Drug-resistant Tuberculosis (Developing Countries)

(Limited Text - Ministerial Extracts only)

Tuesday 4th June 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

What a pleasure it is to serve under your chairmanship, Mr Caton. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate, and I thank him for having done so. I will try to get through all the points that have been raised, but if I do not we will contact hon. Members afterwards.

Tuberculosis is an age-old disease. It is tenacious and persistent, and affects the poorest people in the world and those who are socially marginalised. Every year there are 9 million new cases and nearly 1.4 million deaths. Although its incidence has been declining slowly since a peak in 2004, and mortality rates have fallen by 41% since 1990, the vast majority of TB deaths—more than 95%—are in the developing world.

Despite some progress, there were 400,000 cases of multi-drug resistant TB in 2011. As honourable colleagues will be aware, MDR-TB is more difficult and more expensive to treat than TB. Its spread is threatening the global response to TB, and makes TB control even more difficult. It is true, therefore, that TB continues to affect the poorest people in the poorest countries, and remains a serious threat to global health, especially through the rise of MDR-TB.

The coalition Government share the concerns about drug resistance, and we remain committed to the global goal of halving deaths from TB by 2015. The emergence of drug-resistant strains of tuberculosis poses a serious threat to the achievement of that goal and, indeed, to the effectiveness of our current armoury of medicines and treatments.

Our priorities for TB, and for MDR-TB, are to help to increase access to effective diagnosis and treatment of TB; to invest in research and product development in more effective treatment, diagnostics and vaccines; to support countries to strengthen health systems to deliver quality TB programmes—a really important point—and to work with our partners to tackle the risk factors for TB, including poverty and malnutrition. That is not always highlighted, and most of the work of the Department for International Development focuses on dealing with poverty and malnutrition.

As highlighted by the hon. Member for Poplar and Limehouse, Public Health England is developing a national strategy for TB, and engaging with key partners such as local government, the National Institute for Health and Care Excellence, NHS England, academia, the voluntary sector and the Department of Health. DFID will obviously input into the process, and will work with the partners on their strategy, to produce national and international policy and to ensure that there is co-ordinated action on domestic and global approaches to reducing rates of TB.

Our first priority is to improve basic TB control. Basic control includes early detection and diagnosis, effective and complete treatment, and contact tracing. Basic control is also critical in preventing the further spread of drug-resistant tuberculosis. If we do not deal with basic TB, the incidence of MDR-TB will be accelerated. We also help to strengthen all aspects of TB control through direct and indirect funding channels in a range of high-burden countries.

I will quickly give three examples. We are working with the Government of South Africa to expand the quality of and access to public sector services, including that of TB control, and are increasing the speed with which new TB drugs get registered. We have engaged in a new partnership with the private sector in South Africa and the World Bank that aims to reduce TB in mining communities, which I think will be welcomed on both sides of the House.

In India, DFID is working with Indian pharmaceutical manufacturers to improve the price and security of supply of high-quality drugs for resistant TB and the manufacture of new low-cost diagnostic products. In Burma, we are providing bilateral funding to the 3MDG fund, a multi-donor fund for the health sector, which is supporting disease control among the poorest communities.

[Nick Herbert (Arundel and South Downs) (Con)]

I, too, am a member of the all-party group on global tuberculosis, and I visited South Africa recently with Lord Fowler. Is that country not a good example of the problem of drug-resistant TB? A full third of the budget that South Africa has to deploy in dealing with TB is spent on drug-resistant TB, yet the incidence of such TB is only 2%. That underlines the importance of getting on top of that form of TB so that the costs do not run further out of control and undermine the fight against the disease.

[Lynne Featherstone]

My right hon. Friend makes an excellent point. South Africa is an epicentre, so far as its spend on what is a relatively confined industry is concerned.

I was talking about Burma. It is estimated that between 2013 and 2016, the 3MDG fund will spend $20 million on tuberculosis. Funding is an important strand. DFID also supports a number of global partnerships that work on strengthening basic TB control. For example, the Stop TB Partnership plays a critical role in helping countries to strengthen their TB policies, and in supporting the improvement of funding applications for large TB-control grants.

