaria is a good demonstration of that principle. It was the determination and political will of world leaders to tackle three of the most challenging and infectious diseases of our times, which at that time were killing about 6 million people a year, that led to the establishment of the fund in 2002. As we have heard, in the years since, literally millions of lives have been saved by a massive scaling-up of proven responses and the targeting of funds and resources where they are most needed. The fund is an effective model of co-operation between Governments, the private sector, civil society and affected communities, reaching people in more than 140 countries. As we have heard, it is estimated to have saved more than 17 million lives since it was established.

We have heard about the need for the fund, about the human and societal costs of these diseases, and about the downward spiral that they can bring about for international development. Becoming infected with any of them severely limits the life chances of not only the individual affected but their wider family and community, which can be affected by the loss of income of either the individual or others who have to give up work to take on caring responsibilities. Just as on other issues, it is the poorest and most vulnerable and marginalised in society who are most at risk, with women and girls being disproportionately affected, as is sadly too often the case. The means and opportunity to rid the world of these diseases is there, which is why that ambition is reflected in sustainable development goal 3.3. Because of the challenges I have described, the replenishment of the Global Fund is incredibly important.

As we have heard, last year, for the first time, tuberculosis killed more people than HIV/AIDS. Again, it disproportionately affects the poorest in society, because crowded living conditions, poor ventilation and lack of access to clean water and sanitation all contribute to increased susceptibility. Because it affects people with weakened immune systems, it is one of the biggest killers of people with HIV and AIDS. I was particularly struck by the statistic on the progress that is currently being made on TB: it could easily take between 150 and 200 years to get rid of it, rather than the 15-year ambition that the world has set itself. The need for investment is clear.

Despite being so easily preventable, according to the World Health Organisation, malaria claims the life of a child every two minutes. I was not on the trip that many other Members went on, but in a previous life I spent some time living in Malawi, where I saw how prevalent and debilitating the disease could be. I also saw the challenge of providing relatively simple interventions, such as mosquito nets and prophylactic treatments, given what could sometimes be slightly relaxed attitudes. It seemed to me that in parts of Africa malaria was regarded in the same way that we regard the flu: as a bit of a hassle that some medicine and bed rest will sort out. But, like flu, it is a killer. It has become a catch-all term for all kinds of illnesses. Treating malaria is complex, and investment is needed not just in practical things such as the distribution of nets and treatment, but in education and awareness raising.

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Does the hon. Gentleman recognise that access to clean water through boreholes and the like is also important?

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Absolutely. I mentioned sanitation in the context of TB, but that is true across a range of health interventions. Improving access to water across the whole of sub-Saharan Africa would go a long way towards tackling not just these diseases but many other challenges. Access to water helps children pay attention in school, for example, so I agree with the hon. Gentleman.

One of the biggest barriers to progress against malaria is drug resistance. If people do not take the complete course of treatment, that helps to build resistance. We must therefore continue to invest in medicine research and development. Providing education and challenging stigma are crucial components in the fight against AIDS. Like TB and malaria, AIDS is an easily preventable disease, yet it continues to have devastating consequences in too many parts of the world. We often hear that HIV is no longer a life sentence in the west—that remarkable achievement is the result of significant investment over many years—but in developing and middle-income countries it remains a killer and, like other diseases, it is a barrier to economic and social progress across society.

The scale of the challenge is clear. I want to echo a number of the questions and points that have been put to the Minister. It would be useful to hear how the Government intend to respond to calls for resources for the fund. What amount are they considering contributing? What timetable have they set for their response? What further opportunities for scrutiny will there be? Will the replenishment be put before us as a statutory instrument? What will the process of disbursement be?

The subject of the cap has been well covered, but I want to re-emphasise some points that have been made. If the Government are prepared to say that they can commit up to £1 billion, the money must be there, so why do they not make those funds available in full? The replenishment request is based on a needs analysis. If the need is not met in full, we risk having an incomplete response, which could cost us and the world more in the long run.

We welcome the announcement of the Ross fund, but it would be useful to know how it will complement the Global Fund’s work. I heard for the first time from the right hon. Member for Arundel and South Downs that it is a three-year programme. I did not find that information elsewhere; perhaps I did not read the correct briefings. It would be useful to know what the plans are after that and how the two funds will complement each other.

