Tuberculosis

Part of the debate – in the House of Commons at 1:53 pm on 7th June 2018.

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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.