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Lord Fowler
To ask Her Majesty’s Government what action they are taking to support the global fund on HIV and AIDS, tuberculosis and malaria.
Lord Fowler
My Lords, this short debate is about the importance of the global fund. I saw the global fund at its beginning, when Richard Feachem was the director. Over the past decade it has developed into one of the chief means of combating HIV/AIDS, tuberculosis and malaria around the world. It has helped in the dramatic progress that has been made, particularly in the past five years, and that progress has been truly dramatic. In HIV, the number of people on anti-retroviral treatment worldwide has increased from 1.4 million in 2007 to 4.2 million today. In 2007, there were almost 3 million TB cases detected and treated; today the total is 9.7 million. In 2012, a cumulative 310 million nets were distributed, compared with only 46 million five years ago.
The result is that, with all three diseases, a record number of people are now receiving treatment. To give the example of HIV/AIDS, which I know best, well over half of the people in sub-Saharan Africa who need anti-retroviral treatment are now receiving it. Incidentally, that is probably a bigger proportion than for some countries now in eastern Europe—it just shows how the balances change—whereas for TB in sub-Saharan Africa, the figures for those being successfully treated are higher than for HIV.
Not all these improvements, it should be underlined, can be put down to the global fund. National Governments make a massive contribution themselves. I was in Cape Town a month or two ago and, to take South Africa as an example, it finances much of its own programmes. The years of neglect have been followed by an inspired effort by the South African Department of Health. The result is that, over the past five or six years, life expectation has already improved and increased by something like five years. Furthermore, we should never forget the massive contribution that the United States makes bilaterally through the President’s emergency fund—a fund started, incidentally, not by Bill Clinton but by George Bush, which will stand as a tribute and lasting memorial to him. If it was not for the United States, I think that the world would be in a terrible mess as regards these funds. So we can say, so far so good.
However, there is another way of looking at the figures. We can also look at the death toll from these diseases now, and we can look at the new infections that are taking place every day throughout the world, not just in Africa. The most recent figures show 2.7 million deaths from AIDS and TB-related causes, and 660,000 deaths from malaria and related causes. By any standard, that is a devastating loss of human life. Here we come to the crunch point. I pay tribute to the increases in financing that there have been, but if financing continues just at its present level, the prospect is that there will be many more new HIV infections and fewer TB patients receiving care. In other words, we risk going backwards. One reason for that is the growth taking place in the world population; another is the particular nature of HIV. For some diseases it is possible to give a course of treatment, for a patient to recover and for his place to be taken by a new patient; but HIV is not remotely like that. There is still no cure. It is a lifelong condition. Patients stay on that treatment and, other things being equal, the cost will rise as new cases come forward for treatment.
That is not to say that we should not seek further efficiencies in programmes. We should certainly do that. Incidentally, as far the global fund is concerned, in spite of some of the criticism that it has had, it actually has a very good record in this area. I remember seeing an example of that in Kiev in the Ukraine, where the global fund took the decision that the Government should hand over their responsibility in various aspects to an NGO, the HIV Alliance. The result was a dramatic reduction, an economy, in drug costs. The costs of the antiretroviral drugs which were being bought came down by something like 25 times.
We also need to persuade national Governments to increase their direct contributions to their own epidemics. It is certainly not enough for some countries to rely as heavily as they do on outside finance. Of course, when that happens it is fuel for those who argue—wrongly, in my view—that international aid should be cut back, but let us remember that this is not the easiest time to make that case and to ask Governments to add to their aid programmes. The fact is that however you look at it, it is very much in everyone's interests that the budget for the global fund is increased. The fund is a vital part of the world’s fight against three killer diseases. If we start to go backwards, that obviously affects the lives of millions of people around the world but, more, it also means that the epidemics continue to spread. That in its turn will mean even more money to combat them and bring them under control.
The global fund has estimated that over the next three-year period of 2014-16, it will need something like $15 billion—a substantial increase, certainly, on what is now being spent. However, if the result can be a decisive and irreversible improvement, that is a very considerable prize indeed for the world. No one seriously doubts the global fund’s figures; most significantly, they are not challenged by the United States, which is by far the biggest donor in the fund. That was confirmed to me last week when I was in Washington talking about these things.
What we in this country therefore now await is the British Government’s response. When I was Health Secretary, I harboured an ambition to make the United Kingdom a model of how a nation should respond, particularly, to HIV. We have made progress along that road but I think that no one would say today that it is a model. We spend, for example, far too little on prevention and on publicising not only the threat of HIV but the way in which it can be combated. However, we have maintained a good record in our contribution to the global fund. I hope that the Minister will now be able to put some more flesh on those bones. The US has set an example; we need also to set an example.
