Tuberculosis

Alan Duncan Excerpts

Wednesday 27th November 2013 Westminster Hall

[The Minister of State, Department for International Development (Mr Alan Duncan)]

I thank the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. If I may say so, it has been one of the best Westminster Hall debates I have been to. The speeches have all been passionate and have each come from a slightly different angle. Together, they form a comprehensive picture of the action that this issue requires.

We all know that tuberculosis remains one of the world’s biggest killers. It causes untold suffering and kills more than 1 million people across the world every year. What makes that tragedy much worse is that every single one of those deaths is preventable. The World Health Organisation’s recently launched annual global TB report outlines the progress and challenges in reaching international TB targets. Efforts to tackle TB are having a real effect. The incidence of TB has fallen in all six WHO regions and TB cases have been falling worldwide for a decade. However, the rate of decline remains too slow, at just 2% a year.

Resistance to TB drugs is a growing threat and the risk of resurgence is therefore always present. The figures are compelling: 8.6 million people still developed TB in 2012, and 1.3 million died. TB is one of the top 10 killers of children worldwide—a situation that is wholly unacceptable, as it is wholly preventable. There are wider social and economic costs as well, as TB primarily affects young adults in what should be their most productive years. Right hon. and hon. Members have spoken passionately about the areas for action highlighted in the global TB report.

The UK remains absolutely committed to the global goal of halving deaths from TB by 2015. We are helping people to have effective diagnosis and treatment, including for TB and HIV co-infection and for multi-drug-resistant TB. We are also helping to develop more effective treatment and better vaccines. All that work needs good health systems, so we are helping countries to build effective, efficient and durable health systems to support the delivery of TB programmes. Without such systems, we can have the best intentions, but there will be no means of achieving enough.

What is more, the Department for International Development is tackling the underlying risk factors for developing active TB. TB is a disease of poverty and squalor. Factors associated with poverty, such as malnutrition, overcrowding and poor sanitation, dramatically increase the chance of someone becoming infected and developing active TB. It is no wonder, therefore, that the ghastly prison described by my hon. Friend the Member for City of Chester (Stephen Mosley) —in what I thought was a remarkable speech—is so obviously perilous.

[Grahame M. Morris]

The Minister is responding systematically to the debate, which I appreciate, but will he turn his attention to the issues I raised about the incidence of TB among miners in South Africa? The hon. Member for City of Chester talked about chronic conditions in prisons; the hostel accommodation for miners, along with the confines of the mines they work in, is causing TB to spread. Will the Minister also comment on the obligations on UK-headquartered mining companies?

[Mr Duncan]

The hon. Gentleman has raised a serious point. If he will bear with me, I will come to the issue of South Africa in just a moment. As he and the right hon. Member for Neath (Mr Hain) said, the issue is obvious and compelling, and has to be addressed.

In spite of tough times, the broad picture for the UK is that we are delivering on our promise to spend 0.7% of gross national income on development. This year we will become the first G8 nation ever to do so. We are clear about our responsibility to deliver aid that is transparent, that delivers value for money and that produces the best results for the world’s poorest people. Our support to the Global Fund to Fight AIDS, Tuberculosis and Malaria helps to do just that. Between 2002 and 2012, the global health fund supported the detection and treatment of 9.7 million cases of TB.

To respond to the continuity point raised by the hon. Member for Wirral South (Alison McGovern), who spoke from the Opposition Front Bench, last month the UK Government committed up to £1 billion over the next three years, which is enough to save a life every three minutes. The global health fund allocates 18% of its funds to TB, which equates to £180 million of UK development funding specifically for that disease. Improving basic TB control is critical to prevent the further spread of TB, and includes early detection and diagnosis of people with the illness, ensuring that they get the right treatment and care, and checking that their families and other close contacts do not also have active TB. Also important is the reporting of cases, so that health authorities can better monitor them and improve their services.

Let me turn to the work we are doing through our country bilateral support programmes. DFID is working closely with the Government of South Africa to expand the quality and access of public sector services, including TB control, and is increasing the speed with which new TB drugs are registered. In conjunction with the World Bank, DFID is also engaged in a new partnership with the private sector in South Africa. The partnership has been set up to increase public-private collaboration to reduce the high incidence of TB specifically in miners and in the communities around them. We will continue to focus on that important target group, to which the hon. Member for Easington (Grahame M. Morris) referred. In India, DFID is working with Indian pharmaceutical manufacturers to improve the price and security of supply for high-quality drugs for resistant TB and new low-cost diagnostic products.

