Government Overseas Aid Commitment: Private Investment

Lord Herbert of South Downs Excerpts

Tuesday 9th October 2018 Commons Chamber

[Penny Mordaunt]

I hope that the hon. Lady will welcome the announcement that was made at the UN General Assembly and that I reiterated in my speech today. For the first time, we have a tool that allows us to see how companies are graded against the delivery of the global goals—to see what they are doing socially and environmentally to ensure that the global goals are met. The benchmarking alliance unveiled at UNGA will be a huge tool not just for Parliaments and investors, but for the public, who, I think, care very much about how their savings and pensions are invested.

[Nick Herbert (Arundel and South Downs) (Con)]

My right hon. Friend is surely right to focus on the need to increase private sector investment in developing countries. However big the aid budget is, it will be dwarfed by private sector trade and investment flows, which are essential. Does she agree that aid is particularly important where private sector investment fails—for instance, in the development of new drugs that are essential to beat diseases such as tuberculosis?

[Penny Mordaunt]

I absolutely agree. The more we can help others to lean in and assist with job creation, the more we can do on areas that only we can deal with, particularly health and humanitarian matters.

LGBT Action Plan

Lord Herbert of South Downs Excerpts

Tuesday 3rd July 2018 Commons Chamber

[Penny Mordaunt]

The hon. Lady is absolutely right. Ultimately, what will enable someone to hold their partner’s hand as they walk down the street is not a piece of legislation but a culture change in this nation. As I have said before, back in the 1980s—before many of us were in politics—we saw the homophobia that gay men, for example, faced at the time. I am sure we all agree that if we had been in politics at that time, we would have called that out and stood up for those individuals. That same scenario is happening now to the trans community, and we must show our absolute unwavering solidarity with those individuals. As I said in my speech this morning, trans women are women and trans men are men. That is the starting point for the GRA consultation, and it will be its finishing point too. We need to send out a strong message on that front, and I thank the hon. Lady for affording me the opportunity to do so.

[Nick Herbert (Arundel and South Downs) (Con)]

I congratulate my right hon. Friend on what she has just said about trans issues and on the action plan, which is welcome and comprehensive. I particularly congratulate her on the measures to ensure that Government support will be given through our diplomatic missions and through the Department for International Development to LGBT organisations on the ground worldwide. Will she say more about the Government’s bid for the chairmanship of the Equal Rights Coalition, which is mentioned in the action plan? That would be very welcome, as it would be a statement of the UK’s strong support for LGBT rights globally.

[Penny Mordaunt]

I thank my right hon. Friend for that suggestion. I am in complete agreement with him. In my time in this place, I have seen the effect of whichever party has been in government advancing the rights of LGBT people on other nations around the world. We now have a huge opportunity with our chairing of the Commonwealth, and there are many other opportunities coming up. I agree with him wholeheartedly on this.

Global Fund to Fight AIDS, TB and Malaria

Lord Herbert of South Downs Excerpts

Tuesday 12th January 2016 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I beg to move,

That this House has considered the Global fund to fight AIDS, TB and malaria.

The debate was chosen by the Backbench Business Committee after a submission by the chairs of three all-party parliamentary groups. I have the privilege to co-chair the APPG on tuberculosis; and my hon. Friend the Member for Finchley and Golders Green (Mike Freer), who chairs the APPG on HIV and AIDS, and my hon. Friend the Member for Stafford (Jeremy Lefroy), who chairs the APPG on malaria and neglected tropical diseases, are here today because we are concerned to ensure that there is a continuing fight against three diseases that between them have accounted for, and continue to account for, millions of deaths every single year.

I would like to start by talking about the continuing need to fight these diseases, focusing particularly on tuberculosis, because that is the disease in which I have a particular interest. It continues to kill 1.5 million people every year in spite of the fact that the millennium development goal to halt and reverse the spread of the disease, as well as of HIV and malaria, by 2015, was met, with the prevalence of tuberculosis having halved.

Tuberculosis continues to kill a very large number of people every year. Indeed, the latest figures published by the World Health Organisation indicate that it is now the world’s deadliest disease, surpassing the mortality caused by HIV, although there is a significant issue of co-infection in relation to HIV/AIDS. Some 400,000 people a year die of tuberculosis related to AIDS. Despite the huge progress that has been made on AIDS—progress, however, that did not meet the millennium development goal—the disease continues to kill 1.2 million people a year, and despite the great progress on malaria, it continues to kill 600,000 people a year.

The first point to make is that despite the global effort to counter these dreadful diseases, they remain very significant killers, and continuing action will be needed if they are to be eliminated. It was a fine thing that the world came together in September to agree the new sustainable development goals to replace the millennium development goals, and that objective 3.3 of those goals is to end the three diseases by 2030—in just 15 years’ time. However, the current trajectory of tuberculosis suggests that we will not end the disease in 15 years’ time. We will end it in 200 years’ time, which means that there will continue to be a large number of deaths every year, and indeed an ongoing cost, unless we take firmer action now to beat the disease.

The second reason why it is important to tackle the diseases in question, quite apart from the humanitarian cost, the loss of life and the suffering caused, is that their prevalence has an impact on economic growth. If we want to see the economic development of countries—the continuing development of middle-income countries and the acceleration of development in lower-income countries—it is essential to ensure that there is a healthy population, and it is a condition of economic growth that the population can work and has access to healthcare. These diseases place a burden on the population that impedes economic growth. The circle that needs to be squared is how we support countries in the development of their health systems to produce a healthy population that, in turn, helps to generate economic growth.

The third reason why it is important to tackle these diseases is on the grounds of what one might describe as broader security. For instance, we see the growing risk of drug resistance in the case of tuberculosis, which is a transmissible disease that is easily carried and spread—a disease that knows no borders. The growing risk of drug resistance is linked to the old-fashioned regimes used to treat tuberculosis and to the fact that there has not been a sufficient focus on drug development since the disease resurged. That poses a risk not just to the countries involved but to countries around the world.

The UK Government have taken particular interest in drug resistance. The Prime Minister has led a focus on it through the antimicrobial resistance review, which is chaired by Lord O’Neill. The threat of drug resistance poses a huge risk to the global economy, amounting to billions of pounds of potential cost. By 2050, about a quarter of that cost might be incurred due to drug-resistant tuberculosis if we do not take action.

