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Global Fund to Fight AIDS, Tuberculosis and Malaria

Volume 750: debated on Thursday 12 December 2013

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the impact of the replenishment pledges for the Global Fund to Fight AIDS, Tuberculosis and Malaria, made by world leaders in Washington in early December.

My Lords, at their meeting in Washington at the beginning of this month, world leaders confirmed their pledges on the fourth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund congratulated the UK on demonstrating strong leadership in global health, with a major contribution pledged to the Global Fund for the next three years. The United Kingdom will contribute £1 billion to the Global Fund for the 2014-16 period, the second largest pledge by any Government so far after the United States of America. Dr Nafsiah Mboi, the Global Fund chair, cited the extraordinary generosity and leadership of the United Kingdom since the fund was founded in 2002. She said that this new commitment would underline a transformative step forward for the Global Fund partners in their fight to defeat HIV/AIDS, TB and Malaria, and gave an inspiring model of responsible global partnership.

Perhaps I may say at this stage how pleased I am that my noble friend Lord Fowler is in his place and will be contributing the benefit of his wealth of knowledge on these issues to the debate. I also welcome my noble friend Lord Verjee, who I am delighted to say has chosen to make his maiden speech in this debate. I know that my noble friend is able to speak from his personal experience in these matters and I look forward to his contribution today and to many more in the future.

The United Kingdom commitment to the Global Fund is geared towards encouraging other donors to maximise their own pledges and thus unlock additional funds with each new pledge. Can my noble friend the Minister say in her response what has been the impact so far of the Washington pledges on securing new pledges, or even indications of new pledges, at this time?

In its contribution towards ending world poverty, the United Kingdom is helping to halve malaria deaths in 10 of the worst affected countries by 2015. The United Kingdom has targeted saving the lives of 50,000 women in pregnancy and child birth, and 250,000 new-born babies, as well as helping to immunise more than 55 million children against preventable disease. The Global Fund pledging conference has set a target of $15 billion for the fourth replenishment. So far it has received $5 billion from the USA, the equivalent of $1.6 billion from the United Kingdom, and $612 million from Canada. A number of other pledges, notably from northern Europe, bring the total pledged to date to more than $12 billion.

The Global Fund was created in 2002 as a public-private partnership to raise funds to change the course of HIV/AIDS, TB and malaria. The United Kingdom has now become the second largest donor after the USA, pushing France into third place. Since 2002, the fund has approved more than $23 billion for grants spread over more than 150 countries. The fund accounts for 21% of all international funding for HIV/AIDS, 82% of international funding for TB and 50% of global malaria funding. It is the biggest funder of programmes to prevent, treat and care for people with these diseases. Big strides have been made, with 9.7 million people receiving antiretroviral therapy for HIV/AIDS and a further 30 million mosquito insecticide-treated nets being distributed in the first six months of 2013, making a total of 340 million nets. My noble friend may be aware, however, of disturbing reports that in some areas these bed nets are being used as fishing nets, which is clearly totally inappropriate. Does her department have any details of this departure and the effect it may have on the impact of the fourth replenishment?

The Global Fund’s TB programmes are continuing to expand, with the number of cases being supported now exceeding 11 million. However, the UK could be doing more, to which I shall return later. The UK’s latest £1 billion pledge to the Global Fund will maintain the record of “a life saved every three minutes”. Taking a lead in the worldwide fight against HIV/AIDS, TB and malaria, United Kingdom support over the next three years will deliver antiretroviral therapy to 750,000 people, 32 million more insecticide-treated mosquito nets to protect against malaria, and TB treatment for over 1 million more people. The UK’s allocation to the Global Fund will save a life every three minutes over the next three years and it will dramatically improve the lives of millions of people across the globe. Your Lordships will be aware that there are those who question the efficacy of organisations such as the Global Fund and its ability to channel the generosity of the United Kingdom into effectively combating diseases such as AIDS, TB and malaria. However, serious analysis confirms that the statistics demonstrate incontrovertibly that we can win this global battle on behalf of the poor.

On a human scale, I am sure that noble Lords can recall, like me, witnessing the suffering of those afflicted by these diseases and their like. I think of my visit to a hospice in Soweto in 2004, where volunteers were comforting and caring for patients dying from AIDS. Many were too weak to speak and unable to understand what was happening to them, having been abandoned by their families. Left to die on the streets, they were brought into the hospice by volunteer community workers who had been trained in basic healthcare by a handful of dedicated nurses. Almost 10 years on, thanks to organisations such as the Global Fund, the ravages of AIDS are gradually diminishing, with the hope that they will become something of the past in due course.

