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World TB Day

Volume 657: debated on Wednesday 27 March 2019

I beg to move,

That this House has considered World TB Day and the efforts to end tuberculosis globally.

I am delighted to be able to introduce this debate. It was World TB Day on Sunday, but this is not an anniversary that we should be having to mark at all. It is wrong and extraordinary that we still have to debate the toll from death and suffering of a disease that has been curable for well over half a century, since the discovery of antibiotics by Fleming in 1928. It is unnecessary that so many people die from tuberculosis.

Imagine if the World Health Organisation announced tomorrow that a new disease had been discovered that was highly infectious, airborne and susceptible to drug-resistance, and that next year 10 million people would fall sick, of whom 1.6 million people would die. Imagine the global response to that news. That is in fact a description of the reality of tuberculosis. TB kills more people every year than HIV/AIDS and malaria combined —1.6 million people last year. Of course, there is overlap between HIV/AIDS and TB, because the AIDS epidemic in the 1980s drove the resurgence of tuberculosis. A disease that the world thought it had beaten has come back with a vengeance.

TB was first declared a global health emergency 25 years ago, in 1993. Since then, 50 million people have died. Just consider that. A disease is declared a global health emergency and subsequently 50 million people die, yet that disease is treatable and curable. That represents nothing less than a catastrophic failure on the part of the world’s Governments to deal with a disease that we should deal with more effectively.

My right hon. Friend is making some good points and I congratulate him on securing the debate. He mentions the failure of world Governments. There is clearly a need for greater urgency in the approach taken by the international community in dealing with this issue, but what about the behaviour of pharmaceutical companies, which rarely invest in drugs that will help people in low and middle-income countries in the way that they would do in lucrative medications that they can sell in higher income countries, such as Great Britain?

My hon. Friend makes a good point, but I do not blame pharmaceutical companies, because I think this is a clear case of market failure. The fact is that the demand for better TB drugs, which we need, falls largely in low and middle-income countries, so there is no commercial case for sufficient investment in these new drugs. It can therefore proceed only on a public-private partnership basis. Some pharmaceutical companies have a pro bono programme for the drugs that do exist, such as Johnson & Johnson, where there is a drug to deal with drug-resistant TB. However, that is still insufficient.

This market failure is a striking contrast with what happened with AIDS. There was a serious response to the AIDS epidemic from pharmaceutical companies, not only from publicly funded programmes, but from commercially funded investment. As a consequence we have had extraordinary innovation, and new drugs that can prevent HIV and ensure that it is not a death sentence are available. What is the difference between the two? AIDS was a disease that was killing people in the west and TB is a disease that kills the poor. That is the fundamental difference. That is why we have not had the same level of investment in tuberculosis. Another fundamental difference is that TB was already curable with antibiotics. It is just that these antibiotics were not being delivered, TB patients were not being identified and we did not have the health systems to do it.

I am a little more sceptical about the operation of some pharmaceutical companies than my right hon. Friend. In fact, one reason that the global community was able to so effectively deal with HIV—he is right to identify TB as an AIDS-defining disease—was that international Governments brought pressure to bear on pharmaceutical companies to drop the price of the medications, and push medications out in low and middle-income countries. That has not happened with TB. Unless there is a concerted effort from global Governments to encourage pharmaceutical companies to behave with greater global awareness and corporate responsibility, I am not sure we will see much change in the situation that he is describing, and change is badly needed.

This is an interesting debate, but I disagree with my hon. Friend. The drugs are not in the pipeline, because the return on investment for these companies is insufficient in the first place. I do not think that they are sitting on drugs that are available for wealthier people, which, if pressed, they could simply roll out to poorer people. There is an insufficient quantum of investment in research and development. I will come on to that point. I do not think that the need can be met by the private sector alone.

I believe that there are three key reasons why we need to take more action against this disease: humanitarian reasons, economic reasons and reasons of global public health. The humanitarian reason is that so many people are dying needlessly from this disease and falling sick. The figures speak for themselves.

The economic reason is that this awful loss of life and this illness are a drag on economic success in the poorest countries, hindering their development. There will also be a serious economic impact if we fail to tackle the disease. By 2030, it is estimated that if the current trajectory of TB continues, that will cost the world’s economies $1 trillion. Some 60% of that cost will be concentrated in the G20, and it will be caused by the 28 million deaths over that period. That is a terrible statistic, because that is the period over which tuberculosis is meant to be beaten according to the sustainable development goals. The United Nations set those goals four years ago, and said that the major epidemics—AIDS, malaria and TB—would be beaten in 15 years’ time. We have just 11 years to go. On the current trajectory, TB will not be beaten for well over 100 years. There will be a further 28 million deaths during that period alone, as well as huge economic costs.

The global public health reason is the susceptibility of tuberculosis to drug resistance, because of the old-fashioned drugs that are used to treat tuberculosis. People who take the drugs do not continue with their treatment and it is a very serious fact that there are well over 500,000 cases of drug-resistant TB in the world. The highest burden is actually in the European region. Only one in four people who have drug-resistant TB can access treatment.

