Tuberculosis (Developing World)

– in Westminster Hall at 11:00 am on 21st March 2006.

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Photo of John Barrett John Barrett Shadow Minister, Scotland 11:00 am, 21st March 2006

It is a delight to introduce this debate today, as world tuberculosis day is later this week. People throughout the world will be encouraged to think about this devastating disease, which many thought was in the past, but which is raging throughout the world.

We can take a snapshot of the position in, for instance, Africa. Africa has 11 per cent. of the world's population, but it accounts for more than a quarter of the global TB burden. Since 1990, TB rates have doubled in Africa overall and tripled in areas with high levels of HIV infection. In Botswana, more than 70 per cent. of TB patients are also infected with HIV. Those statistics are truly sobering.

Africa may be on the front line of the global fight against TB, but Asia has the highest TB burden in the world, largely due to its massive population. India is home to just under 2 million TB sufferers, and while often we think of TB as a disease of the developing world—today's debate is focused on the developing world—closer to home, 67,000 Europeans have lost their lives to it.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The hon. Gentleman mentions outbreaks and the incidence in Europe. Indeed, TB is starting to emerge in a worrying way in my home city of Leicester. Perhaps he was about to deal with this, but does he agree that in an era of international trade, travel and migration, TB control is not confined to the countries and continents where it is becoming rife? We have a direct interest—not just moral, but social and economic—in driving it back to its position 40 years ago, when we thought we had virtually eradicated it.

Photo of John Barrett John Barrett Shadow Minister, Scotland

I could not agree more. There have been several isolated outbreaks in this country, in the hon. Gentleman's constituency and in Aberdeenshire, but, more generally, there is a higher incidence in cities such as London. Increased global travel is certainly one of the causes.

People think about whether the issue directly affects them: they are aware that people from the UK travel abroad to the nearer parts of eastern Europe, but large numbers also travel on ever more direct flights to countries with a high HIV incidence. The hon. Gentleman's point is well made.

I was about to touch on an area relatively closer to home: the former Soviet Union has been hit badly by the disease and it has the second-lowest treatment success rate in the world—only marginally better than that of Africa. The collapse of the Soviet Union left many countries in the region with weak health care systems and particularly poor diagnostic facilities. The real problem is multi-drug-resistant TB, which is more expensive to treat and a particular problem in the Baltic states.

TB does not respect national boundaries or international treaties, and I would like to explain the problem in some detail. TB is the leading form of death from a curable infectious disease. Globally, it is second only to HIV/AIDS as a cause of illness and death, infecting 9 million people every year and killing 2 million. Nearly all those people are in the developing world.

What is more shocking, however, is the fact that the illness is entirely preventable and curable. That is why today's debate is so important. With world TB day on 24 March almost upon us, we must do all we can to highlight the need to get to grips with and eradicate the disease, which continues to claim a life every 15 seconds.

About two weeks ago, I was pleased to host an exhibition in the Upper Waiting Hall in this place. I hope that many Members took the time to look at it. The exhibition comprised a collection of photographs by Gary Hampton, a renowned TB photographer, of TB sufferers throughout the world, including in India, Africa, Europe and South America. The message was simple: TB is current, dangerous and on the increase in many parts of the world, but, despite the scale of the problem, we have the means to cure it completely.

About 80 per cent. of the individuals newly diagnosed with the disease each year live in the 22 most populous countries.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

My hon. Friend makes a strong case for the Government and the international community paying close attention to the serious problems of TB, particularly in developing countries. Does he agree that although the media in the west seem to be in a blind panic about avian influenza—which, while not wishing to diminish the deaths, has killed only 90 people—the preventable deaths of 2 million people should grab the attention of the world and of Governments who can make a big impression on this mass killer?

Photo of John Barrett John Barrett Shadow Minister, Scotland

I agree with my hon. Friend absolutely. One problem is that the media are always looking for something new, and TB is not new. It has been around for generations, and many people in this country think of it as something from the past. It is not deemed to be a politically sexy story, but people continue to die. The scale of the problem is massive: 5,000 people die of TB each day. If we were to think that a disaster on the scale of that at the World Trade Centre—about 3,000 people died in that attack—was happening daily, what resources would we be prepared to put into dealing with it?

TB has existed for a long time, and many people have played a part in the fight against it. I shall mention just a few. One who deserves particular praise is Edinburgh's own TB pioneer, Sir John Crofton, whom I met some time ago. He demonstrated more than 50 years ago that TB was curable, and his work led directly to a massive decline in TB cases. Sir John was recently awarded the Union medal, which is the highest honour awarded by the International Union Against Tuberculosis and Lung Disease. I am sure that all who are aware of Sir John's remarkable achievements will agree that he is a more than worthy recipient. I was delighted to table an early-day motion before Christmas to congratulate him on his latest accolade, and I have been touched by the support it received and the contact I have had with people throughout the country who thank Sir John for playing his part in the fight against TB.

The Department for International Development has done much excellent work for many years. I praise the Minister, the Secretary of State and previous Secretaries of State for playing their part and continuing to fund worthwhile projects in several countries even though the issue has not always been at the top of the news agenda.

On a visit with the International Development Committee, I saw at first hand the work that has been done in Andhra Pradesh in India, and in Kenya, Malawi and Mozambique. The Department's absolute commitment for the long term involves considerable financial cost. The DFID paper produced in December 2005 lists sums committed in the fight against TB: £8.5 million in Mozambique, £7.5 million in Malawi and £20 million in Andhra Pradesh. I have seen some of the excellent work that is being done by the Department's staff in conjunction with local partners, and I cannot praise it highly enough.

