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Health: Tuberculosis

Volume 718: debated on Wednesday 24 March 2010


Asked By

To ask Her Majesty’s Government what they are doing to combat drug-resistant tuberculosis in the United Kingdom and overseas.

My Lords, I congratulate the noble Baroness on the timeliness of her Question as today is World TB Day. In England, our strategy is early detection and completion of treatment, which prevents drug-resistant TB developing. The UK Government made a long-term commitment of £1 billion from 2007 to 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria overseas.

My Lords, I thank the Minister for that reply. She will be aware that we are one of the most generous countries in Europe to the global fund. Others should follow us. I congratulate the Government on the national strain-typing service, which is to be opened in May. It will help with all sorts of TB strains. It will be in Newcastle, Birmingham and London. Does she agree that drug-resistant tuberculosis should be treated in negative-pressure isolation rooms? Do we have enough rooms, especially for children?

Baroness Thornton: As ever, the noble Baroness points at important matters to do with TB. Since today is World TB Day, I am pleased to announce that DfID has announced two new allocations of funding for TB research. The first is £8 million to the Aeras Global TB Vaccine Foundation to help develop a booster vaccine, and the second is the process that the noble Baroness mentioned for the diagnostics of TB.

We are confident that we have the resources to deal with drug-resistant TB which, I am very pleased to say, is not increasing. However, we know that it is a problem across the world. Some 440,000 people across the world have drug-resistant TB. Our £1 billion and our commitment to international co-operation on this matter are extremely important.

Can the Minister explain why when over 73 per cent of TB cases come from outside the UK, only 21 per cent of cases are diagnosed within two years of arrival?

The noble Baroness is correct. She is an expert on these matters. Seventy per cent of TB cases in England occur in people who were born abroad but show no sign of illness after living here for many years. We have, as yet, no test that can predict who will develop TB in later life. We know that there are no short-term solutions in tackling TB. The long-term action will take time to take effect, but the strategy in this country is to detect it early. That means that the generation of doctors who thought that TB was a problem that we no longer needed to address in his country need to be trained to recognise TB, diagnose it and make sure that people go through the treatment, which, I am happy to say, is successful, to make sure that we deal with this in this country.

My Lords, one of the areas of great difficulty is in prisons in the United Kingdom; imprisonment carries a high-risk of contracting tuberculosis. Furthermore, the majority of sufferers are UK born—white prisoners—and have pulmonary disease. Many are increasingly resistant to drugs because they are not following up their treatment—nor being followed up—after they leave prison. Have the Government any proposals for energetically following up infected prisoners? Otherwise we shall see increased treatment-resistant tuberculosis in the country because of the prison population.

The noble Lord is right. Certainly in London, one of the main uses of mobile X-ray machines is to go into prisons to help with the diagnosis of prisoners and to ensure that, on release, prisoners who have TB continue their treatment. That is why the detect-and-treat programme includes placing alongside released prisoners people who can ensure that they continue their treatment to the end. This requires vigilance, energy and resources.

My Lords, are the Government aware that one in three people in the world are infected with TB? It is only noticed when the bacteria become active and the patient becomes ill. The bacteria only become active when the immune system is depressed—for example, as a result of contracting HIV or because of advancing age. Are the Government further aware that so unselfish are the ladies in this world that if they do not have enough calcium in their diet when they are pregnant or lactating, they take the calcium from the lymph nodes which have been calcified and in which the TB is entombed and made inactive? The calcium is taken out, the TB escapes and they become infected. Therefore, nutrition is extremely important—hence the slogan “drinka pinta milka day”.

The noble Lord, Lord McColl, as ever, informs me of something that I did not know. I was not aware of that and it certainly was not included in my briefing. The noble Lord points to an important matter—the prevalence of TB in the poorest communities across the world. That is why this programme is so important.

My Lords, there has been criticism of the failure of international co-operation. Can my noble friend explain to the House precisely where we stand on that and what we are doing to improve it?

We remain strongly committed to reducing death and suffering through tuberculosis. My right honourable friend the Prime Minister is today hosting an event for World TB Day which will launch a campaign to obtain the commitment of all the main political parties to continue to support and scale up the fight against TB, globally and in the UK, and to ensure that TB is a priority in the global health agenda. Thirty-six million people have been cured of TB since 1995. That is a good start but it is not sufficient. I invite all parties to sign up to my right honourable friend’s campaign.

Baroness Thornton: I am afraid I do not have the answer to that question. I beg the noble Baroness’s pardon. I shall certainly find out and ensure that I write to her and place a copy of the letter in the Library.

The extra funding that will be made available globally for combating tuberculosis and drug-resistant TB is very welcome, not only at an international level but at the individual level of directly observed therapy, which has proved very effective in different countries. Can the Minister tell the House how much of the funding will go to advance directly observed therapy, as well as to the more major approaches?

The noble Lord has given me the words I was groping for earlier: DOT, a therapy he is very aware of and has been championing. As noble Lords will be aware, in this country TB manifests itself in particular areas such as London, Leicester and Bradford. It is therefore very important that PCTs in those areas put resources into the DOT programme to which the noble Lord has referred.