More recently, indeed just this summer, under the sponsorship of the charity RESULTS, I visited a district hospital outside Lilongwe in Malawi where small children were being comforted by their mothers as they struggled for breath and literally for life against the advances of pneumonia and TB. Further afield, at village health posts, I watched children being vaccinated by health workers, who were hampered by the fact that the transport of the cold boxes essential for the storage of vaccine was at the mercy of the poorly maintained and therefore unreliable fleet of motorbikes. Just to add to the difficulties, it was a 14-kilometre walk to the health posts for families living in the most remote communities.

Considering the Global Fund’s present challenges and the UK’s responses, it is the case that the poor relation in the three worldwide health campaigns seems to be tackling tuberculosis. TB is contagious and airborne. It is the second most deadly infectious disease in the world, and last year it was responsible for 1.3 million deaths and 8.6 million new cases. TB is the leading cause of death for HIV/AIDS-positive people and is responsible for one in five HIV deaths—that was 320,000 deaths last year alone. TB is estimated to have killed more people than any other pandemic in history, and is developing a drug resistance which makes it more expensive and more difficult to treat, with many more adverse implications and side-effects for patients. An estimated 3 million people a year who develop TB are not officially diagnosed or treated, with no guarantee of treatment outcomes.

The Global Fund has demonstrated that, with investment and leadership, significant gains can be made, but it needs to work with agencies such as DfID to be fully successful. It cannot operate in isolation. DfID can and should invest in issues such as TB which have an impact on health outcomes in the UK. DfID can and should prioritise issues that are important to the UK taxpayer. DfID can and should invest in new and innovative projects that could represent significant steps forward.

TB is a largely neglected disease. Only one new drug has received regulatory approval in 42 years and the old-fashioned BCG procedure offers no protection to adults and cannot be used on people with HIV. Moreover, it does not protect against the most common type of the disease. It is estimated to cost the EU region alone almost €6 billion a year, yet the region accounts for only 4.7% of global cases. Leadership from DfID in a country like the UK could be transformative. It could lift the profile of the disease and show that it is still a major issue, which could lead to additional investment. DfID has provided a model response to malaria, putting it at the forefront of the global aid agenda. The 1.3 million people dying every year from TB and the 8.6 million who suffer from the disease need the level of support and commitment that only an aid agency like DfID can provide.

I should be very grateful if, in her response, my noble friend could address this and the other issues that I have raised.

My Lords, I congratulate my noble friend Lord Chidgey on his speech and I look forward to the maiden speech which is to follow in a few minutes. I should perhaps declare a new interest. Last week I joined the board of the International AIDS Vaccine Initiative in New York. I agree entirely with what my noble friend has said in introducing this short debate, in particular about the value for money that the Global Fund represents and, of course, the contribution that it is making to the fight against TB. I will not repeat his arguments because I want to come to this issue from a slightly different position.

Over the past 18 months, I have been looking at HIV and AIDS in different cities around the world. What has struck me is that when I explain this in this country, I am met with the response, “You mean, it is still a problem?”. It depends on what you mean by a problem. Last year some 1,600,000 people worldwide died from AIDS, while 2.3 million were newly infected, and for every person who was put on to antiretroviral treatment, two were infected. Some 36 million people around the world live with HIV, including 100,000 in this country, accounting for a drugs budget in the region of £800 million.

It may be true that Africa has the biggest problem, but more than 2 million people live with HIV in India, while in Russia and Ukraine there are major problems of injecting drug users, home-made drugs and shared needles. Of those with HIV, up to a quarter are undiagnosed and, all other things being equal, continue to spread the virus. Even when people are on antiretroviral drugs, many do not adhere to the treatment, storing up all kinds of problems for the future. So, yes, not only is there a problem, but there is an acute and urgent challenge to every Government in the world. Thanks to the Global Fund and to the President’s fund in the United States, enormous progress has been made. The United States Government in particular should be given credit for what they have done—of course, I agree with my noble friend—as should the Government here, who have redeemed the pledge of my right honourable friend Andrew Mitchell to increase their Global Fund contribution. We should also recognise, however, that over the past few years the overall global contribution has remained stable in real terms; it has not increased.

In no way do I deny the progress that has been made because it has been formidable and dramatic in terms of the number of lives saved, but I would suggest that the lesson is that we must not give up now. We should recognise what that means: we are talking about a lifetime commitment to people living with HIV. It is not a condition where, after treating a patient for six months, you can move on to the next one. That is one reason why the world needs to put far more emphasis than it has on preventing new cases of HIV. As I mentioned, I have joined the board of IAVI and did it for this reason. A vaccine gives the best hope for the future: you cut through some of the prejudice that surrounds testing and, from the financial point of view, it opens up the hope of reducing an otherwise constantly increasing bill. That was why—if I may say so to my noble friend—I was surprised and dismayed a month or two ago, before I joined the board, that the Government slashed the help from a hardly princely £9 million or £10 million down to £1 million.

