Tuberculosis

Grahame Morris Excerpts

Wednesday 27th November 2013 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Dobbin.

In the last three Westminster Hall debates that I have attended—on the privatisation of the east coast main line, the privatisation of blood products laboratories and free schools—I have found myself at loggerheads with Government Members. Unusually, however, today I find myself nodding in agreement with the excellent contribution of the right hon. Member for Arundel and South Downs (Nick Herbert). I pay tribute to my hon. Friend the Member for Scunthorpe (Nic Dakin) for securing this timely, important and significant debate.

I echo the right hon. Member for Arundel and South Downs in paying tribute to the work of the all-party group on global tuberculosis and its members and officers, including the hon. Member for St Ives (Andrew George), who has been an absolute stalwart of the group for a number of years.

I will concentrate on one aspect of this terrible condition that is close to my heart. As Members know, I have the pleasure of representing Easington in east Durham. Easington is a coal mining constituency with a long and distinguished history as one of the great heartlands of the north-east coalfields. I thought it would be poignant in this debate to reflect on why our pits were closed and why Britain now imports more than two thirds of the coal burned in our power stations, when once we imported none.

The UK coal industry was modern, efficient and very health conscious. My right hon. Friend the Member for Neath (Mr Hain) spoke about the incidence of TB among South African miners, which is relevant. I have just come from the annual general meeting of the all-party group on coalfield communities, where we talked about the problems that we face in coal mining communities, the physical legacy of pollution and the ill health associated with mining. That is another reason why this debate is close to my heart.

Although, by its very nature, mining will never be completely safe—it is an extractive process—our mines were about as safe as they could be, and the health, safety and well-being of miners was paramount. There are those who would argue that that drove up costs.

Today, much of the world’s coal production has been offshored and outsourced to countries where health and safety standards are minimal and labour is cheap. There is still blood on the coal, but nowadays it is more likely to be the blood of miners in Colombia, China or South Africa. The price of the irresponsible pursuit of profit and cheap labour is the health and safety of mineworkers worldwide.

Mining is one of the biggest employers of men in South Africa. Tens of thousands of those miners are migrant workers, from neighbouring countries such as Mozambique, Lesotho and Swaziland, who work and live in crowded townships in mining areas. As has been said, diseases such as malaria, TB and HIV/AIDS are rife. South Africa’s mining industry has been the subject of intense international and national media scrutiny due to the recent industrial unrest. Members will be aware of the appalling shooting of striking miners by armed police in scenes reminiscent of the worst days of apartheid. Mining is one of the driving forces of the South African economy; it contributes some 20% of the country’s gross domestic product and is a major employer.

What has not been subject to the same degree of media attention is the devastation caused to miners and their families by TB. The disease remains the leading cause of death in South Africa today. One third of all cases in sub-Saharan Africa have a link to the mines. TB is an airborne disease, spreading through the air when people who have it cough or sneeze, and it is often fatal if left untreated. Rates of TB among South African mineworkers are estimated to be as high as 7,000 per 100,000. That huge figure is 28 times the World Health Organisation’s definition of a health emergency and is the highest such figure in the world.

As we have heard, TB is closely linked to HIV, which is also a challenge in the mines. It is estimated that people with HIV are 21 to 34 times more likely to develop active TB. As we approach world AIDS day, it is important to reflect on that and on the interactions between the two. Such high HIV infection rates, coupled with cramped living conditions and exposure to silica dust, which damages miners’ lungs, creates a perfect breeding ground for the disease. The effects are devastating not only for the families of the many miners who die from TB, but also for communities, companies and Governments.

From a commercial point of view, the disease dents productivity—the issues I am raising are relevant to the British mining companies involved in South Africa—puts a drain on health budgets and spreads far into the rural areas that miners migrate from. Migration also means that the problem is not exclusive to South Africa, which is one reason why sub-Saharan Africa is not on track to meet the target of reducing deaths from TB by half by the expiration of the United Nations millennium development goals in 2015.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being here earlier; I had other business and could not get here any quicker.

The hon. Gentleman mentioned world figures for TB, but the exact number of TB sufferers is not known and many of them cannot be found. How does he think we can best address that problem?

[Grahame M. Morris]

I am grateful to the hon. Gentleman for that relevant point. An estimated 3 million people with TB in southern Africa have not been reached, but programmes, such as TB REACH and those supported by the Department for International Development, exist to identify those people and to secure treatment for them. My point is about the incidence of known TB among miners in South Africa.

TB is curable with drugs, and the costs are relatively modest. Spending £15 a person should be easily affordable. Global underinvestment and indifference mean that the disease killed an estimated 1.3 million people globally in 2012. The failure to deal decisively with TB has allowed drug-resistant strains of the airborne disease to develop, which are much more difficult and significantly more expensive to treat.

Earlier this year, members of the all-party parliamentary group on global tuberculosis, including me, met the Secretary of State for International Development. I want to echo the words of Government Members and compliment the Minister and the Secretary of State for their commitment on this issue. We met them to put TB at the forefront of their dealings with major Anglo-American mining interests, particularly in the gold mining industry, which has a high incidence of TB as well as high rates of HIV. As my right hon. Friend the Member for Neath mentioned, an estimated 750,000 cases—I had to check that incredible figure, as I thought it was a printing error—of TB each year, 9% of the global total, come from South Africa’s gold mines.

Colleagues who represent former British mining communities, such as my right hon. Friend the Member for Rother Valley (Mr Barron), and I are determined to push the battle against TB up the political agenda here in the UK. Along with the South African mining unions, I want to see the British Government make the British mining companies involved in South Africa sign up to a new protocol launched by the South African Department of Health. That would help ensure that mining companies abide by a legal framework governing the treatment and compensation of occupational TB.

In the past, too many stricken miners simply returned to their towns and villages to die lingering and often painful deaths. In the 21st century, it simply cannot be acceptable that mining companies, or any other employers, should systematically endanger the health of their workers. Rates of TB in the mines have been estimated at 28 times the World Health Organisation’s definition of a health emergency. This is a global health emergency. We need Governments, employers and drug companies to act accordingly.

People do not have to live in a mining constituency to know that keeping the lights on should not come at the expense of the health and lives of South African miners and their families, or those in any other countries. That is simply wrong. Global mining operations headquartered in the UK must accept their social, moral and ethical obligations to address the issue as a matter of urgency.

--- Later in debate ---

[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.