I have two last points. First, I very much hope that the global fund will continue to support the efforts to develop a vaccine for both HIV and TB. We have seen what a vaccine can achieve on polio and there are some encouraging signs, as in Thailand, that the prospect of developing a vaccine is not as far-fetched as some critics argue. The problem is that the development time for a vaccine is far in excess of the lifetime of any Government or three-year programme. It is nevertheless a goal which is most certainly worth pursuing. I say that in particular because of my second point. What stands in the way of so much progress in these areas is stigma and discrimination. A further effort is most certainly required there. Stigma infects gay and lesbian people, those with HIV and those with TB. It means that many people around the world are reluctant to come forward for testing. A vaccine would cut through all that. It is therefore, again, a goal which is worth pursuing.
If I may say so, tonight there has been a historic vote in this House. We have sent out a clear message that we in this country believe in equality of treatment for all. That was a massive message, which was underlined by the majority. I believe also that we are united, irrespective of which way we voted on that debate, on the criminalisation of homosexuality being abhorrent. I hope that that message goes out equally strongly, but I put it to the Minister that it would be even better if tonight she could set out the British Government’s plans to help the global fund fight one of the most important health battles that the world now faces. That is a historic battle and this country could make an important and valuable contribution to it.
Lord Chidgey
My Lords, I congratulate my colleague and noble friend Lord Fowler, first, on securing this debate and, secondly, on the remarkable way in which he set out the problems which we face.
I first came face to face with the scourge of HIV/AIDS about 10 years ago, in Soweto in South Africa. I was taken to a hospice and clinic run mainly by volunteers and funded by donations from the local community. At that time, victims of HIV/AIDS whose illnesses had reached their final stages were being cast out into the street and left to die. The hospice volunteers went out into the townships each and every morning to bring in the abandoned and the dying, and to provide them with clean beds and nursing care during their last days and hours in the comfort of the hospice. I recall standing by the bed of a desperately ill young woman, possibly still a teenager, searching for some words of comfort or solace. Beyond speech, she just looked up with despairing and frightened eyes. It was yet another human tragedy unfolding.
The clinic attached to the hospice had the main task of mobilising the community, particularly those from the families of HIV/AIDS victims, to be trained in basic healthcare procedures. The concept was to provide a core of basic healthcare support for HIV/AIDS victims in their homes. At that time, the clinic had trained over 350 volunteer community healthcare practitioners, working with the families in the townships. During the same visit, we met with the leaders of the Johannesburg chamber of commerce to be briefed on the impact of AIDS on the economy. The heaviest toll was being taken in the extractive and heavy haulage industries, where the death rate was so high that employers had to expect a complete replacement of their workforce every four years. A lack of education and of access to antiretroviral drugs and a reluctance to be clinically tested all added to the difficulties in attempts to contain the epidemic. As the noble Lord, Lord Fowler, said, South Africa has made great strides since then but, as he also pointed out, the drugs are not a cure.
A little later, with a delegation to Botswana, I visited the local research centre in Gaborone, established and funded by the Gates foundation as part of a multimillion dollar project to combat the spread of HIV/AIDS. At that time, I recall that more than 35% of the population in Botswana were infected by the disease. The project was having some success, particularly among the young in the more remote areas of the country. A problem was that as their health improved under the Gates drug regime, there was a trend to return to a pattern of unprotected casual sex, in the mistaken belief that they were now cured, so the educational aspects of the programme had to be revisited.
The United Kingdom has been a major supporter of the global fund since 2002. The coalition Government have maintained the commitment to £1 billion over the period 2008-15, with annual commitments in line with this pledge. It is to DfID’s great credit that it has played a key role in supporting the fund, following the cancellation of the 11th round of funding, by bringing some payments forward—meaning that the £1 billion pledge is likely to be met a year earlier.
In 2011 the global fund was rated “very good value for money” in DfID’s multilateral aid review, or MAR, the same as the GAVI Alliance—the former Global Alliance for Vaccines and Immunisation—which, however, received a substantial increase in investment in that year. Since the MAR, DfID Ministers have repeatedly said that they will significantly increase or even double the UK’s contribution with a further £1 billion. However, a strong pledge is needed now, ready for the 2014-16 replenishment. Will the Minister provide the strongest possible indication of when the Government intend to honour their pledge?