On all three grounds—humanitarian, economic growth and security—there is an argument for continuing action to tackle these terrible diseases. The question, then, is what the right mechanism to do so is. More than a decade ago, the world came together in the belief that it was important to set up a new means of fighting them. What was then described as a “massive effort” was launched under the auspices of the United Nations, and it became the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In the 10 years that followed the launch of the Global Fund in 2002, the world’s economies have committed more than $22 billion to the fund. In turn, it has developed 1,000 programmes in more than 150 countries to tackle these diseases. The Global Fund now estimates that since its inception, it has saved 17 million lives and is on course to have saved some 22 million lives by the end of the year. That is more than 2 million lives saved annually as a consequence of the effort that was put in place in 2002 under the Global Fund. It has put more than 8 million people on antiretroviral treatment for HIV and treated more than 13 million people for tuberculosis and more than half a billion people for malaria—a quite staggering effort. As a consequence, it has contributed to a decline of a third in the deaths from these three diseases in the countries where it operates.

The importance of the fund to beating these diseases is illustrated particularly in the case of tuberculosis. The Global Fund provides three quarters of the funds that are committed to beating TB globally. In the absence of the Global Fund and its continuing ability to raise resources to beat TB, how would we continue to ensure that resources were deployed to beat this terrible disease, particularly given the ambition in the sustainable development goals to eliminate it in just 15 years?

The first reason why the Global Fund is the right mechanism to continue to tackle the diseases is that it is an established organisation that has experience in marshalling the resources that are needed. The second is that it encapsulates the important principle of partnership between donor countries—western countries with sufficient resources to contribute to the fight against these diseases—the Governments of the countries affected and civil society and the private sector.

The principle upon which the Global Fund was established is that it does not implement programmes to beat these diseases itself. It provides funding for those programmes and presides over them, but the ownership of the programmes is vested in the countries affected. The fund helps to mobilise and unlock domestic resources in the high-burden countries themselves. The principle of partnership between donor countries and the affected countries, and partnership among those who have a role to play in beating these diseases, is incredibly important and underpins the whole of the Global Fund’s work.

The third reason why the Global Fund is the right mechanism to continue this work is its accountability. It is clearly immensely important to the public’s view of international development money that it is spent properly, with accountability and transparency so that we know that resources are deployed properly. It has been a key principle of the Global Fund since its inception that there should be proper accountability in what was described at the beginning as a programme of “tough love” to ensure that the affected countries themselves are contributing to beating these diseases.

Fraud has surfaced over the life of the Global Fund, and I think it is true to say that the fund revealed most of those instances itself. They are part of the problem that any international aid agency has when it operates in countries where fraud can be a problem. The fund’s accountability mechanisms, which have been strengthened, are part of how we will address such issues. Some of the ongoing media criticism of the Global Fund has been misplaced. There is a misunderstanding of the fund’s success in ensuring that resources are implemented properly.

What are the issues for the Global Fund going forward? The fund is an immensely important mechanism in the fight against these diseases, but it has always been beset by external challenges. The terrible tragedy of 9/11 diverted the world’s attention from the need to maintain support for the Global Fund, and then the world financial crisis severely affected the willingness of donor countries to contribute. Some of the most important contributors to the Global Fund—relatively wealthy western countries—have faced a challenge to their own finances and have scaled back their commitment to the fund. That is a serious mistake for the west to make, despite the great challenges that every country faces because of the downturn. It remains important to continue to invest in beating these diseases, for the reasons that I have set out.

We now enter the replenishment phase that the Global Fund goes through every three years. It estimates that the combined external funding required to beat the three diseases, in line with the sustainable development goals, will be a staggering $97 billion over the next three years, 2017 to 2019. Those resources will be provided by the affected countries themselves and the countries that will be contributing to the fund. That requires the Global Fund to raise some $13 billion over the period, which is slightly less than the $15 billion that it was proposed the fund would raise in the last replenishment period, but it should be noted that the fund did not raise sufficient resources to meet that target. The fund estimates that that additional resourcing over the three-year period will save another 8 million lives, avert up to 300 million new infections and, crucially, support $41 billion of domestic investment, which represents an increased rate of growth. It will generate economic growth of some $290 billion, which underlines my point that such investment in beating these diseases ultimately does not impose a cost on the economies that are required to find the money; it actually helps to generate economic growth.

The UK has a proud record of supporting the Global Fund. In particular, the UK contributed up to £1 billion over the last three-year replenishment period, which made it the third largest contributor among donor countries. That was made possible by the Government’s commitment to meeting the international target of spending 0.7% of gross national income on international development, at a time when other countries have scaled back their spending. However, it would be helpful if the Minister responded to some points about how the Government made their commitment.

First, some conditionality was placed on the investment, so that only if other countries raised a certain amount of money would the full UK commitment be met. There is a question about whether that really produces an incentive for countries to fulfil their contribution or whether the real effect is simply to reduce the UK’s intended commitment. I hope the Government will consider that closely when they review their commitment for the next cycle. For all the reasons that I have set out, I hope the Government will now consider making a similarly significant investment in the Global Fund going forward. We are talking about substantial sums, and they should not be committed lightly. The Government need to assure themselves that the money is being spent properly, and it is encouraging that the Department for International Development’s 2011 multilateral aid review, and its 2013 update, assessed the Global Fund as providing very good value for money. Other studies have underlined the effectiveness of how the Global Fund spends its resources.

If the world community’s support for the Global Fund were scaled back, it would raise serious questions about whether we mean what we say when we sign up to international agreements to beat diseases such as HIV/AIDS and malaria. There is no point in the world coming together and setting an ambitious target to eliminate such diseases in 15 years if those targets are not only not met but not met by a country mile. That would undermine the whole process of international agreement that brings countries together to say, “We will work together to tackle these diseases.” It would place the sustainable development goals in a different position from the millennium development goals, which, at least in part, were met in relation to the diseases in question. There would be an ongoing humanitarian cost, as lives would be lost. There would be a continuing risk of the development of drug resistance, which would not be addressed properly. In relation to diseases such as TB, it would raise the question, “If the Global Fund, the principal agent by which this disease will be tackled, does not have the resources to do so, where are those resources going to come from?”

The UK Government are doing a great deal to fight these diseases in addition to their Global Fund commitment, and I was delighted by the Chancellor’s announcement in the autumn statement of the Ross fund, which, in partnership with the Bill & Melinda Gates Foundation, will ensure that £1 billion is invested over a three-year period in a new fund to develop the new drugs and vaccines that will be needed to address the world’s deadliest diseases, including malaria and tuberculosis. That is exactly the kind of focus that we need on new tools to beat those diseases. Only if such new tools are developed will the diseases be tackled properly, particularly tuberculosis, so that is immensely welcome.