Co-infection has been covered thoroughly today. Many countries have made considerable progress in addressing the combined epidemic of TB and HIV. However, there were still 320,000 deaths from HIV-associated TB in 2012. DFID is supporting improved co-ordination and collaboration between TB and HIV services jointly. As part of our commitment to the global health fund, we are pushing it to do more to prevent, diagnose and treat TB and HIV co-infection.

The UK Government are very concerned about the spread of drug-resistant TB, which probably results from the improper use of antibiotics. A patient who develops active disease with a drug-resistant TB strain can transmit that form of TB to other individuals, which threatens the whole global response to TB. Drug resistance increases the cost of treatment and makes it more difficult to ensure that effective treatment is accessible to the poorest. We support efforts to tackle drug-resistant TB through our support to UNITAID, the global health fund and research.

The UK has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. We support a number of product development partnerships that bring together a range of public, private and community organisations. They are designed to develop and deliver new products more rapidly and more cheaply than either the public or private sectors can do alone.

I should mention TB REACH, to which four or five hon. Members referred. The issue is not as straightforward as any of us in public policy would like. We have reviewed the external mid-term evaluation of TB REACH, and the findings suggest that it has successfully funded pilot projects and innovative approaches, which we applaud. The question is whether it will be able to roll them out effectively in the long term and on an adequate scale. We propose that DFID officials should meet the executive director of the Stop TB Partnership to discuss how the global health fund can better support the expansion of proven TB REACH projects. It is important the TB REACH implementers co-ordinate more closely with national TB control programmes—again, that was raised today—and are part of national planning processes. That is crucial to secure longer-term support.

[Nick Herbert]

I am grateful to the Minister for responding to our points about TB REACH. Does he accept that although it will no doubt be worth having a dialogue with the global health fund about supporting proven TB REACH projects, further projects will rely on the continued funding of that programme? As my hon. Friend the Member for City of Chester (Stephen Mosley) effectively said, TB REACH funds projects that the global health fund will not fund because they are unproven. TB REACH allows innovation on the ground in such projects. Will the Minister reflect on that and consider my request for a meeting to discuss the TB REACH programme before a final decision is taken about its funding?

[Mr Duncan]

I certainly undertake to consider that, but obviously, as I am on my feet at the moment, I cannot give a commitment. We provide core funding to the Stop TB Partnership, some of which is used to support TB REACH continuously. I understand exactly what my right hon. Friend is saying, and I hope that the meeting to which I have referred can explore that point in more detail and address his concerns conclusively.

DFID has also supported the Foundation for Innovative and New Diagnostics—FIND—to develop a rapid molecular test, GeneXpert, to which reference has been made. It can be used by health care workers with minimal training and laboratory facilities. The test is associated with a 40% improvement in case detection rates and can provide test results within two hours. Working through the Stop TB Partnership and UNITAID, the Department has supported the policy development and distribution of GeneXpert, which is available in 29 countries. In August, DFID announced support to nine public-private partnerships, including FIND, the TB Alliance and Aeras. Those partnerships will help to fund crucial work on developing new and more effective tools to prevent, diagnose and treat TB.

We cannot shelter the UK from what is happening around the world. In 2011, nearly 9,000 cases of TB were reported in the UK. More than 6,000 of them were in people born outside the UK. The patterns must be analysed, followed and fully understood. A cross-government approach is also essential. Public Health England has made TB one of its priorities and is working to oversee a stronger national approach.

Resistance to all antimicrobials—the drugs used to prevent and treat bacterial, fungal, viral and some parasitic infections in humans and animals—is increasing, but of greatest concern is the rapid increase in bacterial resistance to antibiotics, including those used to treat TB. In September, the Government published a new five-year antimicrobial resistance strategy, which sets out actions to slow the development and spread of anti- microbial resistance, including strengthened international collaboration. That is why DFID will continue to work with the Department of Health and others to provide national and international policy leadership. We must play our part in ensuring co-ordinated action to tackle TB at home and abroad.

In conclusion, significant progress has been made since 1995 in controlling TB, with more than 56 million cases treated and 22 million lives saved. That progress has been rooted in improved partnership, policy, innovation, and national and international leadership. We have grounds for optimism, but we are not complacent about the significant challenges ahead, in which the UK will continue to play its full part.