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Lord Fowler
To ask Her Majesty’s Government what action they are taking to support the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Lord Fowler (Con)
My Lords, one of my major purposes in raising this short debate is to emphasise a crucial point about public health across the globe. Currently there is vast concern about Ebola, and rightly so. It must be met with all the resources at our disposal. But at the same time we must not forget the even greater challenge posed by the three diseases that the Global Fund was formed to fight—AIDS, TB and malaria.
The figures for deaths tell their own story. In 2013 an estimated 1.5 million people died from HIV/AIDS; 584,000 people died from malaria, and an additional 1.1 million people died from tuberculosis. The burden is heaviest in sub-Saharan Africa, where an estimated 90% of all malaria deaths occur, and—this is perhaps the most disgraceful statistic—in children under five. So, currently, three diseases account for more than 3 million deaths a year, to add to the mountainous totals over the past 25 years. AIDS is an example: the death toll so far is 35 million people. In addition, 36 million people are living with HIV, and in 2013 almost 200 million cases of malaria, and 9 million new tuberculosis cases, were detected.
Having said that, I do not want to downplay or understate the progress made, or the vast contribution that the Global Fund, and the President’s fund from the United States, have made. Without them the world would be in even greater crisis. The latest figures for the Global Fund show that 7.3 million people are on antiretroviral therapy for AIDS. It has tested and treated, or helped to test and treat, more than 12 million people for TB, and has distributed 450 million insecticide-treated nets to protect families against malaria. We have therefore made vast progress since those dismal and tragic days in the 1980s, when AIDS patients died and there was absolutely nothing we could do about it. I pay tribute to the clinicians, the nurses, the volunteers, and all those working for NGOs, throughout the world, who have made this progress possible.
Now we come to what is perhaps the most difficult challenge for any Government. In spite of the progress made, much more needs to be made, and it needs to be made urgently. As UNAIDS says in its latest report, only about three-fifths of countries have risk reduction programmes for sex workers, and 88 countries report that fewer than half of men who have sex with men know their HIV status. Most countries fail to provide drug substitution therapy, or access to sterile needles and syringes for people who inject drugs—even though that is something we started in this country back in the 1980s. Again, most disgracefully of all, antiretroviral treatment for children lags very substantially behind that for adults.
Not all the steps to combat these factors imply increased financial help. If the 80 countries that currently—and disgracefully—criminalise homosexuality were to reform that policy, we would take a massive step forward and reduce one enormous barrier to testing and treatment around the world. There is no question but that that could have a profound effect. I very much hope that in this debate the Government will underline their determination and commitment to do as much as they can to persuade those countries to reform their legal processes.
Just as certainly as that, sustained and increasing financial help is necessary from the nations of the world. Here I pay tribute to the Government for honouring the important pledge, made by Andrew Mitchell when he was Secretary of State for International Development, to add a further £0.5 billion for the Global Fund, as long as other nations join in. There is a slight question about that at the moment, because the total aimed at has not been reached.
Having just praised the Government, if I had a criticism of them it would be that that message about the increased aid should be made loud and clear. At the recent international AIDS conference in Melbourne, where there were Ministers and civil servants—it is by far the most important meeting in the AIDS calendar—we could manage no Minister or civil servant from DfID, and as far as I know, unless he attended very secretly, no British high commissioner. And that was in a Commonwealth country. We need to explain to the world what we are doing and why, and not allow other countries to paint us in terms of the British policy of the Victorian years.
I shall make one last point. With AIDS, antiretroviral drugs have saved millions of lives, but I wonder whether we should put all our eggs in one basket. I believe we should take heed of the warning given today by the review of drug resistance set up by the Prime Minister. Drug resistance can have a profound effect on HIV, TB and malaria. According to Jim O’Neill, who headed the review, drug-resistant infections already kill hundreds of thousands of people a year globally, and by 2050 that figure could be more than 10 million.
There will be further reviews, and I see that it is said, and emphasised, that the role of vaccines to prevent infections, in particular, will be examined. I declare an interest at this point, as a board member of the International AIDS Vaccine Initiative, a non-profit organisation, based in New York, dedicated to developing a vaccine for AIDS. It has been consistently supported by both parties—although this Government’s recent decision to cut help from £10 million a year to £1 million a year in one slash has not exactly helped. I could say more, but I will not, unless I am provoked, because the point I am making is a rather broader one than that.
