World TB Day debate

Nick Herbert

I beg to move,

That this House has considered World TB Day and the efforts to end tuberculosis globally.

I am delighted to be able to introduce this debate. It was World TB Day on Sunday, but this is not an anniversary that we should be having to mark at all. It is wrong and extraordinary that we still have to debate the toll from death and suffering of a disease that has been curable for well over half a century, since the discovery of antibiotics by Fleming in 1928. It is unnecessary that so many people die from tuberculosis.

Imagine if the World Health Organisation announced tomorrow that a new disease had been discovered that was highly infectious, airborne and susceptible to drug-resistance, and that next year 10 million people would fall sick, of whom 1.6 million people would die. Imagine the global response to that news. That is in fact a description of the reality of tuberculosis. TB kills more people every year than HIV/AIDS and malaria combined —1.6 million people last year. Of course, there is overlap between HIV/AIDS and TB, because the AIDS epidemic in the 1980s drove the resurgence of tuberculosis. A disease that the world thought it had beaten has come back with a vengeance.

TB was first declared a global health emergency 25 years ago, in 1993. Since then, 50 million people have died. Just consider that. A disease is declared a global health emergency and subsequently 50 million people die, yet that disease is treatable and curable. That represents nothing less than a catastrophic failure on the part of the world’s Governments to deal with a disease that we should deal with more effectively.

Dr Dan Poulter

My right hon. Friend is making some good points and I congratulate him on securing the debate. He mentions the failure of world Governments. There is clearly a need for greater urgency in the approach taken by the international community in dealing with this issue, but what about the behaviour of pharmaceutical companies, which rarely invest in drugs that will help people in low and middle-income countries in the way that they would do in lucrative medications that they can sell in higher income countries, such as Great Britain?

Nick Herbert

My hon. Friend makes a good point, but I do not blame pharmaceutical companies, because I think this is a clear case of market failure. The fact is that the demand for better TB drugs, which we need, falls largely in low and middle-income countries, so there is no commercial case for sufficient investment in these new drugs. It can therefore proceed only on a public-private partnership basis. Some pharmaceutical companies have a pro bono programme for the drugs that do exist, such as Johnson & Johnson, where there is a drug to deal with drug-resistant TB. However, that is still insufficient.

This market failure is a striking contrast with what happened with AIDS. There was a serious response to the AIDS epidemic from pharmaceutical companies, not only from publicly funded programmes, but from commercially funded investment. As a consequence we have had extraordinary innovation, and new drugs that can prevent HIV and ensure that it is not a death sentence are available. What is the difference between the two? AIDS was a disease that was killing people in the west and TB is a disease that kills the poor. That is the fundamental difference. That is why we have not had the same level of investment in tuberculosis. Another fundamental difference is that TB was already curable with antibiotics. It is just that these antibiotics were not being delivered, TB patients were not being identified and we did not have the health systems to do it.

Dr Poulter

I am a little more sceptical about the operation of some pharmaceutical companies than my right hon. Friend. In fact, one reason that the global community was able to so effectively deal with HIV—he is right to identify TB as an age-defining disease—was that international Governments brought pressure to bear on pharmaceutical companies to drop the price of the medications, and push medications out in low and middle-income countries. That has not happened with TB. Unless there is a concerted effort from global Governments to encourage pharmaceutical companies to behave with greater global awareness and corporate responsibility, I am not sure we will see much change in the situation that he is describing, and change is badly needed.

Nick Herbert

This is an interesting debate, but I disagree with my hon. Friend. The drugs are not in the pipeline, because the return on investment for these companies is insufficient in the first place. I do not think that they are sitting on drugs that are available for wealthier people, which, if pressed, they could simply roll out to poorer people. There is an insufficient quantum of investment in research and development. I will come on to that point. I do not think that the need can be met by the private sector alone.

I believe that there are three key reasons why we need to take more action against this disease: humanitarian reasons, economic reasons and reasons of global public health. The humanitarian reason is that so many people are dying needlessly from this disease and falling sick. The figures speak for themselves.