A number of Members mentioned the need to tackle the spread of diseases in middle-income countries. The UK Government are free to set their own priorities for their international development programme. They announced that 50% of overseas development aid would be spent on fragile states, but they must recognise the Global Fund’s expertise and the need for it to be able to target funding effectively to prevent backsliding. My hon. Friend the Member for Central Ayrshire (Dr Whitford) made an important point about transitioning middle-income countries from aid. It would be useful if the Government would commit today not to interfere with Global Fund decisions to support programmes in middle-income countries.

Drug resistance is a challenge in tackling all of these diseases. The Minister will be aware of the World Health Organisation meeting in Geneva in March, which will look at reforming global research and development structures and ways of incentivising the production of pharmaceuticals to meet global health need, rather than simply tackling the most lucrative and profitable diseases, for which medicines can be sold. It would be useful to know whether the Government will take part in that conference.

The Global Fund estimates that meeting its next replenishment target could save up to 8 million lives and prevent 300 million new infections. That level of achievement would put us firmly on the path to meeting the SDG eradication target by 2030. However, a failure to resource the fund properly risks reversing progress, increasing drug resistance in new strains and new areas, and ultimately resulting in more unnecessary loss of life. The Government have a chance to show leadership. I look forward to hearing their response.

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It is a pleasure to serve under your chairmanship, Ms Dorries. Thank you for skilfully fitting in so many contributions into such a short time. I have to declare an interest: like the hon. Member for Glasgow North (Patrick Grady), I did not go on the Zambia trip last year. We have heard incredibly powerful testimonies from the hon. Members for Pudsey (Stuart Andrew), for Central Ayrshire (Dr Whitford) and for Mid Derbyshire (Pauline Latham), and from my hon. Friend the Member for Edmonton (Kate Osamor). The change that we can make as a developed nation helping developing nations is essential, and they have brought real quality to the debate.

I, too, congratulate the right hon. Member for Arundel and South Downs (Nick Herbert) on securing this timely debate. I thank him for his leadership on the issue of tuberculosis—he chairs the global caucus on the matter. This debate follows on from the debate on malaria that the hon. Member for Stafford (Jeremy Lefroy) secured in October, so the House has been highly focused on these issues and on the Global Fund. It is incumbent on me to welcome the new International Development Minister to his place and congratulate him on his position.

We all welcome the recently adopted agenda for sustainable development, which will guide international co-operation, including the UK’s development co-operation, over the next 15 years. We are entering a new era of efforts to eradicate poverty, foster human wellbeing and protect our planet. It is a universal programme for all people in all countries. As the hon. Member for Finchley and Golders Green (Mike Freer) said, it should leave no one behind. We now have to realise the transformational potential of the agenda.

We are talking about three diseases. In the October debate, the hon. Member for Stafford highlighted the issue of global malaria. Global malaria control is one of the great public health success stories of the past 15 years, but we face substantial challenges, such as the spread of resistance to drugs and insecticides. The prevention of infectious diseases is one of the best uses of aid, as the hon. Member for Pudsey said. It is estimated that if global malaria targets are achieved by 2030, more than 10 million lives will be saved, generating more than $4 trillion of additional economic output. We know what that kind of output can mean to developing nations.

Through sustained efforts, the tuberculosis mortality rate has nearly halved since 1980. However, as has been said, more than 1.5 million people died from TB in 2014. According to the World Health Organisation’s 2015 global tuberculosis report, most of those deaths could have been prevented. The report highlights the need to close the detection and treatment gaps. We want to get there by 2030, as the right hon. Member for Arundel and South Downs said, not in 200 years. We need to fill the funding shortfalls and develop new diagnostic tools. Through partnerships, Global Fund programmes have detected and treated more than 13.2 million cases of TB.

AIDS is the biggest killer in the world of women of reproduction age and the second biggest killer of adolescents. Some 1.2 million people died of HIV or HIV-related illnesses in 2014, and more than 36 million people live with the virus. Global Fund programmes have enabled 8.1 million people with HIV to access antiretroviral therapy.

The Opposition welcome the establishment of the £1 billion Ross fund, in co-operation with the Gates Foundation. We will hold the Government to account on how that co-operation is going in the months and years ahead. That £1 billion includes a £300 million package on malaria and £115 million to develop new drugs and insecticides for malaria and TB. We also need to support multilateral partners, such as the Global Fund, to fight HIV, AIDS, tuberculosis and malaria. It is essential that we continue to fund that work and build on what has already been done. In particular, we must invest in new vaccines, medicines, insecticides and diagnostic tools.

