Tuberculosis

Lord Herbert of South Downs Excerpts

Thursday 7th June 2018 Commons Chamber

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

I beg to move,

That this House recognises that tuberculosis (TB) remains the world’s deadliest infectious disease, killing 1.7 million people a year; notes that at the current rate of progress, the world will not reach the Sustainable Development Goal target of ending TB by 2030 for another 160 years; believes that without a major change of pace 28 million people will die needlessly before 2030 at a global economic cost of £700 billion; welcomes the forthcoming UN high-level meeting on TB in New York on 26 September as an unprecedented opportunity to turn the tide against this terrible disease; further notes that the UN General Assembly Resolution encourages all member states to participate in the high-level meeting at the highest possible level, preferably at the level of heads of state and government; and calls on the Government to renew its efforts in the global fight against TB, boost research into new drugs, diagnostics and a vaccine, and for the Prime Minister to attend the UN high-level meeting.

The motion stands in my name and that of the hon. Member for Ealing, Southall (Mr Sharma), and I am grateful to the Backbench Business Committee for allowing us to have this debate on ending tuberculosis.

I believe that this is the first time that this issue has been debated on the Floor of this House for 65 years. Responding to an Adjournment debate in 1952, the Joint Under-Secretary of State for Scotland, Commander T.D. Galbraith, said:

“Tuberculosis is still the major health problem in Scotland…we must press forward…with every weapon that is available to us until the disease, which is said to be preventable, has been eradicated.”—[Official Report, 29 January 1952; Vol. 495, c. 158.]

At that time, people were optimistic because antibiotics had been discovered and put into mass production, housing was improving and there was no longer any reason to believe that tuberculosis would not be beaten. Tuberculosis was the great killer of history. A disease that dates back at least 7,000 years, it has killed 2 billion people in the last two centuries alone. John Bunyan said that TB was

“the captain of all these men of death”.

TB—otherwise known as consumption or the white death—is caused by a tiny bacteria. When it was first identified in 1882, it was still killing one in seven people. Indeed, TB killed more people in the United States in the late 19th century than any other disease. It is a disease that has killed kings, poets and paupers throughout history. Tutankhamun, Edward VI, Cardinal Richelieu, Eleanor Roosevelt, Keats, Chekhov, Emily Brontë, D. H. Lawrence, Orwell and Chopin all died from TB. Of course, the heroines of the operas “La bohème” and “La traviata” notoriously die from tuberculosis. That was expected in that age, which was not so long ago. Millions of others down the ages have suffered from TB—notably, Nelson Mandela, who suffered greatly from it.

With better housing, better nutrition, the discovery of penicillin by Fleming in 1928, and the mass production of antibiotics in the 1940s, it was thought that tuberculosis would be beaten. In 1962, a Nobel laureate virologist said:

“To write about infectious disease is almost to write of something that has passed into history.”

But TB was not eradicated or eliminated at all. It resurged on the back of the AIDS epidemic. TB is a bug carried by a third of the world’s population that can exist in our bodies latently, but strikes when immune systems are compromised.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

I congratulate the right hon. Gentleman on securing this debate. I chair the all-party parliamentary group on HIV and AIDS, and he knows that we very much share his concerns about TB and are pleased to work with his all-party parliamentary group on global tuberculosis. Today, we met the chief executive of the he Global Fund to Fight AIDS, Tuberculosis and Malaria. Does the right hon. Gentleman agree that that organisation is doing excellent work, not least on co-morbidity, as people live with HIV/AIDS and TB? People living with HIV are 30 times more likely to develop active TB, and TB is the leading killer of people with AIDS.

[Nick Herbert]

I strongly agree with the hon. Gentleman that the diseases must be treated together. However, great progress has been made on tackling AIDS, partly because of the tremendous new tools available. By comparison, less progress has been made on tuberculosis. Last year, 1.7 million people died of tuberculosis. That is more than AIDS and malaria combined. The single fact that most people do not realise is that tuberculosis is now the world’s deadliest infectious disease, and it deserves more attention than it gets. Some 10 million people globally are falling ill each year as a result of this disease.