However, I want the Government to appreciate that unless they and their fellow major donors continue to contribute to the fund, the progress that we have made in beating diseases such as tuberculosis, which has already been too slow, will fall further behind target. That would be a serious matter, which is why this debate is so important, coming at the point when the new round of replenishment is being considered. It is why voices are needed to discuss the value of Britain’s international aid contribution and the importance of investing in the global fund. Of course there are issues to discuss about the fund’s effectiveness and operation, and other Members might discuss them, but the overall picture is that it has made a vital contribution to saving millions of lives. If we want to continue to do so and to beat these diseases once and for all, it is essential that Britain maintains its contribution to the Global Fund.

[Several hon. Members rose—]

--- Later in debate ---

[Nick Herbert]

May I make two apologies? First, I apologise to my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and indeed all hon. Members for foreshortening their time: my maths was insufficient and I had not realised the number of people who wished to take part in the debate, so I spoke for too long. That follows on from moving amendments on planning matters at 2 am last week, which added immensely to my popularity with colleagues. Those of us who wear Apple watches know that it is possible to receive electronic reminders when one should be taking more exercise. Perhaps a reminder to shut up when one is speaking for too long would be a useful additional app for someone to develop.

Secondly, I apologise to the Minister, because I should have welcomed him to his new position. The way in which he responded to the debate confirms the impression that many of us had that it is an ill wind that blows no one any good, and that his appointment and return to Government were immensely welcome, in particular to the Department for International Development. He has a genuine interest in international development matters and speaks with some passion about them. What the Minister said about the importance of the Global Fund and its replenishment to the Government and to him personally was encouraging.

It is important to debate such issues and we had welcome contributions from Members of many parties, in particular on the need to focus on the effectiveness of the Global Fund and the points made by my hon. Friend the Member for Stafford (Jeremy Lefroy). I hope that those points will be taken on board by the excellent director of the Global Fund, Mark Dybul, who has made great efforts to improve its effectiveness. We look forward to further discussion with him as well as with the Government.

A real issue is that of middle-income countries, which affects the Government’s international development agenda more broadly—when countries reach a certain income threshold, what is the right role for wealthier countries? We cannot simply step away. Much of the burden of those diseases falls on the middle-income countries and there is a real question about whether they would devote sufficient resources to tackling the diseases. If international bodies such as the Global Fund concentrate on other, lower-income countries, there is an imbalance in the resourcing and the focus is wrong. That is an important debate, which we will need to have.

This has been an excellent debate. I am delighted to tell the Minister that I, too, have been to Zambia, although I am sorry to say that I was not on the trip with my hon. Friends the Members for Plymouth, Sutton and Devonport (Oliver Colvile) and for Pudsey (Stuart Andrew) and the hon. Member for Edmonton (Kate Osamor). I look forward to an opportunity to follow their example in future.

Question put and agreed to.

Resolved,

That this House has considered the Global fund to fight AIDS, TB and malaria.

Sustainable Development Goals

Lord Herbert of South Downs Excerpts

Wednesday 28th January 2015 Commons Chamber

[Nick Herbert (Arundel and South Downs) (Con)]

I am proud to serve as co-chairman of the all-party parliamentary group on global tuberculosis, which was established as a cross-party committee in 2005, after a group of Members went to see the problems of dealing with tuberculosis in Kenya and were immensely struck both by the then failure to get on top of a disease that had resurged globally and by the inadequate attention paid to this disease in our national discourse. Since then, our parliamentary group has worked to increase the profile of this terrible disease, which still kills 1.5 million people a year worldwide—entirely unnecessarily when this disease is, in the main, easily treatable and curable.

It is striking to reflect that TB was declared a global emergency two decades ago and that since then 25 million lives have been lost. However important our efforts to tackle Ebola—I fully support them and welcome DFID’s work in that respect and the sacrifice that many are making in doing so—we should note that TB kills as many people every two days as Ebola has so far killed in total. We have to make sure that we have a focus on this disease, while maintaining focus on the need to beat old diseases that pose a new threat today.

Yes, there have been successes. New cases have fallen sufficiently to meet the millennium development goal target, and deaths have nearly halved since 1990, but there are still 9 million new cases of TB globally every year. The number of new cases in central Asia, Africa and eastern Europe is not declining, and that is of particular concern. Moreover, we should note that the decline in new cases globally is only 1.5% a year. At the current rate, it will take us two centuries to beat the disease.

When the west got on top of TB, the annual decline was 10 percentage points a year. That tells us that unless we accelerate efforts to tackle the disease, we shall face a huge loss of life over the next 200 years, and we shall also face the growing costs of dealing with the disease. One of the reasons for that rise in costs is drug resistance. Drug-resistant TB is caused by the fact that we have drugs that are 60 years old. We have old-fashioned antibiotics. Nor do we have a proper vaccine for TB, although many believe that we do. As a consequence, we are seeing the emergence of a lethal form of TB that is 450 times as expensive to treat. It is worrying that less than a quarter of drug-resistant cases of TB are detected, and only half are successfully treated. The Prime Minister’s anti-microbial resistance commission, which was established last July, has warned that a failure to tackle drug resistance could mean 10 million deaths from all diseases by 2050, and that, crucially, that would reduce world GDP by two to three and a half percentage points by 2050. All those facts make the case for more action now.

[Pamela Nash]

The right hon. Gentleman is making a powerful speech, and I agree with what he is saying, but is he as disappointed as I am that the Government have not committed themselves to the widely supported target of ending AIDS, TB and malaria by 2030?

[Nick Herbert]

No. I was about to say that the Government’s response has been superb. They have just committed £1 billion to replenish the global fund, which is one of the biggest commitments that have been made. Eighty per cent. of all the world’s funding to fight TB is channelled through the fund, and as a result 12.3 million TB sufferers have been tested and treated so far. However, it should be recognised, in the context of the overall programme for tackling TB and the World Health Organisation’s target of ending TB by 2035, that there is a £2 billion annual shortfall. That is not the responsibility of the United Kingdom. There is a global shortfall amounting to a quarter of the resources that we need to beat this disease.

Let me urge two courses of action. First, we need to focus in the sustainable development goals on diseases that we can beat—TB, HIV and malaria—and on an explicit target to beat them. Secondly, we should step up our research and development effort to combat TB. We are at a tipping point: there is an opportunity, and there is a threat. The opportunity is the availability of new technology, which could enable us to beat TB within a generation. The threat is drug resistance, along with inadequate funding and insufficient efforts to combat the disease. That could mean an awful lot of cost and human suffering in future. DFID is the world’s best funder of research and development, and, given its fantastic leadership position, it could convene an international effort to step up research and development to beat TB.

I am proud to have led the formation of a global TB caucus last year, when 170 Members of Parliament from five continents came together to urge stronger action to tackle this disease. The success of our Committee and the caucus has been due to their cross-party nature, and the fact that they have operated on the basis of consensus. That tone was sadly lacking in the ill-judged speech of the hon. Member for Wakefield (Mary Creagh).