We know that there are 3.5 million missing cases of TB every year that are simply undiagnosed, accounting for one in three sufferers. The proportion is much higher for drug-resistant TB, where 71% of people are missing. This constitutes not only a humanitarian issue, but a serious risk to global public health, because this is an airborne, highly infectious disease.

The right hon. Gentleman is making a very powerful case. He has just said that because so many cases are undetected, the risk is compounded. That is an important issue, which needs tackling urgently.

I strongly agree with the hon. Gentleman. I commend the work he does on the all-party parliamentary group on global tuberculosis, which I have the honour to co-chair with my friend, the hon. Member for Ealing, Southall (Mr Sharma). The big problem is all of these undetected cases. We need to find and then treat millions more people.

There is hope. Last September, the UN convened the first high-level meeting on tuberculosis, which passed a strong declaration that recommitted the world to meeting the sustainable development goal target to beat the disease, and that specifically set a new target of diagnosing and treating 40 million cases of TB by 2022—a very tight timetable. It is vital that efforts are stepped up immediately so we can meet that new, ambitious target. It will require a significant increase in the level of spending on TB programmes globally from nearly $7 billion to $13 billion and on tuberculosis research and development from $700 million to $2 billion a year.

Two key issues arise from those ambitious new commitments, the first of which is accountability. How are we going to hold the world’s nations to account for their commitments at the high-level meeting? I mentioned that the world has already declared TB a global health emergency and has already set the sustainable development goals. The problem is that we keep talking about the disease but not delivering a sufficient global response to beat it, so accountability is crucial.

Among the problems with the otherwise good declaration passed at the UN is that independent accountability was struck out, but it is vital, because we have to hold countries’ feet to the fire for what they have committed to do. Accountability can take multiple forms: it can be done through bilateral relationships; intergovernmental platforms at the G20, the G7 and the Commonwealth; a further review of the UN high-level meeting and the commitments made; or international institutions such as the World Health Organisation. I must say, however, that if the WHO’s existing mechanisms had been effective, we would not be in this position.

My first point to the Minister, who I welcome to her place, is that the UK has a vital role to play in ensuring that there is more effective, sharper and independent accountability for the targets set at the high-level meeting. Without that accountability, I fear that we will not meet those new targets, and if we do not, we do not have a chance of beating the disease within the set timeframe.

The second issue is that we cannot escape the fact that we will need additional resource to meet the ambitions and that must come from the countries affected, particularly middle-income countries, which must find the resources to deal with it. We have seen a huge improvement in the response in India, for example. Resource must also come through multilateral institutions, particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria, through which comes 70% of all international funding for TB. The UK can be proud that it is the third-largest contributor.

This year marks the replenishment of the Global Fund. If we are to have a hope of meeting those TB targets, it is vital that it is replenished to a higher level than before. The investment case requires a pledge of $14 billion from the world’s countries, which will be combined with an increase of nearly 50% in domestic investment, so the money will also come from individual nations. That would suggest that the UK needs to commit £1.4 billion, which is an increase on the £1.2 billion it gave last time. That is the minimum that will be required to meet the Global Fund’s strategy targets and is proportionately the same as the UK previously gave, at about 13% of the budget.

I know other hon. Members want to speak, so I will make one final point. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is no longer here, said, new drugs will be essential. New drugs for tuberculosis have become available only relatively recently; there have been no new drugs for more than 40 years. Most people do not know that we do not have an effective adult vaccine for tuberculosis, and no epidemic in human history has ever been beaten without one. We have to be able to meet the new targets for an increase in research and development, which includes providing public funding.

Again, the UK has a vital role to play because of the strength of our pharmaceutical sector and what we already do on research and development. We need a specific plan to implement a research strategy; we need to establish a baseline for countries to ensure that they are funding their fair share of research and development; and we need to establish a mechanism to co-ordinate that spend. Otherwise, again, countries will talk about the research and development gap, but never do anything to close it.

We should not need to be here. This is not a disease that we should have to talk about any longer—frankly, it is a moral disgrace that we still are. It is a needless loss of life. Many problems confront modern Governments, some of which are nearly intractable. This is not one of them. This disease can be beaten. We have known how to do that for more than half a century and, with new tools, we could do it better. In the words of the Stop TB Partnership’s campaign for World TB Day last Sunday, “It’s time” to beat this disease.

It is a pleasure to see you presiding today, Sir Christopher, and to follow the right hon. Member for Arundel and South Downs (Nick Herbert), whom I congratulate on securing the debate. I am grateful for the leadership that he continues to provide, and for his comprehensive introduction, which makes it easier for those of us who want to speak—

Not at all; it was a great speech, and well delivered.

As the right hon. Gentleman said, TB remains the world’s deadliest infectious disease. Despite it being entirely curable, it has claimed 1.3 million lives in the last year, including the 700 children who died every day.

According to the British Society for Immunology, one third of the world’s population is infected with the TB bacterium. We urgently need to enlarge our treatment of the illness and make vaccines that are safe, affordable and accessible. The BSI states that that is especially essential for pulmonary TB. We all know the tremendous impact that widely available vaccines could have on combating the disease, as the right hon. Gentleman has said; they are absolutely essential. Will the Minister comment on how much funding the Government can allocate to investing in the research to develop such vaccines?