Vaccines can take, and almost always have taken, decades to develop. This is not necessarily a natural area for Governments, with their four-year time limits—and perhaps even less so for Ministers, whose time limits are usually rather shorter than that. That is why it is so significant that the President’s fund in the United States, which obviously has a much longer timescale, is now devoting a small part of its substantial resources to research into prevention and vaccines. That is an extraordinarily important move and underlines the importance of prevention. Following that, I wonder whether the Global Fund should not do exactly the same thing and provide a more certain source of finance as well as underlining the crucial importance of prevention as well as treatment. That is the point about moving in that direction.
The Global Fund has made amazing progress but it is dependent on government resources from and around the world. The message for all those Governments is: for goodness’ sake, don’t stop now, for we are dealing with three of the main killer diseases in the world today.
Lord Cashman (Lab)
My Lords, I thank the noble Lord, Lord Fowler, for initiating this extremely important debate and, indeed, for his long and distinguished record on these very important issues.
The Global Fund is a 21st century partnership. It works because it combines Governments, civil society, the private sector and people affected by these diseases. The genuine nature of this partnership ensures that there is unquestionable success. We should be proud that the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.
HIV/AIDS, TB and malaria disproportionately affect certain groups known as key populations. Despite progress within general populations accessing antiretroviral drugs for HIV treatment, key populations are being left behind in terms of access. TB disproportionately affects those working or living in overcrowded conditions, such as prisoners and labour migrants, particularly mining communities in South Africa. Also at risk are people living with HIV. They are over 20 times more likely to develop TB, and one in five AIDS deaths is from TB alone. HIV poses an increased risk to groups including young women, men who have sex with men, transgender people, who are often forgotten, injecting drug users, those in prison, migrant or mobile workers and sex workers.
Recently, the excellent report of the All-Party Parliamentary Group on HIV and AIDS, Access Denied, published last week, highlighted as a key issue the lack of political prioritisation of key populations. Problems happen, particularly in so-called upper middle income countries, when global funders withdraw support and this happens before domestic Governments are able to pay market prices for antiretroviral drugs. So, will the Government encourage the Global Fund to reassess its decision to withdraw funding from key population groups in middle-income countries unless there is clear evidence of how funding for services and treatment will be provided to key populations? Will the Government pledge to work with the pharmaceutical industry and multilateral organisations to make newer and more effective ARV drugs available and affordable to all, including marginalised populations and people living in middle-income countries?
The sad reality is that HIV/AIDS, malaria and TB do not discriminate. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa, and the region’s young women are twice as likely to contract HIV as their male peers. This is partly due to their unequal status, which constrains women’s ability to negotiate condom use. It is therefore vital to develop a range of HIV prevention tools that can be used by diverse populations, such as female-initiated microbicides. Will the Government continue their support for product development partnerships and other approaches that are developing products targeted at such groups as women in low-income countries?
As I said earlier, sex workers are also at great risk from an increased number of sexual partners, greater exposure to sexual violence and the economic incentive to offer unprotected sex. Will the Government pledge their support for promoting health services and harm reduction globally as the most effective approach for addressing HIV and other diseases among sex workers and drug-using populations?
Much has been said in earlier debates about men who have sex with men, but the sad truth is that they are 13 times more likely to be living with HIV than the general population. The current slide towards criminalisation in certain countries of people accessing HIV services does no good whatever. These include countries within the Commonwealth, such as Uganda, where a Bill is pending. Therefore, I would be interested to know what the Government are doing to promote—we have to promote this; we cannot impose it—a change of direction as regards homosexuality within these countries. Will they follow the recommendation of the report of the All-Party Parliamentary Group on HIV and AIDS to significantly increase the funding of advocacy groups within these countries that need the resources, such as the Robert Carr network or the Stop TB Partnership?
Finally, and probably most importantly, will the Government desist from trying to prevent the Global Fund working in so-called middle-income countries, where the poorest and marginalised are those most in need and where the Global Fund must continue to work if we are to eradicate malaria, TB and HIV? Make no mistake, the weight and influence of the UK on the Global Fund board is significant. Many middle-income countries are facing a perfect storm of bilateral donors and the Global Fund pulling out of funding very rapidly before national Governments have the time, support or money to replace essential HIV funding and programmes. I thank noble Lords and look forward to the noble Baroness’s response to my questions.
