Tuberculosis

– in the House of Commons at 1:24 pm on 7th June 2018.

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Photo of Rosie Winterton Rosie Winterton Deputy Speaker (Second Deputy Chairman of Ways and Means) 1:24 pm, 7th June 2018

I remind colleagues that we have two debates to get through this afternoon, and they are both well subscribed. The guidance from the Backbench Business Committee is that opening speeches should last for 10 to 15 minutes. Because of the pressure on time, I will have to impose an immediate time limit of eight minutes once Nick Herbert has moved the motion.

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs 1:31 pm, 7th June 2018

I beg to move,

That this House
recognises that tuberculosis (TB) remains the world’s deadliest infectious disease, killing 1.7 million people a year;
notes that at the current rate of progress, the world will not reach the Sustainable Development Goal target of ending TB by 2030 for another 160 years;
believes that without a major change of pace 28 million people will die needlessly before 2030 at a global economic cost of £700 billion;
welcomes the forthcoming UN high-level meeting on TB in New York on 26 September as an unprecedented opportunity to turn the tide against this terrible disease;
further notes that the UN General Assembly Resolution encourages all member states to participate in the high-level meeting at the highest possible level, preferably at the level of heads of state and government;
and calls on the Government to renew its efforts in the global fight against TB, boost research into new drugs, diagnostics and a vaccine, and for the Prime Minister to attend the UN high-level meeting.

The motion stands in my name and that of my hon. Friend Mr Sharma, and I am grateful to the Backbench Business Committee for allowing us to have this debate on ending tuberculosis.

I believe that this is the first time that this issue has been debated on the Floor of this House for 65 years. Responding to an Adjournment debate in 1952, the Joint Under-Secretary of State for Scotland, Commander T.D. Galbraith, said:

“Tuberculosis is still the major health problem in Scotland…we must press forward…with every weapon that is available to us until the disease, which is said to be preventable, has been eradicated.”—[Official Report, 29 January 1952;
Vol. 495, c. 158.]

At that time, people were optimistic because antibiotics had been discovered and put into mass production, housing was improving and there was no longer any reason to believe that tuberculosis would not be beaten. Tuberculosis was the great killer of history. A disease that dates back at least 7,000 years, it has killed 2 billion people in the last two centuries alone. John Bunyan said that TB was

“the captain of all these men of death”.

TB—otherwise known as consumption or the white death—is caused by a tiny bacteria. When it was first identified in 1882, it was still killing one in seven people. Indeed, TB killed more people in the United States in the late 19th century than any other disease. It is a disease that has killed kings, poets and paupers throughout history. Tutankhamun, Edward VI, Cardinal Richelieu, Eleanor Roosevelt, Keats, Chekhov, Emily Brontë, D. H. Lawrence, Orwell and Chopin all died from TB. Of course, the heroines of the operas “La bohème” and “La traviata” notoriously die from tuberculosis. That was expected in that age, which was not so long ago. Millions of others down the ages have suffered from TB—notably, Nelson Mandela, who suffered greatly from it.

With better housing, better nutrition, the discovery of penicillin by Fleming in 1928, and the mass production of antibiotics in the 1940s, it was thought that tuberculosis would be beaten. In 1962, a Nobel laureate virologist said:

“To write about infectious disease is almost to write of something that has passed into history.”

But TB was not eradicated or eliminated at all. It resurged on the back of the AIDS epidemic. TB is a bug carried by a third of the world’s population that can exist in our bodies latently, but strikes when immune systems are compromised.

Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth

I congratulate the right hon. Gentleman on securing this debate. I chair the all-party parliamentary group on HIV and AIDS, and he knows that we very much share his concerns about TB and are pleased to work with his all-party parliamentary group on global tuberculosis. Today, we met the chief executive of the he Global Fund to Fight AIDS, Tuberculosis and Malaria. Does the right hon. Gentleman agree that that organisation is doing excellent work, not least on co-morbidity, as people live with HIV/AIDS and TB? People living with HIV are 30 times more likely to develop active TB, and TB is the leading killer of people with AIDS.

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

I strongly agree with the hon. Gentleman that the diseases must be treated together. However, great progress has been made on tackling AIDS, partly because of the tremendous new tools available. By comparison, less progress has been made on tuberculosis. Last year, 1.7 million people died of tuberculosis. That is more than AIDS and malaria combined. The single fact that most people do not realise is that tuberculosis is now the world’s deadliest infectious disease, and it deserves more attention than it gets. Some 10 million people globally are falling ill each year as a result of this disease.

TB was declared a global health emergency by the World Health Organisation 24 years ago. Since then, 54 million people have died. That is not a great advert for the declaration of a global health emergency. Three years ago in New York, the world’s leaders set the sustainable development goals. Target 3.3 was to eliminate these major epidemics in 15 years’ time. At the current trajectory, TB will not be eliminated for 160 years, so another 28 million people will die in the sustainable development goal period alone, costing the world economy $1 trillion cumulatively. Middle and lower-income countries will be the most severely hit, with lower-income countries experiencing a reduction of something like 2% of their GDP.

On top of this, there are new threats. I mentioned that TB strikes when immune systems are compromised, and they can be compromised in new ways, including by the acquisition of diabetes. In Indonesia, TB is striking people with diabetes, which is a growing problem.

Above all—this should concern the House greatly—is the growing risk of drug resistance. TB is the only major drug resistant infection that is transmitted through the air. It is already responsible for one in three deaths worldwide from all forms of drug resistance. Drug resistance generally now kills 700,000 people a year, but Lord O’Neill’s commission, set up by David Cameron, predicted that drug resistance would kill 10 million people a year by 2050, and that those deaths would fall in the west and advanced economies, not just in poor and middle-income ones. That compares with, for instance, 8 million deaths a year from cancer. We are talking about catastrophic loss and catastrophic economic cost, with a cumulative GDP loss of $100 trillion, knocking 2% to 3.5% off global GDP. It is significant that a quarter of those deaths from antimicrobial resistance would be due to tuberculosis, which is already responsible for a third of antimicrobial resistance deaths; that is 200,000 deaths a year.

Photo of David Drew David Drew Shadow Minister (Environment, Food and Rural Affairs)

The right hon. Gentleman is making an excellent speech. Will he also accept the connection between TB and conflict? In the parts of the world where TB is rife—including South Sudan, which I know very well—conflict is adding to the complexity for people suffering from disease.

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

That is a very interesting point. TB is a disease of poverty. This opportunistic infection will strike if there are no basic health systems and if nutrition and housing are poor, and all those conditions would probably exist in areas of conflict.

Drug resistant TB is a terrible affliction. It can be dealt with, but even in an advanced healthcare system, it requires a course of treatment in which some 14,000 pills have to be taken. This treatment is appalling, as it can cause patients to become deaf and creates a lot of suffering. Only half of drug resistant TB patients are successfully treated. In fact, there is a lower survival rate for drug resistant TB than for lung cancer.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

Just to step back, the right hon. Gentleman mentioned diabetes. In this country, we can change our lifestyles as we have access to lots of food and other things to reduce diabetes, but people in third-world countries where TB and diabetes are rampant do not have the same choice. Does the right hon. Gentleman agree that this complicates issues?

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

I do agree. There is a growing list of reasons why we should act, and that is one of them.

Photo of Stephen Timms Stephen Timms Labour, East Ham

The right hon. Gentleman is making a very powerful speech. He is right to draw attention to the scale of the problem in the developed world as well as the developing world. In my constituency, the incidence is now about the same as in Sudan, at just over 80 per 100,000. Does he agree that it is important that people realise that, notwithstanding drug resistance, this is a treatable and curable condition and that people need to get help when they are suffering from it?

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

Again, I do agree. The scale of TB in London makes it one of the TB capitals of Europe. We have some 5,000 cases of TB in the UK. That figure is coming down with the new public health strategy, but it is still too high. The right hon. Gentleman is right. This disease is easily and cheaply curable, and it has been since the discovery of antibiotics, so why are we not doing it?

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons)

I thank my right hon. Friend for his very powerful speech. Further to his points about the importance of public health, would he urge the Government, in their future strategy, to make sure that we look at NHS public health and social care as part of a single system?