I accept that there is, at present, no cure and no vaccine—which is exactly what I said back in 1986. That means we have to do two things. First, we need to keep up our contributions to the Global Fund. It needs to be underlined that, in the vast majority of cases, that has been money well invested, resulting in tremendous advances and the saving of lives. Secondly, we need Governments globally to engage with the key minority populations where the risk of HIV is highest. It is absurd, unjust and counterproductive that homosexuality is criminalised in so many countries in the world. We also need to treat drug dependence as a medical issue, not just as part of a so-called and unsuccessful war on drugs, and to introduce more clean needle schemes, which we did in this country in 1987. We need to engage with people such as sex workers, where the rate of HIV remains very high, and not simply pursue a policy of looking the other way. We also need to fight discrimination against transsexuals, which often forces them into sex work.

We have made massive progress, much of which is down to the success of the Global Fund, to which I pay tribute. However, we should also recognise that there is still a hell of a long way to go.

My Lords, it is with a very full set of emotions that I stand before noble Lords this afternoon to make my maiden speech in the House. These emotions are hard to describe but they include great trepidation, great gratitude and great humility. I will deal with the easy one first: great trepidation as I stand before this august House, full of its long history, tradition and the wisdom of all the noble Lords gathered here today. This would indeed be humbling for any new Member of this House and I will have a great sense of relief when I complete this maiden speech and sit down.

I stand here in gratitude for so many reasons, including gratitude to my noble friend Lord Chidgey for introducing this debate. I am very fortunate to speak in this debate for many reasons. We are debating here a Global Fund not just for HIV but for tuberculosis and malaria, and in the country where I was born, Uganda, malaria is still the biggest killer. It accounts for nearly half of all the deaths of children in any one year.

Ten years ago, I myself contracted malaria in the jungles of India. There are two types of malaria. There is the less lethal type that none the less revisits you and debilitates you year after year, and then there is what is called “cerebral” malaria, which goes straight to your brain and kills you. I had the second kind. That day, I could have easily joined the ranks of the well over 500,000 people who die of malaria every year. I was told I had only a day or more to live. It is only because I had access to the best medical treatment that I survived. Today, thanks to the deal that was recently made in Washington DC, far more people will survive and become malaria-free, as I did. I am proud to say that the British Government’s contribution to the fund has trebled, and we continue to be the second largest contributor in the world—for this, I am here to say thank you.

I am also full of gratitude to all the staff, team, police and security personnel, and to Black Rod’s department, for all the most courteous, patient and kind help over the past few weeks as I so obviously wandered around very lost but trying hard not to appear so. I am full of gratitude, too, to my supporters: my noble friends Lord Dholakia and Lady Brinton. To follow in the immense footsteps of my noble friend Lord Dholakia is both a privilege and a challenge for a new Member of the House, and for me in particular, as we both hail from east Africa. I am full of gratitude to my noble friend Lady Brinton for all her help, support and confidence as we launched a leadership programme for my party that is designed to mentor and develop people from underrepresented groups so they can become MPs and participate in the governance of this country.

I am full of gratitude most of all to the country and people of Great Britain. My family were dispossessed by Idi Amin of Uganda in 1972 because we were Asians, yet I was able to come here and prosper in this country and become an entrepreneur, and my family and I were able to live in freedom and dignity. This country gave me the opportunity to thrive and I truly hope I can help many more people to have that very same opportunity.

The Global Fund and similar institutions provide these very same opportunities to people all over the world. I recently had the honour to travel with former President Clinton, who works with the Global Fund, to five countries in Africa. We visited Zambia, Malawi, Rwanda, Tanzania and South Africa, to see the projects supported by the Clinton Foundation. In Zanzibar, we visited a project called ZAPHA+, established some 20 years ago for Muslim women in a tiny community who had been stigmatised and shunned for being HIV positive. This project took them in, provided support groups and business skills for them and helped them to turn their lives around. When we visited, the women were happy, healthy and confident, and introduced us and President Clinton to their HIV negative children. It showed me what aid money can achieve when it is well spent. I assure noble Lords that the money committed by our Government will transform lives.

Finally, I speak with a great sense of humility. The late President Nelson Mandela once said that,

“after climbing a great hill, one only finds that there are many more hills to climb”.