If we tackle AIDS, TB and malaria, there will be a number of spill-over effects, such as greater productivity and growth, reduced worker and child absenteeism, increased equity and women’s empowerment, and improved wellbeing, particularly for vulnerable and marginalised populations. Failure to act could lead to the diseases resurging, leading to increased deaths and lost opportunities for progress and development. The Ebola crisis in west Africa has painfully illustrated the importance of strong public health systems in fighting diseases. The lessons also apply to our efforts to combat AIDS, TB and malaria.

We need to scale up our efforts in combating malaria, to which the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Scunthorpe (Nic Dakin) alluded. We need to invest more in AIDS and TB research and development, tackling resistance to life-saving medicines and boosting health systems across the world to help bring an end to these terrible diseases.

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It is a pleasure to serve under your chairmanship for the first time, Ms Dorries. I congratulate you on getting everyone in to speak. I also congratulate all three chairs of the relevant all-party groups, especially my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) who gave a powerful opening speech, on working together to secure this debate. My hon. Friend the Member for Mid Derbyshire (Pauline Latham) was cut off mid-speech because three and a half minutes was not enough for her to articulate the power of what she saw in northern Uganda. She has my commitment to sit down with her and reassure her that the Department and the Global Fund to Fight AIDS, Tuberculosis and Malaria are on that situation.

I thank my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) for raising El Niño. As the topic is not central to this debate, I will write to him, but he is quite right to raise it, because in Ethiopia, for example, we are seeing drought conditions that are comparable with 1984. What has changed is the capacity of the domestic Government to manage the situation on behalf of their own people, which has been supported to some degree by our development work over many years.

I am glad that it became clear towards the end of the debate that I was not the only person who had not been to Zambia recently, but it was powerful to hear accounts of how the Global Fund has worked on the ground. I am extremely grateful that this debate is happening now. I am also pleased that so many Members, from both sides of the House and representing all parts of the country, have decided that this is where they want to be this morning, to hold the Government to account and to press ministerial feet to the fire on the future of the Global Fund. I am grateful for that, as it makes my job that bit easier knowing that there is that level of scrutiny and interest inside Parliament.

The debate is extremely timely for several reasons. As many colleagues know, this is an important time because some key decisions, which flow from the spending review, are being taken inside the Department relating to our review of bilateral and multilateral aid programmes, of which the Global Fund is obviously a central piece. As many have said, however, the Global Fund is on the brink of a fifth replenishment, and active discussions between donors and Governments are ongoing. It is therefore an important time to take stock of the progress made through our investments and to think about how we can match resources to need in an even more intelligent way.

What strikes me and what has come through in many of the speeches, and which I had not fully appreciated before taking on this brief, is just what incredible progress our species has made in the face of these dreadful diseases over a relatively short time. We have seen radically improved access to treatment, significantly reducing the number of people dying from HIV, which fell by over a third between 2005 and 2013. There have been dramatic increases in the diagnosis of TB in high-burden countries, saving some 37 million lives since 2000. As my hon. Friend the Member for Stafford (Jeremy Lefroy) brought home so powerfully, global death rates from malaria have almost halved since 2000, saving over 4.3 million lives. As my right hon. Friend the Member for Arundel and South Downs outlined, the Global Fund is a critical part of that success, saving the lives of at least 17 million people who would have died needlessly.

There is no doubt in my mind that the Global Fund is a success. It works. It has made a crucial contribution to the fight against all three diseases. It has been reformed over time and those reforms have strengthened its efficiency and effectiveness. It scores very highly in most independent assessments of transparency, accountability and, critically for us, value for money. It plays an important role in the crucial work of strengthening domestic health systems, although that is challenging to measure. As was shown, the fund has also been an extremely effective catalyst for unlocking domestic resources and really important partnerships that are really the only way forward in bearing down on these diseases and bending the curve, as my hon. Friend the Member for Finchley and Golders Green (Mike Freer) put it so well.

But—it is a big “but”—however amazed and satisfied we can be with the progress so far, we are not where we need to be. I find it chilling that 90 children will have died of malaria and 45 adolescent girls will have been infected with HIV during the course of this 90-minute debate, and that 4,000 people will have died of TB over the course of today. I am sure that everyone here will agree that that is absolutely unacceptable on humanitarian grounds and is undermining everything that we are doing to try to lift people out of poverty and to put economies on a more prosperous path. As was powerfully put by various Members, it also carries a risk to our stability and security, so there are absolutely no grounds for complacency or any suggestion that we should lessen our intensity in this fight.