The economic reason is that this awful loss of life and this illness are a drag on economic success in the poorest countries, hindering their development. There will also be a serious economic impact if we fail to tackle the disease. By 2030, it is estimated that if the current trajectory of TB continues that will cost the world’s economies $1 trillion. Some 60% of that cost will be concentrated in the G20, and it will be caused by the 28 million deaths over that period. That is a terrible statistic, because that is the period over which tuberculosis is meant to be beaten according to the sustainable development goals. The United Nations set those goals four years ago, and said that the major epidemics—AIDS, malaria and TB—would be beaten in 15 years’ time. We have just 11 years to go. On the current trajectory, TB will not be beaten for well over 100 years. There will be a further 28 million deaths during that period alone, as well as huge economic costs.

The global public health reason is the susceptibility of tuberculosis to drug resistance, because of the old-fashioned drugs that are used to treat tuberculosis. People who take the drugs do not continue with their treatment and it is a very serious fact that there are well over 500,000 cases of drug-resistant TB in the world. The highest burden is actually in the European region. Only one in four people who have drug-resistant TB can access treatment.

We know that there are 3.5 million missing cases of TB every year that are simply undiagnosed, accounting for one in three sufferers. The proportion is much higher for drug-resistant TB, where 71% of people are missing. This constitutes not only a humanitarian issue, but a serious risk to global public health, because this is an airborne, highly infectious disease.

Nic Dakin

The right hon. Gentleman is making a very powerful case. He has just said that because so many cases are undetected, the risk is compounded. That is an important issue, which needs tackling urgently.

Nick Herbert

I strongly agree with the hon. Gentleman. I commend the work he does on the all-party parliamentary group on global tuberculosis, which I have the honour to co-chair with my friend, the hon. Member for Ealing, Southall (Mr Sharma). The big problem is all of these undetected cases. We need to find and then treat millions more people.

There is hope. Last September, the UN convened the first high-level meeting on tuberculosis, which passed a strong declaration that recommitted the world to meeting the sustainable development goal target to beat the disease, and that specifically set a new target of diagnosing and treating 40 million cases of TB by 2022—a very tight timetable. It is vital that efforts are stepped up immediately so we can meet that new, ambitious target. It will require a significant increase in the level of spending on TB programmes globally from nearly $7 billion to $13 billion and on tuberculosis research and development from $700 million to $2 billion a year.

Two key issues arise from those ambitious new commitments, the first of which is accountability. How are we going to hold the world’s nations to account for their commitments at the high-level meeting? I mentioned that the world has already declared TB a global health emergency and has already set the sustainable development goals. The problem is that we keep talking about the disease but not delivering a sufficient global response to beat it, so accountability is crucial.

Among the problems with the otherwise good declaration passed at the UN is that independent accountability was struck out, but it is vital, because we have to hold countries’ feet to the fire for what they have committed to do. Accountability can take multiple forms: it can be done through bilateral relationships; intergovernmental platforms at the G20, the G7 and the Commonwealth; a further review of the UN high-level meeting and the commitments made; or international institutions such as the World Health Organisation. I must say, however, that if the WHO’s existing mechanisms had been effective, we would not be in this position.

My first point to the Minister, who I welcome to her place, is that the UK has a vital role to play in ensuring that there is more effective, sharper and independent accountability for the targets set at the high-level meeting. Without that accountability, I fear that we will not meet those new targets, and if we do not, we do not have a chance of beating the disease within the set timeframe.

The second issue is that we cannot escape the fact that we will need additional resource to meet the ambitions and that must come from the countries affected, particularly middle-income countries, which must find the resources to deal with it. We have seen a huge improvement in the response in India, for example. Resource must also come through multilateral institutions, particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria, through which comes 70% of all international funding for TB. The UK can be proud that it is the third-largest contributor.

This year marks the replenishment of the Global Fund. If we are to have a hope of meeting those TB targets, it is vital that it is replenished to a higher level than before. The investment case requires a pledge of $14 billion from the world’s countries, which will be combined with an increase of nearly 50% in domestic investment, so the money will also come from individual nations. That would suggest that the UK needs to commit £1.4 billion, which is an increase on the £1.2 billion it gave last time. That is the minimum that will be required to meet the Global Fund’s strategy targets and is proportionately the same as the UK previously gave, at about 13% of the budget.