It has indeed been a great hill for me to climb from my birth in Uganda to my ascent into the House of Lords. I see now that there are many more hills to climb—hills on which there are people who need our help. I can rest at the end of this, my maiden speech, knowing that I will be climbing those hills together with other noble Lords. Thank you.

My Lords, it is a real pleasure for me to be able to congratulate the noble Lord, Lord Verjee, on what I think all noble Lords would agree was an outstanding maiden speech. It was passionate, very personal and very modest. The noble Lord’s story is an extraordinary one of academic, entrepreneurial and philanthropic success. His business achievements are manifold, but anyone who has ever fought an election campaign will always owe him a particular debt of gratitude as the founder of Domino’s Pizza in the UK.

In his speech, the noble Lord referred to what aid money can achieve when well spent. The noble Lord, Lord Verjee, is not only a generous but an intelligent philanthropist. He works, through the Rumi Foundation, in a variety of fields, but I pay particular tribute to the work that he has described today in encouraging, through the leadership programme, people from underrepresented groups to participate in political life. We hear and see a great deal about the perpetuation of privilege in public life in this country and it is enormously important that stories about those who overcome obstacles and the triumph of talent are also told as examples to others. I first heard about the noble Lord, Lord Verjee, from my son, who works in the philanthropic field. He said, “You should meet Rumi, Mum, he’s one of the really good guys”. I think that the House will share that opinion as time goes by.

When speaking about the Global Fund, I must declare my non-financial interests. I am a trustee of the Sabin Vaccine Institute, a vice-chair of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases and a trustee of the Malaria Consortium. I pay tribute to what the fund has achieved in the battle against malaria, to which the noble Lord, Lord Verjee, referred. Hearing the statistic that since 2001 the number of child deaths from malaria has been halved reminds you what aid money well spent can achieve. The Global Fund has been enormously important in that. The Malaria Consortium is the leading UK implementer of Global Fund money. In Uganda, with the fund’s support, we are working with the Ministry of Health to distribute more than 20 million long-lasting insecticidal nets to achieve universal net coverage in that country.

As many have said in debates about the Global Fund, it is essential that we replenish the fund if we are successfully to continue and build on what has already been done. The fund is hugely important, not only in its own work but—as was made clear to me at a meeting of the all-party group last night—in the effect it has on the upstream work to face the new challenges and create the new vaccines, medicines, insecticides and diagnostics. While those are being developed, there must be the encouragement of knowing that there will be an implementation machine to take them to the patients. It is tremendously important that the fund is replenished.

Replenishment will also allow the Global Fund to build and extend its work. I very much welcome the new funding model, which seeks to align investments in combating HIV, TB and malaria with national health strategies, while strengthening health systems and serving as a platform promoting the health of a person rather than combating only specific diseases. I feel this particularly strongly when I look at the issues of maternal and child health and of neglected tropical diseases.

For the world’s poorest people, these things do not fit into nicely delineated silos and different funding streams; these are the health issues of the poor. To be effective, we need to combine the programmes to ensure that the synergies are achieved and the best value for money is obtained. I think of it most particularly with regard to schistosomiasis. Schistosomiasis increases by twofold or threefold the likelihood that an adolescent girl exposed to HIV will contract HIV. The treatment for schistosomiasis is very cheap but, as a neglected tropical disease, it does not fall within the bounds of the Global Fund. My question to the Minister is: what are the Government willing to do to encourage the Global Fund to take a broader approach to health in the future?

My Lords, I join the noble Baroness in congratulating the noble Lord, Lord Verjee, on his most eloquent maiden speech. I look forward to his future contributions. I, too, am grateful to the noble Lord, Lord Chidgey, for securing this important debate and for his efforts to keep the fund at the forefront of the development agenda.

As the noble Lord said, the fund’s achievements have been remarkable: 6 million treated for HIV; 11 million diagnosed and treated for TB; and 360 million bed nets. I thank the Government for maintaining the support shown to the Global Fund by the previous Labour Government by making such a generous pledge. Although the replenishment campaign is over, the work of replenishing the fund must continue in order to ensure that it reaches its target.

I, too, look forward to the Minister giving us an update on what the Government are doing to galvanise support from other donors to ensure that UK and US money is not left on the table and on what part they are playing to ensure the long-term stability of the funding stream. Only with sustained, long-term funding can you achieve the scale of the interventions needed.

For all these efforts, gaps remain in our responses to these diseases. For 10 years, the UK charity Target Tuberculosis has been working in the field through local partner organisations, focusing on the needs of the poorest communities, who often live in remote locations far from government-led national TB programmes, which receive the bulk of the Global Fund allocations.