Lord Chidgey (LD)
My Lords, I add my congratulations to the noble Lord, Lord Fowler. I also congratulate him on consistently pursuing these issues and the work he is doing month after month, year after year. We owe him a great debt for that. I applaud the remarks made by the noble Lord opposite on middle-income countries and the Global Fund. I cannot remember his name. I do not watch television. You know where I am coming from. The noble Lord raised an important issue. In that context, we should remind ourselves that the Global Fund is a 21st century partnership designed to accelerate the end of the AIDS, TB and malaria epidemics. It is a partnership between Governments, civil society, the private sector and people affected by the diseases. The genuine nature of the partnerships it fosters is critical to the fund’s successes.
The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. Following on from the points made by the noble Lord, Lord Fowler, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment, 1.3 million of whom have been put on the treatment this year. Some 12.3 million people have been tested and treated for TB, 1.1 million of whom have been tested this year. Some 450 million mosquito nets have been delivered, 90 million of which were delivered over the course of this year. This has contributed to tens of millions of lives being saved in the decade since the Global Fund was founded. The Global Fund has set a number of goals in relation to its work on HIV, TB and malaria. These goals are due for delivery in 2016. It has already achieved 100% of its HIV goal, 115% of its malaria goal, but only 58.5% of its TB goal. The fund provides over 80% of international financing for TB, over 20% of all HIV funding and 50% of global malaria spend. As the noble Lord, Lord Cashman, mentioned, the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.
I want to talk a little about the UK Government’s pledge. They made a renewed commitment to Gavi to invest up to £200 million a year for the period 2016 to 2020 to ensure that 76 million children can access life-saving immunisation programmes. The UK’s contribution will save another 1.4 million lives and will help Gavi to move closer to its overall replenishment target of—would you believe?—$7.5 billion.
Despite the shift in the burden of disease, and indeed the population, from low to middle-income, funding allocations from the Global Fund appear to be moving in the other direction, as the noble Lord, Lord Cashman, mentioned. The application of new funding methodology in Kyrgyzstan—a country with significant HIV and TB burdens—has resulted in an almost 50% cut in total funding for HIV prevention and treatment. Funding for HIV and harm reduction programmes in Ukraine is predicted to fall by about $30 million from 2014 to 2015, on top of a 71% reduction in domestic funding for the HIV epidemic.
Another eastern European country, Romania, was allocated no HIV funding for 2014-16 because it was perceived that there were no political barriers to providing services for people living with infectious diseases, and there is no political will for funding harm reduction. Despite countries having greater GDP, it does not necessarily mean that they are choosing to invest more resources in disease-control programmes. I cannot say this loudly enough: a reduction in Global Fund support can result in the closure of key programmes. That threatens a resurgence of disease in countries where there has been a general reduction in rates over recent years. HIV and TB are prevalent in middle-income countries in our neighbourhood. They are infectious diseases and do not respect national boundaries. Growth of these diseases in central Asia and eastern Europe could impact on the broader region. If we inadvertently facilitate a reduction of disease control in countries just because their GDP has increased to place them in a different World Bank income category, we risk a resurgence in the epidemics.
Finally, I want to talk a little about DfID’s role. We must recognise that our Government, as a major supporter of the Global Fund, should be congratulated on the work they do. Accordingly, the UK has significant influence on the Global Fund board. DfID has made a move to close programmes in middle-income countries and focus its efforts on a smaller group of low-income and fragile states. We should be using our influence on the Global Fund to ensure that it continues to support programmes in countries that receive from few or no other external donors, and not try to influence the fund to focus its efforts on the same countries that DfID currently targets.
I hope that our Minister will commit to work with UK representatives on the Global Fund board and with the Global Fund to develop a more gradual taper of support for countries with increasing domestic resources. It is important to remember that access to treatment is still being denied to too many people, with a total of 29 million now estimated to be eligible. As a final quote, Michel Sidibe, the executive director of UNAIDS has said:
“HIV has transformed from a death sentence to a chronic condition”,
that is treatable, enabling millions of people to live long, healthy lives. However, this is far from enough to end AIDS by 2030, let alone ever.
Lord Lexden (Con)
My Lords, in political affairs there are always a number of things that cannot be repeated too often. As regards global health issues, it is impossible to overemphasise either the importance of the work done by my noble friend Lord Fowler over the past 30 years or the value of the leadership that he has provided and continues to provide to politicians across party dividing lines who have committed themselves to doing all they can to support those on the front line—the doctors, scientists, academic authorities, health workers and volunteers—leading a battle against three diseases, malaria, tuberculosis and AIDS, that wreak such havoc in large parts of the world today. Some of us taking part in the debate had the great good fortune to hear a few days ago from a number of experts who have dedicated themselves selflessly to releasing as many as they can from suffering and achieving immensely impressive results, particularly in Africa.