Global Health (Research and Development)

Lord Herbert of South Downs Excerpts

Tuesday 8th July 2014 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I am grateful to be able to take part in this debate and I will speak briefly. First, I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing the debate. I am very proud to co-chair the all-party group on global tuberculosis, which he and I co-founded with our Labour co-chair, the hon. Member for Ealing, Southall (Mr Sharma). I am also very proud of the report that we have just produced, to which my hon. Friend referred, “Dying for a Cure: Research and Development for Global Health”, which covers precisely the issues he has raised in this debate.

May I say in parenthesis that there is much debate about the support provided to all-party groups. Our report simply would not have been possible without our all-party group’s first-class secretariat, which is funded by Results UK and other organisations and has enabled our excellent researcher, Matt Oliver, to help with the drafting of the report. That goes to show that not all external support for all-party groups is bad—far from it. Without that support we simply would not have been able to produce the report. It is important that Members speak up for legitimate all-party groups that have important work to do.

I want to focus particularly on tuberculosis, which still kills 1.3 million people a year—quite unnecessarily, given that it is a treatable and curable disease. There is a particular new threat because of drug resistance, which is a serious problem and a concern not just globally but in this country. I commend the Prime Minister’s stance on the significance of drug resistance as an issue that this country has to address in future. Our all-party group was reminded of that recently when we travelled to Bucharest in Romania and visited prisons and clinics around the country where TB is prevalent—not just TB but drug-resistant TB. In Romania, as well as in other developing and underdeveloped countries throughout the world where TB is a serious problem, the issue is not just access to drugs, which can of course be corrected by the west making significant interventions through the global health fund and other means to provide drugs where they are available; it is also a problem of availability.

Our report seeks to address the simple fact that there is insufficient availability of diagnostics and treatments for tuberculosis. I have mentioned this in a previous debate on the same issues in this Chamber, but I want to repeat myself because it is important: it is sobering that if TB had resurged in the west, pharmaceutical companies would by now have found the investment required to produce significant new tools for its diagnosis and treatment, as has happened for HIV. Amazing new cures and treatments are available for HIV. Why? Because HIV has been a disease of the west as well as cruelly affecting the developing world.

Although it has made something of a comeback in the west, TB has not been perceived in the same way. It has continued to claim the lives of millions, but only in developing countries, so it has not received the attention. Nor are there the straightforward financial incentives for pharmaceutical companies to develop the necessary tools. There is still no vaccine for TB. People believe that there is, but there is not: the BCG vaccine is partial and relatively ineffective for adults.

The first-line drugs that are used to treat TB were developed decades ago, must be taken over an extended period and are part of the reason why drug-resistant TB is a problem. The diagnostics for TB are old-fashioned and inadequate. All this is not the fault of drugs companies; in a free market they simply do not have the commercial incentive to develop new tools because there would be no market for them to sell to.

[Mr O'Brien]

I am grateful to my right hon. Friend for giving way to me, particularly on my second intervention in this debate. I have just returned from Papua New Guinea, where, given my interest in malaria, it was impressive to see Oil Search—to refer to his point about delivery—delivering across extremely difficult and hostile territory, in the complete absence of any other form of provision. Multi-drug-resistant tuberculosis was its main challenge. Often, pharmaceutical, distribution and oil and petrochemical companies are becoming part of the solution as they extend their provision, whether that includes GSK considering the pricing of its malaria vaccine or Novartis distributing malaria drugs. Equally, on TB, Oil Search is becoming part of the solution as part of its extended corporate social responsibility, as well as ensuring research and development for non-purchasing-power markets. I thoroughly endorse where my right hon. Friend is taking this debate.

[Nick Herbert]

I am grateful for my hon. Friend’s intervention. I think that corporate social responsibility can be part of the solution, but it will not be a sufficient solution. What we have here is significant market failure. Where there is market failure, there is an imperative for Government intervention. One can still believe in markets—the power of markets, and pharmaceutical companies’ freedom to do all the wonderful things that they do—yet understand that where there is market failure, there must be intervention. That is what we need. Given that it can cost about £1 billion to bring such drugs to the market, intervention is necessary, whether in the form of product development partnerships or an adjustment to tax credits for research and development. We make that particular proposal in our report, and I commend it to the Minister. That sort of intervention and Government support for research and development will be essential if we are to beat those diseases.

--- Later in debate ---

[Mr Duncan]

We will, of course, write to the right hon. Gentleman, as requested, with our thoughts and views on his proposal. I have no doubt that officials will be happy to discuss with him, in person, what he thinks should be done, should he so wish it.

DFID is also utilising research and development techniques to understand better the environment in which we operate and it is working out how we can anticipate future trends. One example is in antimicrobial resistance, which has been mentioned today—a future threat on which the UK Government are taking a leadership role globally. DFID is supporting an initiative to track drug resistance to malaria in south-east Asia as it potentially spreads through the region and, critically, towards Africa. That will help target new antimalarial drugs, the development of which is also being supported by DFID.

Research alone will not alleviate poverty, which is why DFID also invests heavily into putting research into practice. Our programme, Research into Results, which is designed to convert theory into practice, is a perfect example of that. In my recent visit to Edinburgh university, I saw the good work being done in setting up small-scale businesses able to take the best research ideas coming out of universities and get them into widespread use. So many of the development challenges we face today rely on solutions from research, and solving many of the challenges we will face tomorrow will rely on the research and development investments that we make today.

[Nick Herbert]

Will my right hon. Friend give way?

[Mr Duncan]

I have only three lines of my speech left, but since it is my right hon. Friend, I will.

[Nick Herbert]

I am grateful. I welcome everything that my right hon. Friend has said, the commitment that DFID has shown to this area and his undertaking that the Department will look carefully at the report. Does he think, in the overall scheme of things, that the global response to these diseases, many of which are pandemics, is equal to the task? It has taken an enormous global effort in other respects to tackle these diseases, such as with the establishment of the global fund. Only one TB drug has been approved by the Food and Drug Administration in the past 50 years. It was developed by Janssen Pharmaceuticals, by doctors who were not authorised to take it forward because they knew it would not be commercial. Finally, the company allowed the drug. Unless there is a step change in the response in the developing world to this problem, I wonder whether we will deal with it.

[Mr Duncan]

I agree with my right hon. Friend. We had a passionate debate on TB just a few months ago, in which he spoke on a subject on which he commands the House. The scale of the activity is not yet equal to the task, and it needs to be. That is why I urge all developed countries to match the 0.7% commitment that we have made. We, having taken the lead, should be followed by others. We can be proud that we are in the lead, and if others did what we did, we might well be up to the scale of the task that he illustrated. On that purposeful note, I say that we are committed to maintaining our record of funding high quality, high impact research and to putting that knowledge into use, so that we all, in the work we do, can save many thousands, if not millions, of lives.