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

Yes. My hon. Friend is probably aware that there is a collaborative TB strategy that was introduced by the Government, urged by the all-party parliamentary group on global TB, which the hon. Member for Ealing, Southall and I co-chair. That strategy shows very promising signs. It represents exactly the kind of partnership that we need between Public Health England and NHS England. I commend the Government for having introduced that partnership.

Most people do not realise that there is no vaccine for tuberculosis. There is a child vaccine, BCG, that some of us had when we were young, but there is no adult vaccine that works for tuberculosis—and no epidemic in human history has been beaten without a vaccine. The reason there is no vaccine is that there is market failure. Unlike HIV/AIDS, this is primarily a disease of the poor. With HIV/AIDS, there were people dying in western countries as well. The pharmaceutical companies do not have a commercial incentive to invest in the new tools that we need—better drugs, better diagnostics and a vaccine. Without partnership funding that comes from the Government, and Governments around the world who can afford it, we will not develop these new tools and we will not beat TB in the requisite timeframe.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

I thank my right hon. Friend for all the work he does on TB. As chair of the all-party parliamentary group on malaria and neglected tropical diseases, I would like to point out that there is a malaria vaccine, which is being deployed for the first time. We are not sure how effective it is. It is clearly quite effective, but a lot more work needs to be done on it. Companies such as GSK, which is behind this vaccine, are prepared to invest in these things even though they have no commercial return from them. Let us hope that a similar approach will be taken by commercial companies and Governments in respect of TB.

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

I agree that some companies are willing to take a non-commercial view, such as Johnson & Johnson and Osaka Pharmaceuticals, but many other major pharmaceutical companies are not developing new TB tools because there is no commercial incentive. Therefore, we do need that partnership funding to make this happen.

I would argue that there are three powerful reasons for us to act: a humanitarian reason because of the number of deaths, an economic reason because of the cost to the global economy of not doing so, and a global health security reason because of the risk of drug resistance.

Photo of Julian Lewis Julian Lewis Chair, Defence Committee

May I make a practical suggestion? We sometimes hear that the overseas aid budget struggles to find the best possible causes in which to invest our 0.7% of GNI. Could the rules possibly allow for an investment from that funding in the sort of research that is necessary to find a cure for TB?

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

My understanding is that they already do. That is a good example of how we already—although we need to do more—deploy the resources that are available to us. Indeed, the commitment that we make as the second biggest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria—£1.2 billion in the last replenishment—has been made possible because of the increase in aid spending and the target that has been set.

At last, this disease is commanding greater political attention. It has got on to the G7 and G20 agenda, partly because of the lobbying that is being done by the Global TB Caucus, which I co-chair with South Africa’s Health Minister, and now numbers 2,500 parliamentarians in 130 countries. In November, there was a WHO ministerial summit in Moscow. In February, Prime Minister Modi of India announced a TB strategy.

Above all, there is a reason to be optimistic because, at the United Nations on 26 September, there will be, for the first time ever, a high-level meeting on tuberculosis that it is intended that Heads of Government and Heads of State will attend, where a new declaration will be launched, with a commitment by the world’s leaders to act. That has to address the current funding gap whereby we are $6 billion a year short of the funding needed properly to eliminate TB by the SDG deadline in 15 years’ time. It also has to introduce greater accountability so that Governments are locked into proper targets to ensure that they really do reduce TB. In addition, there needs to be a dramatic increase in research and development to develop the new tools that I mentioned. All this requires leadership.

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham

I am hoping to speak later in the debate, but my right hon. Friend is already making a powerful case. Has he had any indication from the Prime Minister on whether she intends to attend that high-level meeting, because it would seem to be of great significance that she does?

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs

My right hon. Friend asks a very pertinent question. Last month, 100 Members of this House and the other place wrote to the Prime Minister to ask if she would attend the meeting. The motion before the House specifically requests that the Prime Minister attend, as the UN General Assembly has asked. So far—understandably, I believe—the Prime Minister is not committing to attend.

In the time remaining to me, I would like to make the case for the Prime Minister to attend this meeting. It would be completely consistent with UK Government policy. We have made that major investment in the global fund. We are world leaders in international development. We set the agenda on antimicrobial resistance. We have a leadership position, and we should take it on this issue. TB is now the world’s deadliest infectious disease. This needs the support and attention of the world’s leaders. The UK is in a very powerful position to show that leadership and to give that support. Indeed, it is very difficult to see what would be the downside of the Prime Minister attending. I believe it would be all upside, and it would send a very powerful message to other world leaders. It is completely consistent with the ambition for a global Britain. Indeed, it is worth noting that TB is an issue in 19 Commonwealth countries, and 17 of the Department for International Development’s priority countries are high-burden.

This is a once-in-a-generation opportunity. The high-level meeting is the chance, at last, for this disease to get the attention that it needs. It is an easily and cheaply curable disease. Frankly, it is a global scandal that so many people are losing their lives completely unnecessarily when since the 1940s they need not have done so. We can act and we should act. The UK can play a major role in this respect. Speaking at the UN on Monday, I was asked what was the single message that I would want to send to the world’s leaders about whether or not they should attend. I simply said this: if 1.7 million deaths a year is not enough to encourage the world’s leaders to attend, what is?

Photo of Louise Ellman Louise Ellman Labour/Co-operative, Liverpool, Riverside 1:48 pm, 7th June 2018

I congratulate Nick Herbert on securing this very important debate and on his very powerful speech.

Tuberculosis remains the world’s deadliest infectious disease. It was responsible for the deaths of 1.7 million people in 2017. TB was declared a global emergency in 1993, and the sustainable development goals envisioned ending it by 2030. At the current rate of progress, this target will not be reached for 160 years.

I have the privilege of representing a Liverpool constituency where work of world-class excellence in combating this scourge is based. Liverpool University’s Institute of Infection and Global Health, led by Professor Tom Solomon, and the Liverpool School of Tropical Medicine are international leaders. They undertake world-renowned collaborative research in this area. It is because of Liverpool’s outstanding work that it was chosen as host of the 47th Union World Conference on Lung Health in October 2016. I was pleased to be able to participate in that in a small way.

The work in Liverpool to combat this disease is wide-ranging. Scientists at the Institute of Infection and Global Health are leading a €25 million European public-private partnership aiming to accelerate development of new combinations of drugs to fight TB, both in the UK and abroad. They are also looking at how poverty is contributing to the challenge of tuberculosis. Poor people are more likely develop the disease and, indeed, to die from it.

The Liverpool School of Tropical Medicine undertakes significant research into complex poverty-driven global diseases, including TB. The International Multidisciplinary Programme to Address Lung Health and TB in Africa—IMPALA—is led by Professor Bertie Squire, Dr Angela Obasi and Dr Kevin Mortimer. It is a £7 million project funded by the National Institute for Health Research to create an Africa-focused NIHR global health research unit for lung health and TB. It works across 11 African countries, and its work includes strengthening research infrastructure in African institutions.

Dr Gerry Davies is leading the major €25 million European public-private partnership aimed at accelerating the development of new combinations of drugs to fight TB. He is also part of a WHO taskforce on treating TB. STREAM is an international project to investigate treatment of anti-TB drugs for patients with multidrug-resistant TB, which is a major issue in combating the disease. The Liverpool School of Tropical Medicine is one of the international collaborators on that vital project.

The relationship between poverty and the growth and spread of TB has been mentioned, and significant parts of the pioneering work taking place in Liverpool focus on that relationship. Dr Tom Wingfield is leading much of that research, including studies currently taking place in Peru. He is part of the WHO’s taskforce on the catastrophic effects of TB, and he is also responsible for cross-campus collaboration between Liverpool University and the Liverpool School of Tropical Medicine. Some of the key work involves training conducted by the Liverpool School of Tropical Medicine that focuses on TB microbiology, epidemiology, care and prevention, and it attracts international students.

Those are just a few examples of the inspirational work based in Liverpool. It reflects dedicated people with high levels of expertise and institutions that enable this important work to progress internationally in a collaborative way. It is about combating a disease that takes millions of lives a year.

I agree that much more international support is required, and I fully endorse the call from the right hon. Member for Arundel and South Downs for the Prime Minister and others of a high status to attend the important impending conference. That is vital to show the importance attached to combating this dreadful disease. International support and more funding are required, but I ask the House to take note of the groundbreaking collaborative work currently taking place in Liverpool. Liverpool should be proud.