However, there are those who succumb to the illusion that the battle is far advanced and final success is in sight. My noble friend Lord Fowler is tireless in pointing out how much remains to be done. He has made that clear again today, as he did in his recent influential—and, I am sure, best-selling—book, in which he stressed the essential uncomfortable truth that we all need to bear constantly in mind. This is how he put it:
“The central problem that the world faces with HIV and AIDS today is this: it is the millions of people infected with HIV who, in spite of the medical advances and all the money poured in, remain untreated”.
There are millions of people united with us in the brotherhood of man who desperately need the treatment to hold their HIV in check but who are denied it.
That fundamental point was underlined in the authoritative report published on World AIDS Day last week by the All-Party Parliamentary Group on HIV and AIDS, referred to by the noble Lord, Lord Cashman. How welcome he is in this debate and the others that will follow. The all-party parliamentary group calculates that less than two-thirds of adults with HIV and three-quarters of the children living with it today are not receiving the treatment they require. Immense progress has been made, not least through the Global Fund, to which I, like other noble Lords, pay tribute, in extending access to the treatment that contains and controls HIV, and yet so much more remains to be done. The all-party report last week estimated that 55 million people will need HIV treatment by 2030.
It would be an immense tragedy if this country, which has made such a marked contribution to the progress so far, should falter now. However, without adequate funding our contribution is bound to falter, and the inimitably long period of experiment and trial needed to find an HIV vaccine will be extended further. That, I think, is the main cross-party message that this important debate seeks to deliver. Surely we cannot allow the defeat of pandemics that condemn millions to misery to be set back and weakened because of short-term factors in Britain connected with the coming general election. Rather, the main parties must stand firmly together, explaining, as my noble friend Lord Fowler constantly does, why the skills of our doctors and the breakthroughs achieved by our research scientists must continue to be placed at the service of mankind as a whole. We belong at the centre of the Global Fund, this remarkable international partnership that brings together Governments and the private sector.
The all-party report is entitled Access Denied. In her speech in response to it on World AIDS Day, my noble friend Lady Northover, who understands these issues so fully, referred to the need to address the numerous barriers that limit access to medicines. One of the most formidable of these barriers is the criminalisation of homosexuality in so many countries. In nearly 80 countries—too many of them members of the Commonwealth—it is a crime to be gay. In circumstances of such grotesque discrimination, gay people with HIV are not going to draw attention to themselves by seeking treatment, assuming that it is available. We have referred to this intolerable barrier to treatment—indeed, to simple human equality and dignity—often in our debates on global health and Commonwealth affairs in recent years. Like my noble friend Lord Fowler and the noble Lord, Lord Cashman, I believe that we should emphasise this again and again. 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 it is a crime to be gay, the rate of infection is one in four.
It is, of course, the Commonwealth countries that are most prominent in our minds. They are closest to us, united by ties of kinship, friendship and history. The Commonwealth’s collective institutions produced clear evidence in 2011 that where homosexuality has been decriminalised, HIV infection had failed. To the infinite sadness of us all, that has not led to widespread reform, even though the criminalisation of homosexuality is plainly incompatible with the Commonwealth’s new charter, to which all its members nominally subscribe. Some Commonwealth countries glory in oppressing gay people, as we heard from the noble Lord, Lord Cashman, in relation to Uganda. As for the Commonwealth as a whole, does it want to be seen as upholding or blatantly ignoring fundamental human rights? It cannot dodge that question.
Baroness Barker (LD)
My Lords, I, too, want to thank the noble Lord, Lord Fowler, for today’s debate. It is an opportunity to thank this Government for their continuing commitment—a commitment started by the previous Labour Government—to funding for international aid. In times of austerity, there are those cheap political point-scorers who will say that international aid is a luxury which we cannot afford. They could not be more wrong. As today’s report on anti-microbial resistance shows, health issues are now global, and investment in the health of people in countries around the globe is an act of self-preservation for people here, too. Any political party that says it will cut foreign aid is not acting in the best interests of its own citizens.
That said, tackling these three big issues is very complicated. We have all sorts of different actors: academics, national Governments, researchers, scientists and not least the people themselves. By far the agents with the biggest impact are the global funders: the UK and the United States Governments are the biggest contributors to them. They have the most profound impact on what happens to everybody else.