Tuberculosis

Lord Herbert of South Downs Excerpts

Wednesday 27th November 2013 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I congratulate the hon. Member for Scunthorpe (Nic Dakin) on securing this debate. I am delighted to be taking part in it, particularly as I have resumed the co-chairmanship of the all-party group on global tuberculosis, now that I am free to do so. It is, quite properly, a cross-party co-chairmanship, which reflects growing concern in the House about what is often a “Cinderella” disease—one that is not talked about as much as some other diseases that are still claiming lives today.

We are, properly, concerned about the terrible tragedy in the Philippines and the loss of thousands of lives and we are, properly, marking world AIDS day on Sunday and the millions of lives that have been claimed by that disease. There is a strong overlap, as the hon. Gentleman pointed out, between HIV and tuberculosis, which many still believe is essentially a disease of the past. Indeed, before I became involved in this movement, I thought so too. In the 19th century, tuberculosis—consumption—was regarded sometimes even as a romantic disease, as featured in many operas of that era, yet one in four people in Europe were dying of consumption at that time. It was only with the advent of modern medicine—antibiotics—and the west’s attack on poverty in the late 19th and early 20th century that the disease was brought under control.

There are some sobering observations to make about the rate at which TB—which, as the hon. Gentleman said, has now resurged here, as a disease of the present—is being tackled, compared with the rate at which the west dealt with it in that era. At the current level of progress that the west in making in dealing with a disease that is still claiming 1.3 million lives a year—unnecessarily, because in the main it is easily and cheaply curable—we will have to rapidly step up the efforts that are being made, because the incidence of this disease is currently declining by 2% a year. If we continue at this rate, it will take more than a whole lifetime—a whole generation—and it will be more than 100 years before we tackle this disease properly and get it under control. That will mean that millions of lives will needlessly be lost.

On top of that, there is a growing threat—one that now amounts to a serious issue for this country as well—of drug-resistant TB, the emergence of which is entirely a reflection of the ancient way in which we treat this disease. Were it not for the fact that people with TB require lengthy treatment with antibiotics, because the drug regimens are old-fashioned and no new drugs have been developed, and were it not for the prevalence of counterfeit drugs and the inadequacy of health regimes, drug-resistant TB might not have developed with such ferocity. However, it is now a serious matter of concern, and not just in developing countries, where people unlucky enough to be diagnosed with drug-resistant TB—and few are—almost always face a death sentence. Acquiring drug-resistant TB in a developed country with an advanced health system would still require an expensive and extremely painful course of treatment over months and years.

[Mr Gregory Campbell (East Londonderry) (DUP)]

While the right hon. Gentleman is elaborating on the complications that follow diagnosis, does he agree that there is a shocking compounding of the problem worldwide, because in some countries lung cancer is being diagnosed to a considerable degree in people who are subsequently diagnosed with TB?

[Nick Herbert]

The hon. Gentleman raises an interesting point. The starting position has been that we need the means to diagnose this disease.

Let us face up to the fact that if the resurgence of this disease had been in the west, it would already have been tackled by now. The pharmaceutical companies would have had a commercial interest in developing better diagnostics and tools, better drugs and, indeed, a vaccine. Another common misconception is that a vaccine is available to deal with TB, but only the BCG vaccine exists, and that is generally ineffective for most forms of TB and works for children for a limited time. Had this disease resurged in the west, by now we would already have these things, but we do not, because the drug companies did not have a commercial interest in developing them, essentially because the disease was found in developing countries without the economies or the wherewithal to pay for these new tools.

There can be no better example of the necessity for intervention by wealthy western Governments, who have the resources to ensure that such a disease can be tackled, not just in the interests of ensuring that lives can be saved—there is a profound moral reason to tackle this anyway—but in the west’s interests in securing the economic development of high-burden countries that are afflicted with this disease, which is a tremendous brake on economic development. Of course, TB is a disease that knows no borders, and with migration, and so on, we face the prospect of it resurging in our country. We have higher rates of TB in this country now—although they are low by comparison with high-burden countries in the rest of the world—than in the rest of Europe. We have failed to reduce rates in the past 10 years, as compared with the United States, for example, which has got on top of the problem. This is a pressing public health issue in this country.

There are lots of reasons for western Governments to be concerned about this issue. Therefore, I strongly endorse what my hon. Friend the Member for St Ives (Andrew George) said about the UK Government’s recent commitment, which has not been sufficiently noticed, to replenish the global health fund. That is a fantastic commitment, not just because of the absolute sums pledged to the global health fund—which is an effective means of tackling TB and is responsible for 80% of the funding for TB programmes across the world—but because it sends a powerful message, ahead of the replenishment summit next Monday, to other potential donor countries about the value of stepping up our efforts at this time.

The west faces a choice. We have the opportunity, with the potential emergence of new treatments, diagnostics, and so on, to get on top of this disease. If we relax our efforts and fall victim to the idea that, at a time of austerity, the west might pull back from some commitments that it is making, our efforts to tackle TB would go into reverse. This is an important moment to step up to the plate. Britain has done so admirably. I commend the work of the Secretary of State for International Development and Ministers in making that commitment, and I encourage other countries to do the same.

[Andrew George]

Again, I congratulate the Government on their efforts regarding the global health fund, which sets the tone, but is my right hon. Friend and co-chair of the all-party group aware that just before this debate the Government published the HIV position paper, which appears to suggest that the UK’s contribution to eradicating TB can largely be delivered through the global health fund, whereas for HIV it can also be delivered by a significant strategy pursued by the Department?

[Nick Herbert]

I hope the Minister has noted my hon. Friend’s point, because TB control programmes rely on funding from the global health fund. We need to send that message to the global health fund as it determines resource allocations and to other countries as they consider replenishing their support.

My final point is that although the Government’s support for the global health fund is welcome, it is important to understand that that is not the only thing we need to do if we are to get on top of TB globally. Setting aside the action that needs to be taken domestically—Health Ministers are making progress on what needs to be done through a TB control programme—we cannot rely on the generous commitment to the global health fund for the international effort that is needed.