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham 1:53 pm, 7th June 2018

May I start by congratulating my right hon. Friend Nick Herbert on not only his excellent speech but the way in which he has pursued this matter relentlessly across an international audience? He is renowned on an international basis, as I know myself.

I am proud to represent the UK at the Parliamentary Assembly of the Council of Europe with many other colleagues from both sides of the House. The Council of Europe represents 47 countries and is an institution that is far older than—and, I think, vastly superior to— the European Union. It takes up some very important matters. I am pleased to report that on 27 April, in our main plenary session, we were privileged to hear from a very competent and capable Ukrainian Member of Parliament, Serhii Kiral, who was appointed the rapporteur for the “Drug-resistant tuberculosis in Europe” report, contained in document 14525 of the Parliamentary Assembly of the Council of Europe. He presented his report, which was passed unanimously in the plenary session.

Mr Kiral has done much investigation into this area, and he started his speech by saying:

“My report is about fighting tuberculosis, but tuberculosis is like corruption—you do not see it, but it is there. It is equally dangerous, but it is also curable.”

Although many of us thought that TB was a disease of the past, he informed us that during the course of his investigations a professor from the University of Oslo told delegates from the Council of Europe on a fact-finding mission that more than 900 new cases are registered every day. Europe accounts for one in five multidrug-resistant TB cases in the world, and nine out of 30 countries that the World Health Organisation has identified as needing to solve their TB problems are in Europe. It is of particular concern that 45% of cases affect young individuals aged between 25 and 44.

Owing to the time limit, I will concentrate not on the broader facts but on two specific areas: the importance of disease surveillance and diagnostic gaps. On World TB Day this year, 24 March, the European Centre for Disease Prevention and Control released an alarming set of statistics, including the fact that the number of cases of extensively drug-resistant TB has increased 14-fold in the last four years, with almost 5,000 cases reported in 2016, the majority being in eastern Europe. Those statistics are startling and demonstrate the vital importance of TB surveillance systems.

Epidemiological surveillance is a vital global public health investment, since it allows experts to monitor the trajectory of the epidemic and, particularly in the case of the emergence and spread of drug resistance, allows us to identify where we are failing and how we need to address it. Marieke van der Werf, who is the head of tuberculosis at the ECDC, has confirmed that the threat to Europe is caused by the mobility of people who bring drug resistance with them. Countries really need to be vigilant about that. The data released by the ECDC is available because of investments in laboratory and surveillance infrastructures. Routine surveillance of drug-resistant TB, where every case identified is reported, is now available in 90 countries worldwide, with the majority being in Europe and North America.

At the global level, progress is being made. Since 2015, 22 high-burden countries have begun the process of conducting national drug resistance surveys, six of them for the first time ever. In 2016, we saw the discovery of an additional 600,000 cases of TB as a result of those surveys. It is clear that the data garnered from those surveys will be vital in shaping the global response, but gaps remain to be filled.

The need for urgent action is self-evident on the basis of current data alone, but to ensure that our efforts are as appropriately targeted as possible, we had better get on with it. Will the Minister work with colleagues across Government, as well as bilateral and multilateral partners, to improve TB surveillance globally, particularly for drug-resistant forms of TB, including through future programmes of the Fleming fund?

Ultimately, all efforts rely on the availability of accurate diagnostic tests. Currently, that is far from guaranteed, to the detriment of both epidemic preparedness and the individual patient. In 2016, some 3.8 million cases of TB were never formally reported, going completely undiagnosed or at risk of being treated inappropriately. In the same year, just 57% of reported cases were bacteriologically confirmed, and of those, just 39% were tested for resistance against first-line drugs.

In the past 10 years, immense progress has been made in the diagnosis of TB, with new diagnostic tests that allow for accurate diagnosis and the detection of first-line drug resistance in under two hours having the potential to transform our fight against TB. Despite those advancements, however, the vast majority of TB diagnoses made today still rely on the methodology used by Robert Koch to discover TB in 1882. When the Minister responds to the debate, will she commit to finding the missing millions, and to working with partners to guarantee access to WHO recommended diagnostics for all people at risk from TB?

I conclude by returning to the UN meeting and the motion before the House today. This issue is of such importance to the lives of people around the world because of increasingly mobility and the flows of people. It is of such significance that I feel the Prime Minister must put in an appearance on behalf of the UK, not only to bang the drum about the advances we have made, but to make that valuable contribution that will save lives. If one statistic brought me up, it was learning that 700 children die every day from TB. As my right hon. Friend the Member for Arundel and South Downs said, if those statistics are not enough to make world leaders sit up, take notice and attend this meeting, goodness only knows what would be enough.

I am sure we will hear about the projected economic effects of TB in subsequent contributions. If anybody wants to look at them they are quite alarming. They provide both the head and the heart with a reason to participate in this high-level UN meeting, and I therefore hope that the Prime Minister will attend and give this issue her full attention. It is probably one of the most important things she will be asked to do to save lives around the world.

Photo of Stephen Twigg Stephen Twigg Chair, International Development Committee 2:01 pm, 7th June 2018

It is a pleasure to follow Dame Cheryl Gillan; I echo everything she said about this important subject. I congratulate Nick Herbert on securing this important and long overdue debate, on his active leadership of the all-party group on global tuberculosis, and on his co-chairing the Global TB Caucus. I also echo everything said by my hon. Friend Mrs Ellman about the fantastic contribution made in this field by Liverpool University and Liverpool School of Tropical Medicine.

Let us all welcome the upcoming UN high-level meeting on tuberculosis because it is an unprecedented opportunity for Governments around the world to come together and secure a global commitment to bring an end to the world’s deadliest infectious disease. I join other Members, and the motion, in saying that I very much hope the Prime Minister will attend the meeting in September, as that would send a powerful signal of the United Kingdom’s leadership and commitment to tackling deadly diseases and global health emergencies wherever they develop.

As the right hon. Member for Arundel and South Downs rightly reminded us, goal 3 of the global goals for sustainable development is “good health and well-being”, and it commits the world to bringing an end to TB by 2030. That is in just 12 years’ time, and it would be no small feat. On current projections, we are not likely to see an end to TB for 150 years, because the current rate of decline is about 2% on average, and it needs to be closer to 10% if we are to eradicate the disease by 2030.

As my hon. Friend Stephen Doughty reminded us, many of those who live with TB are also living with HIV, and people with HIV have a weaker immune system, meaning that they are at much greater risk of developing TB. People with HIV are up to 27 times more likely to develop active tuberculosis than the average person. I welcome the Minister to her place, and when she responds to the debate, will she say whether the Department for International Development has any plans to develop a new strategy to deal with the two ongoing health emergencies of tuberculosis and HIV/AIDS?

Worryingly, of the 10 million people who fell ill with TB last year, only two thirds were diagnosed with the disease—that builds on what the right hon. Member for Chesham and Amersham said about diagnosis being a key challenge. Almost 4 million people were therefore “missing”, either because they were misdiagnosed or because they did not receive the correct treatment. Children often fare the worst, as just a quarter of cases of TB in children under five are diagnosed correctly and successfully. That has significant implications for treatment. TB is a curable disease, but it requires strict, continuous treatment with a number of antibiotics over a period of months. One reason why drug-resistant TB is becoming such a major problem is because many people do not finish their course of antibiotics, leaving them with mutated TB that is resistant to new antibiotics.

How can we address this issue? Funding is clearly a major part of the challenge we face, and the WHO’s global TB report suggests that more than $9 billion a year is needed to deal effectively with the crisis. In 2016, the amount available was less than $7 billion, so there was a shortfall of more than $2 billion, and funding is a serious barrier to making real progress on driving down the incidence of tuberculosis. The Department for International Development spends £2.3 million on solely TB-focused programmes, but some of the £93 million that it spends on broader infectious disease control is also allocated to tuberculosis. If we are serious about seeing an end to TB by 2030, we must ensure that the funds are there to meet that ambition.

