Skip to main content

Westminster Hall

Volume 711: debated on Thursday 24 March 2022

Westminster Hall

Thursday 24 March 2022

[Mrs Sheryll Murray in the Chair]


World Tuberculosis Day

I beg to move,

That this House has considered World TB Day 2022.

It is a pleasure to serve under your chairmanship—if I can use the term—again, Mrs Murray. I am delighted that we have been granted a debate for World Tuberculosis Day on World Tuberculosis Day itself. In that light, I declare my interest as chair of the all-party parliamentary group on global tuberculosis. I am gratified by the presence of Members who have chosen to join us to share their thoughts on this important day.

Before covid-19, TB held the dishonour of being the world’s deadliest infectious disease, with 10 million cases and 1.5 million deaths in 2020 alone. The situation has deteriorated further over the past two years, with the Stop TB Partnership suggesting that the fight to eradicate TB has been set back by more than 12 years. As we emerge from the covid pandemic, we should put the lessons learned over the past two years to work in order to finally eradicate TB.

TB is one of humanity’s oldest diseases. It is caused by bacteria and most often affects the lungs, but can also spread to other parts of the body. TB is spread from person to person through air droplets, and most people infected with TB show no symptoms at all. It is a disease of poverty, found in areas with low-quality housing, poor access to healthcare, overcrowded communities and high pollution. It does not just affect one part of the world or one group of people but can be found in virtually every corner of the planet. In higher-income countries, TB is more commonly found in migrant communities, among people with alcohol, drug or mental health issues, in homeless communities, or among people with a history of incarceration. Most TB cases in England are found in London and the south-east, and on the whole TB remains concentrated in urban areas. In any given year, London accounts for an average of 35% of TB cases in England.

One of the most frustrating aspects of the fight against TB is that we have medicines and vaccines that mean that TB is entirely preventable, and is for the most part curable. That said, many of the tools at our disposal are woefully out of date. For instance, the one TB vaccine that exists, the Bacillus Calmette–Guérin vaccine, celebrated its 100th anniversary last year. Decades of chronic under- funding for TB medicines and research and development mean that we do not have the most up-to-date tools and diagnostics that would enable us to deal more effectively with the threat of TB. That threat is compounded by the rise of drug-resistant and multi-drug-resistant TB—that is, strains of TB that cannot be treated using even the most potent TB drugs. Antimicrobial-resistant TB occurs when people do not take medicines correctly or break from their treatments early. Treating AMR TB is both incredibly complicated and very costly: according to the TB Alliance, someone with AMR TB will have to take as many as 14,000 pills over two years as part of their course of treatment. The O’Neill review found that by 2050 up to 10 million deaths might be associated with drug resistance each year. Around a quarter of these will come from drug-resistant strains of TB.

Domestically, the UK has a positive story to tell on TB. Between 1980 and 2012, the UK saw a near 2% increase in its TB burden year on year; since 2012, the UK has seen a 44% reduction in the number of people who test positive for TB each year, with 2020 seeing the lowest ever recorded incidence rate in England. It should be noted that 2020 was the first year of covid restrictions, which would have had a significant impact on the reduction in TB transmission that year.

TB is much more prevalent in people who are born outside the UK compared with those born in the UK. Between 2018 and 2020, 72.7% of confirmed cases were in people born outside the UK. The rate of TB is 15 times higher for people born outside the UK. These people do not come to the UK with TB, and there is considerable variation by country of birth in the median time between a person’s first entry into the UK and the time of their TB notification. The data suggests that people come to the UK free of TB, but due to poor living conditions and lack of support from the Government, they develop it over time. As I said, TB is a disease of poverty. In the UK, it is most common in more deprived communities and those with social risk factors. I ask the Minister: what more can the Government do to tackle the social determinants and key risk factors that increase the likelihood of someone contracting TB?

The APPG on global tuberculosis led calls for the Government to develop a domestic TB strategy. In 2019, we held an inquiry to examine the success of the Government’s approach. The collaborative TB strategy for England was widely praised by stakeholders for helping to reduce incidence in England by 29%. However, the APPG made a number of recommendations, including to strengthen awareness-raising activities for healthcare workers, secure more BCG vaccines and begin the development of a new strategy.

In 2021 the Government released their TB action plan for England, which outlined five priority areas for the Government, with the recovery from the covid pandemic the highest priority. As the strategy is in its early days, the APPG for global tuberculosis will continue to monitor its implementation and ambition to ensure that TB levels continue to drop in the UK.