I want to raise the cause of an important programme run by the Stop TB Partnership called TB REACH, which addresses the problem of the missing 3 million cases to which the hon. Member for Scunthorpe referred. Until we find those who are affected by TB, we have no chance of treating them or getting hold of the disease. The power of TB REACH is that it funds innovative programmes on the ground that are finding new ways to go out and identify the missing 3 million cases. TB REACH has been robustly evaluated and shown to deliver value for money. It is relatively cost-effective, but its funding is coming to an end. TB REACH was largely set up with funding from the Canadian Government and now does not have sufficient funding to identify all the necessary cases. TB REACH has helped to identify some 500,000 cases in the past year, and it needs to do more. If we are serious about the level of the challenge we face, it would be worth while for the Government to seriously consider contributing to the ongoing work of TB REACH to ensure that the programme can survive.

[Mr Kevin Barron (Rother Valley) (Lab)]

Earlier this year I was a member of the parliamentary delegation that visited TB REACH in Awasa, in Ethiopia. TB REACH is doing outstanding work to find those missing people. I concur with the right hon. Gentleman and add my support. Hopefully the Government can find money to put into TB REACH, as it is not funded through the global health fund.

[Nick Herbert]

I am grateful to the right hon. Gentleman, because that is precisely the point I am trying to make. I understand that TB REACH has helped to identify some 750,000 cases of TB and prevent those people from becoming infectious, as they would otherwise have continued to infect others.

The budget of TB REACH is relatively small. It is asking for $40 million a year. In the overall scale of the interventions that the west is now making to control the major diseases of HIV, malaria and TB, the funding is relatively small, although obviously it is not insignificant. The programme is worth while; I therefore ask the Minister to address that point. I have just written to the Secretary of State for International Development and hope to meet her to discuss TB REACH at this important moment, as the programme’s future is being considered.

I am grateful to the Government and to hon. Members on both sides of the House for the interest they have shown in TB. A few years ago, very little interest was shown in the disease, despite the huge interest shown in other international development issues. That has changed. I believe that the work of the all-party group has helped, as have the many non-governmental organisations that are supporting us—in particular, Results UK has played an important role in raising the profile of TB. We have a moral imperative to tackle the disease, and doing so is within our reach. It is now essential that we step up the efforts to ensure that it is not another 100 years before we beat a disease that the west once thought it had beaten.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Duncan]

The hon. Gentleman has raised a serious point. If he will bear with me, I will come to the issue of South Africa in just a moment. As he and the right hon. Member for Neath (Mr Hain) said, the issue is obvious and compelling, and has to be addressed.

In spite of tough times, the broad picture for the UK is that we are delivering on our promise to spend 0.7% of gross national income on development. This year we will become the first G8 nation ever to do so. We are clear about our responsibility to deliver aid that is transparent, that delivers value for money and that produces the best results for the world’s poorest people. Our support to the Global Fund to Fight AIDS, Tuberculosis and Malaria helps to do just that. Between 2002 and 2012, the global health fund supported the detection and treatment of 9.7 million cases of TB.

To respond to the continuity point raised by the hon. Member for Wirral South (Alison McGovern), who spoke from the Opposition Front Bench, last month the UK Government committed up to £1 billion over the next three years, which is enough to save a life every three minutes. The global health fund allocates 18% of its funds to TB, which equates to £180 million of UK development funding specifically for that disease. Improving basic TB control is critical to prevent the further spread of TB, and includes early detection and diagnosis of people with the illness, ensuring that they get the right treatment and care, and checking that their families and other close contacts do not also have active TB. Also important is the reporting of cases, so that health authorities can better monitor them and improve their services.

Let me turn to the work we are doing through our country bilateral support programmes. DFID is working closely with the Government of South Africa to expand the quality and access of public sector services, including TB control, and is increasing the speed with which new TB drugs are registered. In conjunction with the World Bank, DFID is also engaged in a new partnership with the private sector in South Africa. The partnership has been set up to increase public-private collaboration to reduce the high incidence of TB specifically in miners and in the communities around them. We will continue to focus on that important target group, to which the hon. Member for Easington (Grahame M. Morris) referred. In India, DFID is working with Indian pharmaceutical manufacturers to improve the price and security of supply for high-quality drugs for resistant TB and new low-cost diagnostic products.

Co-infection has been covered thoroughly today. Many countries have made considerable progress in addressing the combined epidemic of TB and HIV. However, there were still 320,000 deaths from HIV-associated TB in 2012. DFID is supporting improved co-ordination and collaboration between TB and HIV services jointly. As part of our commitment to the global health fund, we are pushing it to do more to prevent, diagnose and treat TB and HIV co-infection.

The UK Government are very concerned about the spread of drug-resistant TB, which probably results from the improper use of antibiotics. A patient who develops active disease with a drug-resistant TB strain can transmit that form of TB to other individuals, which threatens the whole global response to TB. Drug resistance increases the cost of treatment and makes it more difficult to ensure that effective treatment is accessible to the poorest. We support efforts to tackle drug-resistant TB through our support to UNITAID, the global health fund and research.

The UK has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. We support a number of product development partnerships that bring together a range of public, private and community organisations. They are designed to develop and deliver new products more rapidly and more cheaply than either the public or private sectors can do alone.

I should mention TB REACH, to which four or five hon. Members referred. The issue is not as straightforward as any of us in public policy would like. We have reviewed the external mid-term evaluation of TB REACH, and the findings suggest that it has successfully funded pilot projects and innovative approaches, which we applaud. The question is whether it will be able to roll them out effectively in the long term and on an adequate scale. We propose that DFID officials should meet the executive director of the Stop TB Partnership to discuss how the global health fund can better support the expansion of proven TB REACH projects. It is important the TB REACH implementers co-ordinate more closely with national TB control programmes—again, that was raised today—and are part of national planning processes. That is crucial to secure longer-term support.

[Nick Herbert]

I am grateful to the Minister for responding to our points about TB REACH. Does he accept that although it will no doubt be worth having a dialogue with the global health fund about supporting proven TB REACH projects, further projects will rely on the continued funding of that programme? As my hon. Friend the Member for City of Chester (Stephen Mosley) effectively said, TB REACH funds projects that the global health fund will not fund because they are unproven. TB REACH allows innovation on the ground in such projects. Will the Minister reflect on that and consider my request for a meeting to discuss the TB REACH programme before a final decision is taken about its funding?

[Mr Duncan]

I certainly undertake to consider that, but obviously, as I am on my feet at the moment, I cannot give a commitment. We provide core funding to the Stop TB Partnership, some of which is used to support TB REACH continuously. I understand exactly what my right hon. Friend is saying, and I hope that the meeting to which I have referred can explore that point in more detail and address his concerns conclusively.

DFID has also supported the Foundation for Innovative and New Diagnostics—FIND—to develop a rapid molecular test, GeneXpert, to which reference has been made. It can be used by health care workers with minimal training and laboratory facilities. The test is associated with a 40% improvement in case detection rates and can provide test results within two hours. Working through the Stop TB Partnership and UNITAID, the Department has supported the policy development and distribution of GeneXpert, which is available in 29 countries. In August, DFID announced support to nine public-private partnerships, including FIND, the TB Alliance and Aeras. Those partnerships will help to fund crucial work on developing new and more effective tools to prevent, diagnose and treat TB.