The funding issue is compounded by some of the questions about poverty and TB that a number of hon. Members have addressed in this debate. In recent years, DFID has rightly focused more of its work on the poorest people in the poorest countries, but TB is often an major killer in countries where DFID no longer provides, or is migrating out of, bilateral official development assistance. That is a real challenge not just for DFID, but for the rest of Government and the international system. It is right that UK ODA is focused on the poorest countries, but we must ensure that middle and even high-income countries have effective mechanisms to deal with TB. The World Bank has been looking at mechanisms to help to fund a response to TB in countries that are not eligible for ODA. For example, low-interest loans could be made available to those countries to help them tackle their ongoing TB issues, allowing them to deal with TB without shifting funds from other areas of public expenditure. DFID has a wealth of experience in tackling infectious diseases, but if the money is not there to support those programmes, there is a risk that they fall flat or do not get off the ground in the first place. Will the Minister say what more DFID plans to do to tackle that significant funding gap?

The right hon. Member for Chesham and Amersham rightly focused on diagnosis, and we know that even when somebody shows the symptoms of TB, it is often difficult to diagnose. The tests take a long time and are often inaccurate. They also suffer from low sensitivity—that is the ability to correctly detect people with TB—or low specificity, which is the ability to detect people who do not have TB. Together, those two factors mean that people who take TB tests often receive a false negative or a false positive, and that can only further perpetuate the spread of TB in general, and of drug-resistant TB in particular. We need more accurate testing, such as the culture test, although that can take several weeks and its administration requires specialised equipment and skilled medical staff. Clearly a radical new approach is needed to ensure that there is the best diagnosis, treatment and prevention. That will involve improving our understanding of the basic science behind diagnostics, drugs and vaccines, as well as increasing research and development.

Education about disease prevention is important, and some of the most obvious steps in prevention are often the most effective, such as washing hands regularly, or covering our mouths when we sneeze or cough. That might sound obvious, but such small lifestyle changes can go a long way to prevent the spread of TB. Education is also important during the treatment phase, as people need to know how to take their antibiotics correctly and to be aware of the implications of skipping treatment. Will the Minister say what DFID in particular is doing to work with other Government Departments, including Health, to find new and more effective ways to both diagnose and treat TB?

DFID, rightly, is a hugely respected development body in the world. It has long played a strong leadership role in health emergencies. We have an opportunity, as set out in the motion, to reinforce that long-standing UK reputation. The United Kingdom has a chance, if the Prime Minister attends the UN high-level meeting, to send a very clear signal to the world of our priorities and our commitment to fighting TB.

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury 2:10 pm, 7th June 2018

I am grateful for the opportunity to speak in the debate and to follow some excellent speeches. I hope that we do not have to wait a further 65 years before we have the opportunity to debate this important matter again. My right hon. Friend Nick Herbert and Mr Sharma are vocal campaigners on this subject. I am encouraged by the fact that we are now giving it the attention it deserves, particularly in the same week as the UN civil society hearing on the fight against tuberculosis.

I would like to add to some of the dreadful statistics we have heard this afternoon. My right hon. Friend Dame Cheryl Gillan pointed out that around the world an estimated 700 children a day die from this disease. I want to make it clear that 80% of those deaths occur before that child is five. Fewer than 5% of those children have access to the sort of treatment that we all know could save their lives. Treatment gets ever easier. Thanks to DFID-funded research, new child-friendly drugs have been developed. They taste of strawberry and can be added to water in a single dose, which makes things much easier for doctors and parents who until now have had to try to get children to take adult-sized pills. We have done the research on so much of this. We now need to ensure that the treatment programmes are rolled out so that many, many more of those 700 children a day who are dying of this disease get the treatment that they need.

I heard what Stephen Twigg said about treatment in countries where DFID is no longer actively engaged. That is critical in relation to the worldwide disease, but we should also be concerned that TB is still prevalent in the UK. Some of the highest rates in the developed world are found right here in the city we are standing in. My own family has personal experience of tuberculosis. When this matter was last debated in the Chamber, my grandfather was very ill and ultimately died of the disease in south Wales. Since I became an MP some three years ago, I have been surprised to note that I have had quite a lot of casework to do with TB in north Oxfordshire. One of those cases involves a constituent who moved to the UK in the late 1990s. He joined the British Army in 2009. During phase two of his basic training, he was diagnosed with TB. He had never been diagnosed with it before; it has been assumed that he contracted it during his training.

I have also had cases involving the immigration process for people applying for visas from countries including Morocco, Ecuador and the Dominican Republic. They have to undergo quite invasive TB tests by a Home Office-approved clinic as part of their application process. Clearly, the Government, in the wider sense, recognise the extent of the problem, but there is perhaps not always the joined-up cross-departmental working needed to tackle it.

We should be proud of the Government’s efforts so far in the fight against tuberculosis. We should be proud of our contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The number of new TB infections is dropping. DFID’s support in developing new drug combinations to treat TB and the provision of funding to the TB Alliance demonstrates our commitment. In Oxfordshire—we heard earlier about Liverpool, so it is only fair that I mention Oxfordshire—we are fortunate to have one of the world’s largest TB vaccine research centres, based at the University of Oxford. With the support of the Medical Research Council, the Wellcome Trust, DFID and product development partnerships, the centre has been able to undertake cutting-edge research. I am hopeful that that will transform how we treat TB in the future.

There is clearly a great deal more to do. I am sure that the Minister will mention the progress we have made because of DFID’s investment in research. Like everybody else who has spoken, I would welcome assurances that the Prime Minister, or another senior Minister if she is unavailable, will attend the UN’s high-level meeting in September to ensure that research is appropriately funded and co-ordinated so that it can be sustained in future.

I am also concerned that primary healthcare services and maternal and child health programmes are too often run separately from TB programmes. Awareness among healthcare workers, and the capacity more broadly for diagnosis and treatment, remain limited. I hope that the Minister will be able to provide reassurances that she will look at how we improve access to vital diagnosis and treatment services, in particular for children with TB.

My grandfather probably got TB from infected milk. We do not know and we will never know. We still have much to learn about the way in which TB spreads and about cross-species transmission. I would not be doing my job as the Member for Banbury if I did not mention in a debate on TB the fact that bovine TB remains a very hot issue in the fields and market towns I represent. I appreciate that this falls outside the Minister’s remit, but I have serious concerns about the continued effect of bovine TB and its human impact on the farming communities I represent. The relevant Minister from the Department for Environment, Food and Rural Affairs met me and my hon. Friends the Members for Henley (John Howell) and for Witney (Robert Courts) earlier this week to discuss how to reduce TB in cows in our area. We looked at compensation levels for farmers and reduction mechanisms, such as whether we can stop store cattle being moved from high-risk to low-risk areas. We also talked about badger control. If we are to eradicate TB once and for all, we have to look at what is happening in species other than our own.

We have made great progress in the right direction, but there is still much more to do, both at home and abroad. I hope that we will have the chance to talk about tuberculosis many times before we reach our goal—hopefully well before 2030—of eliminating it.

Photo of Jim Fitzpatrick Jim Fitzpatrick Labour, Poplar and Limehouse 2:17 pm, 7th June 2018

I am grateful for the opportunity to make a very brief contribution to the debate. It is a pleasure to follow Victoria Prentis who made a very good contribution. There is a bit of controversy about the Government’s solution to bovine TB, but it is a very serious issue and it does need to be addressed. I congratulate Nick Herbert on securing the debate, his excellent presentation of all the facts and the sterling leadership he has given the House on this issue over a considerable period of time. It is valued and valuable, and we are grateful for the amount of time and effort he puts into it. I thank the Backbench Business Committee for affording the time for the debate.

The right hon. Gentleman, in his presentation, said that the motion succinctly outlines the main issues, so I do not see any reason for me to repeat all the messages contained in the excellent contributions we have already heard and I am sure we will hear before the close of the debate. It will suffice if I just make a few points.

TB is the world’s deadliest infection with, as we have heard, 1.7 million deaths in 2017. The WHO declared it a global health emergency in 1993 and it has not diminished since then. The UK has a very proud record. DFID should be pleased with the respect and recognition it and the UK have received for helping to address the issue across the world. World progress, however, is slow. It appears that the comparison with funding for HIV/AIDS and for malaria does not stand up to scrutiny, and I will come back to that in questions that I will pose to the Minister in due course.

If I may, however, I will stray for a moment from infectious diseases to one of the world’s other huge killers—that is, road crashes—which has an even lower profile. Annually, 1.25 million people die on the world’s roads and 20 million are seriously injured. The figures for malaria—I am not diminishing this in any way, shape or form—show that 429,000 died from malaria in 2015, which is the last year for which figures are available, and 1 million died from HIV/AIDS. There were 1.25 million deaths from road crashes. The UN and the World Health Organisation have recognised that this carnage needs to be addressed and two specific sustainable development goals address just that issue.