I, too, want to echo the points that have been made by a number of speakers about the Global Fund’s current strategy towards middle-income countries. It is right that the Global Fund has gone through a process of refining its funding models. It is important that it should fund work in countries in ways which are compatible with the development of proper national health systems in those countries, including basic health systems, such as access to clean water. However, it is an unfortunate reality that, having gone at such a pace, the Global Fund is withdrawing funding from middle-income countries, such as Ukraine and Vietnam. It is having a devastating impact on those countries, not least on their marginal communities.
I want to echo what was said by the noble Lords, Lord Cashman and Lord Lexden: it is groups within those countries that can have the biggest impact on their own Governments. I would therefore encourage the noble Baroness to commit to working with civil society groups to achieve that. I say that because of the searing experience I had of standing in a top AIDS clinic in New Delhi watching a line of women queuing up for their HIV and TB treatments. They were among the most powerless people I have ever seen. Recognising that they are in the position that they are in through absolutely no fault of their own makes a compelling case not to abandon them, just because they live in a country the economy of which is increasing.
I am proud to be part of the group that produced the Access Denied report. It covers a number of matters in tremendous detail, not least the matters of intellectual property rights and TRIPS agreements. I am not going to talk about that in great depth today, but I would welcome the opportunity to do so some other time. The Global Fund, as noble Lords have said, is an important player when it comes to research. Underlying the whole of the work to deal with these diseases is the issue of research, funding for basic research, funding for translational research, and funding for new medicines. We had the experience in India of talking to generic manufacturers who explained to us, as the commercial people that they are, that there was no market for paediatric formulations for HIV. That makes it even more important that Governments and funds, such as the Global Fund, continue to make the sorts of structural investment over a long term which enables other people to maximise their efforts.
Noble Lords will know that in the last 50 years there have been no new drugs for TB. There have been loads of new drugs for allergies and so on, because they are diseases of the west and there is a market. In the case of drugs for TB, there largely is not a market. It is therefore really important that the Global Fund continues to fund research.
In answering the Question asked by the noble Lord, Lord Collins, on 1 December, the Minister made some remarks about the funding of research which have caused some alarm among the lobby groups and civil society groups that work in this area. Will she commit to meet a cross-party group from both Houses along with some of those groups so that we can talk about that?
I think that we all understand that, now more than ever, there is cause to be efficient and effective in the way in which resources are deployed, but there are some decisions that we need to take, not just for the present moment but for years to come, which will, I hope, bind future Governments. As the noble Lord, Lord Fowler, epitomises in his work, this is something for the long haul. Things that are for the long haul require exceptional political commitment. Will the noble Baroness make that commitment so that we can all rest safe in the knowledge that the investment which has been made over the last 30 years will not be lost?
Lord Avebury (LD)
My Lords, I begin by joining in the congratulations which have been expressed to the noble Lord, Lord Fowler, on his outstanding record over several decades campaigning against homophobia and for the eradication of HIV/AIDS. He continues with this work effectively here in your Lordships’ House, in his book, AIDS: Don’t Die of Prejudice, and in his many speeches and articles on what the world needs to do to eradicate a scourge that my noble friend rightly describes as the greatest public health threat in the world today.
The noble Lord rightly castigated the 80 countries that criminalise homosexuality and the noble Lords, Lord Cashman and Lord Lexden, mentioned Uganda in particular as having an anti-homosexuality Bill currently before its Parliament. It was not for this reason, I think, that we cancelled our budgetary aid to Uganda, but perhaps we ought to review our non-humanitarian aid to all the 80 countries to see whether any pressure can be brought to bear on them through fiscal means.
As has been said, the Global Fund invests some $4 billion a year, of which the UK provides nearly £1 billion as its share. This is a cost-effective partnership, bringing together Governments, civil society, the private sector, philanthropists and patients affected by the diseases. It mobilises programmes run by local experts in 140 countries, avoiding duplication or overlapping.
As your Lordships know, HIV and TB are closely linked and TB is the leading cause of death worldwide for people living with HIV. Last year, the Global Fund provided that all applications for support from countries with high incidences of both diseases should present integrated programmes to qualify for assistance. This is a great step forward in the response to TB, because country HIV programmes have often been significantly more developed than their counterparts that address TB. TB patients will benefit from the greater resourcing, expertise and reach of country HIV programmes. For some reason, DflD currently does not integrate TB into any of its bilateral HIV programmes. This needs to change. I would like my noble friend, when she comes to wind up, to say that we will follow the Global Fund’s example by requiring recipients of our bilateral assistance for HIV/AIDS also to integrate their TB/HIV programming.
