Drug-resistant Tuberculosis (Developing Countries)

Debate between Tony Cunningham and Jim Fitzpatrick

Tuesday 4th June 2013 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you presiding in the Chair, Mr Caton. I will try to get through my remarks as quickly as possible, as a couple of other hon. Members would like to make a contribution and the Minister, whom it is good to see in her place, has very kindly indicated that she would be happy to hear them.

After making a few brief comments on tuberculosis and drug-resistant TB globally and in the UK, I will raise three important points that I hope the Minister will be able to address: support for the Global Fund to Fight AIDS, Tuberculosis and Malaria; investing in innovation; and the need for a national strategy in the UK to include an international target. However, before raising those issues, I would like to make a few observations.

The Minister recently met the all-party group on global tuberculosis to discuss its report, “Drug-Resistant Tuberculosis: Old Disease—New Threat”. Much of what I will speak about today is focused on the conclusion and recommendations of that report, which makes constructive recommendations that are evidence-based. I thank Mr Simon Logan, co-ordinator for the all-party group, for his assistance in preparing my remarks for today’s debate.

Tuberculosis in the UK reflects the global reality. TB is one of the world’s most common deadly infectious diseases. In the 1970s, my wife was a junior hospital doctor. Her consultant told her that by the time she became a consultant, TB would have disappeared, like polio, due to BCG, mass X-ray and drug treatment. How wrong can you be?

One third of the world’s population has latent TB, but only a small percentage goes on to develop the active form of the disease, which makes them sick and can kill if not treated. Unfortunately, little progress has been made towards eliminating TB in the UK—there are about 9,000 new cases each year—and global progress is painfully slow. The disease remains an urgent public health problem around the world, and we now face a new threat—drug-resistant strains that are significantly more expensive and difficult to treat. It should be said that both are curable, albeit with a long course of antibiotics. TB does not get the profile that the death and destruction it causes warrant. This is a serious issue, and we must do more to tackle it. It is not only a moral obligation; it is in our national interest.

The first line of defence against drug resistance is appropriate management of TB and the strengthening of the World Health Organisation’s standard treatment, called directly observed therapy, to prevent resistant strains from developing. However, we also need to take steps to tackle this threat head-on, as it is often airborne and can be passed from person to person in the same way as normal TB.

Rates of drug-resistant TB appear small in terms of the global burden of the disease, accounting for 440,000 of the almost 9 million new cases each year, but only about 10% have access to diagnosis, and the financial and treatment burden is substantial. The number of people affected is increasing and so is the cost. Patients have to take 15 to 20 tablets a day for up to two years to be cured of this more extreme form of the disease and they often experience horrible physical and psychological side effects as a result. It is also on the rise in the WHO European region, particularly in eastern Europe. Almost 80,000 cases occurred in the European region in 2011, accounting for nearly one quarter of all DR-TB cases worldwide.

The UK is not immune to this problem. London has the highest TB rate of any capital city in western Europe, and resistant strains of the disease have gradually but significantly increased since 2000. In my constituency, there are 61 cases of TB per 100,000 people. That is in Tower Hamlets. Neighbouring Newham, which I used to represent before the boundary changes in 2010, has double that amount, giving it the highest rate of TB in the UK. It is comparable to that in some high-TB-burden developing countries. To put that into context, the UK average is 14 cases per 100,000 people.

The threat that this public health concern presents to the UK recently led the chief medical officer for England, Dame Sally Davies, to warn that antimicrobial and infectious disease resistance poses a serious threat. One of her key recommendations was for the Government to campaign for it to be given a higher profile and priority internationally. In that regard, financing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria plays a crucial role in funding programmes for diagnosing and treating TB in low and middle-income countries. The global fund accounts for almost 90% of international TB funding. For many countries, there would not be a response to TB without the global fund’s support.

[Sir Tony Cunningham (Workington) (Lab)]

The hon. Member for South Derbyshire (Heather Wheeler) and I were on a visit to Ethiopia and visited St Peter’s hospital there. I asked what percentage of the funding for the drugs came from the global fund, and it is 100%—without it, people would die.

[Jim Fitzpatrick]

My hon. Friend reinforces the point that I have just made about how important the global fund is. As I am sure the Minister is aware, the global fund is asking donor Governments, such as the UK Government, for new funding in this replenishment year, and the UK Government have a crucial role to play in ensuring that that process is successful.

In the history of the fight against TB, there have been periods of urgency and periods of innovation, but only rarely have urgency and innovation come together. The rise of this new extreme form of the disease has given a new sense of urgency to global TB efforts, and after a decade of focused investment in TB innovation, we have a promising pipeline of new drugs, diagnostics and vaccines.

It is clear that to address rising rates of drug resistance, action is needed at national and international levels. The all-party group recently published its report, which was the culmination of more than six months’ work consulting world-leading experts on steps that the Government could take to help to address the increasing threat of drug-resistant TB. I shall highlight three key recommendations from the report, and I would be grateful if the Minister focused on those in her response.