Currently the British Government do not engage in any bilateral funding of programmes related to TB, despite the Prime Minister co-chairing a high-level panel report on the post-2015 framework that identified treating TB as the most cost-effective health intervention measured. It returns £30 for every £1 spent. Perhaps the Minister will explain why the British Government do not fund TB-specific projects through bilateral funding.

In October the WHO launched its annual Global Tuberculosis Report in London with RESULTS UK, to which I am grateful for the work that it does and the briefing that it has provided for this debate. The report named five key priorities for beating the TB epidemic. I am going to concentrate on the need to:

“Accelerate the response to TB/HIV”.

Last year 1.3 million people lost their lives to TB. As the noble Lord said, 320,000 of those people were HIV positive. TB is the leading cause of death for people with HIV, yet only just over half of all those who are HIV positive and have TB can access anti-retrovirals. TB preys on a weakened immune system and, without access to anti-retrovirals, TB will progress faster in an HIV-positive patient. Co-infected patients without anti-retrovirals are more likely to die. A priority for reducing the number of deaths from TB and HIV is to scale up the response to co-infection and ensure that everyone with TB is tested for HIV, and vice versa, and given the proper medication.

The Stop TB Partnership, the WHO and UNAIDS stated that 1 million deaths could be prevented among people living with HIV by 2015 if the world implemented simple strategies; that is, everyone with TB gets an HIV test and access to treatment. Worryingly, there remains a huge gap between where we are today and complete coverage of anti-retrovirals for TB/HIV patients, as the noble Lord, Lord Fowler, said. The recent DfID position paper reaffirming its commitment to TB/HIV is to be welcomed.

The fund’s strategy committee has decided that it should do more on TB/HIV. It has mandated that any country with high rates of TB/HIV co-infection that applies for funding for treatment programmes will have to design its programmes in a single unified application. Every country will have to have joint, integrated, co-ordinated programmes for TB/HIV. This could be a huge step forward, as the fund provides 80% of international financing for TB and more than 20% for HIV. I urge the Government to take the lead and to support the Global Fund, not with money this time but by supporting and adopting similar policies and by urging other partners to do the same.

Finally, in a week when the eyes of the world have been on South Africa, there is one other area where we could make a difference. South Africa’s gold mines contribute 9% of the global total of TB cases, which in turn fuel the HIV epidemic in the region. The British Government could show real global leadership and I hope that the Minister will update your Lordships’ House on the Government’s recent meetings with mining companies. The South African Health Minister and chair of the Stop TB Partnership board has called a regional gathering of Health Ministers and mining companies for early next year. The meeting will seek to drive a regional response to the disease. It would show real commitment if the British Government sent a high-level representative to that meeting. This is the kind of leadership that the British Government could and should provide. They have stated that TB/HIV is a priority; now I urge them to prove it.

My Lords, I thank the noble Lord, Lord Chidgey, for securing this debate and congratulate the noble Lord, Lord Verjee, on a brilliant maiden speech—I congratulate him even more on surviving cerebral malaria.

I have not exactly heaped praise on the coalition Government in the past three years, but I praise them for having the vision and good sense to see that overseas aid, prudently spent, not only benefits people in developing countries but will eventually benefit us all by reducing poverty and migration and increasing our markets abroad.

Not being a great fan of “vertical lines of expenditure” on specific issues, I was sceptical when the Global Fund was set up, but I accepted that the three diseases that we are discussing were causing such devastation that a new approach was clearly needed—and the Global Fund was that new approach. It has been successful, as we have heard from the fund itself in the excellent briefing that we have received from it and from other noble Lords. I shall therefore congratulate the fund but not repeat what has already been said by other speakers.

Replenishment of the fund is now needed, and we have heard of the plans for it. We must keep up support for the fund and nag other countries to keep pledges. Drug resistance is growing and we must stay vigilant.

This applies also to my main interest, which is population and development, and expenditure on sexual and reproductive health, particularly family planning. According to the ODA, funding for population assistance is still increasing, but at a much slower rate than prior to the financial crisis. This is despite the tremendous boost given to accessible family planning by our coalition Government at the summit in London last year and carried forward by the Gates Foundation, to which we owe a huge debt of gratitude.

Allowing women in the least developed countries to have access to family planning to limit the number of children they have is still crucial to the achievement of the millennium development goals. If the world’s population continues to increase, the MDGs become harder to achieve. We may feel that we are making progress, but more and more people coming into the world will need more help and more treatment. It is crucial therefore to keep up the pressure on family planning provision, always ensuring of course that there is no coercion. If you consult the statistics, you will see that economic growth always follows reduction in family size; it is not the other way round, as used to be believed. And that, reduction in family size, is the way out of poverty for most developing countries.