Funding research into vaccines is especially important because of the increasing number of TB cases that are resistant to multiple antibiotics. That is an issue around the world, with more than half a million cases of drug-resistant TB reported in 2017. I ask the Minister what work is ongoing with colleagues to ensure that the Global Fund to Fight AIDS, Tuberculosis and Malaria is replenished as a means to combat the global spread of drug-resistant TB, as requested by the right hon. Gentleman.

The disease has played an important part in the history of public health in my Tower Hamlets borough. The UK has a high incidence of TB compared with much of western Europe, and London accounts for one third of UK cases. In my borough, the levels have decreased in recent years, which is good news. Incidence has halved from 64.7% in 2010 to 32.5% in 2015, but TB continues to affect Tower Hamlets disproportionately compared with other parts of the country.

Tuberculosis is a disease of poverty, and my constituents are among of the most vulnerable. The approach to tackling this complex disease needs to incorporate not only research into vaccines and cures, but spreading awareness to individuals who possess the aforementioned social risk factors.

As well as the health issues, is it not true that people with TB are socially isolated and excluded because of the effect on other people in the community? I wonder whether that is the experience in Tower Hamlets, because it is certainly the experience in places such as India.

It certainly is. Of course, one of the big downsides is that the risk of spreading the infection means that there has to be some degree of isolation, guilt and emotional stress. My hon. Friend makes a very important point.

The approach to tackling this complex disease needs to incorporate not only research into vaccines and cures but spreading awareness to individuals who possess the aforementioned social risk factors. Early intervention is also key to ensuring that the disease is treated swiftly and the risk of spreading it is minimised. That is why I am pleased that the Government are overseeing the national TB strategy for England between 2015 and 2020, enacted by TB control boards. With this approach, I am sure we will continue to see a decline in cases of TB in Tower Hamlets.

It is simply not acceptable for 10 million people globally to be falling ill from TB in 2019. This disease is curable and with the right funding treatments could be made easily accessible. Our Government need to continue to intervene to ensure that adequate investment is allocated to research vaccinations, to work with global partners and to play our part in eradicating TB worldwide.

I would be grateful to the Minister if she could confirm what is being done to work with other nations to deliver on the UN high-level meeting on TB target to find and treat 40 million people by 2022.

I start by congratulating the right hon. Member for Arundel and South Downs (Nick Herbert) on spelling out how important this issue is. I also pay tribute to everybody worldwide who is working in one way or another to fight TB, whether it is on research or on the frontline of dealing with TB and finding people, supporting them and curing them of this terrible disease.

I was fortunate enough to visit Cambodia with RESULTS UK some years ago and saw the fantastic work going on, with partners from across the world working with the Cambodian health authorities to try to reach people suffering from this disease, to tackle it and root it out, but it is a forever challenge.

When I mention TB to people in everyday parlance, they believe that it is a disease of the past—a disease of the 19th century—and are surprised when I point out the fact that it is the biggest killer in the world today. We should be ashamed that that is the case because, as the right hon. Gentleman said, with the proper will, effort, focus, determination and drive, this disease could be sorted. The resources are there to tackle it. It is a matter of purpose, intention and marshalling our forces. That is partly what this debate today is trying to do.

One third of the world’s population is infected with the tuberculosis bacterium, which is a shocking figure. Annually, more than 10 million people become ill with TB, resulting in 1.6 million deaths. As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) has just pointed out, the UK has a higher incidence of TB than we would wish. We have a higher incidence than the USA or other western European countries, with hotspots in places such as London, Leicester, Luton, Birmingham, Manchester and Coventry.

Indeed, when I was principal of a sixth-form college in Scunthorpe, there was an outbreak in the town, which first focused my mind and made me understand the process of ridding a small community of the disease. It is difficult and requires a lot of work. That brought home to me how much it needs sorting, because TB is an airborne disease and adults with pulmonary TB are the main transmitters, which makes it particularly problematic to root out.

We need a safe and affordable vaccine urgently and we need the significant investment in research worldwide to deliver it. As the right hon. Member for Arundel and South Downs pointed out, that can be done with the proper effort. There are loads of reasons to explain why that is not currently happening but, as has been said, a specific research strategy needs to be put in place and funded.

The Minister is an excellent Minister, and I know she will be very much on board and well-researched already. She has an opportunity to contribute to the global leadership in this process. We are six months from the next UN high-level meeting on TB and the time for replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria is fast approaching. The last UN high-level meeting on TB had lots of positives, but there were also areas where we could have asked for a bit more regarding the accountability that we would like so that people own the process and take it forward.

As the right hon. Gentleman pointed out, if the UK can commit to the £1.4 billion that is needed from us over the next three years to up our global game, that would be the UK playing the role that it has always played—one of global leadership, in a way that partners can stand alongside—and I am sure the Minister would want to be part of that. By making those strides, we will begin to make the strides that are necessary to get rid of this terrible disease, one that we should not still have and that is curable—one that is get-riddable. We need to do that and we need to do it now.

