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Health: Tuberculosis

Volume 744: debated on Wednesday 24 April 2013


Asked By

To ask Her Majesty’s Government, in the light of the recent findings reported in The Lancet, why the incidence of multidrug-resistant tuberculosis in the United Kingdom is higher than that in other European countries.

My Lords, the incidence of multidrug-resistant tuberculosis in the United Kingdom is not higher than in the rest of Europe. However, the proportion of TB cases in the UK that are multidrug-resistant has increased from 0.9% to 1.6% over a decade. Ninety-five per cent of multidrug-resistant cases diagnosed in the UK were not born in the UK.

As always, I am grateful to the Minister for his frankness in his response. The reality is that compared with France and Germany, we have probably three times the rate of tuberculosis in the United Kingdom. In comparison with Italy, we have five times the incidence. The Minister made the point about immigration. Given that we are to have an influx of people from Romania, where the rate of tuberculosis is over seven times what it is in the United Kingdom, and is something like 22 times what it is in Germany and 36 times what it is in Italy, is it not important that his department is able to announce some measure that can be applied to ensure that we are not going to face an epidemic of tuberculosis? Is it not true that the cost of dealing with multidrug-resistant TB is about 14 times that of dealing with an ordinary case of TB?

My Lords, as regards the very last point made by the noble Lord, he is absolutely right. To treat a multidrug-resistant case of TB typically costs between £50,000 and £100,000, and sometimes more if it is an even more complicated case, in comparison with about £5,000 for an ordinary case of TB.

In fact, to correct the noble Lord, if I may, the proportion of TB cases that were multidrug-resistant in the UK was not high compared with the rest of Europe. The only countries in western Europe with a lower proportion of cases that were multidrug-resistant in 2011 were Ireland, Iceland and Malta. However, I take his point about migrants from eastern Europe. Port health regulations give some powers at the port of entry but this involves knowing quite a lot about the individual, so we are left with what is open to us once the person is in the UK. Once here, health protection regulations can be used to provide local authorities with wider and more flexible powers to deal with incidents or emergencies where infection or contamination present a significant risk to human health, or could present such a risk. I could elaborate on those powers, if the House wished.

My Lords, I had TB in my teens. I know that it often takes years to develop, but why are people not tested in their own countries before they come here?

My Lords, we are now introducing a system of pre-entry screening. We recognise the contribution that latent TB makes to the overall TB disease burden and that is why we have commissioned NICE to produce a clinical guideline on this. In the countries where TB presents the most significant risk, we shall in future insist that people are screened before they enter the United Kingdom.

My Lords, drug-resistant TB will not subside until the problem is controlled globally. That requires not only intergovernmental co-operation but cross-departmental working. Will the Minister update the House on the Government’s position on the replenishment of the global fund, which will be useful in tackling this problem globally?

My Lords, the Government fully support the need to scale up efforts to deliver universal access to TB prevention and treatment, and care and support services. Our target date for that is 2015. We have made a long-term commitment of £1 billion between 2007 and 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a 20-year commitment to the international drugs purchase facility, UNITAID, which is helping to increase access to and the affordability of TB drugs.

My Lords, if one puts together the high level of drug resistance in the Far East and the high level of migration from the Far East to this country, there is no reason why drug-resistance to tuberculosis should not be more evident than it is at present. If one compares the rate of drug-resistant tuberculosis in the United Kingdom with that of other countries in the European Union, it is fairly clear that we need to do something quite seriously, especially in densely populated areas such as London and Cardiff, before people can come and live in this country. What do the Government have in mind to deal with this issue?

My Lords, this has to be dealt with nationally and Public Health England is leading a national oversight group for TB that brings together partners from the department, NHS England, local government, NICE, the British Thoracic Society and TB Alert to develop a strategy to reverse the trend of increasing TB rates in the UK. The group recently held its first meeting and the department will continue to support Public Health England in giving national policy leadership in this area.

My Lords, the Minister will be aware that the problem of multidrug resistance is not confined to TB; there are many other areas where we have every reason to be fearful about the development of drug resistance. Is the noble Earl satisfied that enough is being invested in research into the development of new drugs to be reasonably confident that we are making proper inroads into this problem?

My Lords, the Government are supporting a range of research programmes to promote the development of new diagnostics, drugs and vaccines for TB. These include £6.5 million for the Foundation for Innovative New Diagnostics, £23.3 million for the Global Alliance for TB Drug Development and £10.5 million for the AERAS Global TB Vaccine Foundation. However, I will look into other areas of disease where there is drug resistance, and if I can supply the noble Baroness with further information I will be happy to do so.