One of the factors which led to my lack of enthusiasm for “vertical” programmes such as the Global Fund—this has been alluded to by the noble Baroness, Lady Hayman—is that while a patient may get his or her treatment for HIV/AIDS or TB, the provision of reproductive healthcare and contraception may be in another clinic or another place, necessitating another long journey to a health centre—and sometimes the provision does not exist at all. I am delighted, therefore, that the Global Fund is now trying to ensure that more comprehensive health systems will be set up alongside the treatments for AIDS, TB and malaria. I would love to hear the Minister’s assurance on that. There is a direct link, too: contraception in the form of condoms is after all the first defence against AIDS while we are waiting for a vaccine. Every health facility dealing with AIDS should remember this fact and have those available.

Once again, I congratulate the Global Fund and the current and previous Governments on having achieved so much in international development during the past two decades, and I look forward to the next decade with some confidence.

My Lords, I, too, am grateful to my noble friend, Lord Chidgey, for securing this debate, just 10 days after the Global Fund’s replenishment conference. I join others in congratulating my noble friend Lord Verjee on an excellent maiden speech. I want, too, to congratulate the Government on their commitment to the fund, which has raised a remarkable $12 billion for the next three years and made unprecedented strides against HIV, TB and malaria.

When the Economic Affairs Committee took evidence a couple of years ago on the economic impact and effectiveness of development aid, I noted in particular the evidence of Professor Jeffrey Sachs of Columbia University, who said he was,

“a big fan of well targeted, well defined programmes that can accomplish well designed and specified purposes”,

such as delivery of bed nets or vaccines. This is what the Global Fund helps to achieve: as we have heard, 11 million cases of TB have been diagnosed and treated, 360 million bed nets have been distributed to protect against malaria, and 6 million people have received life-saving antiretrovirals.

However, huge gaps remain. Every year, there are 3 million people around the world who develop TB and are not officially diagnosed or treated and remain infectious. That number has not changed for six consecutive years.

There is one initiative which would help: a Stop TB Partnership project called TB REACH, created with a grant from the Canadian Government amounting to $120 million. It is important because, while the Global Fund provides more than 80% of international financing of TB treatment, it is unable to fund projects that do not have a track record of proven success, which inhibits innovation.

TB REACH undertakes feasibility studies for donors such as the Global Fund. It incubates innovations in TB care delivery; for example, using mobile phone technology, developing public/private partnerships and rolling out new, rapid diagnostic tests. That is exactly what it did in Ethiopia, where it supported a project that saw 1,200 community health workers team up with motorbike riders to get TB samples from remote villages.

The project put a comprehensive package of measures in place to improve access to TB care. Health workers identified people who had been coughing for two or more weeks and collected sputum samples, prepared smears and supervised treatment, leading to a doubling of case detection and a 93% treatment success rate. That scheme has since been supported and scaled up by the Global Fund and the Ethiopian Government. It now has a sustainable future.

However, I understand that there may have been concerns about the number of small projects that TB REACH funds, and about their sustainability and their scalability. Inevitably, with any initiative that funds innovation, not all projects will be a success and not all can be scaled up, and that is the price of innovation. But TB REACH is broadly successful, providing fast-track funding so that projects can deliver results within six months of a proposal being received. Its outputs seem impressive. In the past three years, TB REACH has contributed to the detection and treatment of more than half a million people with TB, through more than 100 grants in 44 countries targeting key groups including TB in mining communities and childhood TB. In addition, TB REACH projects have prevented 750,000 people becoming infected.

I am aware of two reports that have the Government’s seal of approval. The first is the high-level panel report on the post-2015 framework, co-chaired by the Prime Minister. The report found that TB interventions offered the best return on investment of any health intervention. The other report is the recent DfID Health Position Paper, which identified the critical importance of innovation in solving the world’s most intractable health problems. I think that the Government are right to identify the importance of TB interventions, and the importance of innovation. I therefore hope that they will look very carefully at the strong case for extra funding for TB REACH.

My Lords, I, too, thank the noble Lord, Lord Chidgey, for initiating this very timely debate. I also congratulate the noble Lord, Lord Verjee, on his excellent and moving maiden speech, making a very powerful, personal case for the fund.

As my noble friend Lady Nye said, the Global Fund to Fight AIDS, Tuberculosis and Malaria has since its inception provided 6.1 million people with life-saving access to HIV treatment, 11 million people with tuberculosis treatment, 360 million households with insecticide-treated nets to prevent malaria, and treated 260 million cases of malaria.

