Global fund to fight AIDS, TB and malaria
I beg to move,
That this House has considered the Global fund to fight AIDS, TB and malaria.
The debate was chosen by the Backbench Business Committee after a submission by the chairs of three all-party parliamentary groups. I have the privilege to co-chair the APPG on tuberculosis; and my hon. Friend the Member for Finchley and Golders Green (Mike Freer), who chairs the APPG on HIV and AIDS, and my hon. Friend the Member for Stafford (Jeremy Lefroy), who chairs the APPG on malaria and neglected tropical diseases, are here today because we are concerned to ensure the continuing fight against three diseases that between them have accounted for, and continue to account for, millions of deaths every single year.
I would like to start by talking about the continuing need to fight these diseases, focusing particularly on tuberculosis, because that is the disease in which I have a particular interest. It continues to kill 1.5 million people every year in spite of the fact that the millennium development goal to halt and reverse the spread of the disease, as well as of HIV and malaria, by 2015, was met, with the prevalence of tuberculosis having halved.
Tuberculosis continues to kill a very large number of people every year. Indeed, the latest figures published by the World Health Organisation indicate that it is now the world’s deadliest disease, surpassing the mortality caused by HIV, although there is a significant issue of co-infection in relation to HIV/AIDS. Some 400,000 people a year die of tuberculosis related to AIDS. Despite the huge progress that has been made on AIDS—progress, however, that did not meet the millennium development goal—the disease continues to kill 1.2 million people a year, and despite the great progress on malaria, it continues to kill 600,000 people a year.
The first point to make is that despite the global effort to counter these dreadful diseases, they remain very significant killers, and continuing action will be needed if they are to be eliminated. It was a fine thing that the world came together in September to agree the new sustainable development goals to replace the millennium development goals, and that objective 3.3 of those goals is to end the three diseases by 2030—just 15 years’ time. However, the current trajectory of tuberculosis suggests that we will not end the disease in 15 years’ time. We will end it in 200 years’ time, which means that there will continue to be a large number of deaths every year, and indeed an ongoing cost, unless we take firmer action now to beat the disease.
The second reason why it is important to tackle the diseases in question, quite apart from the humanitarian cost, the loss of life and the suffering caused, is that their prevalence has an impact on economic growth. If we want to see the economic development of countries—the continuing development of middle-income countries and the acceleration of development in lower-income countries—it is essential to ensure that there is a healthy population, and it is a condition of economic growth that the population can work and has access to healthcare. These diseases place a burden on the population that impedes economic growth. The circle that needs to be squared is how we support countries in the development of their health systems to produce a healthy population that, in turn, helps to generate economic growth.
The third reason why it is important to tackle these diseases is on the grounds of what one might describe as broader security. For instance, we see the growing risk of drug resistance in the case of tuberculosis, which is a transmissible disease that is easily carried and spread—a disease that knows no borders. The growing risk of drug resistance is linked to the old-fashioned regimes used to treat tuberculosis and to the fact that there has not been a sufficient focus on drug development since the disease resurged. That poses a risk not just to the countries involved but to countries around the world.
The UK Government have taken particular interest in drug resistance. The Prime Minister has led a focus on it through the antimicrobial resistance review, which is chaired by Lord O’Neill. The threat of drug resistance poses a huge risk to the global economy, amounting to billions of pounds of potential cost. By 2050, about a quarter of that cost might be incurred due to drug-resistant tuberculosis if we do not take action.
On all three grounds—humanitarian, economic growth and security—there is an argument for continuing action to tackle these terrible diseases. The question, then, is what the right mechanism to do so is. More than a decade ago, the world came together in the belief that it was important to set up a new means of fighting them. What was then described as a “massive effort” was launched under the auspices of the United Nations, and it became the Global Fund to Fight AIDS, Tuberculosis and Malaria.
In the 10 years that followed the launch of the Global Fund in 2002, the world’s economies have committed more than $22 billion to the fund. In turn, it has developed 1,000 programmes in more than 150 countries to tackle these diseases. The Global Fund now estimates that since its inception, it has saved 17 million lives and is on course to have saved some 22 million lives by the end of the year. That is more than 2 million lives saved annually as a consequence of the effort that was put in place in 2002 under the Global Fund. It has put more 8 million people on antiretroviral treatment for HIV and treated more than 13 million people for tuberculosis and more than half a billion people for malaria—a quite staggering effort. As a consequence, it has contributed to a decline of a third in the deaths from these three diseases in the countries where it operates.