The United Kingdom is a world leader on safer roads. We can be of great help to many countries. The fire and rescue service and fire industry charity Fire Aid, which I chair, delivers post-crash response equipment and training to 30 countries. We are engaged with DFID and the Department for Transport and I hope that we can strengthen those links in future, because we can contribute much more to reducing these awful deaths—many are children on the way to and from school.

As I mentioned, I have just a few questions to pose to the Minister. I would be grateful if she could respond later, and if not, I would be very happy to receive correspondence in due course. First, can DFID commit to working with partners to close the TB funding gap? Secondly, will UK embassies champion TB in all high TB burden countries? Thirdly, will DFID establish a specific programme for new resources for TB, as it has for malaria and HIV/AIDS? Fourthly, will the Minister make DFID’s overall investment in HIV, TB and malaria in each of the last five years available through the devtracker website?

In conclusion, east London has been the hotspot in the UK for TB for—forever probably, but certainly in recent years. As the right hon. Member for Arundel and South Downs mentioned, the number of notifiable TB cases was 5,000 in 2017, down from 8,000 in 2011. We are going in the right direction, but people still die from TB in the UK, so it is a domestic issue as well as a global one.

I am grateful to consultant physician Dr Veronica White and her colleagues—she is a TB specialist at Barts and the Royal London NHS Trust—for all the work that they do in east London and to help the UK’s efforts, and for her briefing. I am also grateful to Alysa Remtulla from STOPAIDS and Janika Hauser from the all-party group on Global Tuberculosis for their assistance in producing briefings for all of us for this debate.

This is a hugely important issue. I echo the request to the Prime Minister—I think I signed the letter that the right hon. Member for Arundel and South Downs circulated last year—to attend the high-level global meeting. She will need relief from Brexit at some point. This would give her the perfect antidote by letting her concentrate on something on which I am sure the whole House will agree. It will give her the opportunity to take her mind off what is happening here and between us and the Commission.

Photo of Edward Davey Edward Davey Liberal Democrat Spokesperson (Home Affairs) 2:23 pm, 7th June 2018

Sometimes we come to a debate in the House of Commons and really learn things. I am grateful for the speeches that we have heard so far, because I have learned a lot. I particularly learned about the work that Nick Herbert has done and I pay huge tribute to him not just for securing this debate, but for that. The fact that parliamentarians from this House work around the world to tackle this incredible disease is a tribute to the House and, of course, to him.

It is also great that this country, with cross-party support for the 0.7% of GDP, is enabled through DFID to take a leadership role. One of the reasons we should always defend the cross-party achievement of raising the level of spending on overseas aid is that it can do such a huge amount of good. The relatively small sums of money that are spent on research into TB, for example, can do such a huge amount of good—the value for money is unquestionable.

That is what I want to pick up on in the first part of my remarks. The right hon. Gentleman talked about this concern in reference to Lord O’Neill’s report: although we are having some success, the danger is that with drug-resistant TB, the success will be reversed. Therefore, the urgent need to redouble our efforts, either through DFID funding or by working with others at the UN, could not be greater. If there is one thing that I would urge the Minister to do, not only in replying to this debate but when she goes back to Whitehall, it is to see what more we can do on that. There is some fantastic work, including the trials that we saw in 2013 and 2014, and the trials that are ongoing, which will not report for a few years. There is the work that Médecins sans Frontières and some of the great scientists in our universities are doing. We need to make sure that that concludes and helps us to produce the new drugs that will be essential to avoiding, frankly, a global pandemic, if we are not careful. Remember that this is an infectious disease that kills more people than any other infectious disease in the world, so the importance of that work cannot be underestimated.

I want to turn back to this country, following on from the remarks made by the right hon. Gentleman, the mover of the motion. This is a disease that hits the poorest in society, whether in developing countries or in the UK. We have had real success in this country in reducing the incidence—it has fallen by nearly 40% in the last six years—and we should pay tribute to Public Health England, the NHS and all the people who are working to bring that about. However, one group in our society is not seeing a reduction—that is, the very poorest. Homeless people, drug and alcohol addicts, prisoners and destitute migrants are not seeing any reduction, and one can sort of understand why. Their need for formal healthcare is much greater. A homeless person is twice as likely to die from TB as any other person who contracts TB, so we have to look at that group of people.

Some work is being pushed, and Governments have responded to this need. In particular, I want to bring the work of the London find and treat team to the House’s attention. The team have just one van. They have a mobile digital X-ray unit, and they find, diagnose and enable people to access the healthcare that they need. Remember that this is an infectious disease, so it is really important that we find and treat, so that we help those people to help wider society.

I have one spending request for the Minister. There has been a pledge that there will be more money for these find and treat teams in the UK, so that we can help the most vulnerable in society who are contracting this disease, among whom the incidence of TB has not gone down. I do not believe that this is a massive spending request, but if we could find a bit more to help those find and treat teams—indeed, to expand their work so that it is not just on TB, but on one or two other infectious disease that have high incidences—that would be a tremendous advance, and I am sure that it would get cross-party support. The Minister may not be able to answer that today, but if she could say that that outreach work could be a real boon and talk to colleagues about it, I would be grateful.

I end by paying tribute to those from this House who have done such great work around the world. It is truly impressive.

Photo of Sandy Martin Sandy Martin Labour, Ipswich 2:28 pm, 7th June 2018

It is a real pleasure to follow Sir Edward Davey and all the other speakers. I fully support the motion and all the actions that it calls for. Much has been said about the urgency of ending the scourge of tuberculosis abroad, but I want to focus on what we can do here in the UK to help to stamp out TB among our citizens. If we are going to champion the fight against TB in countries where the prevalence is far greater, but where the general economic situation is far poorer, how can we hold our heads up when England still has one of the highest rates of TB in western Europe? That is from the Public Health England report of this March, so I apologise to colleagues from other nations of the UK—no doubt the figures are similar there.

Of course I support research into the causes and prevention of TB. Of course I support our programmes abroad to help to reduce the millions of deaths in less developed countries. Of course I support the search for new, more effective drugs, but we already know some of the causes, and the lack of effective policies on poverty and homelessness in our country make our commitments to eradicating TB abroad look—how shall I say this?—inconsistent. Public Health England is doing many of the right things, such as improving access to testing and diagnosis, but if we look for the reasons for the 20-year rise in TB rates in the UK from the mid-1980s to the early years of this century, the causal factors are not hard to find.

Some of the policies of the present Government, and, indeed, all Governments since the 1980s, have not helped. First, there is homelessness. Whether the homeless person was born in the Marshall Islands or in Margate, we know that if they are sleeping rough they are far more susceptible to infection and far less likely to seek treatment. Thirty per cent. of people in this country with TB do not seek treatment for more than four months, even after the symptoms have started, and during that time they are infecting the people around them. A very high proportion of those people are marginalised, without easy access to healthcare and without the motivation to seek it. We can try to work with homeless people, and I was delighted to hear about the London find and treat team, but how much better and more effective it would be to eradicate homelessness, and especially rough sleeping.

Secondly, there is our attitude to immigrants. It is yet another outcome of the hostile environment that so many immigrants suffer from diseases and do not have the information or the confidence that would enable them to seek help. Three quarters of TB sufferers in this country last year had not been born in the United Kingdom. That does not mean that they brought the disease with them, but it does mean that we do not do enough to inform immigrants to this country of the healthcare that is available, and do not give them the confidence to seek help from official organisations, including the national health service.

Photo of Jim Fitzpatrick Jim Fitzpatrick Labour, Poplar and Limehouse

My hon. Friend is making a very important point. A matter that attracted quite a bit of controversy about 10 years ago was the number of people coming to this country as refugees or asylum seekers, from sub-Saharan Africa in particular, suffering from TB. The question to NHS England at that point was, should they be screened on entry? There was sensitivity about whether that was discriminatory and whether it was the right thing to do. It now appears that there has been an adjustment to the attitude of NHS England, which is screening people much more effectively. We need to let people know that they are carrying the disease and we can help them, but that means that we need to check them as they come into the country. There is great sensitivity about that, and I am not sure what the current position is.