Although the domestic situation is better, internationally we are miles behind where we need to be. In 1993, the World Health Organisation elevated TB to the level of “global emergency”, marking the first time that an infectious disease had been given that distinction. At the time, the WHO noted that TB kills more adults each year than any other infectious disease—more than AIDS, diarrhoea, malaria and other tropical diseases combined. Never in the history of medicine has one disease caused so many deaths yet remained so invisible. While the global outlook for TB has improved since 1993, many of the same underlying issues continue to affect the fight to eradicate it in 2022.

Even before the outbreak of covid-19, the international community was seriously off target to meet the goals set out at the 2018 United Nations high-level meeting or those set out in the sustainable development goals. SDG 3.3 calls for the international community to eradicate TB globally by 2030, yet at the current pace it will take more than a hundred years for that feat to be achieved. The WHO’s 2020 TB report—the last report before the covid-19 pandemic—highlighted just how far behind the international community was on its targets. For instance, the international community set the target of reducing TB incidence by 20%, between 2015 and 2020, but achieved only a 9% reduction during that period. There was a target to reduce the number of TB deaths by 35% during the same period, but we have seen only a 14% reduction. In the coming years, as the full impact of the covid pandemic is felt around the world, we expect the numbers to rise significantly.

Between 2019 and 2020, the number of people diagnosed with TB globally fell by 18%. Although that may seem like a positive development, we must approach it with caution. We know that the TB burden has not decreased, so a decrease in the number of positive tests suggests there are even more people with TB who do not know they have it. In the same period, the number of people treated for drug-resistant TB and TB-preventative treatments went down 15% and 21% respectively. The similarities between covid and TB meant that at the outset of the pandemic, many TB services were repurposed to deal with the emerging pandemic. Between June 2020 and August 2020, the Global Fund’s TB programmes experienced “very high” disruption as a consequence of covid. By May 2021, TB services delivered by the Global Fund were the most disrupted of the three diseases it works directly with.

The fight against global TB suffers from chronic underfunding. Between 2019 and 2020, global spending on TB diagnostics, treatments and prevention services fell by 5%. Even with that reduction, global spending on TB in 2019 was less than half of what was needed to make meaningful change in the fight to eradicate TB. The 2021 G-FINDER report showed that global investment in TB research and development totalled $684 million, down by $33 million—4.6%—from its record high in 2019. However, the Stop TB Partnership estimates that $2.16 billion is required annually to develop and deliver new tools, such as diagnostics, vaccines and medicines, that can end the TB epidemic.

The United Nations will host the next UN high-level meeting on TB in 2023. It is highly unlikely that between now and then, the international community will be able to meet the ambitious TB targets it has set itself. That meeting must serve as a rallying call for the world to act to eradicate TB before the end of the decade. To achieve this, we need more money for innovative TB vaccines, medicines and diagnostic tools. It is time for the international community to put its money where its mouth is in the fight to eradicate TB globally. I ask the Minister, in advance of the UN high-level meeting, what more can the UK Government do to regain momentum towards achieving the TB targets set out in the UNHLM and the SDGs?

The UK provides no bilateral official development assistance funding for TB. Instead, the Government work through multilaterals, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Historically, the UK is the third largest sovereign donor to the Global Fund, providing over £1.4 billion to the fund since 2002. The Global Fund is the world’s largest financier of TB prevention, diagnostic and treatment programmes, accounting for 77% of all TB financing globally. The Global Fund invests more than $4 billion each year to support programmes run by local experts in more than 100 countries. By its own estimate, the work of that innovative multilateral has saved more than 44 million lives since 2002 and it has overseen a 46% reduction in the number of deaths from AIDS, TB and malaria in the countries in which it operates.

In September this year, the Global Fund will host its seventh replenishment conference in the United States. The final pledged amount at the conference will fund the Global Fund’s work over the next three years. It is vital that the Global Fund is generously replenished so that we can regain the ground and momentum lost in the previous two years. According to the Global Fund, the impact of the pandemic has led to a 33% increase in the global AIDS, TB and malaria burden.

In our report released earlier today, the APPG on global tuberculosis calls on the UK Government to increase our pledge in line with the increase in the global burden. The UK can and should play a leading role in the replenishment process by bringing together our friends and partners around the world to commit generously and showing that we remain a leader in the global health field. Will the Minister outline what more the UK Government can do to ensure that our allies and partners around the world contribute generously to the next replenishment of the Global Fund?