The importance of the fund to beating these diseases is illustrated particularly in the case of tuberculosis. The Global Fund provides three quarters of the funds that are committed to beating TB globally. In the absence of the Global Fund and its continuing ability to raise resources to beat TB, how would we continue to ensure that resources were deployed to beat this terrible disease, particularly given the ambition in the sustainable development goals to eliminate it in just 15 years?
The first reason why the Global Fund is the right mechanism to continue to tackle the diseases is that it is an established organisation that has experience in marshalling the resources that are needed. The second is that it encapsulates the important principle of partnership between donor countries—western countries with sufficient resources to contribute to the fight against these diseases—the Governments of the countries affected and civil society and the private sector.
The principle upon which the Global Fund was established is that it does not implement programmes to beat these diseases itself. It provides funding for those programmes and presides over them, but the ownership of the programmes is vested in the countries affected. The fund helps to mobilise and unlock domestic resources in the high-burden countries themselves. The principle of partnership between donor countries and the affected countries, and partnership among those who have a role to play in beating these diseases, is incredibly important and underpins the whole of the Global Fund’s work.
The third reason why the Global Fund is the right mechanism to continue this work is its accountability. It is clearly immensely important to the public’s view of international development money that it is spent properly, with accountability and transparency so that we know that resources are deployed properly. It has been a key principle of the Global Fund since its inception that there should be proper accountability in what was described at the beginning as a programme of “tough love” to ensure that the affected countries themselves are contributing to beating these diseases.
Fraud has surfaced over the life of the Global Fund, and I think it is true to say that the fund revealed most of those instances itself. They are part of the problem that any international aid agency has when it operates in countries where fraud can be a problem. The fund’s accountability mechanisms, which have been strengthened, are part of how we will address such issues. Some of the ongoing media criticism of the Global Fund has been misplaced. There is a misunderstanding of the fund’s success in ensuring that resources are implemented properly.
What are the issues for the Global Fund going forward? The fund is an immensely important mechanism in the fight against these diseases, but it has always been beset by external challenges. The terrible tragedy of 9/11 diverted the world’s attention from the need to maintain support for the Global Fund, and then the world financial crisis severely affected the willingness of donor countries to contribute. Some of the most important contributors to the Global Fund—relatively wealthy western countries—have faced a challenge to their own finances and have scaled back their commitment to the fund. That is a serious mistake for the west to make, despite the great challenges that every country faces because of the downturn. It remains important to continue to invest in beating these diseases, for the reasons that I have set out.
We now enter the replenishment phase that the Global Fund goes through every three years. It estimates that the combined external funding required to beat the three diseases, in line with the sustainable development goals, will be a staggering $97 billion over the next three years, 2017 to 2019. Those resources will be provided by the affected countries themselves and the countries that will be contributing to the fund. That requires the Global Fund to raise some $13 billion over the period, which is slightly less than the $15 billion that it was proposed the fund would raise in the last replenishment period, but it should be noted that the fund did not raise sufficient resources to meet that target. It that that additional resourcing over the three-year period will save another 8 million lives, avert up to 300 million new infections and, crucially, support $41 billion of domestic investment, which represents an increased growth rate. It will generate economic growth of some $290 billion, which underlines my point that such investment in beating these diseases ultimately does not impose a cost on the economies that are required to find the money; it actually helps to generate economic growth.
The UK has a proud record of supporting the Global Fund. In particular, the UK contributed up to £1 billion over the last three-year replenishment period, which made it the third largest contributor among donor countries. That was made possible by the Government’s commitment to meeting the international target of spending 0.7% of gross national income on international development, at a time when other countries have scaled back their spending. However, it would be helpful if the Minister responded to some points about how the Government made their commitment.
First, some conditionality was placed on the investment, so that only if other countries raised a certain amount of money would the full UK commitment be met. There is a question about whether that really produces an incentive for countries to fulfil their contribution or whether the real effect is simply to reduce the UK’s intended commitment. I hope the Government will consider that closely when they review their commitment for the next cycle. For all the reasons that I have set out, I hope the Government will now consider making a similarly significant investment in the Global Fund going forward. We are talking about substantial sums, and they should not be committed lightly. The Government need to assure themselves that the money is being spent properly, and it is encouraging that the Department for International Development’s 2011 multilateral aid review, and its 2013 update, assessed the Global Fund as providing very good value for money. Other studies have underlined the effectiveness of how the Global Fund spends its resources.