There is no doubt that investments through the global fund and other partners in the treatment of AIDS, TB and malaria have produced dramatic results. AIDS deaths have declined by 24% since 2005, as millions have gained access to the treatment. Half of the malaria-affected countries are on track to reduce cases by 75% by 2015. The global goal to reverse the spread of TB has been achieved ahead of schedule. Nevertheless, donors must be vigilant in detecting financial abuse or incompetence. Last October, the global fund found that in Djibouti over one-third of the $23 million grant had been misused or gone missing. Six months on, what action has DfID taken with the global fund to establish how this happened, and what steps have been taken to prevent a recurrence?
The global fund sees this replenishment year of 2013 as critical for the future, with the need to raise $15 billion to tackle the three diseases in the period 2014-16. The three diseases, AIDS, TB and malaria, face an historic turning point. We now have the tools and the knowledge to curb the trajectory of all three epidemics, but we can achieve this only with an ambitious funding scale-up in the coming years.
Baroness Masham of Ilton
My Lords, I thank the noble Lord, Lord Fowler, for having secured this debate on the global fund. I declare an interest as a member of all-party parliamentary groups on HIV/AIDS, tuberculosis and malaria.
The global fund has been supported by the UK, which knows how important the fight against these and other emerging diseases is. Recently, the funding model of the global fund has been made more flexible on timing, better on engagement with partners and more predictable on the level of funding available. The new funding model allows countries to better plan over time, to increase domestic funding as global fund financing decreases. The World Health Organisation states that there are 440,000 new cases of multidrug-resistant tuberculosis every year, causing at least 150,000 deaths. Many of these people will also have HIV.
There is an urgent need for rapid diagnostics for killer infections. An expert in respiratory tract infections, Alimuddin Zumla, tells me that the absence of rapid, accurate diagnostic tests for pulmonary tuberculosis was further compounded by the widespread inability to screen for drug-resistant bacteria. An ideal diagnostic test for RTIs should be rapid, cheap, easy to use, sensitive and specific and should screen for many micro-organisms and their antibiotic resistance. The diagnostic platform should be transferable, robust and, ideally, run on solar power for use in the remote healthcare settings in developing countries. I am pleased to say that I have a cousin who is a professor of microbiology in Australia. His team have developed a mobile unit that is called a “lab without walls”. They take it to projects in developing countries, so it is exciting that progress is being made by dedicated people. However, to achieve this across the world, physicians, scientists, biotechnology companies, funding agencies and Governments need to work together to drive the development of improved diagnostic tests for both developed and developing countries.
MDR-TB and extensively resistant TB are an increasing problem in Asia, Africa and eastern Europe. Global fund money is only for supporting programmes in developing countries. There is a need for part of this money to be used for research. Good research would result in better treatment outcomes—money well spent, rather than just supporting programmes. Without research, progress will not be achieved. The global fund has done much to help. I hope that it will continue to do so with renewed efforts from our Government and other countries to increase this valuable work. With modern travel, many people have access to the world. Health infections should be everyone’s business.
The Lord Bishop of Derby
My Lords, I too want to thank the noble Lord, Lord Fowler, for his persistence and commitment to this very important work and for his prophetic leadership.
I want to focus on TB, which, as we know, is preventable and manageable but needs the right resources. I commend the enormously impressive work of the global fund and, as mentioned by the noble Lord, Lord Fowler, the importance of national Governments. I want to particularly remind us of the importance of the global fund’s aspiration to work with what it calls civil institutions: partnership with people on the ground. To explore what that might mean and to encourage the Government to take that aspiration seriously in the way that we offer funds and seek accountability, I want to talk a little about Peru, which is recognised as among the countries with the highest TB burdens in the western hemisphere. If I understand them correctly, the indicators show that TB control in Peru may actually be deteriorating.
My second reason for talking about Peru is that I am privileged to be a friend of the Bishop of Peru. He and his family come from Chesterfield in my diocese and he visits us when he is in this country. This year, we have in our diocese of Derby a harvest appeal fund to help him build a school, a clinic and a church on one site where there will be proper provision from the system, civic society and education. That is a model of partnership. Last week, I spoke to Dr Townsend Cooper who is running a project for the diocese in Peru. He describes the working of all these efforts from the point of view of civil society—the church on the ground—as “filling in holes”. They do not have a sense of working in partnership; they feel they are running round filling in holes.