Several groups and organisations are involved. TB Alert produces easy-to-access literature to ensure that people in this country know the basics about TB and are able to find out exactly how they can detect infection and what preventive measures should be taken if they are travelling to a high-risk area. Individuals play an enormous part in the fight against TB, none more so than Bill Gates of the Bill and Melinda Gates Foundation, which has pledged more than $900 million over the next 10 years towards tackling the disease. I shall come back to that.

There are also a number of advocacy groups, including Results, which deserves particular praise for its work on the issue—especially its lobbying of hon. Members. Two members of its staff, Sheila Davie and Louise Holly, deserve a special mention for having contacted several Members from all parties to keep the fight against TB high on the agenda.

As I said, however, the scale of the problem is truly massive. TB is curable, and we have to ask why the problem has not been dealt with. Up to 60 per cent. of TB cases can be detected using existing diagnostic measures, and nearly all of them can be cured using existing treatment methods, so what are the obstacles? One of the first that we need to overcome is the perception that TB is a disease of our grandparents' generation. TB is not a disease of the past, and I mentioned the sobering statistic that 5,000 people die from TB every day, which certainly concentrates the mind.

As recently as 1993, the World Health Organisation declared TB a global health emergency, and when we look at the figures, it is difficult to disagree. Incredibly, it is estimated that a third of the world's population, or nearly 2 billion people, are infected with TB and that 5 to 10 per cent. of them will deliver the active disease.

When I mentioned this debate to my hon. Friend Annette Brooke, she said that she was unable to attend, but that she had been a TB sufferer as a young child. More than 50 years after the introduction of effective treatments for TB, the disease remains unconquered. Indeed, in many developing countries—particularly those stricken with HIV/AIDS—the disease remains dangerously unstable.

Moreover, although TB predominantly affects developing countries, as the title of the debate suggests, it is worth remembering that TB is making a comeback in western Europe. Indeed, as David Taylor said, the number of TB cases in England has increased by 25 per cent. over the past 10 years and continues to increase. About 7,000 new cases are reported each year, most in London. Although multi-drug regimes are available and cure 95 per cent. of patients with active drug-sensitive TB, newer and better drugs are needed because of poor compliance with the six-month treatment regime.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

My hon. Friend knows that I share his interest in this subject, because we visited Kenya with Results last September to look at TB projects. Does he not accept, however, that the treatment regimes are pretty robust, at least in the UK, and that the vast majority of patients will survive if they stick to those regimes? Surely the problem is in the developing world, where multi-drug-resistant TB is developing and the bacillus is getting stronger because people do not stick to the regimes. A particular concentration of effort is clearly needed.

Photo of John Barrett John Barrett Shadow Minister, Scotland

What my hon. Friend says is true for several reasons. Not only has the medical battle been fought and largely won in this country, but TB is very much a disease of poverty, and poverty is most clearly associated with the developing world.

I was astounded at the poverty that exists to this day in places such as Kibera—the massive slum on the outskirts of Nairobi—and the general public can see that poverty if they go to see "The Constant Gardner", which is on in cinemas as we speak. The vast majority of people in that slum have no supply of drinking water or sanitation and they live in cramped accommodation with no adequate ventilation—perfect circumstances for TB to thrive in.

In this country, we have managed to ensure that people have clean drinking water supplies and sanitation, but we have also managed almost to eradicate poverty. Poverty is why TB is such a problem throughout the developing world. Whether we are talking about drug-resistant TB or one of the traditional forms of TB, the disease is closely associated with poverty.

We must seek to alleviate poverty through the millennium development goals and other means of raising people's standard of living. We must improve how people live and the quality of their accommodation to ensure that individuals with TB do not live in cramped conditions, because that would mean the rest of their family, their neighbours and their friends being far more likely to contract the disease. Therefore, I entirely agree with my hon. Friend Andrew George.

There has been progress, however, and there is hope. Despite the scale and severity of the problems, Marcos Espinal, executive secretary of the Stop TB Partnership, has said that

"we have the possibility to finally beat TB over the coming decades."

Indeed, over the next 50 years, the aim must be to eradicate TB as a global health problem. In 1991, the World Health Assembly set a target of detecting 70 per cent. of all infectious cases of TB and curing 85 per cent. of those detected by 2005. Those targets were undoubtedly achievable, but they have not been met. Some 80 per cent. of known cases are successfully treated, but only 45 per cent. of cases are detected.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The hon. Gentleman refers to the targets that have been set. How confident is he that the unlikely alliance of the Chancellor of the Exchequer and Bill Gates—a commitment to double the £1.2 billion global spend on TB was announced at Davos earlier this year—will halve the number of deaths to which the hon. Gentleman referred? Past targets have proved difficult and illusive, have they not? Is he confident that the new target will drive down the number of deaths in the way the Chancellor and Mr. Gates anticipate?

Photo of John Barrett John Barrett Shadow Minister, Scotland

I am optimistic about the commitments that Bill Gates and the Chancellor have made, and I look forward to the international dimension of tomorrow's Budget being given as much importance as the domestic agenda, but I am pessimistic about the end results. Large amounts of resources have been poured in, but we have not dealt with the combination of factors that have built up the environment in which TB thrives.

Although the resources have gone in, we have seen first hand how many countries have suffered from famine and drought—factors outwith donors' control. In addition, there is still conflict in some countries, and other factors mean that TB is a difficult nut to crack, even though the resources have increased. As I said, I want to ensure that donors, funders and organisations working on TB make the necessary commitment in the developing world, and I can hope for the best, but time will tell how successful we are.

As was suggested earlier, we need a plan for the long term and a commitment to see the issue through beyond national elections, G8 summits and Davos. The Chancellor said:

"If 2005 was the year of commitment then 2006 must be the year of delivery".