I know other hon. Members want to speak, so I will make one final point. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is no longer here, said, new drugs will be essential. New drugs for tuberculosis have become available only relatively recently; there have been no new drugs for more than 40 years. Most people do not know that we do not have an effective adult vaccine for tuberculosis, and no epidemic in human history has ever been beaten without one. We have to be able to meet the new targets for an increase in research and development, which includes providing public funding.

Again, the UK has a vital role to play because of the strength of our pharmaceutical sector and what we already do on research and development. We need a specific plan to implement a research strategy; we need to establish a baseline for countries to ensure that they are funding their fair share of research and development; and we need to establish a mechanism to co-ordinate that spend. Otherwise, again, countries will talk about the research and development gap, but never do anything to close it.

We should not need to be here. This is not a disease that we should have to talk about any longer—frankly, it is a moral disgrace that we still are. It is a needless loss of life. Many problems confront modern Governments, some of which are nearly intractable. This is not one of them. This disease can be beaten. We have known how to do that for more than half a century and, with new tools, we could do it better. In the words of the Stop TB Partnership’s campaign for World TB Day last Sunday, “It’s time” to beat this disease.


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

It is a pleasure to serve under your chairmanship, Sir Christopher. [Interruption.] If only you could stop the noise outside, we would not be quite so distracted. I pay tribute to my right hon. Friend the Member for Arundel and South Downs (Nick Herbert), whose leadership on this issue is absolutely remarkable. Not only does he co-chair the all-party parliamentary group with the hon. Member for Scunthorpe (Nic Dakin), but he shows leadership globally, in the Global TB Caucus. His contribution to the recent Lancet Commission report on building a tuberculosis-free world was also incredibly valuable.

It is a real honour for me to respond to the debate. I wish to pay tribute on the record to my former ministerial colleague, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who would have responded to the debate. I assure colleagues that I will pick up where he left off in championing this cause.

We heard a really passionate case from my right hon. Friend the Member for Arundel and South Downs on why we need not only to mark World TB Day with debates such as today’s, but to keep sustained momentum behind the progress that the world has made. I am always a sunny optimist, and I like to see that progress. Some 53 million lives have been saved since 2000, and there has been a 37% reduction in mortality. We heard from the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about the progress in the UK and our 2015 strategy. Our wonderful NHS is making tremendous progress, and we are now at a 30-year low, but I acknowledge that there is still more to do, and we have heard powerful speeches arguing that. A range of points were raised, and I will try to address them all in the few moments that are left.

The importance of the work that was done with the declaration cannot be underestimated, because it is a forum where the whole world can come together and make commitments. The UK was proud to lead the work behind the declaration at the UN. The importance of the work on missing cases also cannot be overemphasised. Some of the Global Fund work has supported finding those missing cases. Each missing person can infect another 15 people through not being diagnosed or treated. So far, out of 1.5 million missing cases, 450,000 have been found.

I heard the call from my right hon. Friend the Member for Arundel and South Downs for strong accountability mechanisms. The UN is a very good forum for that. We want to ensure that money is spent on frontline treatment, and that any accountability mechanism adds value by working with the grain of what is already there, making best use of existing mechanisms, and is proportionate.

We should also note that there has been further progress since last year’s debate. We should put on the record the fact that the M72 vaccine seems to be showing promising early results. The UK spends a significant amount—I think it is £12.7 million every year—on research. It is important to co-ordinate research globally, and the World Health Organisation is the right organisation to do that. I assure colleagues that the UK will remain at the forefront as a leader, and that we will take part in the replenishment. I cannot, however, announce exactly how much it will be; obviously, we will wait until October to do that.

The hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) spoke powerfully about the side-effects and the treatment that he witnessed at first hand in Liberia, and we heard a range of other powerful speeches. I welcome the hon. Member for Nottingham North (Alex Norris) to the Front Bench; he did fantastically in his first outing in that role. I also recognise the call for leadership made by the hon. Member for Liverpool, West Derby (Stephen Twigg) and note the strong links between the work done in Eswatini and the work that the hon. Member for Strangford (Jim Shannon) sees in his constituency in Northern Ireland. I pay tribute to the Scottish research tradition, which goes back 100 years, and to the contribution that the Scottish Government make to this work.