Photo of Sandy Martin Sandy Martin Labour, Ipswich

I thank my hon. Friend for his helpful intervention. I would fully support a screening programme to help people who have TB and do not know it to receive the treatment that they need, and I cannot understand why anyone would be opposed to that. However, we are not just talking about people who were infected when they arrived; we are also talking about immigrants in this country who have contracted TB and who are afraid to go to the national health service, or do not know how to do so. Unless all UK residents can trust the major public institutions in our country, we are endangering ourselves. I urge Her Majesty’s Government to carry out a serious study of the take-up of health services by first-generation immigrants, and what can be done to remove the hurdles.

I fully support everything that has been said about the need to eradicate TB throughout the world, but let us also do something to remove the beam in our own eye, and deal with the poverty and marginalisation that prevent us from eradicating it here in the United Kingdom.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 2:33 pm, 7th June 2018

I am last but hopefully not least.

I thank Nick Herbert for setting the scene so well. I think that his speech gave us all an appetite for the debate, but he also challenged us in the House to do better. I thank other Members for their contributions as well; they have been much appreciated.

Most diagnoses are still made with the use of a technology pioneered in the 19th century that relies on laboratory infrastructures and several weeks of culture to determine drug resistance. In the weak health systems to which many Members have referred, where so much of the global TB burden is concentrated, the consequences are catastrophic. That is the issue for me and, I think, for others who have spoken today. Sandy Martin was right to refer to what has been done on the UK mainland, but I want to focus on what is happening in the rest of the world, where TB is rampant and can be catastrophic in terms of the lives that are lost and the lives that are affected.

The drug regime that was used to treat TB was developed in the 1950s. It is cheap and can cure the disease, but it is no match for drug resistance. People who suffer from drug-resistant strains of TB must currently undergo up to two years of treatment, swallowing thousands of tablets and having painful injections that lead to the most severe side effects and may ultimately not cure the disease. We also have no effective adult vaccine for TB.

The BCG vaccine that many Members will have received as infants offers protection against only the most severe forms of childhood TB. Although it is worth while, it does not do what vaccines are usually so good at: preventing disease for life and interrupting the chain of transmission. If we want to talk about the eradication of any disease, whether TB or HIV, we must invest in vaccines research. A Member who is no longer in the Chamber mentioned that to the right hon. Member for Arundel and South Downs in an intervention.

If new tools are to become available to us in seven years, we must invest. Currently, we are not doing so. Funding for TB research has consistently fallen short of 50% of the estimated annual need. We must address that issue as well, and I look to the Minister for a response. She is always very forthcoming, and I know that she will take our views on board. Unless that funding shortfall is addressed with great urgency, we have no hope of ever achieving the sustainable development goal to which our Government signed up three years ago.

It should be noted that the UK Government have done a great deal in this regard and currently rank as the second largest funder of global health research. Let us give some credit to our Government, to the Department and to the Minister for what has been done. The Government’s work, the product development partnerships and the researchers working on TB, HIV, malaria and other diseases should be celebrated. We have led by example—I wish that others could follow that example—but the funding gap for TB persists, and we will never close it unless concrete pledges are made. It would be a shame for the UN high-level meeting to pass with just another set of empty promises that have no impact on the people most affected by TB.

The Treatment Action Group estimates that if countries pledged to devote just 0.1% of their overall gross domestic expenditure on research to TB research and development, the R&D funding gap would be closed. That is a goal for which I am sure other countries could aim. People watching this debate could say, “Let’s do that.” If other countries did that along with us, we could do something significant very quickly. In terms of the average over the past five years, the UK Government have already been hitting the target, but many other countries continue to invest far less than their fair share, and without them, we will not achieve the sustainable development goal.

The UK has established itself as a leader on TB research, in respect of both funding and our fantastic research institutions in the public and private sectors. That is a very good example of the two sectors working together for the benefit of a great many people. The UN high-level meeting gives us an opportunity to demonstrate our leadership and to bring other funders to the table to talk about how we, as a community, might close the funding gap in a way that is fair and does not place an undue burden either on countries that are already investing significantly or on those that are simply unable to afford it. Will the Minister and her Department commit themselves to working with partner countries to develop concrete, fair-share funding targets for closing the research funding gap at the high-level meeting?

Let me end by saying something about co-ordination. As we work with partners to increase investments in TB research, it is essential for those investments to be well targeted and co-ordinated so that they can have an impact on patients’ lives as quickly as possible. I do not think that that is currently the case. The first two new drugs that became available for the treatment of TB were developed in isolation, which necessitated years of additional research to see how they could be safely and effectively integrated into existing regimens. That is something we should consider. The new diagnostic test, GeneXpert, which promised to revolutionise the diagnosis of TB, remains inaccessible to most. That is another shortcoming, which is due in no small part to the lack of operational and implementation research that would tell us how to use the tool most efficiently. We need to address that as well.

The UK Government have demonstrated the ability and willingness to convene partners and co-ordinate research funding, particularly in the field of antimicrobial resistance, of which TB is such a major part. Most recently, the Government supported the launch of the G20 AMR research and development collaboration hub, which has been a really good step in the right direction, providing an innovative new model through which research investments by countries from across the G20 and the world can be effectively co-ordinated to ensure patients have equitable access to innovation as quickly as possible.

In conclusion, I urge the Minister to work with partners through the G20 AMR R&D collaboration hub, which is a great idea that could really do things and move us in the right direction. The consensus from everyone who has contributed today, on both sides of the House, is that we want this to happen. We want the hub to make TB one of its priority pathogens and to begin work to co-ordinate TB R&D investments. I thank the right hon. Member for Arundel and South Downs for securing the debate. I am happy to have contributed and to support both him and the energy of the House in its desire to make things better for those who cannot do it for themselves.

Photo of Martyn Day Martyn Day Scottish National Party, Linlithgow and East Falkirk 2:40 pm, 7th June 2018

I am pleased to be able to speak in this important debate, and I am grateful to Nick Herbert and Mr Sharma for securing it.

The fact that TB continues to kill more people every year than any other infectious disease is appalling. We have enjoyed a harmonious and well-informed debate, and I am grateful to the right hon. Member for Arundel and South Downs for his tremendous summary and history of the issue. I have a bit more history for the House. First, though, I would like to give the Scottish picture. TB levels in Scotland are relatively stable and low. It accounts for between eight and nine cases per 100,000 of the population and is a contributing factor in about 40 deaths a year—although any death is a death too many.

Archaeological records show signs of tuberculosis in the remains of ancient mummies, and on this very day 689 years ago, Robert the Bruce, King of Scots, is alleged to have died of tuberculosis. TB has killed more people than any other disease in history. The modern Scottish Government are playing their part in tackling global challenges, including epidemics and health inequalities. Since 2005, the Scottish Government have committed at least £3 million a year towards funding international development work. This was initially focused on Malawi to reflect 150 years of collaborative development between our two countries. In 2017, that was increased to £10 million a year. TB is a major public health problem in Malawi, and multi-drug resistant TB is an emerging issue. As mentioned, there is also a significant link between TB and HIV, with more than half the cases in Malawi being infected with both.

When Alexander Fleming discovered penicillin back in 1928, the world changed, yet for as long as there have been antimicrobials, there has been antimicrobial resistance—as much as I hate acronyms, I will refer to it as AMR throughout the rest of my comments. Indeed, from the discovery of the very first anti-TB drug, streptomycin, scientists identified that the TB bacteria swiftly evolves to resist treatment, in large part due to its waxy shell and ability to pump drugs out from inside its cell wall. This unique trait led Sir John Crofton to pioneer what would become known as the Edinburgh method for treating TB with a combination of different drugs, ensuring that if any one bacterium were to develop a resistance to an antibiotic, it would fall prey to another. That model still forms the basis of TB treatment today. TB treatment, in the best-case scenario, requires six months of consistent treatment, but when these drugs are used sporadically, as is often the case in remote and difficult healthcare environments, resistance flourishes.

It comes as no surprise, then, that Lord Jim O’Neill’s independent AMR review estimated that multi-drug resistant TB was responsible for one in three AMR-associated deaths and described it as

“a cornerstone of the AMR threat” not least because it is also the only major drug-resistant infection to be transmitted through air. As is the case with so many resistant infections, we lack the tools we need to treat it. The few drugs available to treat drug-resistant TB are slow, toxic, require daily injections and are associated with severe side-effects, such as deafness, blindness, liver failure and neurotoxicity. It can take over two years to complete treatment, and success is not even guaranteed. In addition to side-effects, many people require months of hospitalisation, and the months of missed employment can drive patients to make the impossible choice between completing treatment and going back to work to provide for their families.