If the world community’s support for the Global Fund were scaled back, it would raise serious questions about whether we mean what we say when we sign up to international agreements to beat diseases such as HIV/AIDS and malaria. There is no point in the world coming together and setting an ambitious target to eliminate such diseases in 15 years if those targets are not only not met but not met by a country mile. That would undermine the whole process of international agreement that brings countries together to say, “We will work together to tackle these diseases.” It would place the sustainable development goals in a different position from the millennium development goals, which, at least in part, were met in relation to the diseases in question. There would be an ongoing humanitarian cost, as lives would be lost. There would be a continuing risk of the development of drug resistance, which would not be addressed properly. In relation to diseases such as TB, it would raise the question, “If the Global Fund, the principal agent by which this disease will be tackled, does not have the resources to do so, where are those resources going to come from?”
The UK Government are doing a great deal to fight these diseases in addition to their Global Fund commitment, and I was delighted by the Chancellor’s announcement in the autumn statement of the Ross fund, which, in partnership with the Bill & Melinda Gates Foundation, will ensure that £1 billion is invested over a three-year period in a new fund to develop the new drugs and vaccines that will be needed to address the world’s deadliest diseases, including malaria and tuberculosis. That is exactly the kind of focus that we need on new tools to beat those diseases. Only if such new tools are developed will the diseases be tackled properly, particularly tuberculosis, so that is immensely welcome.
However, I want the Government to appreciate that unless they and their fellow major donors continue to contribute to the fund, the progress that we have made in beating diseases such as tuberculosis, which has already been too slow, will fall further behind target. That would be a serious matter, which is why this debate is so important, coming at the point when the new round of replenishment is being considered. It is why voices are needed to discuss the value of Britain’s international aid contribution and the importance of investing in the global fund. Of course there are issues to discuss about the fund’s effectiveness and operation, and other Members might do so, but the overall picture is that it has made a vital contribution to saving millions of lives. If we want to continue to do so and to beat these diseases once and for all, it is essential that Britain maintains its contribution to the Global Fund.
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 outlined by my right hon. Friend the Member for Arundel and South Downs, the Global Fund is a critical part of that success, saving the lives of at least 17 million people who would have needlessly died.
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, 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—
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.
May I make two apologies? First, I apologise to my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and indeed all hon. Members for foreshortening their time: my maths was insufficient and I had not realised the number of people who wished to take part in the debate, so I spoke for too long. That follows on from moving amendments on planning matters at 2 am last week, which added immensely to my popularity with colleagues. Those of us who wear Apple watches know that it is possible to receive electronic reminders when one should be taking more exercise. Perhaps a reminder to shut up when one is speaking for too long would be a useful additional app for someone to develop.
Secondly, I apologise to the Minister, because I should have welcomed him to his new position. The way in which he responded to the debate confirms the impression that many of us had that it is an ill wind that blows no one any good, and that his appointment and return to Government were immensely welcome, in particular to the Department for International Development. He has a genuine interest in international development matters and speaks with some passion about them. What the Minister said about the importance of the Global Fund and the replenishment to the Government and to him personally was encouraging.
It is important to debate issues such as this one today and we had welcome contributions from Members of many parties, in particular on the need to focus on the effectiveness of the Global Fund and the points made by my hon. Friend the Member for Stafford (Jeremy Lefroy). I hope that those points will be taken on board by the excellent director of the Global Fund, Mark Dybul, who has made great efforts to improve its effectiveness. We look forward to further discussion with him as well as with the Government.
A real issue is that of middle-income countries, which affects the Government’s international development agenda more broadly—when countries reach a certain income threshold, what is the right role for wealthier countries? We cannot simply step away. Much of the burden of those diseases falls on the middle-income countries and there is a real question about whether they would devote sufficient resources to tackling the diseases. If international bodies such as the Global Fund concentrate on other, lower-income countries, there is an imbalance in the resourcing and the focus is wrong. That is an important debate, which we will need to have.
This has been an excellent debate. I am delighted to tell the Minister that I, too, have been to Zambia, although I am sorry to say that I was not on the trip with my hon. Friends the Members for Plymouth, Sutton and Devonport (Oliver Colvile) and for Pudsey (Stuart Andrew) and the hon. Member for Edmonton (Kate Osamor). I look forward to an opportunity to follow their example in future.