Tuberculosis

Cheryl Gillan Excerpts

Thursday 7th June 2018 Commons Chamber

[Nick Herbert]

My understanding is that they already do. That is a good example of how we already—although we need to do more—deploy the resources that are available to us. Indeed, the commitment that we make as the second biggest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria—£1.2 billion in the last replenishment—has been made possible because of the increase in aid spending and the target that has been set.

At last, this disease is commanding greater political attention. It has got on to the G7 and G20 agenda, partly because of the lobbying that is being done by the Global TB Caucus, which I co-chair with South Africa’s Health Minister, and now numbers 2,500 parliamentarians in 130 countries. In November, there was a WHO ministerial summit in Moscow. In February, Prime Minister Modi of India announced a TB strategy.

Above all, there is a reason to be optimistic because, at the United Nations on 26 September, there will be, for the first time ever, a high-level meeting on tuberculosis that it is intended that Heads of Government and Heads of State will attend, where a new declaration will be launched, with a commitment by the world’s leaders to act. That has to address the current funding gap whereby we are $6 billion a year short of the funding needed properly to eliminate TB by the SDG deadline in 15 years’ time. It also has to introduce greater accountability so that Governments are locked into proper targets to ensure that they really do reduce TB. In addition, there needs to be a dramatic increase in research and development to develop the new tools that I mentioned. All this requires leadership.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

I am hoping to speak later in the debate, but my right hon. Friend is already making a powerful case. Has he had any indication from the Prime Minister on whether she intends to attend that high-level meeting, because it would seem to be of great significance that she does?

[Nick Herbert]

My right hon. Friend asks a very pertinent question. Last month, 100 Members of this House and the other place wrote to the Prime Minister to ask if she would attend the meeting. The motion before the House specifically requests that the Prime Minister attend, as the UN General Assembly has asked. So far—understandably, I believe—the Prime Minister is not committing to attend.

In the time remaining to me, I would like to make the case for the Prime Minister to attend this meeting. It would be completely consistent with UK Government policy. We have made that major investment in the global fund. We are world leaders in international development. We set the agenda on antimicrobial resistance. We have a leadership position, and we should take it on this issue. TB is now the world’s deadliest infectious disease. This needs the support and attention of the world’s leaders. The UK is in a very powerful position to show that leadership and to give that support. Indeed, it is very difficult to see what would be the downside of the Prime Minister attending. I believe it would be all upside, and it would send a very powerful message to other world leaders. It is completely consistent with the ambition for a global Britain. Indeed, it is worth noting that TB is an issue in 19 Commonwealth countries, and 17 of the Department for International Development’s priority countries are high-burden.

This is a once-in-a-generation opportunity. The high-level meeting is the chance, at last, for this disease to get the attention that it needs. It is an easily and cheaply curable disease. Frankly, it is a global scandal that so many people are losing their lives completely unnecessarily when since the 1940s they need not have done so. We can act and we should act. The UK can play a major role in this respect. Speaking at the UN on Monday, I was asked what was the single message that I would want to send to the world’s leaders about whether or not they should attend. I simply said this: if 1.7 million deaths a year is not enough to encourage the world’s leaders to attend, what is?

--- Later in debate ---

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

May I start by congratulating my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) on not only his excellent speech but the way in which he has pursued this matter relentlessly across an international audience? He is renowned on an international basis, as I know myself.

I am proud to represent the UK at the Parliamentary Assembly of the Council of Europe with many other colleagues from both sides of the House. The Council of Europe represents 47 countries and is an institution that is far older than—and, I think, vastly superior to— the European Union. It takes up some very important matters. I am pleased to report that on 27 April, in our main plenary session, we were privileged to hear from a very competent and capable Ukrainian Member of Parliament, Serhii Kiral, who was appointed the rapporteur for the “Drug-resistant tuberculosis in Europe” report, contained in document 14525 of the Parliamentary Assembly of the Council of Europe. He presented his report, which was passed unanimously in the plenary session.