I will give one example of a case that he is treating at the moment that he discussed with me last week. They are helping a 13 year-old girl in Ventanilla who has cerebral palsy from a birth injury and was recently diagnosed with TB of her spine. The existing system swung into action: she was admitted to hospital and had surgery and medicines. Then, of course, she was sent home to complete the treatment, and home for this 13 year-old girl is one room on the back of a family property that she shares with her mother. She was discovered in this place by one of the visitors from the diocesan medical team. She was unable to go to hospital by bus because the surgery on her back made that journey virtually impossible. Taxi drivers refused to take her because, as the noble Lord, Lord Fowler, said, there is a stigma about having TB and she is regarded as dirty. Quite frankly, she would not have the money for a taxi anyway. The diocesan medical team picked her up and began to visit her. They did very simple things: hygiene, transport, education for her and her mother about management of the treatment and co-operation. What the doctor calls a very small amount of targeted help has transformed the situation, and the initial investment in the treatment is now again beginning to bear fruit.
That is just one little story, but I share it because it shows the problems of people of good will and faith on the ground who are trying to fulfil the aspiration to work with civil society. It alarms me that the director of this project says they feel like they are filling in holes. It is not a comprehensive enough system of outreach, partnership and co-operation so that the good work being done by the fund and national Governments is not biting as much as it might to make the difference.
I would like to make two points. First, I support the request for the Minister to comment on the Government’s pledge to increase investment in this fund. I also want to ask what the Government might be able to do to encourage the fund to take seriously its aspiration to work with civil society, and how to bed that in better so that those on the ground trying to fulfil this part of the complex response to TB do not feel that they are just filling in holes but are part of a more joined-up and coherent system.
Baroness Chalker of Wallasey
My Lords, it is a pleasure to speak in this debate, which was initiated by my noble friend Lord Fowler. I, too, commend him on his energy, commitment and his determination to keep HIV/AIDS and other diseases at the forefront of debate and always to remind my old department, now DfID, that it has to keep up to the mark. As noble Lords will know, my interest in the health of people in the developing world has gone on for a very long while. I spent more than 10 years at the Liverpool School of Tropical Medicine, six years chairing the Medicines for Malaria Venture and eight years chairing the London School of Hygiene and Tropical Medicine, so I have particular interests.
I hope that we can hear from the Minister and the department a strong pledge to the global fund, which is already operating in 151 countries. I also ask the department to look hard at what more can be done to enhance the training of rural health workers, particularly in prevention. The Touch Foundation, at the moment only in America, works in Tanzania, supported also by the Vitol Foundation in this country. The work to prevent disease and to get early diagnosis has meant a much better use of the resources that we get from the global fund. We can be very grateful to the Bill and Melinda Gates Foundation for the $650 million that it has given since 2002, and it has now given a promissory note for another $750 million. However, we can make the money work only if we have people on the ground to communicate with those who do not understand why these diseases develop so strongly.
In the new funding model of the global fund we have a real opportunity. I understand that it is to be piloted in nine countries, which have not yet been disclosed. It will try to get a greater alignment with country schedules and their priorities and to focus on the countries with the highest disease burden and lowest ability to pay. It will make it simpler for the implementers and the global fund, will mean greater predictability of process and financing and will have a real ability to elicit full expressions of demand and to reward ambition. The global fund can do that. However, the new funding model will work only, first, if it is financed, and secondly, if there is a translation of what you can do with the money through the people on the ground. That is why I make an additional plea to the department that it should consider those organisations that can help in prevention and, particularly, in early diagnosis.
My main interest is clearly in malaria and in trying to beat the mosquito in spreading falciparum and vivax. However, we can have success with new drugs only if those on the ground know when, how and in what quantities to apply them, as well as using the nets that for so long the global fund has provided. I therefore ask the Minister two things. First, that we have early notification from the department of what it can give to the global fund but, secondly, that we now focus a lot more on local-level training, maybe through non-governmental organisations such as the Touch Foundation and other good organisations such as AMREF—I can mention many others, but I will not go on. It is no good just putting the money in unless we motivate the people to do the right things.
Baroness Jolly
My Lords, I, too, thank my noble friend Lord Fowler for securing this well informed and timely debate. I realise that I am a newcomer to this field, and recognise that I am among experts with a wealth of experience. However, I hope that what I lack in both experience and expertise I can make up for in strength of feeling and enthusiasm.