Although I wholeheartedly support those sentiments, it will take more than a year. We are all in this fight for the long haul. Tomorrow's Budget is the ideal opportunity for the Chancellor to confirm that the commitment to further spending will be high up the agenda.

At the beginning of the 21st century, TB has been declared a full-blown global emergency, and a global emergency requires a global plan of action. Thankfully, we have one in place. The Stop TB Partnership provides a platform for international organisations, countries, donors and governmental and non-governmental organisations. It recently launched its new stop TB strategy whose objectives are to achieve universal access to high-quality diagnosis and patient-centred treatment; reduce the human and socio-economic suffering caused by TB; protect the most vulnerable groups from TB, HIV and multi-drug-resistant TB; and support the development of new tools in the fight against TB.

The components of that strategy include the high-quality expansion of DOTS—the directly observed therapy short-course scheme—which is often used in the fight against TB and which, I am glad to see, has been successful. The strategy must be collaborative to meet the challenges of TB and HIV control, along with multi-drug-resistant TB.

We must help to strengthen health systems—I am aware that DFID has been involved in that work as well. We must engage aid providers and agree international standards for TB care while empowering those with TB and those communities that are badly affected by the disease. We must also help to promote and sustain research. The global plan, finalised just two months ago, aims to break the back of the global TB epidemic and to eliminate it as a global problem by 2015.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The hon. Gentleman is most generous in giving way once more. He mentioned research, but one difficulty is that there is no significant commercial market in developing countries for drugs that tackle the diseases of poverty. Does he hope that the Minister will refer to the possibility of pharmaceutical companies lowering the prices of their drugs that are designed to tackle the diseases of poverty, of which TB is but one?

Photo of John Barrett John Barrett Shadow Minister, Scotland

As I mentioned, the film "The Constant Gardener", which many members of the public have seen, deals with the issue of the price that drugs companies charge to deliver effective treatment. Clearly there is not money to be made in the commercial world by supplying very poor people with drugs that will save their lives. We await the Minister's reply on that. It is in all our interests—not just morally, but economically—to help the poor nations of this world, which are often the sub-Saharan nations, to improve their economic growth and start trading their way out of poverty. They will benefit financially and we will also benefit.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

I am sure that my hon. Friend accepts, however, the need for early intervention and proper treatment before the TB bacilli become multi-drug-resistant. If patients are caught early enough and the treatment is followed through fully, it costs only $10 to cure someone and prevent a death. Surely that is $10 extremely well spent.

Photo of John Barrett John Barrett Shadow Minister, Scotland

My hon. Friend is one step ahead of me. I was aware that he was a keynote speaker at the launch of the global plan. Without a doubt, few things are better value for money than $10 that can save a person's life. As he said, one problem is that successful treatment can be started, but if it is not maintained for the full six months of therapy, patients might feel better and stop taking the drugs, which might allow drug-resistant TB to develop.

In certain areas, drugs are not available or people have to pay, and in countries of extreme poverty paying for drugs can often be the barrier between life and death. That is why I am pleased that some of the many projects funded by DFID ensure that drugs are freely available and that cost is not an issue. Access and maintaining the course for six months might be issues, but the cost of treatment is not in many countries.

The global plan for 2002–15 builds on the partnership's first global plan for 2001–05. It supports the need for long-term planning and for action at regional and country levels. The plan provides a consensual view of what the Stop TB Partnership can achieve by 2015, provided that we mobilise the resources to implement the stop TB strategy, according to the steps laid out in the global plan.

The global plan will help to stimulate political commitment, financial support, effective intervention, patients' involvement, community participation, and research and development. All those will be central planks of the overall strategy to tackle TB.

The cost of the global plan is $56 billion, which represents a threefold increase in funding as compared with the first global plan. Although that is a significant increase, any doubts that anyone might have should be dashed when we consider what we get for that $56 billion. The estimated funding gap is $31 billion, which must be met because the rewards are high. Full funding would save 14 million lives at a cost per life saved of $157, which is much less than the average economic productivity per person per year, even for the poorest individuals.

Even under such a crude economic calculation, the economic benefits far outweigh the costs. When we consider the amount of money spent post-9/11, this is a small price to pay. If averaged out, it is $5.6 billion a year, which is what the US spends in Iraq every month. The figure is three days' global military spending and the amount spent each month is estimated at $58 million—more than the total 10-year cost of the global plan.

What will be achieved if we implement the global plan? Implementation of the stop TB strategy will expand access for all to quality TB diagnosis and treatment. About 50 million people will be treated under the strategy and 14 million lives will be saved. The first new TB drug for 40 years could be introduced in 2010, with vastly improved diagnosis.

By 2015, we will have a new, safe, effective and affordable vaccine available if all goes according to plan. Targets could be met, such as the global achievement of the millennium development goal to halt and begin to reverse the incidence of TB, and the TB partnership's 2015 targets to halve prevalence and death rates from 1990 levels.

What else can we all do, in the House and elsewhere? As I mentioned, the exhibition in the Upper Waiting Hall was one small attempt to raise awareness while today's debate will generate coverage, interest and column inches. Those interested will be able to follow it and know that hon. Members are facing up to the problem. TB is not a disease of the past, and we must remind people of that.

The decline in the incidence of TB in the developed world has been accompanied by a fall in the commercial incentive to develop and invest in new anti-TB drugs. The DOTS programme has revolutionised the treatment of TB across the world, but it is 50 years since its introduction, and treatment and detection rates have remained constant since 1995—still far below the rates and targets set out in the MDGs. To contain the disease properly, new drugs and vaccines are needed to tackle multi-drug-resistant TB. Despite the undoubted success of the DOTS expansion, most countries look unlikely to meet the MDGs for TB by 2015. Further innovation is crucial if, ultimately, we are to tackle TB.