TB was declared a global health emergency by the World Health Organisation 24 years ago. Since then, 54 million people have died. That is not a great advert for the declaration of a global health emergency. Three years ago in New York, the world’s leaders set the sustainable development goals. Target 3.3 was to eliminate these major epidemics in 15 years. At the current trajectory, TB will not be eliminated for 160 years, so another 28 million people will die in the sustainable development goal period alone, costing the world economy $1 trillion cumulatively. Middle and lower-income countries will be the most severely hit, with lower-income countries experiencing a reduction of something like 2% of their GDP.

On top of this, there are new threats. I mentioned that TB strikes when immune systems are compromised, and they can be compromised in new ways, including by the acquisition of diabetes. In Indonesia, TB is striking people with diabetes, which is a growing problem.

Above all—this should concern the House greatly—is the growing risk of drug resistance. TB is the only major drug resistant infection that is transmitted through the air. It is already responsible for one in three deaths worldwide from all forms of drug resistance. Drug resistance generally now kills 700,000 people a year, but Lord O’Neill’s commission, set up by David Cameron, predicted that drug resistance would kill 10 million people a year by 2050, and that those deaths would fall in the west and advanced economies, not just in poor and middle-income ones. That compares with, for instance, 8 million deaths a year from cancer. We are talking about catastrophic loss and catastrophic economic cost, with a cumulative GDP loss of $100 trillion, knocking 2% to 3.5% off global GDP. It is significant that a quarter of those deaths from antimicrobial resistance would be due to tuberculosis, which is already responsible for a third of antimicrobial resistance deaths; that is 200,000 deaths a year.

[Dr David Drew (Stroud) (Lab/Co-op)]

The right hon. Gentleman is making an excellent speech. Will he also accept the connection between TB and conflict? In the parts of the world where TB is rife—including South Sudan, which I know very well—conflict is adding to the complexity for people suffering from disease.

[Nick Herbert]

That is a very interesting point. TB is a disease of poverty. This opportunistic infection will strike if there are no basic health systems and if nutrition and housing are poor, and all those conditions would probably exist in areas of conflict.

Drug-resistant TB is a terrible affliction. It can be dealt with, but even in an advanced healthcare system, it requires a course of treatment in which some 14,000 pills have to be taken. This treatment is appalling, as it can cause patients to become deaf and creates a lot of suffering. Only half of drug-resistant TB patients are successfully treated. In fact, there is a lower survival rate for drug-resistant TB than for lung cancer.

[Jim Shannon (Strangford) (DUP)]

Just to step back, the right hon. Gentleman mentioned diabetes. In this country, we can change our lifestyles as we have access to lots of food and other things to reduce diabetes, but people in third-world countries where TB and diabetes are rampant do not have the same choice. Does the right hon. Gentleman agree that this complicates issues?

[Nick Herbert]

I do agree. There is a growing list of reasons why we should act, and that is one of them.

[Stephen Timms (East Ham) (Lab)]

The right hon. Gentleman is making a very powerful speech. He is right to draw attention to the scale of the problem in the developed world as well as the developing world. In my constituency, the incidence is now about the same as in Sudan, at just over 80 per 100,000. Does he agree that it is important that people realise that, notwithstanding drug resistance, this is a treatable and curable condition and that people need to get help when they are suffering from it?

[Nick Herbert]

Again, I do agree. The scale of TB in London makes it one of the TB capitals of Europe. We have some 5,000 cases of TB in the UK. That figure is coming down with the new public health strategy, but it is still too high. The right hon. Gentleman is right. This disease is easily and cheaply curable, and it has been since the discovery of antibiotics, so why are we not doing it?

[Dr Sarah Wollaston (Totnes) (Con)]

I thank my right hon. Friend for his very powerful speech. Further to his points about the importance of public health, would he urge the Government, in their future strategy, to make sure that we look at NHS public health and social care as part of a single system?

[Nick Herbert]

Yes. My hon. Friend is probably aware that there is a collaborative TB strategy that was introduced by the Government, urged by the all-party parliamentary group on global TB, which the hon. Member for Ealing, Southall and I co-chair. That strategy shows very promising signs. It represents exactly the kind of partnership that we need between Public Health England and NHS England. I commend the Government for having introduced that partnership.

