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?