I am not sure how much time I have to sum up, but the UK can be proud of being the third largest donor to the Global Fund, which managed to reach 5 million people in 2017 alone. I do not have the figures for 2018, but that is a significant impact. The Global Fund is also very important in terms of research, and of course where we have strong bilateral relationships—particularly in DFID countries—it combines with the work we do to strengthen health systems in those counties. The Global Fund also fits in with DFID’s wider work to reduce poverty and improve access to services in some very hard-to-reach places.

I am proud that the UK is the second largest donor to the current replenishment of the Global Fund. Colleagues have recognised the £1.2 billion that we have contributed since 2017, and we are the first and only country in the world to have enshrined in law our overseas development assistance contribution of 0.7% every year. We will announce our replenishment in October, but we will continue to support the fund in its remarkable and successful work of reducing the burden not only of TB, but—as hon. Members have noted—of HIV and malaria in the world’s poorest countries. The fund is central to efforts to tackle TB, but we need to link that to strengthening health systems in countries where DFID has a strong bilateral programme. We will certainly be playing our part.

We continue our strong tradition, which goes back more than a century, of being involved in research and development as one of the largest funders of tuberculosis research worldwide. Several colleagues spoke about research by drug companies. We are a leading supporter of product development partnerships, which are a mechanism to incentivise the pharmaceutical industry and academia to develop new therapies and diagnostics so that the intellectual property can be fairly distributed. As part of that effort, we are investing £37.5 million in the TB Alliance for the development of new drug regimens, particularly where current treatments are failing because of antimicrobial resistance—a point that was raised several times in this debate.

The challenges that the world still needs to overcome include antimicrobial resistance, ensuring that the most vulnerable and disadvantaged can benefit from care, and the complexities of patients who have both HIV and TB. We have heard the shocking statistic that antimicrobial resistance is now responsible for more than 700,000 deaths a year, of which drug-resistant TB accounts for a third. In response to that challenge, we are leading the work to bring new effective antibiotics to market, funding the development of new treatment combinations for resistant TB, and investing in new ways to rapidly test for drug resistance; it was interesting to hear the anecdote told by the hon. Member for Brighton, Kemptown about the cost of the GeneXpert machine, which is clearly something that we all need to think about. Since 2002, the Global Fund has provided financial support to implement multi-drug-resistant TB diagnosis and treatment in 25 of the 27 most affected countries.

One of the most challenging aspects of TB is the difficulty of finding some of the people affected. If we are to meet our sustainable development goals, we will need to sustain our efforts to find the missing 1.5 million. The likelihood of progression to active TB infection can be reduced if TB is detected and treated early in people who are HIV-positive, so we are actively working on programmes to identify such cases and respond appropriately.

There are clearly a range of challenges, and sustained action will be needed. I welcome the support that colleagues have shown for the international policy dimension, the leadership on research, and the strong bilateral partnerships on health, particularly in DFID’s focus countries. It is clear that progress has been made, but that it needs to be stepped up. We have heard the request for the replenishment of the Global Fund and will closely analyse what the UK can do and what other donor countries will be doing.

This debate has been extremely important in highlighting the issue, and I pay tribute again to the all-party group and its chairs for their leadership. I assure my right hon. Friend the Member for Arundel and South Downs that the UK Government will continue, both at the UN and with our allies in DFID’s priority countries and around the world, to step up our impact and resolve the many issues raised today.

Sir Christopher Chope (in the Chair)

Nick Herbert has a minute and a half to sum up, if he wishes.

Nick Herbert

I am grateful for the Minister’s response, which reiterated the UK Government’s commitment. I thank all hon. Members for their contributions today and for their commitment to beating this terrible disease. I reiterate that the UK has a leadership position, and this year we can show it by replenishing the Global Fund, pressing for independent accountability and trying to achieve better co-ordination for research and development. Yes, we have made progress, but there is more to do. The UK needs to continue to show the necessary leadership to beat this terrible disease.

To read the full debate please see the Hansard report available here.