The UK’s contribution to UNITAID, of up to €60 million per year, has funded new laboratory infrastructure in 18 countries, 10 of which now routinely diagnose MDR-TB. The network will have detected approximately 12,000 MDR-TB cases by the end of 2011, compared with only 2,300 cases in the same countries in 2008.

I will move on to the Global Fund to Fight AIDS, Tuberculosis and Malaria, because I know it is of particular interest—this is not the first occasion on which it has been raised with me. The majority of UK funding to global TB control is channelled through the Global Fund to Fight AIDS, Tuberculosis and Malaria, and we have increased and accelerated our funding and are on track to meet our £1 billion commitment to the fund for 2008 to 2015. The fund is, as hon. Members have mentioned, absolutely critical to achieving many of the UK’s health-related international development objectives, so it is important to us that it continue to deliver ever-more impressive results. The UK intends to increase its contribution, pending, as we have said, progress on the implementation of crucial reforms. That obviously falls within my portfolio, and I have had reports from all DFID offices around the world, having asked them to report to me on the fund. Recently I was in Nigeria and had a meeting with recipients of global funding from across the three diseases, to understand the changes that are being heralded in with the reforms at the global fund—so far so good.

We are committed to working with others to ensure that the planned autumn replenishment is a success. We are a world leader, but sometimes it would be nice to be at least equalled in some of these things by other donor countries. We will use our influence to draw in more overall financing. I understand the call to go early, but there are many multinational decisions to be made and, as I have said, this all depends on progress.

On investment in research and innovation, which I think all Members would agree is critical, DFID has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. An example of that is our effort to increase the affordability of diagnostic testing for MDR-TB. DFID’s support of the Foundation for Innovative New Diagnostics has contributed to the development of a rapid molecular test, GeneXpert, which has the potential substantially to improve the diagnosis of TB and drug-resistant TB.

DFID aims to continue our strong record of supporting investment in TB research and development, including through product development partnerships, and we will strive for value for money in such investments. On DFID’s support for innovation, we will consider the hon. Gentleman’s request that we fund TB REACH against, obviously, the competing priorities and commitments in our international health financing decisions.

[Sir Tony Cunningham]

Will the Minister recognise the importance of TB REACH? We can have all the drugs in the world, but if we cannot find the people with TB, we cannot use those drugs.

[Lynne Featherstone]

Absolutely. The point is that we are waiting for the evaluation. TB REACH worked by giving a small amount to a great number of organisations to test how to reach people in difficult circumstances. It had precise pre-specified targets and cost-effectiveness benchmarks, and we have to await the evaluation of that first phase to assess what our funding might be for the second phase. We cannot go ahead of that, although I understand that reaching people is critical. We should also work to strengthen health systems, because ultimately we want health systems that are able to reach every individual in a country and dispense whatever medical care is necessary, but I understand the point in relation to TB.

On Ethiopia, about which I have not yet responded, DFID provides significant support to its health system, directly supporting community health workers, and we agree that they do a great job, including on TB. I have been to Ethiopia myself—twice, in fact.

In conclusion, I am very proud to serve in the coalition Government who, even in tough times, have protected the development budget and will reach the target of 0.7% of gross national income this year. I am also proud that we have cross-party consensus in this Parliament: it is one of our finer moments. We are equally clear about the responsibilities that come with those resources, particularly when this country is itself struggling for survival. Those responsibilities are to spend taxpayers’ money well, to deliver aid that is accounted for transparently, and to ensure that our support delivers value for money and gets to where it is most needed.

Significant progress has been made in controlling TB since 1995, with more than 51 million cases treated and 20 million lives saved. That progress was rooted in improved partnership, policy, innovation and leadership, so there is cause for optimism. I thank all hon. Members here, because the issue is really important and I appreciate their continued pressure. The issue needs to be worked on in all the ways they have proposed if we are to get the better of this disease: our progress is good, but not remarkable. The UK is playing its part, but as I have said, we are all clear that significant challenges remain.

Question put and agreed to.