There is also a case for the co-ordination of delivery systems for malaria diagnosis and treatment with programmes for TB and HIV. The APPG on Malaria and Neglected Tropical Diseases points out in its latest report that,
“HIV and malaria frequently co-exist and the treatments most commonly used for each are now known to interact with each other”.
This would not be the case, I hope, with the first ever vaccine against malaria, RTS,S, developed over the last 20 years by GSK with additional funding by the Gates Foundation in one of the product development partnerships which are proving to be so successful in addressing the lack of commercial incentive to undertake R&D for vaccines, diagnostics and drugs for neglected diseases of the developing world. Does my noble friend the Minister think that we are likely to be able to eliminate these three diseases by 2030? On malaria, the APPG says that the Medicines for Malaria Venture has,
“the strongest anti-malaria … development pipeline that has ever existed”.
The rollout of the RTS,S vaccine before the end of the decade will be a significant milestone on the road to eradication. However, targets are needed for the post-2015 agenda, which is to be discussed shortly.
For HIV/AIDS, the fast-track approach of UNAIDS to ending the epidemic by 2030 is supported by a strong consensus, according to UNAIDS, which has identified headline intermediate targets for 2020. It recalls that African countries committed in the 2001 Abuja declaration to spend 15% of their budgets on health, but only six of them have met that commitment. Additional funding—the amount not specified—would be needed from donor countries; presumably, as the third-largest donor to the Global Fund, we are entitled to ask our EU partners to step up to the plate and contribute proportionately to their national income, as we do.
In conclusion, I am sorry to note that there was not a word about DfID in the Chancellor’s Autumn Statement, still less any mention of our commitment to the Global Fund over the next five years as we embark on the post-2015 agenda. The fund’s three-year pledging cycle does not fit with our five-year Parliaments, but it would be useful to hear from my noble friend what Mr Osborne has pencilled in for the 2016 round.
Lord Collins of Highbury (Lab)
My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating the debate. I also thank him for his lifetime commitment to the battle against HIV and AIDS, and, more importantly, against the prejudice and stigma that all too often hinder treatment and prevention.
The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. As noble Lords have said, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment. About 12.3 million people have been tested and treated for TB. Some 450 million mosquito nets have been delivered. Of the goals it set in relation to its work on HIV, TB and malaria for delivery in 2016, the fund has already achieved 100% of its HIV goal, 115% of its malaria goal, but, regrettably, only 58.5% of its TB goal. As we have heard, despite the huge progress on malaria in particular, still more needs to be done. I was shocked to hear yesterday a DfID scientific adviser state that half the children in high-risk areas still sleep without nets.
The fund is short of its TB targets because countries do not have the capacity to run programmes of the scale of those for HIV and malaria. As the noble Lord, Lord Chidgey, said, the fund provides more than 80% of international financing for TB, more than 20% for HIV and 50% for global malaria. As my noble friend Lord Cashman said, the UK contributed £1 billion to the fund in December 2013, saving a life every three minutes. Again as we have heard, the UK has pledged £1 billion to the Global Fund for the next 2014-16 round, but this funding is capped at a total of 10% of the total sum raised. The US contribution, which is huge, is also capped at 33% of the total funds pledged.
Sadly, as the noble Lord, Lord Fowler, said, the Global Fund is still short of its funding target. Given its importance to the global response to these three diseases, what action have the Government taken to ensure others step up to the mark in this round of funding? Also, if these fail, will the Government commit to disbursing the full £1 billion, regardless of whether other countries pledge or not? As the noble Lord said, the Global Fund has led the way on integrating TB and HIV programmes as recommended by the World Health Organization. When I raised in an Oral Question last December just how integrated DfID’s bilateral HIV programmes were, the Minister agreed to write to me. In fact, in her subsequent letter the noble Baroness stated that DfID,
“responds to partner countries’ health priorities”,
including tackling TB/HIV co-infections. The noble Baroness assured me that DfID will ensure that this approach is followed where we have bilateral TB/HIV programmes.