Malaria is a preventable and treatable disease yet it continues to kill almost half a million people a year, the vast majority of whom are children and pregnant women in Africa. Progress is threatened by drug-resistant malaria and by mosquitoes adapting to the insecticides that we use to treat bed nets. As we have heard, TB is now the leading cause of death, with an estimated 1.5 million people dying and 9.6 million falling ill with TB in 2014. At least one in 10 of those people were also HIV-positive. There is no doubt that drug-resistant TB threatens global health security with only around a quarter of those with the disease diagnosed and treated, meaning that tackling it is both the right thing to do and firmly in our national interest.

HIV continues to be one of the leading causes of death and disability globally, disproportionately affecting the poorest and the most marginalised. Some 22 million people living with HIV still do not have access to treatment. It remains the leading cause of death in women of reproductive age globally and in adolescence in Africa. In 2013, an adolescent girl was infected with HIV every two minutes. In sub-Saharan Africa, she is twice as likely to get HIV as her male peers. Although incredible progress is being made, there is no doubt that this is absolutely not the time to ease up. The Global Fund is central to the global effort to bear down on the diseases. I hope that I have reassured Members that the matter and our evaluation of how effective it is are important to this Government. However, it is our responsibility—I was interested in the various comments about this—to ensure that the fund works even more efficiently and effectively in its next phase, and that the lessons of the last phase are absorbed and understood. I was particularly interested in the points made by my hon. Friend the Member for Stafford and I will be discussing them further with the head of the Global Fund when I meet him shortly.

The central challenge for all of us who are accountable for the money and who care passionately about this agenda is to ensure that resources are directed where they are most needed. There are priorities to set and difficult decisions to take in that context, but we must certainly give priority to countries with the highest burden or risk of disease and the lowest ability to pay for tackling the epidemics on their own. The point was powerfully made by my hon. Friend the Member for Finchley and Golders Green and the hon. Members for Scunthorpe (Nic Dakin) and for Central Ayrshire (Dr Whitford) about the need to ensure that any transitions—in particular for middle-income countries—or movement of resources are managed extremely responsibly. My hon. Friend has my reassurance that that is very much top of mind in our discussions with donors and other countries.

As my right hon. Friend the Prime Minister remarked at the launch of the global goals in September 2015, we

“commit to putting the last first”,

and to end extreme poverty

“we need to put the poorest, the weakest and the most marginalised first to Leave No One Behind”.

Those words are important to the Department.

How may we ensure that the Global Fund delivers? For HIV it needs to work with young women in Africa, who on average catch HIV between five and seven years earlier than their male peers. For malaria it means ensuring that the children and pregnant women who account for 80% of all malaria deaths have access to bed nets and quick diagnosis and treatment. For TB it means working with people with HIV and harder-to-reach groups, such as migrants and miners, to test and treat them. The Global Fund must use the right interventions, evidence-based tools that we know work, and diagnostics, treatments and tools for prevention.

My hon. Friend the Member for Finchley and Golders Green asked about the need for the UK to finance the most vulnerable in middle-income countries, but the numbers need to be treated with caution. The middle-income country category is very broad, ranging from countries that have just crossed the threshold, such as Zambia, where the GDP per capita is less than $2,000, to countries such as Malaysia, where the GDP per capita is more than $11,000, which primarily self-finance their own disease responses. We therefore need to match the solution to the problem. The vast majority of people living with the three diseases are in the first category of middle-income countries—countries that do not yet have the ability to pay for the response to their disease epidemics—and in that context external resources are still needed, so we encourage continued investment by the Global Fund.

In other middle-income countries the issue is willingness to pay, in particular for the marginalised and hard-to-reach groups of people. There the different parts of the health architecture must work together to encourage and enable Governments to step up and take responsibility for the rights of their citizens, which means ensuring that the World Bank works with Governments to build systems that allow them to plan and independently finance their disease responses according to need. It also means encouraging the World Health Organisation to provide technical assistance to help countries develop the most cost-effective way of delivering services as part of a broader health system. It means holding Governments to account to deliver for their most marginalised, not least by working with civil society and partners such as UNAIDS. My key point is that I absolutely understand what my hon. Friend and other colleagues were saying about the need to manage transition responsibly. I hope I have given him some reassurance that we are aware of that and take it seriously.