Mr Kiral has done much investigation into this area, and he started his speech by saying:

“My report is about fighting tuberculosis, but tuberculosis is like corruption—you do not see it, but it is there. It is equally dangerous, but it is also curable.”

Although many of us thought that TB was a disease of the past, he informed us that during the course of his investigations a professor from the University of Oslo told delegates from the Council of Europe on a fact-finding mission that more than 900 new cases are registered every day. Europe accounts for one in five multi-drug-resistant TB cases in the world, and nine out of 30 countries that the World Health Organisation has identified as needing to solve their TB problems are in Europe. It is of particular concern that 45% of cases affect young individuals aged between 25 and 44.

Owing to the time limit, I will concentrate not on the broader facts but on two specific areas: the importance of disease surveillance and diagnostic gaps. On World TB Day this year, 24 March, the European Centre for Disease Prevention and Control released an alarming set of statistics, including the fact that the number of cases of extensively drug-resistant TB has increased fourteenfold in the last four years, with almost 5,000 cases reported in 2016, the majority being in eastern Europe. Those statistics are startling and demonstrate the vital importance of TB surveillance systems.

Epidemiological surveillance is a vital global public health investment, since it allows experts to monitor the trajectory of the epidemic and, particularly in the case of the emergence and spread of drug resistance, allows us to identify where we are failing and how we need to address it. Marieke van der Werf, who is the head of tuberculosis at the ECDC, has confirmed that the threat to Europe is caused by the mobility of people who bring drug resistance with them. Countries really need to be vigilant about that. The data released by the ECDC is available because of investments in laboratory and surveillance infrastructures. Routine surveillance of drug-resistant TB, where every case identified is reported, is now available in 90 countries worldwide, with the majority being in Europe and North America.

At the global level, progress is being made. Since 2015, 22 high-burden countries have begun the process of conducting national drug resistance surveys, six of them for the first time ever. In 2016, we saw the discovery of an additional 600,000 cases of TB as a result of those surveys. It is clear that the data garnered from those surveys will be vital in shaping the global response, but gaps remain to be filled.

The need for urgent action is self-evident on the basis of current data alone, but to ensure that our efforts are as appropriately targeted as possible, we had better get on with it. Will the Minister work with colleagues across Government, as well as bilateral and multilateral partners, to improve TB surveillance globally, particularly for drug-resistant forms of TB, including through future programmes of the Fleming fund?

Ultimately, all efforts rely on the availability of accurate diagnostic tests. Currently, that is far from guaranteed, to the detriment of both epidemic preparedness and the individual patient. In 2016, some 3.8 million cases of TB were never formally reported, going completely undiagnosed or at risk of being treated inappropriately. In the same year, just 57% of reported cases were bacteriologically confirmed, and of those, just 39% were tested for resistance against first-line drugs.

In the past 10 years, immense progress has been made in the diagnosis of TB, with new diagnostic tests that allow for accurate diagnosis and the detection of first-line drug resistance in under two hours having the potential to transform our fight against TB. Despite those advancements, however, the vast majority of TB diagnoses made today still rely on the methodology used by Robert Koch to discover TB in 1882. When the Minister responds to the debate, will she commit to finding the missing millions, and to working with partners to guarantee access to WHO recommended diagnostics for all people at risk from TB?

I conclude by returning to the UN meeting and the motion before the House today. This issue is of such importance to the lives of people around the world because of increasingly mobility and the flows of people. It is of such significance that I feel the Prime Minister must put in an appearance on behalf of the UK, not only to bang the drum about the advances we have made, but to make that valuable contribution that will save lives. If one statistic brought me up, it was learning that 700 children die every day from TB. As my right hon. Friend the Member for Arundel and South Downs said, if those statistics are not enough to make world leaders sit up, take notice and attend this meeting, goodness only knows what would be enough.

I am sure we will hear about the projected economic effects of TB in subsequent contributions. If anybody wants to look at them they are quite alarming. They provide both the head and the heart with a reason to participate in this high-level UN meeting, and I therefore hope that the Prime Minister will attend and give this issue her full attention. It is probably one of the most important things she will be asked to do to save lives around the world.