Of the 28 countries DfID lists as partners, 14 are on the list of high-burden TB countries and two are on the list of high-burden drug-resistant TB countries. In which case, I am concerned as to why TB is not identified as a health priority in any of those countries. Does the Minister accept that DfID could better integrate its TB/HIV programme in its bilateral arrangements and help to build the capacity of national TB programmes? Further, there is a £2 billion a year funding gap for TB that the Global Fund cannot fill. TB is an infectious disease that does not recognise national boundaries. Failure to control the disease in one country can and will lead to resurgence in others that have successfully tackled the disease.
The Global Fund helps countries purchase drugs, diagnostics and vaccines to tackle the three diseases. However, for many conditions, such as paediatric HIV, as we heard from the noble Baroness, Lady Barker, and TB—particularly drug-resistant TB—we do not have drugs of sufficient quality. I conclude by stressing the point I made on Monday in Grand Committee: there is a strong case for DfID to scale up its investment in R&D for TB, HIV and malaria to develop the treatments needed to eliminate these three diseases. I, too, would welcome the meeting suggested by the noble Baroness, Lady Barker, to raise these issues and the concerns of many people.
The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)
My Lords, I also thank my noble friend Lord Fowler for putting this issue once again on the Order Paper, for his passionate and informative introduction of it, and for his long campaigning history in this field. He makes the point that, although progress has been made, there is still much to do. I fully agree with that. I also congratulate him on the publication of his book AIDS: Don’t Die of Prejudice, as was noted by my noble friends Lord Lexden and Lord Avebury. The concerns he raises in that book and elsewhere—the noble Lord, Lord Cashman, and my noble friend Lord Lexden referred to this—about the discrimination and bigotry that surround this issue are, as noble Lords have indicated, of tragic significance.
Various noble Lords addressed the legal and societal barriers to human rights in this field. I can assure them that the Government are at the forefront of promoting human rights around the world. We regularly engage with Governments that violate these rights. We also support civil society groups that advocate for the relevant groups. I have just come from a meeting with Stonewall and the Kaleidoscope Trust. We explored how best to support voices in this area. I assure noble Lords that we will continue to engage in as effective a way as we possibly can.
Clearly, the level of prejudice is very striking. I saw that at first hand, when I visited South Africa recently. Representatives of the lesbian, gay, bisexual and trans -gender community told me of the difficulty they had, even in an environment where the law would seem to protect their rights, in accessing specialised services geared to their needs. I learnt also of the terrible plight of rape survivors in South Africa and southern Africa, about 30% of whom become infected with HIV, and who risk rejection from society. It is enormously challenging. AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2013 alone HIV/AIDS killed 1.5 million people, malaria killed 584,000 people and TB killed 1.5 million people.
Progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared with 1990 levels. Clearly, the Global Fund has played a major part in this and that is why we are so strongly supportive of it. As my noble friend Lord Chidgey spelt out, since 2002, Global Fund-supported programmes have kept 7.3 million people alive with HIV therapy, distributed 450 million insecticide-treated nets, and detected and treated 12.3 million TB cases. These efforts to end the AIDS epidemic accelerated last year, with increases of 20% in the number of people being treated for HIV and malaria through Global Fund-supported programmes, and smaller increases in numbers being treated for TB. That is a truly remarkable achievement.
The UK has played, and continues to play, a critically important part in these successes. I can assure the noble Lord, Lord Collins, that we are very active in seeking others’ help; that is one of the reasons why we have used the help as we have, in order to lever the other assistance that needs to come in internationally. We worked with the Global Fund to develop a new funding model that prioritises investments in countries with low incomes and a high burden of disease—countries such as the Democratic Republic of Congo, where over 11% of all global malaria deaths take place. The model has increased allocations to these countries by 40%. It is worth noble Lords bearing that in mind, as we seek to tackle the high burden of very poor countries that the Global Fund has identified.
One year ago, the UK pledged up to £1 billion to the Global Fund for 2014-16, but our contribution does not end there. For example, last year the UK worked with the Global Fund and others to pool our procurement of insecticide-treated nets—the most effective intervention to prevent deaths from malaria—and used our market power to drive sustainable reductions in prices. Noble Lords rightly highlighted the challenge of cost here: that is saving $140 million over two years. The Global Fund is now rolling out similar approaches across a range of commodities. Savings will be used to enable the Global Fund to reach more people with life-saving interventions.