It is a pleasure to serve under your chairmanship today, Sir Christopher.

I congratulate the right hon. Member for Arundel and South Downs (Nick Herbert) on securing this important debate, but more importantly I congratulate him on his strong and consistent leadership and on the work of the all-party parliamentary group on global tuberculosis.

I declare a relevant interest. I visited Liberia with RESULTS UK in 2017 to look at its post-Ebola healthcare system strengthening. My hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) was part of that delegation and I understand, Sir Christopher, that if he catches your eye he will say a little more about what we learned.

Goal No. 3 of the sustainable development goals is good health and wellbeing. It commits the world to bringing about an end to TB by 2030. We know that, given the current rate of progress, we will miss that target by 150 years. As the right hon. Gentleman said, the UN high-level meeting on TB political declaration includes a commitment to find and treat 40 million people with TB by 2022. If we are going to do that, we not only need to diagnose but to successfully treat 8.5 million people this year, which is 2 million more people than were officially diagnosed in 2017.

As we have heard, later this year we have the sixth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is a critical opportunity to mobilise efforts to build stronger and more resilient health systems. The Global Fund is an incredibly important mechanism for donors, recipient countries, civil society and the private sector to come together in response to these epidemics. Since it was founded in 2002, the Global Fund has helped to save over 27 million lives and that is in no small part due to the generous involvement of the United Kingdom.

Almost a fifth of Global Fund annual funding goes to fighting TB—as the right hon. Gentleman reminded us, that is 70% of all of the international financing that exists to fight tuberculosis. The UK played a leading role during the last replenishment cycle, but if we are going to close the gap in the finance that is required to meet the targets that have already been described, all donors—including the UK—need to step up their financial commitment to the Global Fund.

As the right hon. Gentleman said, drug resistance has complicated the fight against TB, as it has the fight against other diseases. TB is a curable disease, but it requires strict, continuous treatment with a number of antibiotics over many months. As others have said, TB is now responsible for one in three deaths worldwide from drug resistance. If we do not step up our global efforts, we risk a resurgence in the incidence of TB, which could have a catastrophic impact on public health and the global economy.

The theme of the global goals is to leave no one behind, and addressing a health emergency is central to that. I reiterate to the Minister what others have said: we have an extraordinary opportunity. UK civil society has said that we want to step up in commitment. It has called on the British Government to pledge £1.4 billion to the Global Fund’s vital work over the next three years. I hope the Minister will respond positively on the UK’s continued commitment to tackling deadly diseases.

As we have heard, accountability is central. It involves working with civil society, working with citizens in the countries that are most affected and working with the key multilaterals—the World Bank, the United Nations and the Stop TB Partnership—so that we have a comprehensive plan that brings to an end tuberculosis by the target date of 2030. I hope the Minister will demonstrate once again the strong and clear leadership that is needed, so that we rise to the challenge in the months ahead.

I thank the right hon. Member for Arundel and South Downs (Nick Herbert) for securing this important debate. Many things have been said already; I will come on to the topic of my trip with RESULTS UK, on which I was accompanied by my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) and which appears in my entry in the Register of Members’ Financial Interests.

During my introduction to this speech, one person has died from TB. Some 18 seconds will pass until another person dies from TB somewhere around the world. In the UK alone, someone will be infected with TB every two hours, and in 2016 there were more than 6,000 cases in the UK. However, very few people die from TB in the UK, because treatment is available. The real challenge is that 99% of tuberculosis deaths occur in developing countries. As we have heard, it is a disease of poverty. That is partly because of TB’s intersection with other major issues, and particularly with compounding health conditions. It remains one of the biggest causes of death worldwide.

The sustainable development goals say that we should try to tackle this condition in the next period, but at the current rate, we will have to wait 160 years to eradicate TB and save 28 million lives. Those lives will be lost if we do not pick up the pace. Working to end tuberculosis means that we must engage with civil society and communities, and in particular work with high-risk groups and other people who are especially vulnerable. Most importantly, we must ensure there are universal, free-to-access health services, which are the best way—almost the only way—of tackling TB.

In 2017, my hon. Friend the Member for Liverpool, West Derby and I went to Liberia to examine its response to tuberculosis, particularly drug-resistant tuberculosis, which now accounts for a third of all tuberculosis deaths. Let us be clear: there is a treatment for drug-resistant tuberculosis, but the side effects are gruelling. It is a two-year course of medicine, with a success rate of only 50%. A person is likely to experience chronic nausea, psychosis, and painful blistering on almost all of their limbs, which they may scratch, causing further infection. They face the permanent loss of hearing in one ear, or maybe both, and after enduring that treatment they still only have a 50% chance of survival. The real problem is that the side effects of those drugs are so awful—reading out that list does not show how awful they are. If a person is experiencing psychosis, painful blisters all over their body and nausea, they are unlikely to complete their course of treatment, and that was the case for the vast majority of people we saw. They are sent back out into the community for the disease to spread.