On intellectual property, my hon. Friend rightly pointed out that the costs of treatment are an important factor in determining a country’s ability to pay for it. The Global Fund supports countries to obtain quality-assured products at the lowest cost. I am pleased to say that in 2014 and 2015 IP restriction was only an issue for 0.5% of the total value of antiretroviral orders made by the Global Fund. We recognise, however, that intellectual property is a very important issue in some cases, which is why the UK also funds the medicines patent pool, which works to address IP blockages related to HIV, and why we are starting to explore TB and support the WHO, the United Nations Development Programme and UNAIDS in working with countries to support them to address their intellectual property issues.

A number of colleagues raised the issue of the UK’s cap in the most recent replenishment. It is important to note that the cap was intended not only to incentivise others, but to ensure that everyone plays an appropriate part in addressing global challenges. To be frank, it is difficult to assess the impact of the cap on other donors; some said—one in particular—that the cap was a factor for them, but we will have to review that in terms of our tactics in relation to the forthcoming replenishment.

I am very proud and many colleagues in the House are extremely proud of the leadership that this country has shown under successive Governments to move the development agenda, to shift gears of ambition, to meet international commitments and to encourage others to step up and meet their responsibilities. We helped to shape the latest round of sustainable development goals. We have been extremely ambitious in the commitments we have made through the new official development assistance strategy, through our manifesto commitments, and on the role that this country intends to play in supporting that ambition with action that will make a difference on the ground. The Global Fund is a key element in the delivery of that strategy.

Colleagues know that because discussions are ongoing, I am absolutely not in a position to front-run any decisions or to make any commitments. That would be something with career implications that I am not prepared to contemplate—

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Be brave!

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I will resist the call to be brave. I hope, however, that I have reassured Members that successful replenishment of the Global Fund, which is about not only the UK’s commitment, but the role we play in encouraging others to step up, is personally important to me and extremely important to the Government. I am grateful to all Members who were present today for putting a spotlight on the Global Fund and on the need for Britain to stay up and to maintain its position of leadership in the world.

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May I make two apologies? First, I apologise to my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and indeed all hon. Members for foreshortening their time: my maths was insufficient and I had not realised the number of people who wished to take part in the debate, so I spoke for too long. That follows on from moving amendments on planning matters at 2 am last week, which added immensely to my popularity with colleagues. Those of us who wear Apple watches know that it is possible to receive electronic reminders when one should be taking more exercise. Perhaps a reminder to shut up when one is speaking for too long would be a useful additional app for someone to develop.

Secondly, I apologise to the Minister, because I should have welcomed him to his new position. The way in which he responded to the debate confirms the impression that many of us had that it is an ill wind that blows no one any good, and that his appointment and return to Government were immensely welcome, in particular to the Department for International Development. He has a genuine interest in international development matters and speaks with some passion about them. What the Minister said about the importance of the Global Fund and its replenishment to the Government and to him personally was encouraging.

It is important to debate such issues and we had welcome contributions from Members of many parties, in particular on the need to focus on the effectiveness of the Global Fund and the points made by my hon. Friend the Member for Stafford (Jeremy Lefroy). I hope that those points will be taken on board by the excellent director of the Global Fund, Mark Dybul, who has made great efforts to improve its effectiveness. We look forward to further discussion with him as well as with the Government.

A real issue is that of middle-income countries, which affects the Government’s international development agenda more broadly—when countries reach a certain income threshold, what is the right role for wealthier countries? We cannot simply step away. Much of the burden of those diseases falls on the middle-income countries and there is a real question about whether they would devote sufficient resources to tackling the diseases. If international bodies such as the Global Fund concentrate on other, lower-income countries, there is an imbalance in the resourcing and the focus is wrong. That is an important debate, which we will need to have.

This has been an excellent debate. I am delighted to tell the Minister that I, too, have been to Zambia, although I am sorry to say that I was not on the trip with my hon. Friends the Members for Plymouth, Sutton and Devonport (Oliver Colvile) and for Pudsey (Stuart Andrew) and the hon. Member for Edmonton (Kate Osamor). I look forward to an opportunity to follow their example in future.

Question put and agreed to.

Resolved,

That this House has considered the Global fund to fight AIDS, TB and malaria.