In November 2020, the Chancellor of the Exchequer announced that the Government would no longer spend the statutory 0.7% of gross national income on official development assistance. The decision amounted to a £4.5 billion reduction in the UK’s ODA budget, although the full impact of the cuts is yet to be recognised. I must declare my interest: I am also a member of the International Development Committee, so I am wearing the hats of two bodies.

In 2020, the APPG wrote to the then Foreign Secretary, the right hon. Member for Esher and Walton (Dominic Raab), highlighting that any cuts to the UK’s aid budget would have a significant impact on global health research, severely limiting international public-private partnerships that have been developing new and innovative medicines to tackle the world’s deadliest infectious diseases. Not only does the cut to the ODA budget threaten future research and development funding, but it jeopardises research capacity built up over a decade. The Government must commit to the restoration of the UK’s R&D funding on global health issues so that the UK can remain a leader in developing the tools that will bring an end to deadly epidemics.

The APPG on global TB’s most recent report called for the Government to commit at least 5% of ODA to research, and to ensure spending for TB research does not fall below the 0.1% of gross domestic expenditure on research and development between 2020 and 2025. Will the Government commit to restoring TB R&D funding so that the UK can remain a leader in developing the tools necessary to end the TB epidemic? In November 2021, the Chancellor of the Exchequer announced that the Government are to invest £20 billion in R&D funding by 2024-25. The Government should commit a sizeable portion of that funding to the development of new diagnostic tools and vaccines for the fight to eradicate global TB. How much of the £20 billion committed to R&D in the autumn spending review will be used to end TB epidemics?

In the last few days there have been concerning reports in The Daily Telegraph and Devex that the Foreign Secretary is planning to make substantial cuts to health, humanitarian aid and climate change ODA spending. I share the sentiments of the Chair of the International Development Committee, who called this potential move “illogical”. Does the Minister agree that if the UK is to remain a respected leader and a reliable partner in the global health community, the Foreign, Commonwealth and Development Office and the Foreign Secretary must not reduce their ODA health spending?

I want to briefly mention the situation in Ukraine and its implications for the fight against global TB. Ukraine has one of the highest drug-resistant TB burdens in the world, with nearly one third of all new TB infections there having some level of resistance. Some 22% of Ukrainians who contract TB also have an HIV co-infection, and TB is the leading cause of death among Ukrainians living with HIV. The Global Fund has been providing drug procurement facilities in Ukraine since the Russian invasion. It released $30 million in emergency funding, including $15 million to support the continuity of HIV and TB prevention, testing and treatment services in Ukraine. Peter Sands, executive director of the Global Fund, has said:

“We are extremely alarmed by the devastating effects on peoples’ lives in Ukraine. Ensuring patients affected by the conflict can continue to access prevention and treatment services is our immediate priority.”

The UK has played a leading international role throughout the Russian invasion of Ukraine. What additional humanitarian support can the UK offer Ukraine to ensure that the war does not lead to a significant rise in TB or HIV in the country?

TB remains a global killer, but it is almost unrecognised, except where it blights lives. In my years of political activism, I have seen Governments commit multiple times to ending TB. I have heard warm words of concern, but they fall by the wayside as Ministers change—I hope that will not happen here—and new fashions rise and fall. I hope we can finally be the Parliament that gets a grip on global TB and acts for the good of all.

It is a pleasure to speak in this debate. I congratulate the hon. Member for Ealing, Southall (Mr Sharma) for setting the scene extremely well. He has been incredibly helpful with the information he has provided. I have spoken on this subject on a number of occasions in Westminster Hall. The former Member for Stafford, Jeremy Lefroy—he was your colleague, Mrs Murray, and you will remember him—used to bring this issue up, and he always reminded us that TB, while a terrible disease, is in many cases complicated by a combination of HIV and malaria. Again, I support the hon. Member for Ealing, Southall in highlighting this matter, and I ask the Minister to give us an idea of how we can respond in a way that addresses some of the issues.

When I was a child, which was not yesterday, I remember hearing the dreaded—in those days—diagnosis of TB. Yet, when I asked my aide, who seeks out the information for my speeches, to prepare the notes for this debate, her first reaction was, “Surely TB is extinct. It’s no longer an issue—they don’t even give the BCG anymore.” Maybe we need to be more aware of the data the hon. Gentleman referred to; some of the information in the APPG’s report illustrates the importance of this issue. The data is there, and it did not take my aide long to learn that she could not be more wrong. The fact that the younger generation believes there is no such thing as TB anymore does not bode well.