I will take this opportunity to build on what the other speakers have said and emphasise the importance of the global fund in the fight against tuberculosis. Ninety per cent of international donor funding to fight TB comes through the fund, mainly because it is such an effective institution but also because TB does not get the profile or attention warranted by the devastation it causes. It is a disease closely associated with poverty, and 90% of cases are in developing countries. In 2011 there were almost 9 million cases of TB and the disease killed 1.4 million people. That is scandalous when you think that the majority of cases are curable with a course of cheap antibiotics. There are 22 high TB-burden countries in the world today, of which six are totally reliant on funding from the global fund, while two-thirds of the budget for the other 15 comes from global fund financing. Let us be clear: for many countries there would be no response to TB without the global fund’s support.
Last summer I was lucky enough to visit one of the projects supported by the global fund in Zambia. We visited St Luke’s Mission Hospital in Mpanshya, which serves a population of over 30,000 people and receives funding from the Churches Health Association of Zambia, or CHAZ, for its work on malaria, TB, HIV/AIDS and preventing mother-to-child transmission of HIV. CHAZ receives a grant from the global fund and is one of two principal recipients of such funding in the country. Through the grants that the global fund has distributed, CHAZ has brought about catalytic change in Zambia. Global fund-supported programmes have diagnosed and treated 44,000 new cases of TB, distributed 1.6 million bed nets to protect families from malaria since 2003, and provide lifesaving antiretroviral treatment to over 450,000 people living with HIV.
On our visit we heard from community health workers who included TB and HIV treatment supporters, traditional-birth attendants and former TB patients. These comments also reflect the observation of the right reverend Prelate the Bishop of Derby, because these people were church-based workers. They were based at this religious foundation, some 200 kilometres east of the capital. They carry out their work entirely voluntarily, covering long distances on foot in order to reach patients. Their commitment to improving the health of their communities was truly inspirational; but this is only one part of the global fund’s portfolio. It really brought home to me the important work that they do and the hope that the projects that they support brings to millions.
It is essential that this work continues in Zambia but also elsewhere. This replenishment year is critical for the future of the fund’s work. It announced in April that it will need $15 billion to tackle the three diseases for 2014-16. Speaking about the call for new pledges, the executive director of the global fund said:
“Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering”.
These costs are not just financial; they are costs in lives.
If this goal were achieved, it would mean that 17 million patients with TB and with multidrug-resistant TB could be treated, saving over 6 million lives over the three-year period; I cannot do the sums, but per day those numbers run to four figures. Some 1.3 million new HIV infections could be averted each year and 196,000 additional lives saved from malaria.
Of the money needed by the fund, the United States has signalled that it could pledge an unprecedented $5 billion. However, according to US law it cannot donate more than one-third of total contributions to the Global Fund. For the US contribution to become a reality, other donors must increase their contributions to commit the remaining funds. I echo the comments of my noble friend Lord Fowler: the UK Government have a key role to play. They can exert leverage on other donors by demonstrating their continued support for the Global Fund with an increased contribution of £1 billion for this replenishment period. An early summer announcement of increased UK funding at this key moment would lay down a marker for other Governments to follow.
This is just not my view. It was shared by the International Development Select Committee last year when it urged the Government to do all possible to commit funds early, and at a time that raises the most amounts of money from other donors. I urge my noble friend the Minister, for the reasons that I have just outlined, to do all in her power to ensure that the Government bring forward this anticipated increased contribution, ahead of the Summer Recess.
Lord Lexden
My Lords, we are fortunate that my noble friend Lord Fowler has brought these immensely important international health issues before the House today. My noble friend has been a tireless champion of the global fund, whose crucial role he has underlined once again. The fund embodies a remarkable international partnership, bringing together Governments and private-sector organisations and uniting them in an unrelenting campaign to overcome the world’s pandemics.
We are united this evening in believing that the fund can be even more successful in the future than in the past. There remains so much for it to do, as we have heard from speakers in this debate. It is a matter of considerable pride that our country, under both the previous Government and this one, has been the third largest contributor to the global fund. Like all those who have taken part in this debate, I look forward to hearing what my noble friend the Minister has to say about our future contribution.
I hope that she will be able to allay widespread concerns that government support for research into new treatments and advances in prevention is about to be cut significantly. Continued funding is essential if recent scientific progress is to be carried forward steadily by those involved in highly regarded, not-for-profit public/private partnerships, such as the International AIDS Vaccine Initiative. This works with more than 50 academic, industrial and governmental organisations around the world to research and develop AIDS vaccines. There could be no more important work.