Most people do not realise that there is no vaccine for tuberculosis. There is a child vaccine, BCG, that some of us had when we were young, but there is no adult vaccine that works for tuberculosis—and no epidemic in human history has been beaten without a vaccine. The reason there is no vaccine is that there is market failure. Unlike HIV/AIDS, this is primarily a disease of the poor. With HIV/AIDS, there were people dying in western countries as well. The pharmaceutical companies do not have a commercial incentive to invest in the new tools that we need—better drugs, better diagnostics and a vaccine. Without partnership funding that comes from the Government, and Governments around the world who can afford it, we will not develop these new tools and we will not beat TB in the requisite timeframe.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend for all the work he does on TB. As chair of the all-party parliamentary group on malaria and neglected tropical diseases, I would like to point out that there is a malaria vaccine, which is being deployed for the first time. We are not sure how effective it is. It is clearly quite effective, but a lot more work needs to be done on it. Companies such as GSK, which is behind this vaccine, are prepared to invest in these things even though they have no commercial return from them. Let us hope that a similar approach will be taken by commercial companies and Governments in respect of TB.

[Nick Herbert]

I agree that some companies are willing to take a non-commercial view, such as Johnson & Johnson and Osaka Pharmaceuticals, but many other major pharmaceutical companies are not developing new TB tools because there is no commercial incentive. Therefore, we do need that partnership funding to make this happen.

I would argue that there are three powerful reasons for us to act: a humanitarian reason because of the number of deaths, an economic reason because of the cost to the global economy of not doing so, and a global health security reason because of the risk of drug resistance.

[Dr Julian Lewis (New Forest East) (Con)]

May I make a practical suggestion? We sometimes hear that the overseas aid budget struggles to find the best possible causes in which to invest our 0.7% of GNI. Could the rules possibly allow for an investment from that funding in the sort of research that is necessary to find a cure for TB?

[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 ---

[Nick Herbert]

This has a been a good debate, with a large degree of consensus across the House and many well-informed contributions from right hon. and hon. Members on both sides, including the Front Benchers. I am grateful for that and for the help that hon. Members are giving to raise the profile of this disease.

I pay tribute to the work of the co-chair of the all-party group on global tuberculosis, the hon. Member for Ealing, Southall (Mr Sharma). He was expecting to speak, but was taken away from the House for something else. However, I am sure that he would have wanted to draw attention to the huge progress being made in India, where the Prime Minister, as I mentioned earlier, has shown real leadership by getting India to commit to eliminate TB on a tighter timescale than the one in the sustainable development goals. That has shown the kind of global leadership that will be necessary, and if we can encourage other global leaders to follow that lead, we will make huge progress. I congratulate the Government on what they have been doing. I accept the Minister’s description of all the things that DFID and other Departments are doing, and I note that the International Development and Health Secretaries have personally committed to the issue, for which I am grateful.

TB has been the orphan disease. Despite its terrible record of claiming lives, it does not have the celebrity champions or the pop stars of other diseases, and it does not get the same media attention. Although the disease claims more lives every year than any other infectious disease, I can guarantee that the media will pay no attention whatsoever to this debate. That needs to come to an end. Today, we in this House have at least played our part in raising the profile of the disease, helping to make TB truly a disease of the past.

Question put and agreed to.

Resolved,

That this House recognises that tuberculosis (TB) remains the world’s deadliest infectious disease, killing 1.7 million people a year; notes that at the current rate of progress, the world will not reach the Sustainable Development Goal target of ending TB by 2030 for another 160 years; believes that without a major change of pace 28 million people will die needlessly before 2030 at a global economic cost of £700 billion; welcomes the forthcoming UN high-level meeting on TB in New York on 26 September as an unprecedented opportunity to turn the tide against this terrible disease; further notes that the UN General Assembly Resolution encourages all member states to participate in the high-level meeting at the highest possible level, preferably at the level of heads of state and government; and calls on the Government to renew its efforts in the global fight against TB, boost research into new drugs, diagnostics and a vaccine, and for the Prime Minister to attend the UN high-level meeting.