AIDS, Tuberculosis and Malaria

Lord Chidgey Excerpts

Thursday 11th December 2014 Lords Chamber

[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.