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Health: Tuberculosis

Volume 700: debated on Monday 31 March 2008

asked Her Majesty’s Government:

What actions they are taking to help to eliminate tuberculosis as a global public health problem by 2050.

My Lords, the UK provides support for TB control through its funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria; through bilateral country programmes; through organisations such as the World Health Organisation; and through new research evidence and drugs. The Prime Minister, then Chancellor, launched the Global Plan to Stop TB with former President Obasanjo, of Nigeria, and Bill Gates, co-chair of the Gates Foundation, in 2006.

My Lords, I thank the noble Baroness for that reply. I had TB at the age of 15. With the spread of large-scale TB and HIV co-infection, and, now, drug-resistant TB nearer to home, do we test immigrants when they come from the worst-affected countries? Perhaps we cannot catch up with them when they disappear into the system; I gather a lot of immigrants disappear and we do not know where they are.

My Lords, it is interesting that the noble Baroness said that she had had TB. A third of the world’s population has the TB bacteria. The total number of cases of TB in the UK in 2006 was 8,479; that is the latest figure we have. Of that, 72 per cent of new TB cases were non-UK born. However, the vast majority of these cases only develop active disease after they have been in the UK for at least two years, and often much longer than that.

The noble Baroness asked about screening. Of course, we have a long-standing policy, as the noble Baroness will know. Anyone who appears unwell, mentions health problems or medical treatment and is seeking entry for more than six months will be screened. As the noble Baroness will know, there is a list of high-prevalence countries for which there is screening.

My Lords, the recruitment of health professionals is of great concern in this House and elsewhere. What, if anything, are the Government doing to discourage—as I believe they should—recruitment of such professionals from developing countries where their skills are critically required?

My Lords, my noble friend is right. We have a code of practice that embodies ethical principles for international recruitment of health workers, and an agreed list of developing countries that should not be targeted for their health workers. The UK has systematic policies to prevent the targeting of developing countries.

My Lords, what is being done to ensure that the British medical profession is adequately trained in the diagnosis of tuberculosis? I ask because a neighbour of mine, who died a very short time ago, had been treated in hospital and by her GP for some time, and was found when she died to have had advanced but undiagnosed tuberculosis.

My Lords, my briefing mainly deals with the problem of diagnostics on the global scene. However, I agree with the noble Lord that there is a real problem of diagnosis whether we are talking about the UK or internationally. There is a need for rapid tests that correctly identify people with the disease. If we are talking globally, those tests must be easy to use at a local level. I will write to the noble Lord on what the UK is specifically doing internally to ensure that combating TB is strengthened. I know that the National Health Service is looking carefully at strengthening its TB policy.

My Lords, given that most cases of TB are being diagnosed through sputum microscopy, a technique that is more than 100 years old, what role is being played by Her Majesty's Government, the universities and the pharmaceutical industry to help develop more rapid and effective diagnostic tools including those that will diagnose drug-resistant TB and people with the TB/HIV co-infection?

My Lords, the UK is doing a great deal to try not to be complacent about the problems that the twin epidemics—the twin scourges—of TB and HIV, to which the right reverend Prelate referred, present. We are supporting a number of programmes on AIDS/TB co-infection through the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNITAID, a new drugs-purchase facility of which the right reverend Prelate will be aware. DfID is currently working to update its strategy on tackling HIV and AIDS. HIV/TB co-infection is included in that strategy, which has had wide consultation. There is a problem about diagnostics, as I said earlier: they are out of date, and we have to put more focus on, and funding into, updating them.

My Lords, the Minister said that we have a list of countries and that people coming from those countries are screened. What screening is carried out?

My Lords, the screening process is that under the Immigration Act 1971, immigration officers at ports of entry have powers to refer passengers subject to immigration control for medical examination on arrival. They look at the person’s health. People claiming asylum at ports are routinely referred to the port medical inspector, and at Heathrow and Gatwick airports X-ray equipment is available.

My Lords, what is being done to co-ordinate the battle against HIV and TB? How are the Government facing the need? The World Health Organisation suggests that we might be short of 4 million health workers. What are we doing to encourage the training of more health workers?

My Lords, we launched the international health partnership directly to address the problem of the shortage of international health workers. If we look at the example of Malawi, we see that, as a result of our work with the partnership, in the first six months of the programme more than 500 new health workers were trained. The shortage is a continual problem, but we are focused on it and are determined to overcome it. On the twin epidemics of TB and HIV, we are supporting many programmes on AIDS, TB and TB/HIV co-infection through the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNITAID, as well as efforts to tackle AIDS and TB in specific countries, such as China, India and South Africa.