We also saw a GeneXpert machine being used to test samples taken from people who came into hospital. The machine can be used instead of a microscope to examine a sample to see whether a person is drug resistant, and they can be treated immediately. The problem is that the machine costs $20 per person to use. Although it was in use in Monrovia, the capital, when we went out to the county hospitals we saw that it was rarely, if ever, used. We saw the machine packed away in a cupboard, not plugged in and not being used, because $20 per test is too high a cost. Instead of using the machine, those hospitals would do a traditional microscope test—through which it is not possible to tell whether someone has drug resistance—work out that a person had TB, give them the normal drug and send them back into the community for a few weeks. If there was no improvement, the person would be brought back in for the GeneXpert machine test. The problem is that over that time, drug resistance has spread, family members have got it and the cost has increased. Without early detection and treatment, more people will have to undergo the two-year regime that I have described. More people will drop out, and more people will suffer needlessly.

Drug-resistant TB is a battle, and if it is lost in the developing world, it is only a matter of time before drug resistance reaches these shores. We will suffer, and we will struggle to deal with it just as much, because no British person will willingly suffer those side effects. We need immediate action on pharmaceutical development to find decent drugs that do not cause such side effects, but we also need to nip the problem in the bud. As we have heard, the UK has been one of the biggest backers of the Global Fund, but it needs replenishment, and it needs it now. I hope the Minister will commit to redoubling the UK’s funding.

In 2015, among people in whom non-drug resistant tuberculosis was detected, reported and treated, 80% were successfully cured. This fight can be won, but we must reach out to those vulnerable groups, fund research and ensure that everyone can access good, universal healthcare that is free at the point of delivery to eradicate this condition once and for all.

It is a pleasure to speak in this debate. I thank the right hon. Member for Arundel and South Downs (Nick Herbert) for bringing this issue before the House, and the Speaker’s Office for allowing me to speak on it.

The issue is close to my heart. It is no secret in the House or in my constituency that I tend to get emotional when it comes to disease, and the effects of TB and HIV on children. I have had some contact with groups that fight against those diseases across the world. Images of children dying are a large part of why I am and have always been an advocate of overseas aid, although I believe we must be more stringent in ensuring that such aid is effective, and that perpetrators do not benefit from any aid that we send. My heart aches sorely when I think of children dying from a disease that is completely curable, as the right hon. Gentleman said in his introduction. It is a pity that this disease persists despite the fact that a cure is achievable and should be accessible. I wonder what we can do to stop children dying from that disease.

As a member of the all-party parliamentary group on HIV and AIDS, I am grateful for the briefing that has been provided, which is both informative and heartbreaking: informative because it gives us the background, but heartbreaking because it emphasises the issues that we all know. TB is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person—when we sneeze, we often wonder how far a sneeze would go if we did not put our hand over our mouth or sneeze into a hankie. TB is a serious condition, but it can be cured with proper treatment, and we can clearly do something and make a change. We should be doing more, if at all possible, although I recognise that our Government and the Minister, in particular, have taken great steps to address TB.

TB can affect any part of the body, including the glands, the bones and the nervous system. In 2017, there were some 10 million cases of TB worldwide; it is the top infectious killer, claiming some 4,400 lives a day. It is an incredible disease that strikes those who are vulnerable and weak.

TB occurs in many parts of the world. In 2017, the largest number of new TB cases occurred in south-east Asia and the western Pacific regions, which had 62% of new cases, followed by the African region, which had 25% of new cases. I want to speak a wee bit about Africa, because that is where my knowledge comes from. In 2017, 1.6 million people died of TB and 95% of those deaths occurred in low or middle-income countries. As the right hon. Member for Arundel and South Downs said, those on low incomes are recipients of the disease. It simply makes my heart ache. There is no need for anyone to die of TB any more, if early prevention and medication are available. I say this gently, but there is no excuse for those deaths.

It is clear that TB disproportionately impacts hard-to-reach groups, including people who use drugs, prisoners and people living with HIV. Challenge Ministries NI, which is from my constituency, does a lot of work in Swaziland in Africa. Every year, the children from that school and hospital in Swaziland come to Northern Ireland —they are sponsored to do so—as part of an outreach project. That is one of their ways of creating some income to take back home. Every child in that choir is HIV-positive, in many cases from abuse or directly from their mother’s womb. I can clearly see what our Government have done with some of their work on HIV/AIDS and the cure. A short time ago, I met some people from the HIV/AIDS group, and they put me in contact with some other groups. I hope we can do more work in Swaziland and Zimbabwe, where they are now working.

I am conscious of time, so I will work towards a conclusion. Swaziland is a little country where almost one in every two people has AIDS. A hospice inside the orphanage is staffed by voluntary nursing staff from the UK. The end result of an HIV diagnosis is often that TB is the killer. TB is the killer of those with complex needs. That matches the figures, which show that TB is the leading cause of death for people living with AIDS, accounting for one third of deaths. In 2017, 300,000 people died from TB and 920,000 people living with AIDS fell ill with TB. It is colossally hard to encapsulate in the numbers how many people are dying. We see young people who have had the TB vaccine and been cured. When I see them singing lustily in concerts in the churches in my constituency, I see practically what we can do if we get in there early. That is what the right hon. Gentleman said in his introduction, and it is why I am totally committed to making the changes we wish to see.

