Global Fund to Fight AIDS, TB and Malaria

Debate between Nick Hurd and Kate Osamor

Tuesday 12th January 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for International Development (Mr Nick Hurd)]

It is a pleasure to serve under your chairmanship for the first time, Ms Dorries. I congratulate you on getting everyone in to speak. I also congratulate all three chairs of the relevant all-party groups, especially my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) who gave a powerful opening speech, on working together to secure this debate. My hon. Friend the Member for Mid Derbyshire (Pauline Latham) was cut off mid-speech because three and a half minutes was not enough for her to articulate the power of what she saw in northern Uganda. She has my commitment to sit down with her and reassure her that the Department and the Global Fund to Fight AIDS, Tuberculosis and Malaria are on that situation.

I thank my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) for raising El Niño. As the topic is not central to this debate, I will write to him, but he is quite right to raise it, because in Ethiopia, for example, we are seeing drought conditions that are comparable with 1984. What has changed is the capacity of the domestic Government to manage the situation on behalf of their own people, which has been supported to some degree by our development work over many years.

I am glad that it became clear towards the end of the debate that I was not the only person who had not been to Zambia recently, but it was powerful to hear accounts of how the Global Fund has worked on the ground. I am extremely grateful that this debate is happening now. I am also pleased that so many Members, from both sides of the House and representing all parts of the country, have decided that this is where they want to be this morning, to hold the Government to account and to press ministerial feet to the fire on the future of the Global Fund. I am grateful for that, as it makes my job that bit easier knowing that there is that level of scrutiny and interest inside Parliament.

The debate is extremely timely for several reasons. As many colleagues know, this is an important time because some key decisions, which flow from the spending review, are being taken inside the Department relating to our review of bilateral and multilateral aid programmes, of which the Global Fund is obviously a central piece. As many have said, however, the Global Fund is on the brink of a fifth replenishment, and active discussions between donors and Governments are ongoing. It is therefore an important time to take stock of the progress made through our investments and to think about how we can match resources to need in an even more intelligent way.

What strikes me and what has come through in many of the speeches, and which I had not fully appreciated before taking on this brief, is just what incredible progress our species has made in the face of these dreadful diseases over a relatively short time. We have seen radically improved access to treatment, significantly reducing the number of people dying from HIV, which fell by over a third between 2005 and 2013. There have been dramatic increases in the diagnosis of TB in high-burden countries, saving some 37 million lives since 2000. As my hon. Friend the Member for Stafford (Jeremy Lefroy) brought home so powerfully, global death rates from malaria have almost halved since 2000, saving over 4.3 million lives. As my right hon. Friend the Member for Arundel and South Downs outlined, the Global Fund is a critical part of that success, saving the lives of at least 17 million people who would have died needlessly.

There is no doubt in my mind that the Global Fund is a success. It works. It has made a crucial contribution to the fight against all three diseases. It has been reformed over time and those reforms have strengthened its efficiency and effectiveness. It scores very highly in most independent assessments of transparency, accountability and, critically for us, value for money. It plays an important role in the crucial work of strengthening domestic health systems, although that is challenging to measure. As was shown, the fund has also been an extremely effective catalyst for unlocking domestic resources and really important partnerships that are really the only way forward in bearing down on these diseases and bending the curve, as my hon. Friend the Member for Finchley and Golders Green (Mike Freer) put it so well.

But—it is a big “but”—however amazed and satisfied we can be with the progress so far, we are not where we need to be. I find it chilling that 90 children will have died of malaria and 45 adolescent girls will have been infected with HIV during the course of this 90-minute debate, and that 4,000 people will have died of TB over the course of today. I am sure that everyone here will agree that that is absolutely unacceptable on humanitarian grounds and is undermining everything that we are doing to try to lift people out of poverty and to put economies on a more prosperous path. As was powerfully put by various Members, it also carries a risk to our stability and security, so there are absolutely no grounds for complacency or any suggestion that we should lessen our intensity in this fight.

Malaria is a preventable and treatable disease yet it continues to kill almost half a million people a year, the vast majority of whom are children and pregnant women in Africa. Progress is threatened by drug-resistant malaria and by mosquitoes adapting to the insecticides that we use to treat bed nets. As we have heard, TB is now the leading cause of death, with an estimated 1.5 million people dying and 9.6 million falling ill with TB in 2014. At least one in 10 of those people were also HIV-positive. There is no doubt that drug-resistant TB threatens global health security with only around a quarter of those with the disease diagnosed and treated, meaning that tackling it is both the right thing to do and firmly in our national interest.

HIV continues to be one of the leading causes of death and disability globally, disproportionately affecting the poorest and the most marginalised. Some 22 million people living with HIV still do not have access to treatment. It remains the leading cause of death in women of reproductive age globally and in adolescence in Africa. In 2013, an adolescent girl was infected with HIV every two minutes. In sub-Saharan Africa, she is twice as likely to get HIV as her male peers. Although incredible progress is being made, there is no doubt that this is absolutely not the time to ease up. The Global Fund is central to the global effort to bear down on the diseases. I hope that I have reassured Members that the matter and our evaluation of how effective it is are important to this Government. However, it is our responsibility—I was interested in the various comments about this—to ensure that the fund works even more efficiently and effectively in its next phase, and that the lessons of the last phase are absorbed and understood. I was particularly interested in the points made by my hon. Friend the Member for Stafford and I will be discussing them further with the head of the Global Fund when I meet him shortly.

