Tuberculosis

Part of the debate – in the House of Commons at 2:01 pm on 7th June 2018.

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Photo of Stephen Twigg Stephen Twigg Chair, International Development Committee, 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.