In 2017, 49% of all people with HIV-associated TB did not reach care, according to the data. The World Health Organisation referred to the African region, where the burden of HIV-associated TB is the highest. I see that in the missions in my constituency that work in Swaziland, Zimbabwe and other countries.

I will quickly finish in the time that the Chair has indicated to me. Will the Minister tell us whether there is an intention to step up the financial commitment in the upcoming sixth replenishment conference scheduled for October? As the right hon. Gentleman said, it is important to do that now and then work towards October to try to make it happen. We can and must provide a better response if we are to meet our achievable, yet slightly out-of-reach goal of eradicating TB by 2030. If we can do it—I believe we can—we need to do it together with other nations and use any influence we have to remind them of their international duty to ensure that no child in the world ever dies from this terrible disease.

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the right hon. Member for Arundel and South Downs (Nick Herbert) for securing this important debate. He spoke with conviction, passion and urgency and I think we all agree that it is ridiculous that we are having to debate something that is curable and treatable and that we all agree needs to be resolved.

In 1882, when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the disease killed one in every seven people living in the United States and Europe. Today, TB is a treatable and curable disease, yet it is still one of the leading causes of death worldwide. Shockingly, one quarter of the world’s population is estimated to be infected by latent TB. Ten million people fall ill with the disease annually, and it caused 1.6 million deaths in 2017 alone. To put that in perspective, that is 30% of Scotland’s entire population. The people most likely to die of tuberculosis are the poorest and most vulnerable throughout the world. In 2017, there were fewer than 10 new cases per 100,000 of population in most high-income countries.

In contrast, however, 30 countries—primarily in the global south—account for 87% of the world’s TB cases. Countries such as Mozambique, the Philippines and South Africa have more than 500 new cases per 100,000 of their population. I remind everyone in this debate that tuberculosis is preventable, treatable and curable. There is some good news: more than 60 million lives have been saved since 2000 alone, and we have the power to end tuberculosis in our lifetime. However, that can happen only if the Government take seriously the need for international development funding to rid the world of TB.

I have deep concerns about the former Foreign Secretary’s call a couple of weeks ago to change the purpose of the Department for International Development from poverty reduction to furthering

“the nation’s overall strategic goals”.

The Department must remain absolutely dedicated to its mission of helping the world’s most vulnerable people. That is how we keep the faith with the public and their kind generosity.

The sustainable development goals agreed by world leaders in 2015 have a target to end TB by 2030. We have heard about that already today. However, if the global mortality rate for tuberculosis continues to fall at the current level, tuberculosis will not be beaten in 10, 20 or 50 years, but in 160 years. We are failing people globally on TB. We must work to combat that, and the UK Government can make a significant contribution to the fight against TB with aid funding aimed at tackling poverty and inequality globally, rather than aid viewed through the prism of national and commercial interest.

The first ever UN General Assembly high-level meeting on tuberculosis in September endorsed a declaration that committed to finding and treating 40 million people with TB by 2022 and mobilising increased funding for TB programmes and research. Without significant progress on TB prevention, diagnosis and treatment, we will not reach the UN high-level meeting commitments or the SDGs, both of which the UK signed up for. The Global Fund, which provides 70% of all international financing for TB programmes, is asking donors to step up their investments and, in addition, is asking the UK Government to pledge £1.4 billion at the forthcoming replenishment conference. May I ask the Minister, as everyone else has, whether the Government will commit to the full funding and ensure that world leaders are held to account on delivering the UN high-level meeting political declaration? I hope to hear that shortly.

In Scotland, our universities have been at the forefront of research into tuberculosis. The University of Dundee in my constituency has collaborated with the University of Cape Town and the pharmaceuticals division of Bayer to develop new treatments, while research published by the University of St Andrews—just over the River Tay from where I am—outlining new methods to diagnose and treat undetected TB was hailed as a “game changer”. The Scottish Government have increased their international development fund to £10 million a year to tackle global challenges including epidemics and health inequalities. As part of Scotland’s global goals partnership agreement with Malawi, it has pledged to strengthen the prevention and management of infectious diseases such as malaria, TB and HIV/AIDS.

There is a direct link between TB and HIV in that TB is the leading killer of HIV-positive people and causes approximately one in four deaths among those who are HIV-positive. People infected with HIV are up to 30 times more likely to develop active TB, and the World Health Organisation has recommended implementing collaborative TB-HIV activities to tackle that. Given the devastating impact that tuberculosis can have on those with HIV, will the UK Government use their influence to ensure that TB programmes and research are similarly prioritised and appropriately funded to meet the global ambition of eliminating tuberculosis altogether?

Finally, while tuberculosis is no longer as prevalent as it was when Dr Koch discovered its cause in 1882, it remains—tragically and ridiculously—an epidemic across the globe. We have to remind ourselves that it is treatable. World TB Day needs to be constantly in our consciousness, and we need to make TB synonymous with the past. We need to eradicate it with the same targeted focus and precision that were brought to polio and smallpox.