At the same time, it is accepted by the global fund and by all those who back it that at a time of severe pressure on the public purse everywhere, contributions from individuals, corporations and private foundations must be encouraged. That point was made forcefully in a recent report from the influential Center for Strategic and International Studies in Washington. It needs strong emphasis in this debate.
If the global fund is well equipped and resourced, as we hope strongly, as a result of a combination of public and private support, it will still labour under a formidable handicap. However successful the fund and the efforts of the vast numbers of people working to end the pandemics may be, they will not be able to reach and relieve all the suffering with which they contend. That is because homosexuality is a criminal offence in some 78 countries. Where homosexuals are criminals, HIV cannot be fully relieved or curtailed. The statistics are stark. In Caribbean countries where homosexuality is not against the law, of every 15 men who have sex with other men, one is infected with HIV. In Caribbean countries where homosexuality is criminalised, the rate of infection is one in four. So we come back to the deep-seated problem of criminalisation, which is and always should be a prominent feature of our debates on these issues.
We naturally direct our concern principally to the countries of the Commonwealth. In 42 of the Commonwealth’s 54 member states, homosexuality is a criminal offence. The Commonwealth’s collective institutions produced clear evidence in 2011 that where homosexuality had been decriminalised, HIV infection had fallen. To the infinite sadness of us all, that has not led to a widespread acceptance of the case for decriminalisation. In some countries the situation has got worse. Last week the Nigerian Parliament passed a harsh anti-LGBT Bill that is bound to fuel prejudice and hatred in other countries.
On moral as well as on health grounds, the Christian churches in Commonwealth countries ought to be at the forefront of efforts to stem the tide of oppression and extend basic human rights to all LGBT people. In fact, as we know well, all too often the churches are to be found in the forefront of militant antigay activity. The Church of England, which is my church, has great influence in many Commonwealth countries. I end with a fervent plea that it should consider issuing a strong public statement utterly condemning the criminalisation of homosexuality. If it did that, it would confer an inestimable boon on those working, through the Global Fund and other remarkable, selfless organisations, to end the pandemics that so disfigure the world today.
Lord Collins of Highbury
My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating this debate. I thank him also for his lifetime commitment to the battle against HIV and AIDS, and, more importantly, against the prejudice that all too often hinders treatment and prevention. His contribution to the earlier debate made me feel proud of this House and of all the people who have supported equality.
The Global Fund to fight AIDS, Tuberculosis and Malaria has, since its inception, saved an estimated 8.7 million lives, disbursed antiretroviral drugs to 4.2 million people, treated 9.7 million cases of TB and distributed 310 million insecticide-treated bed nets. Like the noble Lord, Lord Chidgey, I very much welcome the fact that the coalition Government have maintained the previous Government’s commitment of £1 billion to the fund.
I also recognise the key role that DfID has played in supporting the fund through a turbulent period. In 2011-12, following the cancellation of the 11th round of funding, the UK acted and, with the support of DfID, brought forward some payments during this period, which means that we are likely to reach the £1 billion pledge a year early, in 2014. Since these difficulties, we have seen, as the noble Baroness, Lady Masham, said, a radical restructuring. Simon Bland, a leading DfID civil servant, was appointed chair and has overseen the implementation of reforms at the fund. These have refocused resources and efforts on effective grant management, while remaining true to the organisation’s vision, mission, principles and values. As we heard in the debate, the fund received the highest possible value for money rating in DfID’s multilateral aid review.
Since the publication of that review, DfID Ministers have repeatedly stated that the UK will significantly increase its contribution to the fund. The previous Secretary of State for International Development said that the UK would up to double its contribution to the global fund. In these circumstances, and like many noble Lords in the debate, I ask the Minister clearly to signal that the Government will double their contribution to the global fund. As the noble Baroness, Lady Chalker, said, an early announcement on this, in June or early July, would provide the impetus for other countries to make their commitments, providing the global fund with certainty on how much of the next replenishment it is likely to achieve.
Like the noble Lord, Lord Fowler, I acknowledge the role and commitment of the United States Government. As the noble Baroness, Lady Jolly, said, that is critical for the future of the fund’s work. A $15 billion contribution to the global fund would see close to 90% of the global resource needs to fight these diseases met. However, for the US contribution to become a reality, other donors must increase their contributions. If we meet that goal it would mean that 17 million patients with TB and multi-drug resistant TB could be treated, saving over 6 million lives over the three-year period, and 1.3 million new HIV infections could be averted each year. As we have heard from the noble Baroness, Lady Jolly, 196,000 additional lives could be saved. These are real objectives and I welcome the Minister’s response in making sure that we can make that doubling-up contribution.