The non-profit organisation Global Alliance for TB Drug Development, which is supported by the Bill and Melinda Gates Foundation and the Rockefeller Foundation, has brought badly needed new focus and leadership for drug development. In the short term, six new drug candidates for TB are now undergoing clinical trials. Indeed, Bill Gates has already pledged $900 million over the next 10 years towards tackling the disease.

However, action from above must be matched by renewed and improved action on the ground—the front line of the battle against TB. The DOTS strategy has helped not only to cure millions of people worldwide, but to strengthen public health care capacities. Indeed, it has been argued that the greatest legacy of DOTS to the overall health of developing countries might be not in control of TB alone, but in helping to build the basic infrastructure of a public health system. For example, in India, where the public health system is weak, more than 422,000 health workers have been trained during the expansion of DOTS. DOTS plus is the first step in moving beyond DOTS.

We must also be aware of the problems of HIV that are associated with TB. Although originally they were largely considered separate diseases, co-ordinated planning and implementation of TB and HIV programmes will lead to more effective prevention and treatment of TB among patients infected with HIV/AIDS. In countries with high levels of AIDS, the scale of the challenge posed by TB simply exceeds control capacities. As a result, DOTS, or any other programme focusing on one disease, will always fall short. TB symptoms are often the reason for accessing the health care system.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

My hon. Friend makes an extremely strong case for giving the challenge of the global plan up to 2015 a much higher priority. Given that TB killed more people than all the wars, earthquakes, floods, armies, air accidents, terrorist attacks and murders worldwide last year, and following on from his comparison between the money needed for the global plan and military spend, does he believe that Ministers should use that comparison and take a fraction of the defence budget, for example, to fund the global plan? Should we not use such rhetoric to up the ante and get the plan the priority that it deserves?

Photo of John Barrett John Barrett Shadow Minister, Scotland

My hon. Friend knows exactly where I stand on that. I have never thought that the amount spent in Iraq is particularly good value for money. The amount of money spent on—

Photo of Bill Olner Bill Olner Labour, Nuneaton

Order. I think that the hon. Gentleman is straying way off the point.

Photo of John Barrett John Barrett Shadow Minister, Scotland

I stand corrected Mr. Olner. I may have been inadvertently led into that by my hon. Friend.

I shall draw my remarks to a conclusion. Our efforts need not be focused on simply managing this disease. TB can be cured and consigned to the history books within the next 50 years if we are determined to tackle it in other countries the way that we have tackled it here. The fight against TB must be a marathon, not a sprint. It requires sustained action and attention from the international community. Just as the DOTS treatment is effective only if patients follow the full course of treatment, we will fulfil the aims of the global plan only by committing to it for the long haul.

I look forward to hearing from the Minister and hope that the Government also confirm that they will continue to play their part in the battle against TB.

Photo of Susan Kramer Susan Kramer Shadow Minister, Treasury, Shadow Secretary of State for International Development, International Development 11:32 am, 21st March 2006

I did not want to interrupt your line of sight earlier by stepping forward, Mr. Olner. I thank you for the opportunity to follow my hon. Friend John Barrett.

Obviously, the case has been laid out exceedingly powerfully, and I very much want to associate myself and my party with the World Health Organisation and the stop TB strategy. It is not my goal to repeat the facts and figures that have been laid out so eloquently this morning. I wanted to speak in this important debate because world TB day is an opportunity to remind all of us that no matter what medical advances we pursue in our own country and the developed world, basic diseases continue to devastate much of the globe. It is also an opportunity to recognise that the developing world pays a double penalty by being affected by poverty and disease, which so often go hand in hand.

I want to draw attention to some aspects of WHO's strategy, and to pick up on the research provided by the African Medical and Research Foundation, which works extensively in this area. Through many of its studies in Africa, the foundation draws attention to the frequent difference between what appear to be effective TB strategies at national level, and the difficulty of delivering those strategies on the ground.

Many hon. Members will be aware that many African countries, as they develop their health systems, focus on managing TB in a hospital environment, and on diagnosis and prescription. But there is comparatively little penetration and effort to tackle the disease within the communities where people live. If one considers the poverty of the individuals involved, the difficulty in accessing more sophisticated aspects of health care and the way in which the disease impacts on mothers and children and undermines entire communities, looking at the disease in a community context is typical.

I draw hon. Members' attention to AMREF's research in the eastern cape of South Africa, in the designated homelands, which is where millions of black South Africans were forcibly removed during apartheid. It is therefore one of the poorest communities in South Africa. The research showed that health personnel did not have an adequate understanding of TB management; that on the ground, locally, within the community, there were insufficient supplies of TB drugs; and that testing was slow, so it sometimes took up to two weeks to get results. The situation was made worse by the fact that TB patients did not understand prevention, the cause of the disease, or why they needed to take medication for six or eight months to eliminate the disease from their systems permanently.

As a result of that health study, approaches to the problem are changing in the eastern cape. Nurses are being trained in TB management and public transport is being provided to ensure that sputum specimens can be delivered to laboratories and back to clinics with results within 24 hours. That is completely changing the way in which that community is experiencing and tackling the disease. It falls well within the DOT—directly observed therapy—strategy that has been structured and underpinned by WHO, and which has been so effective generally in furthering TB management worldwide.

An issue that has been touched on but not developed, and is, presumably, the risk that we face most viscerally in the future, is the link between TB and HIV/AIDS. Many people will be aware that that is a growing arena for TB as a disease. We are aware that it affects the developing world powerfully, and that it is beginning to take hold in our communities.