It is a pleasure to serve under your chairmanship, Sir Christopher. I, too, thank the right hon. Member for Arundel and South Downs (Nick Herbert) for not only securing the debate, but providing me with my first opportunity to respond from the Front Bench. He is very passionate about this topic, and that passion has been reflected in the contributions of every Member this afternoon.

Last week, along with many colleagues present in the Chamber, I attended an event in Speaker’s House on ending tuberculosis, where I was deeply moved by the impassioned words of Emily Wise, a doctor who had been on the front line of the battle against TB, working with Médecins Sans Frontières in Uzbekistan. She spoke of her trauma as she watched a patient die, and her anger at the fact that, as a doctor, she was unable to save her. The patient did not die for medical reasons; she did not die because Emily did not know how to save her, or because TB is incurable. Let me repeat Emily’s professional diagnosis of why her patient died. She said:

“In this modern age, all deaths from TB boil down to a lack of commitment from the international political community and the pharmaceutical industry to address this disease.”

Her message is clear: as politicians, we must do more. We have to step up to the challenge of ending the world’s deadliest infectious disease, and it is entirely within our reach to do so.

Sunday marked World TB Day: an occasion to remind ourselves of where we are in the fight to end TB. It has been curable for more than 50 years, yet in 2017 it killed 1.6 million people, and there were 10 million new infections, of which 3.6 million were never officially diagnosed or treated. It is a disease of inequality, with the poorest most at risk, and 95% of the deaths occur in low and middle-income countries. Here at home, the poorest 10% of people are at a seven times higher risk of contracting TB. According to the World Health Organisation, at the current rate of progress we will fail to reach the global goal of ending TB by 2030.

I am hopeful that the world might be beginning to wake up to that severe injustice. As we heard, last September the first UN high-level meeting on TB took place. Governments committed to significant investment for programmes and research. The meeting was clearly a step in the right direction, but we must now accelerate progress. We know that in order to effectively diagnose and treat TB, countries need a strong public health system. My hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) made that point very strongly.

In the UK, 81% of people who contract TB fully recover, thanks to our wonderful national health service. Does the Minister agree that the Department for International Development ought to focus on building strong public services, so that people’s right to access healthcare is not based on their ability to pay? Of course, getting people the treatment that they need also requires international funding. That is why we must ensure that the Global Fund is fully resourced and I, too, encourage the Government to make a commitment to increase the UK’s contribution to it.

Finally, let me address the issue of access to medicines. In all countries, there are now TB strains that are resistant to at least some of the treatments available. In recent years, new, highly effective medicines for multi-drug-resistant TB have been approved, but they are reaching only 5% of the people who need them. Among the barriers to access, affordability is a major concern—[Interruption.] Not now, please.

That lack of affordability is despite huge public investment from the UK and other sources into one of the drugs: bedaquiline. We have a crisis in the research and development system for medicines. I therefore ask the Minister whether DFID will commit to working with other Government Departments, and partners globally, to revisit the system of exclusive intellectual property rights that prevents drugs from getting to those who need them the most.

Parliamentarians last discussed TB nine months ago. It seems that not an awful lot has changed. I hope that when we are next together, we can reflect on more progress.

It is a pleasure to serve under your chairmanship, Sir Christopher. [Interruption.] If only you could stop the noise outside, we would not be quite so distracted. I pay tribute to my right hon. Friend the Member for Arundel and South Downs (Nick Herbert), whose leadership on this issue is absolutely remarkable. Not only does he co-chair the all-party parliamentary group with the hon. Member for Scunthorpe (Nic Dakin), but he shows leadership globally, in the Global TB Caucus. His contribution to the recent Lancet Commission report on building a tuberculosis-free world was also incredibly valuable.

It is a real honour for me to respond to the debate. I wish to pay tribute on the record to my former ministerial colleague, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who would have responded to the debate. I assure colleagues that I will pick up where he left off in championing this cause.

We heard a really passionate case from my right hon. Friend the Member for Arundel and South Downs on why we need not only to mark World TB Day with debates such as today’s, but to keep sustained momentum behind the progress that the world has made. I am always a sunny optimist, and I like to see that progress. Some 53 million lives have been saved since 2000, and there has been a 37% reduction in mortality. We heard from the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about the progress in the UK and our 2015 strategy. Our wonderful NHS is making tremendous progress, and we are now at a 30-year low, but I acknowledge that there is still more to do, and we have heard powerful speeches arguing that. A range of points were raised, and I will try to address them all in the few moments that are left.

The importance of the work that was done with the declaration cannot be underestimated, because it is a forum where the whole world can come together and make commitments. The UK was proud to lead the work behind the declaration at the UN. The importance of the work on missing cases also cannot be overemphasised. Some of the Global Fund work has supported finding those missing cases. Each missing person can infect another 15 people through not being diagnosed or treated. So far, out of 1.5 million missing cases, 450,000 have been found.

I heard the call from my right hon. Friend the Member for Arundel and South Downs for strong accountability mechanisms. The UN is a very good forum for that. We want to ensure that money is spent on frontline treatment, and that any accountability mechanism adds value by working with the grain of what is already there, making best use of existing mechanisms, and is proportionate.