Baroness Northover
My Lords, I, too, thank my noble friend Lord Fowler for securing this important debate and, like others, I pay tribute to his leadership in this field. Both he and the noble Lord, Lord Collins, are right to say that this debate follows a stunning endorsement of our commitment to equality and fairness for all. The noble Lords, Lord Lexden and Lord Fowler, and others flagged the difficulty of tackling disease and explained how stigma, criminalisation and lack of equality hold us back.
The United Kingdom Government are strongly committed to the fight against these three diseases, which represent some of the leading causes of mortality and morbidity in developing countries, posing the largest threat to achieving the health-related MDGs. They also slow economic activity, widen inequality and cause severe financial and emotional strain on affected households. We heard from my noble friend Lord Chidgey and the right reverend prelate the Bishop of Derby about the individual human impact of these diseases.
As we have heard, the global fund plays a key role in the fight against these diseases, and we recognise that its results to date have been very impressive. In a little over 10 years it has enabled a significant and sustained response that has changed the course of these diseases around the world, as my noble friend Lord Fowler highlighted. Thus, Bangladesh has seen a 92% reduction in malaria deaths. In Cambodia, TB prevalence has declined by 43% and malaria deaths have declined by 80%. In South Africa, life expectancy has risen for the first time in a decade from 51 years in 2005 to 60 years in 2010. In HIV there have been huge gains, as my noble friend Lord Fowler and others noted, with 700,000 fewer infections globally in 2011 than in 2001.
Challenges remain, however, such as the growth of drug-resistant TB and HIV epidemics driven by drug injection, as the noble Baroness, Lady Masham, pointed out. From 2001 to 2010, the number of people living with HIV rose 250% in eastern Europe and central Asia, again a problem flagged by my noble friend Lord Fowler.
We are currently the fund’s third largest contributor. As the noble Lord, Lord Collins, pointed out, in 2007 the United Kingdom committed up to £1 billion from 2008 to 2015 for the fund. Europe generally is also an active supporter. Taken together, the European Commission and the EU countries that contribute to the fund account for well over 40% of its receipts.
A year ago, my right honourable friend the previous Secretary of State Andrew Mitchell confirmed to the International Development Committee that the United Kingdom would contribute £128 million to the fund in the years 2012 to 2014. He also said that the United Kingdom would consider increasing that commitment depending on progress with the fund’s crucial reforms, to which the noble Lord, Lord Collins, referred.
DfiD Ministers have indeed increased or accelerated our funding to help the fund through short-term difficulties. In 2010, we advanced a payment so that all the proposals under the fund’s 10th round of applications could be approved, and in 2011 we brought forward another payment so that these same grants could be signed off. Because of this, we are on track to meet in full and one year early our £1 billion pledge, even before any increase. The United Kingdom also continues to be an active and engaged member of the fund and its committees in Geneva.
At country level, the United Kingdom provides a range of complementary funding and other support to national plans and global fund-supported programmes, as well as through in-country governance bodies, most notably the country co-ordinating mechanisms that manage global fund grants. However, as noble Lords have flagged, there have been some recent challenges; the noble Lord, Lord Collins, referred to this. The fund invites scrutiny and is a highly transparent organisation. In 2011, the Global Campaign for Aid Transparency ranked the fund fourth in their “Publish What You Fund” data, and in 2012 the global fund ranked joint third. That is very encouraging. As my noble friend Lord Chidgey and others have noted, we rated the fund as providing very good value for money in the multilateral aid review.
However, press reports in 2011 claiming fraud and corruption caused the fund to examine its systems and procedures. It became apparent that the reports were exaggerated and extrapolated from audits that the fund itself had published. None the less, they triggered a series of events, including the cancellation of the fund’s 11th round of applications for funding. A high-level independent review panel was established to look at the fund’s fiduciary controls and oversight mechanisms. The panel concluded that the fund’s purpose was right and that it had achieved significant results, but that it had outgrown its original structures and was in urgent need of reform, including changes to its business model.
The fund responded in full to the panel’s recommendations. Subsequent reforms have been rapid and far-reaching. It has changed its business model and practices and made significant and strategic senior appointments so that the senior management team is even stronger than before. It has redirected staff towards active grant management and working more closely with high-burden countries.