The purpose of this debate is to highlight the issue of TB in the countries where it is a severe killer. The disease is rampant in some parts of the world, and the hon. Gentleman helpfully reminded us that there are rising numbers of TB cases in the United Kingdom as well.

The data is clear. Between 2019 and 2020, there was a 9.2% increase in the number of deaths from TB, and the World Health Organisation predicted that the number of deaths would increase in both 2021—which they did—and 2022. During the same period, the number of people diagnosed with TB, according to the APPG’s report, dropped by 18%. Some 16 countries accounted for 93% of that reduction, suggesting that countries that already have a high TB burden have fared worse than others.

Covid has not been kind to any diagnostic data collection. Before covid, TB was known as the world’s deadliest disease, which it quite clearly is. The information in the APPG’s report refers back to when TB was more prevalent in a different century. Between 1980 and 2012, the UK saw a 1.9% increase in TB cases year on year. The number fell in 2018, but rose in 2019. I know it is not directly the Minister’s remit in the UK, but the debate is about TB, and perhaps she could give us some indication of what has been done to address TB in the United Kingdom to make sure it does not become rampant and a serious issue?

There is a TB action plan for England for 2021 to 2026. The Government have recognised that there is an issue, and it is clear they want to ensure that action can be taken and that we can play our part to ensure that TB does not become the problem it was in the past. We are looking to eliminate TB by 2035 across the world, which would be good.

Again, I am not sure this is a question the Minister can answer directly, and I am happy to have a response from her civil servants, who are always helpful. Have we any indication about TB in England? It is the responsibility of Ministers here, and it is a devolved matter in Scotland, Wales and Northern Ireland. Is it possible to find out if there is any indication of those figures for the regions?

The Centres for Disease Control and Prevention noted that in 2018 1.7 billion people were infected by TB bacteria, which is roughly—this is quite worrying—23% of the world’s population, and the disease claimed 1.5 million lives each year. It is clear where it is prevalent. It is a serious and deadly disease. Of the 10 million individuals who became ill with TB in 2018, approximately 3 million were missed by health systems and did not get the care they needed, allowing the disease to continue to be transmitted. I repeat the question asked by the hon. Member for Ealing, Southall: if those 3 million were missed, how can we ensure that others are not missed? We have to, first, raise awareness through this debate and, secondly, make sure we clearly address the issue of TB in parts of the world where it is most prevalent.

From looking at the information that we were sent beforehand, it is clear that there are parts of the world where TB is more prevalent—China, Pakistan, India, Bangladesh, Indonesia, the Philippines, Nigeria and South Africa. We in the all-party parliamentary group for international freedom of religion or belief hope to visit Nigeria at the end of May, so we will need to make sure we get all our inoculations and so on before we go. One of the things I want to speak about is those who travel from a missionary organisation in my constituency, which is very effective.

Statistics show that in 2020, there was an estimated total of 1.5 million TB-related deaths. Some 1.3 million of those were among HIV-negative people, up from 1.2 million in 2019—again, a worrying trend—and an additional 214,000 were among HIV-positive people. I referred earlier to a former Member, Jeremy Lefroy, who always spoke about three things: HIV, malaria and TB. People who have both TB and HIV when they die are internationally classified as having died from HIV; maybe the data needs to be corrected to ensure we have a fuller picture of what the issues are. The combined total is back to 2017 levels, and an estimated 230,000 children died of TB in 2019, including children with HIV- associated TB. Of those children, 194,000 were HIV-negative and 36,000 were HIV-positive. As most of us know, HIV/AIDS affects immune systems, so those infected with TB unfortunately have little defence against it.

In countries such as Eswatini—formerly Swaziland—where the AIDS incidence rate is one in four people, TB is a real and present danger. I have a particular interest in Eswatini because a church in my constituency, Elim church, has a very strong mission there. The church works in Eswatini, as well as in Zimbabwe, and it is confronted with these health issues all the time. It fundraises heavily to support those two countries—Eswatini in particular—and it sends money, drugs, food, and all the other help it can, which clearly makes a significant difference to the lives of the people out there. My constituency always supports those things, and the help its people give is vital.