As we have heard from noble Lords in the debate, it was rated as “very good” value for money in DFID’s 2011 Multilateral Aid Review, and continued to make progress according to the 2013 follow-up.

As we have heard in the speeches this afternoon, the donors’ decision earlier this month to pledge $12 billion over the next three years is extremely welcome but still $3 billion short of the $15 billion needed. If that goal was achieved it would mean that: 17 million patients with TB and multidrug-resistant TB could be treated, saving more than 6 million lives over the three-year period; 1.3 million new HIV infections could be averted each year; and 196,000 additional lives could be saved from malaria, helping to avert a resurgence of the disease that could see the world return to levels of mortality not seen since the year 2000.

Like the noble Lord, Lord Fowler, I pay tribute to the US Government for their action here. The US has committed itself to a one-third match of all funds raised up to the full $15 billion, so a further $1 billion is now on the table if other donors can step up to raise the remaining $2 billion needed. Like the noble Baroness, Lady Tonge, I am very proud of this Government for maintaining my Government’s commitment to the £1 billion funding. That places us in a strong position to exert influence over others for this round of replenishment. What steps will the Government and department take to help the fund realise the full $15 billion replenishment and thereby maximise the support from both us and the USA?

Key to this will be more effective engagement with emerging economies that have the capability to support the fund. As we have heard in previous debates, India and China between them donated less than Ireland did on its own. For malaria, the Global Fund represents half of all international financing and will go a long way towards helping meet some of the urgent needs for prevention, diagnosis and treatment. Current prevention measures have dramatically reduced malaria cases and deaths, particularly in young children. The WHO World Malaria Report published yesterday shows impressive progress in the global malaria campaign. However, as quoted in today’s Guardian, Margaret Chan—director-general of the WHO—warned:

“This progress is no cause for complacency. The absolute numbers of malaria cases and deaths are not going down as fast as they could”.

The Global Fund also makes up more than 80% of all international financing for TB, making it the single most important funding mechanism in the fight against TB. If global funding for HIV, TB and malaria were to flat-line, we could see 2.6 million new HIV infections every year, some 3 million fewer people treated for TB, and 430 million malaria cases that could have been prevented. As Mark Dybul, executive director of the fund said:

“We have a choice: we can invest now or pay forever”.

My Lords, I thank my noble friend Lord Chidgey for securing this important debate at a very important time. I also pay tribute to my noble friend Lord Verjee for his moving maiden speech. I am absolutely delighted that, with all his wide experience—as the noble Baroness, Lady Hayman, outlined—he chose to make his first speech in this debate, which I am answering. It is also excellent that so many noble Lords who have such an outstanding track record in this area, especially my noble friend Lord Fowler, have contributed. I thank noble Lords who paid tribute to what we are doing, especially my noble friend Lady Tonge, as I know how very hard won is her praise.

As noble Lords made clear, AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2012 alone, AIDS killed 1.6 million people, malaria 627,000 and TB 1.3 million. However, great progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared to 1990 levels. Just 10 years ago, the world struggled to respond to HIV, TB and malaria, and access to key prevention and treatment interventions was very limited—as noble Lords will remember. This picture has now been transformed and the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a major part in this. Since 2002, Global Fund-supported programmes have detected and treated 11.2 million TB cases and distributed 360 million treated nets. Some 6.1 million people living with HIV are now receiving antiretroviral therapy thanks to the Global Fund. That is truly a remarkable achievement.

However, as my noble friend Lord Fowler and the noble Lord, Lord Collins, pointed out, we must not give up now and cannot be complacent. Improvements are not uniform in all countries. As my noble friend Lady Tonge said, resistance to effective medicines is a growing threat. Devastating rebounds can occur quickly. That is why we must redouble our efforts and increase our commitment. As my noble friend Lord Fowler made clear, we now have a historic opportunity to make a decisive impact on these diseases. We have effective tools to prevent and treat them and an unprecedented global commitment to transform the three diseases into manageable health problems rather than national and global emergencies.

Last week at the Global Fund’s replenishment conference in Washington, donors pledged $12 billion. That is the largest amount ever pledged—a 30% increase on the amount pledged at the 2010 replenishment conference. But $12 billion is only the start: the fund aims to raise a further $3 billion over the next three years to bring this to $15 billion and make the most of this historic opportunity. The UK is playing a groundbreaking part in that, as noble Lords noted. We are committing £1 billion—provided that that is not more than 10% of the total replenishment value—to encourage other donors to come forward and meet the target. Developing countries, civil society and the private sector also have crucial roles to play. Last week the Gates Foundation announced that it would provide up to $200 million to match other donor commitments. We hope that that will encourage new partners, including private contributors, to join the global effort.

