Global Fund: AIDS, Tuberculosis and Malaria
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Baroness Northover
My Lords, I thank my noble friend for securing this debate on the Global Fund to Fight AIDS, TB and Malaria. My noble friend’s record in this area is second to none, as the noble Lord, Lord Hunt, indicated, and he introduced this debate very powerfully. I, too, pay tribute to the Terrence Higgins Trust on this, the 30th anniversary of Terrence Higgins’ death.
As many noble Lords have said, the Global Fund has accomplished much, but there is still much to do. It was founded to increase funding on a massive scale to change the course of AIDS, TB and malaria, and in its first decade results have been dramatic. The fund has become the largest multilateral funder of programmes addressing the health-related MDGs. It has approved more than $23 billion for more than 150 countries.
The UK Government—this and the previous one—have been a major supporter of the fund. In 2007, they pledged up to £1 billion between 2008 and 2015. They have consistently brought forward and increased their commitments to live up to this pledge. Recently my right honourable friend the Secretary of State for International Development confirmed that the Government would commit £128 million this year, next year and the year after. That means that we will meet in full, and a year early, the 2007 pledge to make the UK the fourth largest donor to the fund.
More than 3.3 million people in the world's poorest countries are receiving life-saving and life-prolonging antiretroviral treatment through the fund. Ten years ago, there were almost none. The fund has helped to detect and treat more than 8.6 million new cases of infectious TB and has delivered 142 million malaria drug treatments and more than 230 million insecticide-treated bed nets, saving an estimated 6.5 million lives.
Prices for first-line HIV treatment have fallen dramatically, from approximately $10,000 per patient per year in 2000 to $125 in 2009. The fund has played a major role in shaping the market. New research suggests that treatment can also play an important role in prevention, and we have the opportunity to eliminate the transmission of HIV from mothers to children and to eliminate malaria in many endemic countries.
More than 33 million people live with HIV. There were 2.7 million new infections in 2012. Globally, the number of new infections is falling, but that hides regional disparities and, for every person put on treatment, two others become newly infected. According to the WHO, fewer than half of the 19 million people who need ARV treatment receive it.
Over the past few years, there has been significant progress in reducing deaths and illness due to TB, and 187 countries implement the WHO treatment guidelines. That has resulted in a decline of one third in deaths associated with TB since 1990. But the global burden remains significant and TB caused the deaths of 1.7 million people in 2009. There remain challenges: getting people to complete the long course of treatment; responding to drug resistance, as emphasised by the noble Baroness, Lady Masham; and HIV/TB co-infections. On drug-resistant TB, through DfID’s support, 13 low-income countries with a high burden of TB now have state-of-the-art testing laboratories to detect multidrug-resistant TB. We also know that the issue is increasingly important within the United Kingdom.
Malaria is preventable and treatable. Insecticide-treated bed nets, indoor residual spraying and new artemisinin combination therapies (ACT), together with better diagnostic technologies and new vaccines under trial potentially give us powerful tools to combat this disease. Improvements in child and maternal health have been achieved. But there are many hard-to-reach people in fragile and conflict-affected regions, and drug and insecticide resistance pose real challenges for the future. That is an area where DfID is investing. I assure the House that that is a significant investment. Those were issues raised by the noble Lords, Lord Rea and Lord Boateng.
The fund remains critical to the fight against the three diseases. The UK's Multilateral Aid Review, as noble Lords have said, assessed the fund as providing very good value for money, but identified the need for serious reforms. My noble friend Lord Fowler and others referred to some of the issues that have arisen in recent times. In September 2011, a high-level independent review panel recognised the achievements of the fund but identified significant areas for improvement and reform. It argued that the fund needed to transform from an emergency to a more sustainable response to the three diseases. There is cross-over between these three diseases and others such as the so-called neglected tropical diseases to which the noble Baroness, Lady Hayman, referred. We have seen a knock-on benefit from investment in the three diseases in bringing down other diseases as well.
The Government have strongly advocated reform of the fund: a DfID official, in his personal capacity, chairs the board, and the UK continues to take a close interest in the fund and to lobby others to achieve the necessary changes. In November last year, a new strategy for the fund was approved. This challenges the fund to invest more strategically, in the way that the noble Lord, Lord Parekh, referred, and to provide better support to improve implementation at country level, to promote and protect human rights, and to raise money.
At the same time, there was considerable uncertainty over the financial position of the fund, which noble Lords mentioned. The board decided that it could not move forward with round 11, but in response to concerns that people then flagged up—that people would suffer as a result—it agreed transitional funding. I am pleased to tell the noble Lord, Lord Fowler, that the fund board has decided to accelerate funding decisions to spring 2013 and it still plans to spend between $9 billion and $10 billion during 2012-2014. The board also decided to bring in new, interim leadership to transform the organisation, and we are pleased that significant and rapid progress has been made. I note with interest what the noble Lord, Lord Parekh, said about strategically sharing expertise. He is right to look at the fund’s activities in that strategic sense.
The fund also needs to think about where it works. Much remains to be done in low-income countries but there are particular challenges elsewhere. Nowhere is the spread of HIV/AIDS more rapid and aggressive than in eastern Europe and central Asia. As my noble friend Lord Fowler said, Ukraine has done almost nothing to address the challenges of HIV spreading among injecting drug users. Civil society organisations, often funded by the global fund, play a crucial role, as he emphasised.
In responding to a number of other points, I assure my noble friend Lord Fowler that the UK’s drug strategy 2010 acknowledges the value of needle and syringe programmes. I am very happy to emphasise that. The noble Lord, Lord Black, and other noble Lords are quite right about the importance of addressing stigma, an issue on which the noble Lord, Lord Fowler, has been at the forefront throughout his own work. The noble Lord, Lord Black, may wish to note the commitment to human rights in the fund’s strategy.
In response to the noble Earl, Lord Sandwich, the noble Lord, Lord Parekh, and other noble Lords, I say that 33% of the fund’s disbursements are to civil society. The noble Lords, Lord Rea, Lord Fowler, Lord Lexden, and Lord Sheikh, and other noble Lords, asked about the uplift in commitment. The Government are looking for clear evidence in key reforms so that they can make sound judgments in early 2013 on future funding increases in 2013 and 2014. I have given the commitments that are already in place, so I am talking here about that increase.
I thank noble Lords for their tributes to DfID for its support in this area but also for making sure that money will be well spent, as the noble Lord, Lord Hunt, and other noble Lords pointed out. The noble Lord, Lord May, focused on the absence of research into new drugs for neglected tropical diseases. It is certainly very important in the control of neglected topical diseases, and others, that research is carried out. I think he will be aware of the initiative that DfID announced, putting £21.4 million into that up to 2013.
In conclusion—I know noble Lords are desperate to get back to the Crime and Courts Bill—I emphasise that the Government will continue to support and monitor progress in the Global Fund. We have already confirmed that the UK will live up to its financial commitments. I confirm again that a significant uplift is also possible, subject to continued progress. We are optimistic in terms of the reforms that have been taken through. We recognise how the Global Fund, in 10 years, has transformed the prospects of millions around the world who were suffering from these three terrible diseases. However, we and the fund know how much more there is to achieve, which is why this debate is so timely.