A lot of work has been carried out by international bodies in the fight against TB. The incidence of TB in Eswatini has fallen gradually from 1,010 cases per 100,000 people in 2001 to 309 cases per 100,000 in 2020, so there has been some positive change as a result of the work of non-governmental and missionary organisations such as the Elim church mission, headquartered in Newtownards in my constituency. That is a victory we can all claim, and it must be replicated in the Congo, where the incidence rate sits at over 440 per 100,000. There are parts of the world that are not shown on the map in the report, so there are other places where there is work to be done. While I understand the rationale behind not vaccinating all our children, families who travel to these countries from Newtownards, for example, need to be aware that they face a risk and should consider getting vaccinated before they go. Obviously, we will also take note of that when we make our journey to Nigeria at the end of May, God willing.

As the hon. Member for Ealing, Southall referred to, we are now encountering drug-resistant TB. Maybe the Minister will be able to give us some indication of how she and our Government are partnering with the World Health Organisation to combat drug resistance. There has been a significant reduction in the number of people treated for drug-resistant TB and with TB-preventative treatments, which are down 15% and 21% respectively, so this is clearly a massive issue that needs more focus than it is currently receiving. We must fund more research into solving this difficult and worrying problem. I ask the Minister again, in a constructive and positive way, what extra moneys have been set aside for R&D to ensure that we can do these things?

I will conclude because I am looking forward to hearing from the shadow Minister, the hon. Member for West Ham (Ms Brown), and especially from the Minister. The shadow Minister takes a particular interest in this matter, and like me and the hon. Member for Ealing, Southall she wishes to see giant steps forward. We aim high with the purpose of trying to change things.

Giving the BCG vaccine to children has reduced TB, but that most certainly does not mean that the disease has gone away. I am thankful for having had the opportunity to highlight that, and to put it to the Minister that the gift of combating the disease lies in our United Kingdom of Great Britain and Northern Ireland and in other developed nations. Will we give that gift or will we choose to accept that we have only eight cases per 100,000 people and leave it there? I sincerely hope not.

I respectfully, honestly and beseechingly ask the Minister to assure every one of us of the steps that we are taking and will take in the near future to combat this dreadful disease. The document that the hon. Member for Ealing, Southall gave me beforehand refers to the Global Fund to Fight HIV, Tuberculosis and Malaria. That is a battle that we all have to fight together. I hope that we have done our part today to help in that battle to eradicate tuberculosis across the world. We in this House, in this great United Kingdom of Great Britain and Northern Ireland, must ensure that, through our Minister and our Government, we deliver for the people who need it. That is what our debates are always about: others.

It is an absolute pleasure to serve under your chairship, Mrs Murray. I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing the debate and for his excellent speech. May I say what a pleasure it is to follow the hon. Member for Strangford (Jim Shannon), whom I see in many of the debates I attend? It is a real joy to be here with both those Members, who are really nice, gentle men.

World TB Day is a reminder that this terrible sickness is thriving because of the poverty and inequality that persists in the UK and across our world. TB is deadly: in 2020, it killed 1.5 million people. However, TB is both preventable and curable. The UK, with international partners, has rightly committed to the achievable goal of finally ending the epidemic by 2030. I hope the Government will join the Labour party not only in recommitting to that goal, but in committing the resources necessary to achieve it.

Unfortunately, the goals in the World Health Organisation’s “End TB Strategy” are not even close to being met. We targeted a 20% reduction in incidence, but we have achieved just 11%. We targeted a 35% reduction in deaths, but they fell by only 9%. We aimed to reduce to zero, by 2020, the number of people who face catastrophic costs as a result of TB. Instead, almost half of all people who are infected with TB still deal with catastrophic costs. TB is a disease of poverty, and it keeps people in poverty worldwide.

The efforts of NGOs and many Governments have been powerful and have made a massive difference. The WHO estimates that 66 million lives were saved by TB treatment between 2000 and 2020—but it ain’t enough. The job is not nearly done, and recently, following covid, we have slipped backwards. Does the Minister believe that the sustainable development goal to end the TB epidemic by 2030 has a chance of being met without more resources? As my hon. Friend the Member for Ealing, Southall stated, it will not take eight years to end the TB epidemic; it will take more than 100.

Surely, part of the reason for the limited progress is that we are less than halfway towards the 2022 targets for funding both TB research and universal access to TB prevention, diagnosis and treatment. The largest supporter of action against TB globally is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds 77% of all anti-TB projects. The Global Fund was co-founded by the Labour Government in 2002. After 18 years of work, the Global Fund estimates that its programme has saved 44 million lives. What an extraordinary achievement of the UK leadership that has been. The Global Fund is not just about direct delivery of projects to prevent, diagnose and treat the most deadly diseases. It also helps to build up sustainable healthcare systems and tackle the broader issues of poverty and social exclusion that make TB such a deadly threat that continues today.