I assure my noble friend Lord Chidgey and the noble Baroness, Lady Nye, that we are working very hard to ensure that others follow suit. That is why the UK, the US and the Gates Foundation have made our contributions conditional. The most important role, of course, will be played by the countries themselves: designing effective national strategies; using funds transparently and well; and providing the bulk of financing from their own domestic resources. It was notable and historic that Nigeria participated in Washington as an equal partner, committing $1 billion for investments in treatment, care and prevention for Nigerian people affected by the diseases.

The noble Baroness, Lady Hayman, asked about the broader health sector support for the Global Fund. Clearly, the focus of the Global Fund is on the three diseases, but there has been a widespread understanding of the effect that it has on other diseases and the importance of ensuring that action in one area is supported by action in another, and that it is important to look across the sector. Whether it is neglected tropical diseases or family planning, to which the noble Baroness, Lady Tonge, referred, it is recognised that these areas interplay.

The noble Lord, Lord Fowler, asked about key populations. We strongly support a public health approach to key populations affected by HIV, including men who have sex with men, sex workers and injecting drug-users, that respects human rights and addresses the stigma and discrimination that they face. It is very important that that is recognised.

Of course, we wish to see the money spent effectively. On the misuse of bed nets, I can assure my noble friend Lord Chidgey that the World Health Organisation’s World Malaria Report 2013, which was launched yesterday, estimates that 86% of people who had access to a bed net used it to protect themselves from getting malaria. We are supporting efforts to maintain and increase that.

On TB, we are committed to the global goal of halving deaths from it by 2015. Various noble Lords mentioned this. The noble Baroness, Lady Nye, suggested that there were no TB-specific bilateral programmes. The majority of UK funding for TB treatment is through the Global Fund, but we are providing bilateral funding to TB-specific programmes in a number of countries, including South Africa, Burma, Nigeria and India. In August, we announced support for nine public-private partnerships, including FIND, the TB alliance and Aeras. These partnerships will help fund crucial work on developing new and more effective tools to prevent, diagnose and treat TB, in addition to our spend through the Global Fund.

In addressing my noble friend Lord Shipley on TB REACH, I will say that we have reviewed its external mid-term evaluation and agreed that it has successfully funded innovative approaches leading to additional TB cases being detected among high-risk populations and in high-burden countries. Besides supporting it through the Global Fund, DfID also supports TB REACH through our £53 million annual core support to UNITAID.

The noble Baroness, Lady Nye, spoke of integrated approaches to tackling TB and HIV, which is something that her noble friend Lord Collins put to me the other day. DfID has been leading in this area, and we have been strongly involved in the recent Global Fund requirement for countries burdened by the two diseases to put forward a unified and integrated application for joint TB/HIV programmes. This is a strong signal that disease-specific initiatives will not address TB/HIV co-infection alone. That is also highlighted in DfID’s HIV position paper review, which has just been published, because we recognise the importance of co-infection.

In terms of working in the extractives industry, which the noble Baroness, Lady Nye, also brought up, we are working with the Government of South Africa, the Chamber of Mines and the World Bank to expand the quality and access of TB-related services, including TB control and treatment referral across borders. There are some other details, which I can provide to her.

We now have to ensure that we use the funds pledged at the recent conference, and those that will follow, as we seek to meet the $15 billion requirement for the Global Fund. We have to make sure that these funds are used in the most effective way possible, so that we achieve the greatest impact from the money contributed. The UK will continue to work closely with the Global Fund to ensure: that we are financing the highest-impact interventions; that we are increasing funds to the lowest-income or most fragile countries with the greatest disease burdens; that we are focusing interventions on the most at-risk populations, using the latest epidemiological evidence to target disease hotspots in country; and that we are using funds to support implementation of robust national disease strategies with full country ownership.

We will ensure that the Global Fund implements and builds on its new systems of governance and risk management, so that no one is denied access to life-saving treatment due to a loss of funds through fraud and corruption. We must not forget the importance of shaping markets and reducing costs, and have made huge strides already in this area, which I think that noble Lords are familiar with. But with continued work, we believe that further sustainable price reductions are possible, so that more lives can be saved for every £1 raised.

The $12 billion pledged in Washington is the start of a process towards full replenishment and achieving the maximum impact from $15 billion. This in turn is part of something bigger, with vital contributions from other donor sources, the private sector, civil society, and, most importantly, from the countries themselves. Working together in a true global partnership with clear goals and targets and unwavering national and global commitment is the only way to end the death and suffering caused by HIV/AIDS, malaria and TB.