The cost of drug resistance for health systems is also profound. A survey in 2011 found that while drug-resistant TB made up only 2% of cases in South Africa, it took up nearly one third of the budget. Through the UK Government’s commissioning of Lord O’Neill to conduct a review of AMR and the campaigning of the chief medical officer, Dame Sally Davies, the UK Government have established AMR as one of the world’s leading health priorities.

In spite of TB being declared a cornerstone of AMR and having been included on a World Health Organisation’s list of priority pathogens with a high risk of drug resistance, initiatives to tackle AMR have not given TB the focus that it warrants. The UK’s investment in the Fleming Fund, established to improve surveillance capacity in developing countries, does not include TB in its remit. Will the Government commit to including TB in the next round of Fleming Fund programmes and press for the mainstreaming of TB within the AMR agenda?

At last year’s G20 summit, Governments recognised the importance of addressing drug-resistant TB with great urgency. The G20 is home to over 50% of global cases of TB and will feel over 60% of the economic impact of the disease over the next 15 years— a significant estimate of about $600 billion. The G20 is also responsible for funding over 95% of all publicly supported TB research and development, so co-ordinated action on addressing drug-resistant TB within its AMR agenda is critical. Following the 2017 G20 leaders’ declaration, the G20 launched an AMR R&D collaboration hub at last month’s World Health Assembly. In the year of the UN high-level meeting, this collaboration hub is the perfect vehicle for co-ordinating and enhancing publicly funded TB research and development from across the G20.

In conclusion, I have a couple of asks for the Minister. Will she commit to contacting her counterparts on the board of the G20 AMR collaboration hub and asking them to prioritise TB within its initial work? Furthermore, can she assure the House that the UK Government will champion a continued focus on TB in the G20 AMR agenda both at the forthcoming Argentinian summit and through any future AMR initiatives?

Photo of Kate Osamor Kate Osamor Shadow Secretary of State for International Development 2:46 pm, 7th June 2018

I congratulate Nick Herbert and my hon. Friend Mr Sharma on bringing this debate to the Floor of the House, and I thank every Member who has spoken for bringing so much knowledge and passion to the debate, especially my hon. Friend Mrs Ellman, who spoke about the University of Liverpool and the Liverpool School of Tropical Medicine, which lead on research here in the UK. I also pay special thanks to Lucy Drescher and Janika Hauser from RESULTS UK for producing parliamentary briefings for the debate and providing the research that went into my speech.

The forthcoming United Nations high-level meeting on TB offers a truly unprecedented opportunity to transform the fight against TB, so today’s debate could not have been called at a more significant moment to discuss TB. I join my hon. Friend Stephen Twigg, Dame Cheryl Gillan, Victoria Prentis, Sir Edward Davey and the 150 Members from across the House who are calling on the Prime Minister to confirm her intention to attend the meeting personally in September.

Some 10.4 million people are infected with TB. In 2017, 1.7 million people died of TB—almost 5,000 a day. In the time allocated for this debate, 582 people will lose their lives to a curable disease—that is perhaps the most outrageous fact of all. TB is curable, and has been for more than 50 years. Every death from TB can be, and should have been, avoided. The global response against TB has been one of failure: not a failure of those doctors, nurses, scientists and civil society groups who have been working tirelessly in a system stacked against them, but a failure of political will.

Two years ago I visited Zambia with RESULTS UK and met with doctors who spoke of the horror of needing to prescribe drugs they knew to be toxic and potentially ineffective despite years of treatment, in the knowledge that there is simply no alternative. Those on the treatment whom I met spoke of the pain of side-effects, the stigma, and the feeling of hopelessness. Those who successfully make it through the treatment bear lifelong mental scars.

I want to put on record that I welcome the work that the Minister and the Department are already doing in the global response to TB. In the debate we heard my hon. Friend Stephen Doughty and Nick Herbert speak positively of the impact of UK aid on communities most affected by TB through investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria and through strengthening of public health services, but the consistent funding shortfall for TB programmes has had catastrophic consequences. Some 3.8 million people go undiagnosed each year, and global treatment outcomes are nowhere near what they could be. When the Government signed up to the sustainable development goals the UK signed up to the commitment to be at the forefront of their delivery, but projections show that at the current rate of progress there is little likelihood of ending TB by 2030 and that that will not be met for more than 150 years.

Last year’s World Health Organisation global TB report stated that there is a $2.1 billion funding shortfall for the diagnosis and treatment of TB drug susceptibility alone, and funding for drug-resistant TB services will need to double before 2020 to be in line with the WHO global plan to end TB. The global plan estimates that the annual investment needed for TB is $9.2 billion a year, rising to $12.3 billion a year in 2020. With a single course of MDR-TB treatment costing 10 times more than drug-sensitive treatment, the global cost of ending TB will skyrocket unless action is taken now. The UK’s investment in TB continues to be dwarfed by our investments in HIV and malaria. I have no criticism of the UK investing in strengthening HIV maternal and child health systems, but sadly, antimicrobial resistance continues to exclude TB programming.

I must add that despite TB being the world’s deadliest infectious disease, 17 of the Department’s priority countries are classified as high-burden countries, but DFID currently has no dedicated TB programmes and offers no direct bilateral investments, and often bilateral funding is dependent on country requests. Does the Department have a plan in place for addressing TB in its own priority countries? Many high-burden countries can and should invest more in their national TB programmes.

Another central theme of today’s debate is the need for TB research and development. Sadly, in the absence of adequate funding for TB programmes, drug resistance has emerged and spread, rendering a curable disease increasingly difficult to treat. The UK’s investment in TB research and development is already transforming lives second to none on the global stage. New diagnostic tools will allow us to diagnose people more quickly and accurately; new drugs and paediatric formulations are improving treatment outcomes. None the less, data collected from the Treatment Action Group show that global funding for TB research and development falls consistently short of 50% of the annual funding need. I therefore join my hon. Friend Jim Fitzpatrick and Jim Shannon in asking the Minister whether DFID will commit to working with global partners to ensure concrete steps are taken at the UN high-level meeting to close the TB research funding gap and to ensure that funding is appropriately co-ordinated so that affected communities can access the products of such innovation as easily and quickly as possible.

If we are to talk seriously of ending TB before 2030, we will need to diagnose and treat a cumulative total of 40 million people before 2022. The WHO’s “End TB Strategy” shows that we will only reach the SDG 3 target if new tools to prevent, diagnose and treat TB are made accessible to affected communities before 2025. With just seven years left, we have a long way to go. The UK has an opportunity to use the high-level meeting to lead on the global challenge—ultimately, by demanding and effecting change to deliver on the SDGs.

I therefore ask the Minister: does the Department have plans for fairer national targets to be discussed or developed at the UN high-level meeting? I join Victoria Prentis in asking the Minister to commit to DFID improving cross-departmental working to ensure these targets are delivered. I know that the Minister literally embodies cross-departmental work, so I hope that will make it easy for her to do so.

In conclusion, I hope that the Prime Minister will attend the UN high-level meeting in earnest, first, to demonstrate the UK’s commitment to ending TB and, secondly, to convene partners at the UN to demand a meaningful political declaration that will effect change. It would be a tragedy if all that came out of the UN high-level meeting was another political declaration full of empty promises. Let the current trend be a warning to the Government: we cannot let our successors stand at these Dispatch Boxes years from now to have the very same debate once again.

Photo of Harriett Baldwin Harriett Baldwin Minister of State (Department for International Development) (Jointly with the Foreign and Commonwealth Office), Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development) 2:56 pm, 7th June 2018

It is a pleasure to serve under your chairmanship, Madam Deputy Speaker. I, too, thank my right hon. Friend Nick Herbert and Mr Sharma for persuading the Backbench Business Committee to arrange this very important debate. I thank all Members in the Chamber for contributing to an absolutely excellent debate. They have really shown a commitment to keeping TB high on the agenda.

Most of the questions I have been asked will be covered in my speech but, in response to the specific points raised, I want to add my tribute to the work done on this agenda in Liverpool and in Oxford, which was highlighted by colleagues. I pay tribute to the work done by Jim Fitzpatrick and others on the subject of road deaths, which has been covered elsewhere. I also pay tribute to Sir Edward Davey for bringing to the House’s attention the work of the find and treat teams. Such work is clearly outstanding, and those responsible for funding those teams will have heard that.