My noble friend Lord Chidgey asked about an incident in Djibouti. We and the fund take a zero tolerance approach to fraud and corruption, which he will not be surprised to hear me say. We have supported the fund in appointing a chief risk officer, undertaking a grant-by-grant and country-by-country assessment of risk and strengthening the secretariat to manage risks better. The fund is further improving its audit investigation units, and recovery of any and all fraud is being vigorously pursued.
A new funding model, intended to ensure that the fund improved its performance and better met the needs of poor people affected by the three diseases was agreed late last year. I reassure my noble friend Lady Chalker that the secretariat is focusing in particular on the 20 high-impact countries in Africa and Asia that account for 70% of the burden of the three diseases and 54% of the fund’s grants. We are very glad that the global fund appears to be back on track and even stronger than before. On 28 February this year, it allocated £1.9 billion to 50 countries to test its new funding model, and on 15 May we learnt that the first five country concept notes have passed their review stages and will be recommended to the board for funding later this year.
I was asked a number of questions, and I shall go through some of them. The right reverend Prelate the Bishop of Derby asked about civil society involvement and emphasised the significance of that, and of course that is right. Roughly 33% of global funding grants go to civil society recipients in parallel to Governments. My noble friend Lady Chalker asked about the training of health workers. As she probably knows, the global fund supports health workers, including through general health system strengthening and through the countries’ own national programmes. She was concerned that there should be better targeting on prevention, which the noble Lord, Lord Fowler, emphasised, and we agree. Clearly, the 310 million bed nets—again the noble Lord, Lord Fowler, referred to this—are a demonstration of what can be done.
Various noble Lords emphasised the reduction of stigma, including my noble friends Lord Lexden and Lord Fowler. My noble friend Lord Fowler interestingly linked that to vaccines. We agree that the support for the development of vaccines is very important and we have increased funding. As part of a package of interventions, even an inefficient vaccine can have its uses.
My noble friend Lord Lexden suggested that we needed to work closely with private sector foundations and individual contributors, and we agree. We are doing that generally across DfID. He will note that Bill Gates will be joining us on Friday and Saturday at the hunger summit, for example, outside this debate.
The noble Baroness, Lady Masham, asked about diagnostics. I assure her that DfID is providing £6.5 million to the Foundation for Innovative New Diagnostics to develop new diagnostic tests for a range of diseases. She is absolutely right about the importance of that. She and my noble friend Lady Jolly emphasised the importance of TB research and taking this forward. DfID supports a range of research, including £23.3 million to the Global Alliance for TB Drug Development and various other projects.
We liaise closely with our colleagues on the fund’s board, including those from the United States, France, Germany, Japan and the EC, and—I hope this reassures the right reverend Prelate—with those from civil society. We recognise President Obama’s request to Congress of $1.65 billion for 2014 as a strong vote of confidence in the fund and its reforms. Like the noble Lord, Lord Fowler, we pay tribute to the United States’ record here.
Our own reform priorities are to reduce transaction costs levied on recipients and on partners, as flagged by my noble friend Lady Chalker; to gain even better value for the money spent; to continue the focus on the poorest and most vulnerable; and to develop the longer-term sustainability of global fund-supported programmes. Clear, positive developments have already been made and we are seeing early signs of the impact of these reforms. The multilateral aid review update for the global fund, which will be published in the summer, will help to provide further important evidence.
I welcome the interest of all noble Lords in this area. The focus is to make sure that in a period of global austerity, when we all face major health problems, such as those resulting from HIV/AIDS, malaria and TB, resources are used as effectively as possible. The global fund has an impressive track record and it is vital that such international players, whose reach is far wider than that of individual countries, are as efficient as possible as we seek to combat poverty and disease around the world.
Lord Fowler
My Lords, I thank the Minister very much for what she has said. I particularly thank everyone who has taken part in the debate. It has necessarily been a short debate, but the speakers have brought in virtually all the areas of the global fund: AIDS, tuberculosis and malaria. In addition, the point has been made very strongly about the stigma that attaches to a number of these areas and which stands in the way of testing and is therefore totally counter- productive.
I thank the Minister for her reply. I think I will need to look at it with a little more care. She went very rapidly at one stage when I thought she was getting to the point of pledging herself to doubling the contribution, but I do not think that quite came. I thought she made the case entirely for doubling the contribution, so I was not sure why she did not go that final bit, but there we are. I live in optimism.
In all seriousness, the pledge has been made a number of times and it is getting just a wee bit dog-eared. I do think it is rather important that if the Government want to set an example, get some credit for what they are doing and have some influence, they should make a firm pledge and make it stick. However, I thank the noble Baroness for her reply and I thank everyone who has taken part.