The presence of HIV results in a high degree of multiple-drug-resistant TB. Not only do TB drugs have a tendency to be ineffective on people with HIV, but it is much harder to diagnose TB in people with HIV, especially in its early stages. That is one reason why it is crucial that research in this area does not stand still. Although there are effective therapies for the more traditional variants and versions of TB, the HIV-related strains of the disease are not well understood or managed in almost any community. It is crucial, therefore, that the funding that is necessary for new diagnostics to enable efficient testing for HIV and TB in health facilities is available to communities not only in London, but in poor and rural areas across the globe.

TB is a disease of the poor. In the era in which we live, in which we have made the commitment to make poverty history, we must, by definition, also make TB history. I highly commend what has been said today, and I look forward to hearing what the Government have to say about the support that they will give the programme. I note that when my hon. Friend the Member for Edinburgh, West asked the Minister a question on this issue recently, the Government were unable to identify how much funding goes into TB work. I wonder whether they now have a clearer idea of how that money is being used. I appreciate the opportunity to associate myself with this debate.

Photo of Mark Simmonds Mark Simmonds Shadow Minister (International Development) 11:38 am, 21st March 2006

I start by congratulating John Barrett on securing this important debate, particularly considering that world TB day is coming up, which he rightly highlighted. He summarised well the totality of the issues surrounding TB, and made the significant point that it is not only developing nations that suffer from TB; it affects the developed world as well, albeit, thankfully, to a significantly lesser extent. None the less, we can ensure that we constantly monitor that situation.

The hon. Gentleman is right to highlight and confront the perception that TB is a historic disease. Statistics and personal stories clearly demonstrate that that is not the case. The whole world community—both developing nations and donors—needs to ensure, both bilaterally and through multilateral institutions, that TB is at least stopped in its tracks, if not eradicated, as quickly as possible.

I also welcome Susan Kramer. I congratulate her on her new position and I am sure that she will enjoy the role. We look forward to significant contributions such as that which she has made today. She was right to draw attention to the disparity between national strategies in many developing nations and delivery on the ground in communities. I will say a little more about that later. The hon. Lady was also correct to draw attention to the link between HIV/AIDS and the prevalence of TB. I want to ask the Minister some questions about the cross-availability of antiretroviral drugs to enable both diseases to be eradicated.

As hon. Members will hopefully be aware, the Conservative party is supportive of much of what the Government are doing in this area. We support the Global Fund to Fight AIDS, Tuberculosis and Malaria and we acknowledge and support the Government's commitment to double the amount of UK taxpayers' money that has gone into that fund. However, we acknowledge, as I am sure that the Minister will, that there have been problems of delivery through the global fund to date.

We support the international finance facility for immunisation and also world TB day later this month. We hope that it will raise the profile of that debilitating and dangerous disease in developing nations, not only in the traditional areas of sub-Saharan Africa but in those areas where the disease has significant and growing prevalence, such as Asia and the ex-Soviet republics, and where the problem has been ignored for far too long.

We welcome the recent announcement of £6.5 million of funding to the Global Alliance for TB Drug Development and the commitment from the Chancellor of £41.7 million to tackle TB in India. We also agree with the G8 Africa communiqué, which said that people should have

"access to basic health care (free wherever countries choose to provide this)".

Alongside the Government, we want to encourage countries to drop user fees, which limit access to health care and are a major deterrent in developing countries, particularly for those who find themselves in poverty.

Like the hon. Member for Richmond Park, I do not wish to bore the Chamber by repeating the statistics that the hon. Member for Edinburgh, West gave in his full and articulate speech. However, I would like to add two statistics that struck me, which I do not think he used. One person per second catches TB. That is a staggering statistic. Also, between 8 million and 10 million people per annum become infected with TB. The problem is not growing in a small way; it is a significant and accelerating disease, and we need to ensure that we tackle it across the international community.

As the hon. Gentleman rightly pointed out, effective treatment is inexpensive. A six-month course costs between $5 and $10, depending on which medical people one talks to. He was absolutely right to highlight the fact that TB is a totally curable disease. We need to ensure—through such debates in the UK Parliament, and in our constituencies—that we highlight the fact that the disease is not historic, but is growing and is more greatly prevalent in all parts of the world than people's perceptions would allow them to believe.

Having said that, in Africa 45 per cent. of people with infectious TB have access to life-saving treatment. However, an untreated person can infect 10 to 50 people a year, which tends to happen in the workplace and through the adult population. That can have a very debilitating impact on the economic performance of communities, giving rise to greater exacerbation rather than alleviation of poverty. The treatment of TB can take up to eight months, during which time a person is unable to work and falls deeper into poverty, as do their dependants if they are an adult. The World Bank estimates that TB costs the average patient three or four months of lost earnings, which can represent up to 30 per cent. of annual household income.

The millennium development goals made specific reference to stopping the prevalence of diseases such as TB by 2015. The international community is a significant way off that. Tackling TB will go a long way to making a significant contribution to many of the other millennium development goals, such as access to education. Fewer children will drop out of school because of infection, to care for relatives or because they do not have teachers any more because they are suffering from TB or, in particular, from HIV.

The hon. Member for Richmond Park rightly made a point about the correlation between TB and HIV/AIDS, which is one of the issues that I want to highlight today. Since 1990, overall TB rates across Africa have doubled, and they have tripled in areas with high levels of HIV. The hon. Member for Edinburgh, West mentioned the fact that in Botswana 79 per cent. of TB patients also have HIV. It is our view that there needs to be significantly better collaboration between TB and HIV programmes, as that will vastly improve the control of both diseases.