Last week, the National Institute of Economic and Social Research found that UK aid spending has clear economic benefits for the UK. That is particularly true of health spending, which can massively increase productivity by tackling long-term conditions. As well as benefiting millions of people and building a fairer and safer world, part of UK ODA spend goes back into the UK economy by boosting exports to developing countries. In total, the cut from 0.7% to 0.5% of GDP will actually cost the UK between £300 million and £400 million in lost exports. If the Government do not stick to their word and return to their manifesto promise, that number will simply grow.

This year the Global Fund needs to have its financing replenished by international partners. As the Minister knows, the UK has previously always been one of the top funders. We give money not just because of the impact on our international reputation and the relationships that we build around the world, and not just because preventing so much human suffering and death is simply the right thing to do. We do it because we in the UK are affected by TB too.

In the UK, just like the rest of the world, people are more vulnerable to TB if they are malnourished, have chronic illnesses like diabetes or are living with HIV. Over 70% of UK cases of TB are in people born outside the UK, but they are overwhelmingly concentrated in deprived communities, with overcrowded and poor-quality housing. That includes my constituency. The cost of living crisis and housing crises will put more people in these vulnerable positions. Unless we tackle poverty and disease throughout the world, our own communities will be affected, too. What do the Government plan to do about that?

Recent England-wide strategies have had some success since 2015 in tackling TB in England, but we know that success had stalled—even reversing slightly—just before the pandemic. We have to recognise that with TB, just as with Covid, none of us is truly safe until all of us are safe. We need international as well as domestic action. That action must go beyond diagnosis and treatment. We must put resources into research, too. There is still just one approved vaccine for TB, even though it remains deadly and destructive; and that vaccine is more than 100 years old, and highly effective only for young children. A new vaccine could save not only millions of lives, but vast amounts of money. Therefore I am hoping that the Minister can reveal how the UK will contribute to vaccine development and other TB research efforts over the coming year.

As we have heard, this autumn there will be a replenishment of the Global Fund. Will the UK continue as the third-largest funder? I hope that the Minister can give clear assurances on that today, because the rumours are that the existing priorities of global health, combating global heating, and conflict prevention could be dropped. Those are all areas where the UK does excellent work, with support across the House, but we hear that all will be slashed to the bone. Reportedly, the decision to make those brutal cuts will be made by the Foreign Secretary alone, ignoring warnings and advice from both inside and outside the Department. I desperately hope that those rumours are not true, that the Minister will reassure us today, and that those assurances will be borne out by the international development strategy.

I know that the Government will say that they are focusing on women and girls, and that that justifies any cuts. Labour proposes a feminist approach to international development; we see efforts towards gender equality worldwide as a massive priority. Half a million women die of TB every year. Waits for diagnosis and treatment are generally longer for women than men, and TB is a massive risk during pregnancy. The Minister must recognise that global health funding protects women and girls and advances gender equality. So does action against the climate emergency, as the Minister knows, because she was at a meeting in New York about that issue just last week. Will a comprehensive equalities impact assessment be published, so that all hon. Members can see some analysis—as well as the Government’s own PR—about these cuts?

I want to say a little about another area of global health where the UK was a leader—the neglected tropical diseases that affect 1.7 billion people globally and, as with TB, primarily the poorest and most disadvantaged. Until last year, the Department for International Development funded a programme called Ascend—Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases—providing lifesaving treatments and strengthening health systems. As we know, that is vital for eliminating diseases, including TB, in the long term. Ascend delivered more than 350 million preventive treatments, fighting diseases that cause everything from blindness to organ damage to death. But last April, Foreign, Commonwealth and Development Office funding to Ascend was cut, leaving a funding hole of about £100 million. Because of that cut, 100,000 people across east Africa and south Asia did not receive planned care for the horrific symptoms, and the social and economic consequences, of elephantiasis.

How many more proven programmes will be cut if global health is no longer a priority? How much more will our reputation for leadership in this field be damaged? What will happen to the Department’s health-system-strengthening approach, launched with such fanfare just three months ago? Most importantly of all, Minister, how many more lives will be blighted by preventable diseases if the rumoured cuts go ahead? How many more years will the progress that we have made on eradicating TB be set back?

It is an absolute pleasure, Mrs Murray, to serve under your chairmanship.