We heard excellent contributions from Mrs Ellman, my right hon. Friend Dame Cheryl Gillan, Stephen Twigg, my hon. Friend Victoria Prentis, the hon. Member for Poplar and Limehouse, Sandy Martin, for Strangford (Jim Shannon) and for Linlithgow and East Falkirk (Martyn Day). That is testament to the importance of this subject.

I am pleased to say that the UK Government are truly a leading player in global healthy generally. Good health is clearly valuable not only in its own right, but in contributing to the prosperity and stability of developing countries, as well as to the health of people in the UK. As colleagues may know, the UK is in fact the largest funder of GAVI—the Global Alliance for Vaccines and Immunisation. In 2016 alone, that vaccines alliance immunised over 15 million children against vaccine-preventable diseases such as diphtheria and polio, and saved approximately 300,000 through its work that year. Through such programmes, I am proud to say that we have almost eradicated polio and guinea worm worldwide, while typhoid and diphtheria are being tackled and small pox has been eradicated.

However, as colleagues have stated, tuberculosis presents a vast challenge, with 10.4 million people falling ill with, and 1.7 million dying from, TB in 2016 alone. Although the TB death rate dropped by 37% between 2000 and 2016—that success should be applauded—TB is now the world’s leading infectious disease killer. That is why the Department for International Development will provide up to £1.1 billion for the 2017 to 2019 replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

As colleagues have noted, this year’s high-level meeting at the United Nations General Assembly presents an important opportunity for the world to accelerate global progress in tackling TB and drug resistance. The debate—and, indeed, the letter from 150 colleagues—has shown the importance that this House attaches to the Prime Minister’s attendance at the high-level meeting. The UK will work closely with other member states to negotiate the commitments to be made in the political declaration of the meeting. In fact, I can assure hon. Members that the entire diplomatic network will be engaged in ensuring that the declaration is ambitious, including through G7 and G20 discussions. For example, we have already helped to secure specific references to TB in the most recent G20 Health Ministers’ and leaders’ declarations. I cannot personally commit the Prime Minister’s diary at this time, but No. 10 will have heard the voices of parliamentarians this afternoon. I assure Members that, whatever happens, there will be strong, high-level UK representation at the meeting.

Of course, that one meeting is only part of the story. The UK should be rightly proud of the action it has taken to fight TB at home and abroad. At home, there has been a remarkable 40% decline in new cases since 2011. In fact, TB cases in the UK are at their lowest level for 30 years. Most of the recent decline is down to the TB control measures that have been discussed today, and to screening in the 59 high-incidence clinical commissioning group areas. I pay tribute to the excellence of the cross-departmental and cross-country working that has been done as part of this initiative.

Abroad, DFID is a global leader on tackling the TB epidemic, and we do that in three ways. Mainly, we fund increased access to care through our contribution to the global fund. We are the second largest funder, with £162 million of this investment going to tackle TB. That will support the treatment of 800,000 people with TB and accelerate innovation to provide access to new drugs and diagnostic tests. Secondly, we tackle TB through programmes to strengthen health systems in a wide number of countries. We are working with national Governments, particularly in low-income countries, to help people to access high-quality healthcare for all priority health needs, including TB. The prevention, diagnosis, and treatment of TB are underpinned by people having access to good-quality health services. Given that TB is most widespread amongst the poorest, our wider work on reducing poverty and increasing access to services, including efforts to reduce the poverty and vulnerability of populations, also has an impact on this terrible disease.

Thirdly, we fund research into developing new products to combat TB. This is hugely important. We need better and cheaper diagnostics that are available on the spot, including diagnostics that detect drug resistance. Thanks to UK funding, a new test—the GeneXpert test mentioned by the hon. Member for Strangford—has been developed. It reduces the diagnosis time from many days to under four hours, and is now available in 140 countries worldwide. It is also used in the UK, so this is a real, practical example of UK aid funding something that is in our national interest.

Research is also needed to provide shorter drug treatments, which make it easier for people to complete treatment courses and to help themselves, and prevent drug resistance. We provide support to the TB Alliance for this. It has successfully developed paediatric TB drugs and is now working to develop new, faster-acting and more effective TB drugs, including drugs that can be taken by people with HIV. DFID is funding this drive for new drugs and diagnostics as part of the £1 billion Ross Fund portfolio.

Many colleagues have mentioned antimicrobial resistance. Tackling drug-resistant strains of TB, like other forms of antimicrobial resistance, presents a significant challenge to all our work on TB. The disease accounts for one third of all antimicrobial resistance-related deaths worldwide. We are therefore working to prevent, identify and treat drug-resistant TB globally. UK support to Gavi for immunisation reduces infections and the need for treatment. The UK’s Fleming Fund is improving laboratory capacity for diagnosis and surveillance of AMR in low-income countries. Our support to the TB Alliance is helping to develop new regimens for treating drug-sensitive and drug-resistant strains of TB. We also fund Unitaid, which aims to triple access to RAID testing for drug-resistant TB, and to reduce prices for drugs to treat TB and drug-resistant TB. The UK Government recognise another challenge: many of those suffering from TB also have HIV; and, as several colleagues mentioned, being HIV positive increases vulnerability to TB. UK aid has helped the global fund to keep 11 million people alive with HIV therapy. DFID prioritises the integration of services to avoid siloed HIV and TB responses through our programmes.

I started with praise for the efforts of my right hon. Friend the Member for Arundel and South Downs in his work on TB globally, and I will end by recognising the significant UK contribution to that agenda. Our universities carry out basic science research, explore how to improve TB services, and work to develop new treatments and vaccines. The UK’s world-leading pharmaceutical companies also contribute by developing new TB treatments and vaccines. The UK is working hard with the global community to achieve progress on the agenda and a successful high-level meeting. We hope that our shared efforts will enable us to achieve the ambitious targets of the WHO’s “End TB Strategy” and the global goals. I thank all hon. Members for discussing this important issue today.

Photo of Nick Herbert Nick Herbert Conservative, Arundel and South Downs 3:06 pm, 7th June 2018

This has a been a good debate, with a large degree of consensus across the House and many well-informed contributions from right hon. and hon. Members on both sides, including the Front Benchers. I am grateful for that and for the help that hon. Members are giving to raise the profile of this disease.

I pay tribute to the work of the co-chair of the all-party group on global tuberculosis, Mr Sharma. He was expecting to speak, but was taken away from the House for something else. However, I am sure that he would have wanted to draw attention to the huge progress being made in India, where the Prime Minister, as I mentioned earlier, has shown real leadership by getting India to commit to eliminate TB on a tighter timescale than the one in the sustainable development goals. That has shown the kind of global leadership that will be necessary, and if we can encourage other global leaders to follow that lead, we will make huge progress. I congratulate the Government on what they have been doing. I accept the Minister’s description of all the things that DFID and other Departments are doing, and I note that the International Development and Health Secretaries have personally committed to the issue, for which I am grateful.

TB has been the orphan disease. Despite its terrible record of claiming lives, it does not have the celebrity champions or the pop stars of other diseases, and it does not get the same media attention. Although the disease claims more lives every year than any other infectious disease, I can guarantee that the media will pay no attention whatsoever to this debate. That needs to come to an end. Today, we in this House have at least played our part in raising the profile of the disease, helping to make TB truly a disease of the past.

Question put and agreed to.

Resolved,

That this House
recognises that tuberculosis (TB) remains the world’s deadliest infectious disease, killing 1.7 million people a year;
notes that at the current rate of progress, the world will not reach the Sustainable Development Goal target of ending TB by 2030 for another 160 years;
believes that without a major change of pace 28 million people will die needlessly before 2030 at a global economic cost of £700 billion;
welcomes the forthcoming UN high-level meeting on TB in New York on 26 September as an unprecedented opportunity to turn the tide against this terrible disease;
further notes that the UN General Assembly Resolution encourages all member states to participate in the high-level meeting at the highest possible level, preferably at the level of heads of state and government;
and calls on the Government to renew its efforts in the global fight against TB, boost research into new drugs, diagnostics and a vaccine, and for the Prime Minister to attend the UN high-level meeting.