I want to ask the Minister what progress the Government and DFID have made in expanding the collaborative TB and HIV strategy. What steps is DFID taking to ensure that developing nations co-ordinate TB and HIV programmes, that those infected with HIV are screened for TB, and that those infected with TB are screened for HIV? That would ensure the provision of antiretroviral drugs to all who need them, not just those who may require them on a superficial basis.

I want to highlight three particular issues: drug development, drug resistance and drug availability. I have some questions that I hope the Minister can answer. There have been some successes. We should not think that TB is on the rampage unchecked. The most notable success has been in Vietnam, where 76 per cent. of all infectious cases in the past year have been cured. That can be done with commitment from the international community and the Governments in the respective countries.

The hon. Member for Edinburgh, West rightly highlighted that there has been no new drug for TB in the past 40 years. The Global Alliance for TB Drug Development aims to have developed a new drug by 2010, but current estimates are not optimistic. It has been estimated that there is only a 5 per cent. chance of that. The cost of producing successful drugs in that time scale is estimated at about $400 million.

As well as research on new drugs, steps must be taken towards new methods of diagnosis and vaccination. I would welcome any explanation from the Minister of exactly what progress is being made not only towards the treatment of TB but towards its prevention. There also needs to be predictable and sustainable funding, particularly to assist research and development. What steps is the Minister's Department taking to ensure predictable and effective funding flows for those research bodies, so that they can come up with new drugs and vaccinations?

Multi-drug-resistant TB has been identified in 91 countries and is widespread in many populous countries, including China, India and the former Soviet Union. What steps are the Government taking to fund the development of treatments for MDR-TB? It is clearly more challenging and requires greater on-the-ground monitoring as people become resistant to the initial programme of drugs.

The hon. Member for Richmond Park also mentioned drug availability. It is important that DFID and other relevant institutions do more to encourage the pharmaceutical industry to allow the manufacture of generic drugs for use in the developing world. The former director-general of the World Health Organisation's HIV programme suggested the designation of humanitarian corridors, which would allow leading drugs manufacturers to produce drugs at low prices for modest royalties, giving greater access to those with limited resources in developing nations. What action is the Minister taking to ensure that TB drugs can be accessed in developing nations? He will be aware that some developing nations have placed tariffs on certain health care products. Some of those tariffs have been reduced, but not sufficiently to ensure the free access of drugs in the developing nations where they are needed most.

Can the Minister also say what steps his Department is taking to ensure collaboration between all the different interest groups—public sector, private sector and non-governmental organisation initiatives? Also, what improvements in collaboration are proposed between all the interested parties in the developed world and the developing nations to ensure the maximum impact of the inevitably limited resources that can be put into controlling TB? Are TB control mechanisms included in the respective countries' poverty reduction strategies? If not, why not? And if not, I hope that they will be included in future.

It would also be helpful if the Minister explained what supportive role the Government will play in implementing the Stop TB Partnership strategy. The 58th World Health Assembly took place in 2005, where all countries made a commitment to ensure the availability of sufficient resources to achieve the millennium development goal relevant to TB, but there is currently a $31 billion funding gap. What is the Minister doing to encourage the UK Government and other countries to fulfil their international commitments, particularly those made at the 58th World Health Assembly?

For strong health care provision to flourish, there must also be political stability. Corruption plays a role; I have debated that with the Minister at other times, and I do not intend to go into it again now. Suffice it to say that economic growth is impossible if a country's population are sick and dying. That is particularly the case in respect of TB, which disproportionately affects adults in the work force. We must encourage schemes that include civil society, NGOs, regional Governments, donor country Governments and the communities on the ground if we are to see progress towards the millennium development goal of halting and beginning to reverse the incidence of major diseases such as TB by 2015.

I want to repeat something that the hon. Member for Edinburgh, West said in respect of the campaign against TB, because it succinctly summarises what the global community needs to do. It needs to

"stimulate political commitment, financial support, effective intervention, patients' involvement, community participation and research and development."

If the UK Government are supportive of that strategy and programme, they will find Opposition Members supportive of them.

Photo of Gareth Thomas Gareth Thomas The Parliamentary Under-Secretary of State for International Development, Party Chair, Co-operative Party 11:53 am, 21st March 2006

I join other hon. Members in paying due tribute to John Barrett on securing this debate on tuberculosis. Given its timing just days before world TB day, he has done the House a particular service. TB places an unnecessary burden on the developing world in particular—TB causes 2 million deaths a year—and the House has benefited from the opportunity to discuss these issues again. I should also pay tribute to the hon. Gentleman's continuing advocacy on this topic; he has not come to it fresh today. I know through his work on the Select Committee on International Development and his visits to our programmes in Andhra Pradesh and Kenya that he has followed this issue for some time.

I also congratulate Susan Kramer on her elevation to her current position. She is fortunate to have in her constituency arguably the greatest professional rugby club—London Welsh. That makes her almost, but not quite, as privileged as I am in terms of the constituencies that we represent. She raised a number of issues, as did the hon. Members for Edinburgh, West, for St. Ives (Andrew George) and for Boston and Skegness (Mark Simmonds) and my hon. Friend David Taylor. I will try to do justice to their contributions.

As all hon. Members said, there is a huge challenge before us because of the number of people who die or become infected as a result of TB. It is, however, a challenge that the international community, supporting developing countries, could rise to. There is already an internationally agreed strategy for TB control—directly observed short-course treatment programmes or DOTS—which we know has considerable impact. I understand that later this week the World Health Organisation will announce that in 2004 DOTS programmes were able to detect 53 per cent. of TB cases worldwide, and to treat successfully 82 per cent. of them. That is encouraging, but those figures also reveal the scale of the challenge that remains. We need to build on that success and do more.