We should also note that there has been further progress since last year’s debate. We should put on the record the fact that the M72 vaccine seems to be showing promising early results. The UK spends a significant amount—I think it is £12.7 million every year—on research. It is important to co-ordinate research globally, and the World Health Organisation is the right organisation to do that. I assure colleagues that the UK will remain at the forefront as a leader, and that we will take part in the replenishment. I cannot, however, announce exactly how much it will be; obviously, we will wait until October to do that.

The hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) spoke powerfully about the side-effects and the treatment that he witnessed at first hand in Liberia, and we heard a range of other powerful speeches. I welcome the hon. Member for Nottingham North (Alex Norris) to the Front Bench; he did fantastically in his first outing in that role. I also recognise the call for leadership made by the hon. Member for Liverpool, West Derby (Stephen Twigg) and note the strong links between the work done in Eswatini and the work that the hon. Member for Strangford (Jim Shannon) sees in his constituency in Northern Ireland. I pay tribute to the Scottish research tradition, which goes back 100 years, and to the contribution that the Scottish Government make to this work.

I am not sure how much time I have to sum up, but the UK can be proud of being the third largest donor to the Global Fund, which managed to reach 5 million people in 2017 alone. I do not have the figures for 2018, but that is a significant impact. The Global Fund is also very important in terms of research, and of course where we have strong bilateral relationships—particularly in DFID countries—it combines with the work we do to strengthen health systems in those counties. The Global Fund also fits in with DFID’s wider work to reduce poverty and improve access to services in some very hard-to-reach places.

I am proud that the UK is the second largest donor to the current replenishment of the Global Fund. Colleagues have recognised the £1.2 billion that we have contributed since 2017, and we are the first and only country in the world to have enshrined in law our overseas development assistance contribution of 0.7% every year. We will announce our replenishment in October, but we will continue to support the fund in its remarkable and successful work of reducing the burden not only of TB, but—as hon. Members have noted—of HIV and malaria in the world’s poorest countries. The fund is central to efforts to tackle TB, but we need to link that to strengthening health systems in countries where DFID has a strong bilateral programme. We will certainly be playing our part.

We continue our strong tradition, which goes back more than a century, of being involved in research and development as one of the largest funders of tuberculosis research worldwide. Several colleagues spoke about research by drug companies. We are a leading supporter of product development partnerships, which are a mechanism to incentivise the pharmaceutical industry and academia to develop new therapies and diagnostics so that the intellectual property can be fairly distributed. As part of that effort, we are investing £37.5 million in the TB Alliance for the development of new drug regimens, particularly where current treatments are failing because of antimicrobial resistance—a point that was raised several times in this debate.

The challenges that the world still needs to overcome include antimicrobial resistance, ensuring that the most vulnerable and disadvantaged can benefit from care, and the complexities of patients who have both HIV and TB. We have heard the shocking statistic that antimicrobial resistance is now responsible for more than 700,000 deaths a year, of which drug-resistant TB accounts for a third. In response to that challenge, we are leading the work to bring new effective antibiotics to market, funding the development of new treatment combinations for resistant TB, and investing in new ways to rapidly test for drug resistance; it was interesting to hear the anecdote told by the hon. Member for Brighton, Kemptown about the cost of the GeneXpert machine, which is clearly something that we all need to think about. Since 2002, the Global Fund has provided financial support to implement multi-drug-resistant TB diagnosis and treatment in 25 of the 27 most affected countries.

One of the most challenging aspects of TB is the difficulty of finding some of the people affected. If we are to meet our sustainable development goals, we will need to sustain our efforts to find the missing 1.5 million. The likelihood of progression to active TB infection can be reduced if TB is detected and treated early in people who are HIV-positive, so we are actively working on programmes to identify such cases and respond appropriately.

There are clearly a range of challenges, and sustained action will be needed. I welcome the support that colleagues have shown for the international policy dimension, the leadership on research, and the strong bilateral partnerships on health, particularly in DFID’s focus countries. It is clear that progress has been made, but that it needs to be stepped up. We have heard the request for the replenishment of the Global Fund and will closely analyse what the UK can do and what other donor countries will be doing.

This debate has been extremely important in highlighting the issue, and I pay tribute again to the all-party group and its chairs for their leadership. I assure my right hon. Friend the Member for Arundel and South Downs that the UK Government will continue, both at the UN and with our allies in DFID’s priority countries and around the world, to step up our impact and resolve the many issues raised today.

I am grateful for the Minister’s response, which reiterated the UK Government’s commitment. I thank all hon. Members for their contributions today and for their commitment to beating this terrible disease. I reiterate that the UK has a leadership position, and this year we can show it by replenishing the Global Fund, pressing for independent accountability and trying to achieve better co-ordination for research and development. Yes, we have made progress, but there is more to do. The UK needs to continue to show the necessary leadership to beat this terrible disease.

Question put and agreed to.


That this House has considered World TB Day and the efforts to end tuberculosis globally.

Sitting adjourned.