We cannot shelter the UK from what is happening around the world. In 2011, nearly 9,000 cases of TB were reported in the UK. More than 6,000 of them were in people born outside the UK. The patterns must be analysed, followed and fully understood. A cross-government approach is also essential. Public Health England has made TB one of its priorities and is working to oversee a stronger national approach.

Resistance to all antimicrobials—the drugs used to prevent and treat bacterial, fungal, viral and some parasitic infections in humans and animals—is increasing, but of greatest concern is the rapid increase in bacterial resistance to antibiotics, including those used to treat TB. In September, the Government published a new five-year antimicrobial resistance strategy, which sets out actions to slow the development and spread of anti- microbial resistance, including strengthened international collaboration. That is why DFID will continue to work with the Department of Health and others to provide national and international policy leadership. We must play our part in ensuring co-ordinated action to tackle TB at home and abroad.

In conclusion, significant progress has been made since 1995 in controlling TB, with more than 56 million cases treated and 22 million lives saved. That progress has been rooted in improved partnership, policy, innovation, and national and international leadership. We have grounds for optimism, but we are not complacent about the significant challenges ahead, in which the UK will continue to play its full part.

Drug-resistant Tuberculosis (Developing Countries)

Lord Herbert of South Downs Excerpts

Tuesday 4th June 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

What a pleasure it is to serve under your chairmanship, Mr Caton. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate, and I thank him for having done so. I will try to get through all the points that have been raised, but if I do not we will contact hon. Members afterwards.

Tuberculosis is an age-old disease. It is tenacious and persistent, and affects the poorest people in the world and those who are socially marginalised. Every year there are 9 million new cases and nearly 1.4 million deaths. Although its incidence has been declining slowly since a peak in 2004, and mortality rates have fallen by 41% since 1990, the vast majority of TB deaths—more than 95%—are in the developing world.

Despite some progress, there were 400,000 cases of multi-drug resistant TB in 2011. As honourable colleagues will be aware, MDR-TB is more difficult and more expensive to treat than TB. Its spread is threatening the global response to TB, and makes TB control even more difficult. It is true, therefore, that TB continues to affect the poorest people in the poorest countries, and remains a serious threat to global health, especially through the rise of MDR-TB.

The coalition Government share the concerns about drug resistance, and we remain committed to the global goal of halving deaths from TB by 2015. The emergence of drug-resistant strains of tuberculosis poses a serious threat to the achievement of that goal and, indeed, to the effectiveness of our current armoury of medicines and treatments.

Our priorities for TB, and for MDR-TB, are to help to increase access to effective diagnosis and treatment of TB; to invest in research and product development in more effective treatment, diagnostics and vaccines; to support countries to strengthen health systems to deliver quality TB programmes—a really important point—and to work with our partners to tackle the risk factors for TB, including poverty and malnutrition. That is not always highlighted, and most of the work of the Department for International Development focuses on dealing with poverty and malnutrition.

As highlighted by the hon. Member for Poplar and Limehouse, Public Health England is developing a national strategy for TB, and engaging with key partners such as local government, the National Institute for Health and Care Excellence, NHS England, academia, the voluntary sector and the Department of Health. DFID will obviously input into the process, and will work with the partners on their strategy, to produce national and international policy and to ensure that there is co-ordinated action on domestic and global approaches to reducing rates of TB.

Our first priority is to improve basic TB control. Basic control includes early detection and diagnosis, effective and complete treatment, and contact tracing. Basic control is also critical in preventing the further spread of drug-resistant tuberculosis. If we do not deal with basic TB, the incidence of MDR-TB will be accelerated. We also help to strengthen all aspects of TB control through direct and indirect funding channels in a range of high-burden countries.

I will quickly give three examples. We are working with the Government of South Africa to expand the quality of and access to public sector services, including that of TB control, and are increasing the speed with which new TB drugs get registered. We have engaged in a new partnership with the private sector in South Africa and the World Bank that aims to reduce TB in mining communities, which I think will be welcomed on both sides of the House.

In India, DFID is working with Indian pharmaceutical manufacturers to improve the price and security of supply of high-quality drugs for resistant TB and the manufacture of new low-cost diagnostic products. In Burma, we are providing bilateral funding to the 3MDG fund, a multi-donor fund for the health sector, which is supporting disease control among the poorest communities.

[Nick Herbert (Arundel and South Downs) (Con)]

I, too, am a member of the all-party group on global tuberculosis, and I visited South Africa recently with Lord Fowler. Is that country not a good example of the problem of drug-resistant TB? A full third of the budget that South Africa has to deploy in dealing with TB is spent on drug-resistant TB, yet the incidence of such TB is only 2%. That underlines the importance of getting on top of that form of TB so that the costs do not run further out of control and undermine the fight against the disease.

[Lynne Featherstone]

My right hon. Friend makes an excellent point. South Africa is an epicentre, so far as its spend on what is a relatively confined industry is concerned.

I was talking about Burma. It is estimated that between 2013 and 2016, the 3MDG fund will spend $20 million on tuberculosis. Funding is an important strand. DFID also supports a number of global partnerships that work on strengthening basic TB control. For example, the Stop TB Partnership plays a critical role in helping countries to strengthen their TB policies, and in supporting the improvement of funding applications for large TB-control grants.

The UK’s contribution to UNITAID, of up to €60 million per year, has funded new laboratory infrastructure in 18 countries, 10 of which now routinely diagnose MDR-TB. The network will have detected approximately 12,000 MDR-TB cases by the end of 2011, compared with only 2,300 cases in the same countries in 2008.

I will move on to the Global Fund to Fight AIDS, Tuberculosis and Malaria, because I know it is of particular interest—this is not the first occasion on which it has been raised with me. The majority of UK funding to global TB control is channelled through the Global Fund to Fight AIDS, Tuberculosis and Malaria, and we have increased and accelerated our funding and are on track to meet our £1 billion commitment to the fund for 2008 to 2015. The fund is, as hon. Members have mentioned, absolutely critical to achieving many of the UK’s health-related international development objectives, so it is important to us that it continue to deliver ever-more impressive results. The UK intends to increase its contribution, pending, as we have said, progress on the implementation of crucial reforms. That obviously falls within my portfolio, and I have had reports from all DFID offices around the world, having asked them to report to me on the fund. Recently I was in Nigeria and had a meeting with recipients of global funding from across the three diseases, to understand the changes that are being heralded in with the reforms at the global fund—so far so good.

