Nick speaks in Commons debate on Ending Tuberculosis

On Thursday 7 June, Nick spoke in a Commons debate (which he secured) on ending tuberculosis (TB).  Nick's speech can be read in full below.

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 my hon. Friend the 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 as 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’ time. 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 he 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 isease 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 auses 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 pside, 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?

The Minister of State, Department for International Development (Harriett Baldwin)

It is a pleasure to serve under your chairmanship, Madam Deputy Speaker. I, too, thank my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) and the hon. Member for Ealing, Southall (Mr Sharma) for persuading the ackbench Business Committee to arrange this very important debate. I thank all Members in the Chamber for contributing to an absolutely excellent debate. They have really shown a commitment to keeping TB high on the agenda.

Most of the questions I have been asked will be covered in my speech but, in response to the specific points raised, I want to add my tribute to the work done on this agenda in Liverpool and in Oxford, which was highlighted by colleagues. I pay tribute to the work done by the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and others on the subject of road deaths, which has been covered elsewhere. I also pay tribute to the right hon. Member for Kingston and Surbiton (Sir Edward Davey) for bringing to the House’s attention the work of the find and treat teams. Such work is clearly outstanding, and those responsible for funding those teams will have heard that.

We heard excellent contributions from the hon. Member for Liverpool, Riverside (Mrs Ellman), my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan), the hon. Member for Liverpool, West Derby (Stephen Twigg), my hon. Friend the Member for Banbury (Victoria Prentis), the hon. Member for Poplar and Limehouse, the right hon. Member for Kingston and Surbiton, and the hon. Members for Ipswich (Sandy Martin), for Strangford (Jim Shannon) and for Linlithgow and East Falkirk (Martyn Day). That is testament to the importance of this subject.

I am pleased to say that the UK Government are truly a leading player in global healthy generally. Good health is clearly valuable not only in its own right, but in contributing to the prosperity and stability of developing countries, as well as to the health of people in the UK. As colleagues may know, the UK is in fact the largest funder of GAVI—the Global Alliance for Vaccines and Immunisation. In 2016 alone, that vaccines alliance immunised over 15 million children against vaccine-preventable diseases such as diphtheria and polio, and saved approximately 300,000 through its work that year. Through such programmes, I am proud to say that we have almost eradicated polio and guinea worm worldwide, while typhoid and diphtheria are being tackled and small pox has been eradicated.

However, as colleagues have stated, tuberculosis presents a vast challenge, with 10.4 million people falling ill with, and 1.7 million dying from, TB in 2016 alone. Although the TB death rate dropped by 37% between 2000 and 2016—that success should be applauded—TB is now the world’s leading infectious disease killer. That is why the Department for International Development will provide up to £1.1 billion for the 2017 to 2019 replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

As colleagues have noted, this year’s high-level meeting at the United Nations General Assembly presents an important opportunity for the world to accelerate global progress in tackling TB and drug resistance. The debate—and, indeed, the letter from 150 colleagues—has shown the importance that this House attaches to the Prime Minister’s attendance at the high-level meeting. The UK will work closely with other member states to negotiate the commitments to be made in the political declaration of the meeting. In fact, I can assure hon. Members that the entire diplomatic network will be engaged in ensuring that the declaration is ambitious, ncluding through G7 and G20 discussions. For example, we have already helped to secure specific references to TB in the most recent G20 Health Ministers’ and leaders’ declarations. I cannot personally commit the Prime Minister’s diary at this time, but No. 10 will have heard the voices of parliamentarians this afternoon. I assure Members that, whatever happens, there will be strong, high-level UK representation at the meeting.

Of course, that one meeting is only part of the story. The UK should be rightly proud of the action it has taken to fight TB at home and abroad. At home, there has been a remarkable 40% decline in new cases since 2011. In fact, TB cases in the UK are at their lowest level for 30 years. Most of the recent decline is down to the TB control measures that have been discussed today, and to screening in the 59 high-incidence clinical commissioning group areas. I pay tribute to the excellence of the cross-departmental and cross-country working that has been done as part of this initiative.

Abroad, DFID is a global leader on tackling the TB epidemic, and we do that in three ways. Mainly, we fund increased access to care through our contribution to the global fund. We are the second largest funder, with £162 million of this investment going to tackle TB. That will support the treatment of 800,000 people with TB and accelerate innovation to provide access to new drugs and diagnostic tests. Secondly, we tackle TB through programmes to strengthen health systems in a wide number of countries. We are working with national Governments, particularly in low-income countries, to help people to access high-quality healthcare for all priority health needs, including TB. The prevention, diagnosis, and treatment of TB are underpinned by people having access to good-quality health services. Given that TB is most widespread amongst the poorest, our wider work on reducing poverty and increasing access to services, including efforts to reduce the poverty and vulnerability of populations, also has an impact on this terrible disease.

Thirdly, we fund research into developing new products to combat TB. This is hugely important. We need better and cheaper diagnostics that are available on the spot, including diagnostics that detect drug resistance. Thanks to UK funding, a new test—the GeneXpert test mentioned by the hon. Member for Strangford—has been developed. It reduces the diagnosis time from many days to under four hours, and is now available in 140 countries worldwide. It is also used in the UK, so this is a real, practical example of UK aid funding something that is in our national interest.

Research is also needed to provide shorter drug treatments, which make it easier for people to complete treatment courses and to help themselves, and prevent drug resistance. We provide support to the TB Alliance for this. It has successfully developed paediatric TB drugs and is now working to develop new, faster-acting and more effective TB drugs, including drugs that can be taken by people with HIV. DFID is funding this drive for new drugs and diagnostics as part of the £1 billion Ross Fund portfolio.

Many colleagues have mentioned antimicrobial resistance. Tackling drug-resistant strains of TB, like other forms of antimicrobial resistance, presents a significant challenge to all our work on TB. The disease accounts for one third of all antimicrobial resistance-related deaths worldwide. We are therefore working to prevent, identify nd treat drug-resistant TB globally. UK support to Gavi for immunisation reduces infections and the need for treatment. The UK’s Fleming Fund is improving laboratory capacity for diagnosis and surveillance of AMR in low-income countries. Our support to the TB Alliance is helping to develop new regimens for treating drug-sensitive and drug-resistant strains of TB. We also fund Unitaid, which aims to triple access to RAID testing for drug-resistant TB, and to reduce prices for drugs to treat TB and drug-resistant TB. The UK Government recognise another challenge: many of those suffering from TB also have HIV; and, as several colleagues mentioned, being HIV positive increases vulnerability to TB. UK aid has helped the global fund to keep 11 million people alive with HIV therapy. DFID prioritises the integration of services to avoid siloed HIV and TB responses through our programmes.

I started with praise for the efforts of my right hon. Friend the Member for Arundel and South Downs in his work on TB globally, and I will end by recognising the significant UK contribution to that agenda. Our universities carry out basic science research, explore how to improve TB services, and work to develop new treatments and vaccines. The UK’s world-leading pharmaceutical companies also contribute by developing new TB treatments and vaccines. The UK is working hard with the global community to achieve progress on the agenda and a successful high-level meeting. We hope that our shared efforts will enable us to achieve the ambitious targets of the WHO’s “End TB Strategy” and the global goals. I thank all hon. Members for discussing this important issue today.

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 peak, 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.

To read the Hansard of the full debate, click here.