I start by thanking the hon. Member for Ealing, Southall (Mr Sharma) for securing this debate on this incredibly important topic. I pay tribute to him for his long-standing advocacy for action on TB, including as co-chair of the all-party parliamentary group on global TB. I also thank the other hon. Members for their contributions today. I will try to respond to many of the points that have been raised.

Every year on World TB Day, it is important to reflect on the impact that tuberculosis has on people across the world. We are reminded of the devastating cost of this deadly disease. We are continuing our efforts to combat it, by investing in services worldwide to prevent, test for and treat TB, funding cutting-edge research to fight TB locally, and working to strengthen healthcare across the world and at home. I will set out further details on this work during my speech.

First, however, it is important to understand the scale of the challenge that we face. Despite the fact that TB is preventable and treatable, it continues to have a devastating impact. It is truly shocking that every day more than 4,100 people die from it: mothers and fathers, and sons and daughters. Thousands of families are torn apart daily. TB kills more people each year than malaria and AIDS put together. In Africa, it is the leading killer of people with HIV. And as the Opposition spokeswoman, the hon. Member for West Ham (Ms Brown), pointed out, TB is particularly harmful to women, especially pregnant women, causing complications and increasing both maternal and infant mortality rates.

As hon. Members have pointed out, TB preys on some of the world’s most vulnerable people. The hon. Member for Ealing, Southall mentioned Ukraine. In Ukraine, TB has the potential to add to the horrific impact of Putin’s illegal invasion. Ukraine already had the fourth-highest incidence of TB in Europe and Putin’s war is disrupting medical care, which heightens the risk of the disease spreading. The UK and the rest of the international community will continue to support the Ukrainian Government and people, including with medical supplies. We also welcome the Global Fund’s announcement of an additional $15 million of emergency funding to Ukraine, which will support the continuation of HIV and TB prevention, testing and treatment services. However, I also want to be really clear that the best way to prevent deaths from TB and other diseases in Ukraine is for Russia to stop this illegal war.

As the hon. Gentleman also mentioned, the covid pandemic has continued to take a toll on people’s lives and it has had a knock-on effect on the work to combat TB. In 2020, deaths from tuberculosis increased for the first time in a decade. However, we have also seen an 18% decrease in the number of people being diagnosed with TB, because the pandemic disrupted TB services and people’s ability to seek care.

It is vital that we continue our efforts and work with partners to boost access to essential services, in order to prevent and treat this disease, and that we continue improving global surveillance systems, so that we can detect and respond to outbreaks quickly.

As all the hon. Members who spoke today have mentioned, the World Health Organisation’s TB strategy has set out the global scale of the ambition to end the TB epidemic by 2035. We continue to strive towards that target and have strongly supported work to deliver it. In fact, the UK helped to establish the Global Fund to Fight AIDS, Tuberculosis and Malaria more than 20 years ago. We have remained a strong supporter ever since, contributing more than £4.1 billion to it. The Global Fund has made a huge difference over the past two decades, saving an incredible 44 million lives. It will continue to play an important role and I welcome the focus in its latest investment case on supporting health systems and global health security.

Many Members mentioned reductions to official development assistance. We all know that the economic situation is deeply challenging and that was a very difficult decision to make, but it was also a temporary decision. We are committed to returning to 0.7% as soon as the situation allows, and I remind Members of the positive statements that the Chancellor made about that in his autumn Budget. We remain committed to improving global health, and are looking at our work in a number of areas to ensure the best configuration to deliver our priorities.

International development remains a core priority. It is integrated across the FCDO, including across the country network, and developmental priorities will continue to be embedded in multiple areas. We are reviewing the Global Fund’s recently released investment case and considering what commitment we can make for the seventh replenishment, but I cannot provide details on that now.

I have listened very carefully and I am not as dismayed as I thought I might be. Will the Minister let me know when she might be in a position to give us details on that spend? As she will appreciate, there is real anxiety out there.

I thank the hon. Lady for her excellent question. I understand the urgency of getting the details agreed, but, as she knows, there has been a restructuring in the FCDO because of the changing situation that we now face, given the geopolitical impact of Russia’s illegal invasion of Ukraine. It is important that we continually assess how best to use our structures to reflect different global challenges to enable us to deliver for the UK. As I said, we maintain a strong commitment to improving global health, and I understand the importance of getting the numbers agreed. We cannot do everything, but we will get the numbers as soon as possible.

Research was mentioned in the opening speech. The UK is a global leader in the funding of TB research. We continue to support academics and industry to develop the evidence, and new technologies and approaches to diagnose and treat TB. We have been a critical investor in product development partnerships to combat infectious diseases, including TB, for many years. The FCDO has supported the Foundation for Innovative New Diagnostics to develop a new PCR-based technology to test for TB, which is now available in more than 140 countries worldwide, including in the NHS.