However, although these achievements are impressive —and I think they are worth noting, as noble Lords flag up what else needs to be done—clearly we are not complacent. Improvements are not uniform in all countries; we have heard that referred to in this debate. Resistance to effective medicines is indeed a growing threat and devastating rebounds can occur quickly if there is any let-up in prevention and treatment efforts.
One issue in particular that is concerning is the impact of the AIDS epidemic on women and girls. The noble Lord, Lord Cashman, referred to this. Every hour, 50 young women are newly infected by HIV. The infection rates are twice as high as in young men. The Global Fund, with UK support, has made a strong commitment to the health of women and girls, and we are very pleased that that is the case. It is increasing its own capacity and building capacity at country level to mainstream women’s and girls’ concerns into programme design. But the power dynamics within societies that underlie these problems will not be easily tackled, and we look to the Global Fund to redouble its efforts. Of course, programmes such as the use of microbicides are also relevant here, as the noble Lord, Lord Cashman, said.
There were a number of specific issues that noble Lords mentioned. The noble Lord, Lord Fowler, mentioned the AIDS conference in 2014. That happened to be held in the same week in July as the Girl Summit —which I hope the noble Lord was acutely aware of—and at which Malala spoke, among others, as I referred to yesterday. It was a stunning occasion and I was very glad to be able to be there. I was also happy to go to Australia; my noble friend will have to ask the previous Chief Whip about why I was not allowed to. Nevertheless, I was the beneficiary, therefore, of being able to attend the Girl Summit here, in Simon Hughes’s constituency. FCO colleagues from the high commission in Canberra attended the meeting in Australia on behalf of the United Kingdom. The noble Lord will know how committed we are in terms of the Global Fund and as far as tackling HIV, malaria and TB is concerned.
The noble Lords, Lord Cashman and Lord Chidgey, and my noble friend Lady Barker challenged us on lower-income countries. We support the Global Fund’s new funding model, which funds the most cost-effective interventions where the need is greatest, which is in the low-income, high-burden countries; but we do ask the fund to focus more heavily on key populations in the middle-income countries, where they are investing. I hear what noble Lords say; but it is also important that we all galvanise here, to ensure that Governments themselves—such as the Government of India, where the noble Baroness, Lady Barker, saw what she saw and I have seen it, too—step up to provide those services. They cannot simply be underpinned because we have the Global Fund; we must make sure that we are not neglecting the poorest in the poorest countries for the sake of those countries in which something more can, and must, be done.
The noble Lord, Lord Cashman, referred to harm reduction. Clearly, we are firmly committed to supporting harm reduction to reduce HIV transmission in injecting drug users. My noble friend Lord Fowler referred to that as well. The United Kingdom has indeed—no doubt, chivvied along by my noble friend Lord Fowler—led in this regard.
We are supporting market shaping, which I think we have spoken about before. The noble Lord, Lord Cashman, and my noble friends referred to ARVs. We are working with others to try to ensure that we have got reduction in prices, to get ARVs to as many people who need them as we possibly can.
My noble friend Lord Avebury and the noble Lord, Lord Collins, asked about bringing together TB and HIV. We are well aware of that as a co-infection and it is part of our ongoing work. In 2011, when we reviewed this, that was one of the issues we particularly focused on. As noble Lords will know, we are working through UNITAID, UNAIDS and also the Stop TB Partnership and are seeking further product development research and market shaping for TB vaccines as well as HIV drugs and diagnostic tools.
My noble friend Lord Avebury invited me to suggest what the Chancellor might do in the future—in the year, I think, beyond the general election—which is an interesting suggestion. I am afraid that I cannot foresee exactly what will happen in that general election, though perhaps he can. But he will know that the Department for International Development’s budget is ring-fenced until 2015-16, and therefore the commitment that he might have wanted to see in the Autumn Statement was already in place in terms of the funding for DfID.
I am extremely happy to meet Peers and CSOs in the way my noble friend Lady Barker suggested, and if the noble Lord, Lord Collins, wants to join, I am very happy to talk about that and our support for research. I hear what noble Lords are saying about drug-resistant diseases. I have a personal interest in this issue, in that one of my children is currently being treated in hospital for such a thing. It brings into focus exactly what Jim O’Neill is saying. Looking at this whole area will be exceedingly important.
The Global Fund has made a fantastic difference. We have been a major support of it in terms of tackling TB, malaria and HIV. We will continue in that way. We welcome people’s engagement in ensuring that we are focusing as we should. We listened carefully to what noble Lords are saying but they should not doubt our commitment in this area.