A number of things need to happen if poor people are to get better access to effective TB care. Simply put, they are threefold: there needs to be much greater political commitment to this challenge, more money needs to be allocated, and we need to make better use of the existing money that is available.

Let me start with that last point. Making better use of the money means working in partnership with developing countries, donor partners, those in research institutions and NGOs that specialise in this field. I join other hon. Members in paying tribute to the campaigning work of Results UK, TB Alert and the African Medical and Research FoundationAMREF—not least for their efforts to enlighten the House further by calling a meeting later this week. The Department for International Development is familiar with all those organisations because of their work in this area. The House owes them a debt of gratitude for their lobbying, campaigning and informative work.

Secondly, we need to ensure that we spend more of the money that is available on research, and make better use of the existing facilities. We also need to ensure that the systems are in place for the money to get down to health care services in the most remote areas and the most marginalised communities. The hon. Member for Richmond Park rightly alluded to that. We need to ensure that people who want to access the drugs are able to do so, wherever they live and whatever their circumstances.

The hon. Member for Boston and Skegness rightly alluded to the Commission for Africa's underlining how critical TB is to the health and development agenda. He will be aware that a similar message was highlighted by the Gleneagles communiqué, the United Nations world summit, and the European strategy on development—that consensus was agreed towards the end of last year. All of them committed the global community to do more on TB.

All hon. Members have also referred to the excellent global plan to stop TB, which was launched by my right hon. Friend the Chancellor of the Exchequer, with Bill Gates and President Obasanjo of Nigeria. As hon. Members said, that global plan sets out a clear picture of what we need to do to achieve the millennium development goal on communicable disease. That plan makes it clear that it is possible, with greater commitment and more money, and by using money more wisely, to halve deaths from TB by 2015. We now need to move from those commitments in the global plan and the various communiqués of last year to implementation on the ground.

Hon. Members who follow the issue will know that last year the Department held a consultation on TB and malaria, in which we reviewed our spend to date and considered whether we needed to increase our spend and how to make better use of the resources available. As a result of that consultation, we doubled funding for the Global Fund to Fight AIDS, Tuberculosis—crucially—and Malaria for 2006–07. We increased our funding for country programmes; that is the direct bilateral support to which the hon. Member for Richmond Park alluded. As the hon. Member for Boston and Skegness rightly said, the Chancellor announced funding of just over £41 million for TB drugs in India, through partnership with the World Health Organisation. We also committed some £5 million to the global Stop TB Partnership. Those are examples of our work on TB and Malaria. We intend to continue to expand such support later this year.

All the hon. Members who spoke raised the issue of finance. The hon. Member for Boston and Skegness highlighted the current $31 billion gap in the plan and pointed out that $56 billion would be needed through to 2015. Some $25 billion is already available and, as I said, we must ensure that that is well spent. I accept that there is a major gap in resources, and we cannot pretend that it will be closed if it is a case of business as usual. We need to maximise commitments from developing country Governments and donors, and we need to work on the commitments made last year.

Crucially, we must explore new sources of finance. Critical to that is ensuring that TB is recognised in developing countries' own health plans—a point made by the hon. Member for Boston and Skegness—and that Ministries of Health are supported in making the case to Ministries of Finance for more funding for health care in general and TB specifically, so that that money is locked into poverty reduction strategies. Of course, we do advocacy work in areas where our country programmes are strong and where we have identified particular problems.

The global fund needs to be supported if it is to maintain its share of the growing response to TB. Hon. Members who follow the progress of the global fund will know that in June there is to be a mid-term review of the global fund's performance to date, and of how the replenishment has gone. That will provide an opportunity to encourage new donors, in particular the oil-producing countries and the private sector, to play their part in supporting the effort on all three poverty diseases.

Even with the new resources that have been pledged, the $30 billion gap is a considerable challenge. Hon. Members will know that this year the international finance facility for immunisation began its work. We hope that that does considerable good in its own right, but also serves to encourage other nations to support a full international finance facility, delivering new resources for work on TB—and health care generally—more quickly.

The hon. Member for Edinburgh, West, knows that I cannot prejudge what my right hon. Friend the Chancellor will say in the Budget tomorrow, but he will be aware of the commitment made last year by the Chancellor and my right hon. Friend the Prime Minister to spend 0.7 per cent. of national income on aid by 2013. I am sure that the hon. Gentleman will want to praise this Government for trebling spending on international development assistance since we were elected.

The hon. Member for Richmond Park asked for more information on how much we have already spent on tuberculosis. Perhaps it would help if I explained that although we fund TB control directly through a number of specific bilateral projects in the focal countries where we operate, we also increasingly fund broader health sector development plans for developing countries through multilateral agencies, including the World Bank, the European Commission and the Asian Development Bank. It is not always possible to draw out exactly what is spent on TB, because money that goes into health sector budgets helps to fund action on a range of other health conditions, too.

Let me give some additional examples of the direct, bilateral support that we provide. In Nepal, we committed some £5.4 million from 2001 to the end of next year to helping with effective diagnosis and treatment for all TB patients who come to existing primary care facilities. In South Africa, we are providing assistance on TB to KwaZulu-Natal, the province with the highest HIV prevalence and the worst treatment outcomes.

Hon. Members have referred to the often considerable links between HIV infection and TB infection. In Pakistan, one of the seven national health programmes supported by our sectoral spend of £60 million is a national TB programme. In Uganda we are providing direct support to strengthen the health system and to strengthen our response on implementing the DOTS programme at community level.