The central challenge for all of us who are accountable for the money and who care passionately about this agenda is to ensure that resources are directed where they are most needed. There are priorities to set and difficult decisions to take in that context, but we must certainly give priority to countries with the highest burden or risk of disease and the lowest ability to pay for tackling the epidemics on their own. The point was powerfully made by my hon. Friend the Member for Finchley and Golders Green and the hon. Members for Scunthorpe (Nic Dakin) and for Central Ayrshire (Dr Whitford) about the need to ensure that any transitions—in particular for middle-income countries—or movement of resources are managed extremely responsibly. My hon. Friend has my reassurance that that is very much top of mind in our discussions with donors and other countries.

As my right hon. Friend the Prime Minister remarked at the launch of the global goals in September 2015, we

“commit to putting the last first”,

and to end extreme poverty

“we need to put the poorest, the weakest and the most marginalised first to Leave No One Behind”.

Those words are important to the Department.

How may we ensure that the Global Fund delivers? For HIV it needs to work with young women in Africa, who on average catch HIV between five and seven years earlier than their male peers. For malaria it means ensuring that the children and pregnant women who account for 80% of all malaria deaths have access to bed nets and quick diagnosis and treatment. For TB it means working with people with HIV and harder-to-reach groups, such as migrants and miners, to test and treat them. The Global Fund must use the right interventions, evidence-based tools that we know work, and diagnostics, treatments and tools for prevention.

My hon. Friend the Member for Finchley and Golders Green asked about the need for the UK to finance the most vulnerable in middle-income countries, but the numbers need to be treated with caution. The middle-income country category is very broad, ranging from countries that have just crossed the threshold, such as Zambia, where the GDP per capita is less than $2,000, to countries such as Malaysia, where the GDP per capita is more than $11,000, which primarily self-finance their own disease responses. We therefore need to match the solution to the problem. The vast majority of people living with the three diseases are in the first category of middle-income countries—countries that do not yet have the ability to pay for the response to their disease epidemics—and in that context external resources are still needed, so we encourage continued investment by the Global Fund.

In other middle-income countries the issue is willingness to pay, in particular for the marginalised and hard-to-reach groups of people. There the different parts of the health architecture must work together to encourage and enable Governments to step up and take responsibility for the rights of their citizens, which means ensuring that the World Bank works with Governments to build systems that allow them to plan and independently finance their disease responses according to need. It also means encouraging the World Health Organisation to provide technical assistance to help countries develop the most cost-effective way of delivering services as part of a broader health system. It means holding Governments to account to deliver for their most marginalised, not least by working with civil society and partners such as UNAIDS. My key point is that I absolutely understand what my hon. Friend and other colleagues were saying about the need to manage transition responsibly. I hope I have given him some reassurance that we are aware of that and take it seriously.

On intellectual property, my hon. Friend rightly pointed out that the costs of treatment are an important factor in determining a country’s ability to pay for it. The Global Fund supports countries to obtain quality-assured products at the lowest cost. I am pleased to say that in 2014 and 2015 IP restriction was only an issue for 0.5% of the total value of antiretroviral orders made by the Global Fund. We recognise, however, that intellectual property is a very important issue in some cases, which is why the UK also funds the medicines patent pool, which works to address IP blockages related to HIV, and why we are starting to explore TB and support the WHO, the United Nations Development Programme and UNAIDS in working with countries to support them to address their intellectual property issues.

A number of colleagues raised the issue of the UK’s cap in the most recent replenishment. It is important to note that the cap was intended not only to incentivise others, but to ensure that everyone plays an appropriate part in addressing global challenges. To be frank, it is difficult to assess the impact of the cap on other donors; some said—one in particular—that the cap was a factor for them, but we will have to review that in terms of our tactics in relation to the forthcoming replenishment.

I am very proud and many colleagues in the House are extremely proud of the leadership that this country has shown under successive Governments to move the development agenda, to shift gears of ambition, to meet international commitments and to encourage others to step up and meet their responsibilities. We helped to shape the latest round of sustainable development goals. We have been extremely ambitious in the commitments we have made through the new official development assistance strategy, through our manifesto commitments, and on the role that this country intends to play in supporting that ambition with action that will make a difference on the ground. The Global Fund is a key element in the delivery of that strategy.

Colleagues know that because discussions are ongoing, I am absolutely not in a position to front-run any decisions or to make any commitments. That would be something with career implications that I am not prepared to contemplate—

[Kate Osamor]

Be brave!

[Mr Hurd]

I will resist the call to be brave. I hope, however, that I have reassured Members that successful replenishment of the Global Fund, which is about not only the UK’s commitment, but the role we play in encouraging others to step up, is personally important to me and extremely important to the Government. I am grateful to all Members who were present today for putting a spotlight on the Global Fund and on the need for Britain to stay up and to maintain its position of leadership in the world.