Our investment also helped the TB Alliance to develop new combinations of drugs that significantly reduce the severity of side effects and the length of treatment from over 18 months to six months for drug-resistant TB, and even shorter for drug-sensitive TB. UK funding is bringing partners together to solve critical problems. For example, through support to British Investment International, MedAccess, the Clinton Health Access Initiative and Unitaid have secured a lower price for an innovative short-course TB preventive therapy.

As a further demonstration of our commitment to invest in the fight against TB, I am pleased to announce £6 million of funding for TB REACH, which will support piloting innovative ways to hunt down and treat millions of missing TB cases. I am pleased that the US and Canada are also backing that fantastic work; only through joined-up efforts with our partners will we meet our target to eliminate TB. The UK Government are one of the largest bilateral funders of TB research and development globally, and we continue to invest in research and development, including developing new tools and approaches to tackle TB.

The hon. Members for Ealing, Southall and for West Ham spoke about the situation in the UK. With an eye on the global picture, it is important not to lose sight of the challenge that TB presents here in the UK. As in other countries, we see that the disease often affects the most marginalised and vulnerable people. We are investing in early detection and treatment, including genome sequencing, which can help to detect drug resistance and clusters of transmission.

As the hon. Member for Ealing, Southall said, the UK has a TB action plan for England, which will run for five years from 2021 to 2026. It was jointly launched by the UK Health Security Agency and NHS England, and it sets out the work that will support year-on-year reductions in TB incidence in order to move England towards its elimination target. It includes specific actions relating to underserved populations.

I thank the Minister for her positive responses; we are greatly encouraged. I do not expect to have an answer today, but will she let us know the number of TB cases in Scotland, Wales and Northern Ireland compared with England?

I will get back to the hon. Member with the impact on Northern Ireland. England is one of the few countries that routinely use genome screening for diagnosing and detecting drug resistance and clusters of transmission. The technology was pioneered in the UK and is routinely used in England, Scotland and Wales, but I am not sure about Northern Ireland.

People born outside the UK account for more than 70% of TB notifications, so the UK has a latent TB infection screening programme that detects new migrants with latent inactive TB. That early detection and treatment reduces the chances of a reactivation of the active disease. The Government’s additional £36 billion investment in the health and care system over the next three years will also support TB detection and treatment.

I was born in Northern Ireland, so it was heartening to hear the hon. Member for Strangford (Jim Shannon) speak about the relationship between his constituents and the people of Eswatini and Lesotho—two countries that I visited in, I think, my second week after taking on my current role. It is important that we support smaller countries as well as larger countries, and the Global Fund is working in both Eswatini and Lesotho. I assure the hon. Member that we work globally to tackle the risk factors for TB, including poverty and malnutrition.

To conclude, the UK will continue to work with partners to pioneer scientific breakthroughs, to invest in detection and treatment, and to strengthen health systems globally. That is the only way that we will make tuberculosis a thing of the past.

I thank hon. Members, but I am a bit disappointed that not many joined us for such an important debate. As a Member, I can understand that people’s priorities are different on a Thursday afternoon and when there is a one-line Whip in place. However, I am grateful to the hon. Member for Strangford (Jim Shannon) for joining us, and I thank my hon. Friend the Member for West Ham (Ms Brown) for contributing on behalf of the Opposition. I am pleased to hear a conciliatory tone from the Minister—given the sensitivity of the issue, sometimes misunderstandings can arise.

From the APPG’s point of view and my personal point of view, we are here to work together and support the Minister and the Government to ensure that we achieve our goals, so the most important thing is understanding how we can best work together. I am glad that the Minister pointed to that partnership role in her contribution. I am also grateful for her announcement of £6 million for TB REACH, and I am sure that more will come in the future.

I will not repeat what I have already said. As no solution can be found overnight, it will be a long struggle. I have been in a TB campaigning role for more than 25 years. Before I joined Parliament, I was a local councillor and involved in TB activism, and I look forward to working with the Minister and the Government —not only so we can eradicate TB in Britain, but so we can be the best partners in eradicating TB globally.

Thank you, Mrs Murray, for the way you have chaired the debate; although you have not been under a lot of pressure, I thank you for giving me the longest time to contribute.

Question put and agreed to.


That this House has considered World TB Day 2022.

Sitting adjourned.