One or two hon. Members mentioned Russia. It is worth drawing the House's attention to Russia's hosting of the G8 agenda this year. The Russians have shown an interest in discussing infectious diseases in St. Petersburg later this year. As the hon. Member for Edinburgh, West, rightly said, it is one of the countries with the greatest burden of TB, and it has a particular problem with drug-resistant TB, so we have been pushing for the St. Petersburg summit to endorse support for the global plan. Indeed, when my right hon. Friend the Chancellor launched the global plan, he made specific reference to that.

I have mentioned the issue of the better use of money. The hon. Member for Boston and Skegness rightly drew attention to the need better to co-ordinate the response to HIV with the response to TB. In some African countries—Malawi is an example—70 per cent. of people with TB are infected with HIV, so there is a clear case for bringing responses to the two diseases much more closely together. In some African countries, people still need to go to one clinic to get their TB drugs and another to be tested and get treatment for HIV. Clearly, that is nonsense in the longer term, and we need to support those African countries in bringing those services together.

In 2005, the G8 committed itself to providing universal access to HIV treatment, prevention and care. That commitment was endorsed by the UN world summit. As part of the global steering committee that we co-host with UNAIDS, we have been trying to make a reality of that commitment. We are drawing up plans on how to achieve that, and on how to ensure that TB is seen as a core element of the package of AIDS care.

In an intervention on the hon. Member for Edinburgh, West, my hon. Friend the Member for North-West Leicestershire rightly alluded to lack of drugs and problems with diagnostics and vaccines for diseases. Those are major problems; those in developed countries have considerable access to those services, and those in developing nations have very poor access to them. We know from international research on the issue that 10 per cent. of global health research and development is directed at diseases of relevance to 90 per cent. of the world's population. That is a huge imbalance and a glaring example of global inequality. That is one reason why we need to accelerate research and development of new technologies; a second reason is to deal with the specific issue of multi-drug-resistant TB. That is one reason why we are supporting the WHO's tropical disease research programme, which includes a major research project in improving TB diagnostics, which the hon. Member for Richmond Park mentioned. If we can get those new diagnostic methods to come on line, it will mean that we can detect TB earlier in primary health services and we shall be able to diagnose it much earlier in people who are also infected with HIV, where diagnosis is often particularly difficult.

We are keen to see new drugs developed, particularly ones that would allow for shorter and simpler courses of treatment that reduce the burden on often fragile health care systems. Ultimately, the goal must be to find a vaccine, if we are genuinely to achieve long-term control.

One key way to try to ensure that new drugs and diagnostics come on line is through public-private partnerships, which are beginning to change the landscape of TB research. The need for public-private partnerships will continue to increase, particularly when embarking on expensive clinical trials. That is why, earlier this month, I was pleased to announce UK funding of some £6.5 million over the next three years to the global alliance for TB drug development. However, that does not preclude the point that my hon. Friend the Member for North-West Leicestershire made, which was that we need to see, and should continue to encourage, the major pharmaceutical companies in their programmes of research into diseases in developing countries. We should try to ensure that they have effective differential pricing regimes in place to charge higher prices in developed nations and recognise the unaffordability of those prices for poorer nations and bring in cheaper prices there. I have already made it clear that this is a particular issue for second-line antiretroviral drugs to fight the HIV/AIDS epidemic, but, more generally, it is one that developing countries are facing.

The hon. Member for Boston and Skegness also mentioned access to drugs. He will be aware of the flexibilities in the legislation on trade-related aspects of intellectual property—TRIPs—which has only just come into force in general terms and is not in force for the least developed and very poorest countries. We are working with a number of developing countries, including Ghana, to ensure that they can take advantage of the flexibilities in the TRIPs regime.

The hon. Gentleman said that many developing countries impose tariffs on drugs and that it is difficult to see the sustainability of such tariffs, given the huge public health burden faced by many of those countries. Nevertheless, he will recognise that Finance and Health Ministers and Parliaments in developing countries must consider that in the round. As I said in answering the point made by the hon. Member for Richmond Park about our spend on TB directly, we put considerable resources into financing health systems to help with the fight against TB and more broadly.

My right hon. Friend the Secretary of State has, in various speeches to generate debate on our forthcoming White Paper, referred to the need for us to increase access to basic health and education services. It is worth pointing out that the WHO estimates that it would only cost approximately £20 per person to provide an essential package of health services. Many Ministries of Health in low-income countries typically spend less than £5 per person, which indicates the scale of the challenge that we face and just how much of a step change we need to see in funding from domestic budgets in developing countries and from international aid.

I draw hon. Members' attention to Malawi, where we are providing £100 million of support to its health sector budget, as part of the health sector plan, which is specifically supporting the Government of Malawi to try to double the number of nurses and treble the number of doctors that they recruit over the next six years. That is being done partly by tackling many aspects of the poor conditions in which people in the health service in Malawi have to operate, partly by raising their pay by just over 50 per cent., an increase that only came on line in April. Early indications are that a significant increase in recruitment is beginning to happen.

The hon. Member for Boston and Skegness rightly mentioned user fees for health care services. We have made it clear that user fees can deter people from accessing the health care services that are needed, that we support the elimination of health care fees and that we will put resources behind efforts to eliminate such fees. In Zambia, when the Minister of Health recently announced her intention to abolish health fees for those in rural areas, my right hon. Friend the Secretary of State announced additional funding for Zambia to help compensate for the loss of those user fees.

In conclusion, I congratulate the hon. Member for Edinburgh, West on securing this debate. I hope that world TB day receives considerable media and parliamentary attention; it certainly needs to. We in the Department for International Development intend to continue scaling up our work on health care services in general and, through that, our response to the fight to tackle tuberculosis. I look forward to working with the hon. Gentleman and other hon. Members to continue the campaign on this issue.

Sitting suspended.