We are committed to working with others to ensure that the planned autumn replenishment is a success. We are a world leader, but sometimes it would be nice to be at least equalled in some of these things by other donor countries. We will use our influence to draw in more overall financing. I understand the call to go early, but there are many multinational decisions to be made and, as I have said, this all depends on progress.

On investment in research and innovation, which I think all Members would agree is critical, DFID has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. An example of that is our effort to increase the affordability of diagnostic testing for MDR-TB. DFID’s support of the Foundation for Innovative New Diagnostics has contributed to the development of a rapid molecular test, GeneXpert, which has the potential substantially to improve the diagnosis of TB and drug-resistant TB.

DFID aims to continue our strong record of supporting investment in TB research and development, including through product development partnerships, and we will strive for value for money in such investments. On DFID’s support for innovation, we will consider the hon. Gentleman’s request that we fund TB REACH against, obviously, the competing priorities and commitments in our international health financing decisions.

HIV (Developing Countries)

Lord Herbert of South Downs Excerpts

Wednesday 19th December 2012 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing the debate and on drawing attention to the continuing importance of these issues. [Interruption.]

[Hugh Bayley (in the Chair)]

Order. I must interrupt the right hon. Gentleman early in his speech, because there is a Division in the House. I suspend the sitting, and I ask Members to get back as quickly as possible. We will resume as soon as those who are here have returned to their places.

Sitting suspended for a Division in the House.

On resuming—

[Nick Herbert]

As I was saying before I was interrupted, I am grateful to my hon. Friend the Member for Mid Derbyshire for securing the debate and for raising the issue of tuberculosis. It is often the orphan disease, in terms of public attention and understanding in this country. Nowadays it is possible to hear people say that they believe TB is resurgent, and that betrays a certain attitude—that somehow the disease is relevant only when it occurs in this country, where we believed we had it beaten, whereas there continue to be 1.5 million unnecessary deaths a year globally, because of a disease that is, essentially, easily and cheaply treatable. That is relevant to this debate in the context of TB and HIV co-infection, which is a particular problem.

At least one third of the 34 million people living with HIV worldwide are infected with latent TB, and TB is the leading cause of death among people living with HIV. It accounts for one in four HIV-related deaths. In fact, last year, some 430,000 people died of HIV-associated TB. In 2005, when I was first elected, I joined a party that included my hon. Friend the Member for St Ives (Andrew George), who is now the chair of the all-party group on global tuberculosis, on a visit to Kenya, indirectly sponsored by the Bill and Melinda Gates Foundation, to go and see the problem. The success of the visit was that it drew the importance of TB to the attention of a few of us. Afterwards, we founded the all-party group, and since then we have continued to try to raise the profile of the need to deal with that disease. I had to step down as co-chair of the group when I became a Minister, but I am pleased to have resumed my interest since stepping down from the Government.

There are things that we still need to draw attention to, in connection with the problem, and I want to raise a couple of them. First, anyone who doubts the importance of focusing on HIV and TB together, and ensuring diagnosis of both diseases, need look no further than sub-Saharan Africa. There were more than 1 million HIV-positive new TB cases globally in 2011, but around 79% of those patients live in sub-Saharan Africa. That is the only World Health Organisation region that is not on track to meet the millennium development goal for TB, which is to halve the 1990 prevalence and mortality rates by 2015. We need attention on that region and on that incidence of co-infection. It is highly unlikely that the target will be met, because of the negative impact of the HIV epidemic. For the world as a whole, reaching the 2015 prevalence and mortality rate targets will be possible only if TB control efforts, and funding for those efforts, are sustained.

The Government have a clear understanding of the importance of an approach based on the possibility of co-infection, and the need for integrated programmes of diagnosis and treatment. Their position paper on HIV, published in May last year, recognised that, which is welcome. The Government’s major contribution, in particular through multinational channels such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, is also welcome. A considerable portion of it is invested in TB interventions.

There are two things that I want to draw to the attention of my hon. Friend the Minister. The first relates to diagnosis. It is striking that the diagnostic ability and treatment for HIV are much further ahead than they are for TB, yet TB is a more easily and cheaply treatable disease. Why is that? It is straightforwardly because HIV is a disease that affected the west, and TB was a disease that the west believed had gone. Its attention was therefore not on it. The resources and money that were invested in necessarily trying to deal with the terrible and growing problem of HIV were not directed in the same way at TB. Therefore, the diagnosis of TB is not as quick as it should be, and the treatments go on for an extended period, with old-fashioned drugs that must be taken on a continuous basis; if they are not taken in that way, the problem of drug-resistant TB arises—and that is a killer and particularly difficult to deal with.

When people living in poverty are far from the facilities that they need to travel to repeatedly for diagnosis and to get drugs, there are no incentives to get the diagnosis and continue to take the drugs for an extended time. Something that should be cheaply and easily dealt with is not, and that accounts for the numbers of deaths. That is why programmes that improve diagnosis are welcome.

I want to draw the Minister’s attention to the TB REACH programme, which is a WHO initiative that gives small grants of up to $1 million to find and treat those who have no access to TB diagnosis or treatment. It is an incubator for innovation. It pushes the frontiers of mobile phone technology in health, and the deployment worldwide of rapid diagnostics. Even if my hon. Friend cannot answer today—I know she has a lot to get into her response—perhaps she would just consider the power of the TB REACH programme, and the support that the Government might be willing to give it in future.

The second issue that I wanted to raise was diagnosis and vaccination. The first thing that people in the west tend to say about TB is “Surely there is a vaccination available for it.” People know about vaccinating children in this country. However, the vaccination is not available for adults; if a vaccination were available, in developing countries, there would not be such a problem, and there would not be deaths on such a scale. Research and development of a vaccination is therefore as important as R and D of improved diagnostics. It is particularly important for the growing threat of drug-resistant TB, which is not so easily and cheaply dealt with, and can indeed be a killer, evading all medical treatment, including what might be available in the west. My second question to the Minister is therefore this: what support are the Government giving to TB vaccine development, which would be so important in heading off the incidence of the disease and save a large number of lives every year?

On the wider debate about why it is necessary to maintain public spending on international development and aid, there are few better examples than the successful spending of money, through the global fund and directly, on programmes doing very simple things—providing the diagnostics for TB and securing treatment. The intelligent organisation of those programmes to address TB and HIV co-infection is particularly important. We should hold TB up as an example of a disease that we in the west believed we had conquered, but that we are now concerned about, because it is coming back. We can treat it relatively easily, but we have ignored the fact that every year it killed 1.5 million in the rest of the world. We should be concerned about that, too.