Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Northover Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Northover (LD)]

My Lords, I thank my noble friend Lord Chidgey for securing this important debate at a very important time. I also pay tribute to my noble friend Lord Verjee for his moving maiden speech. I am absolutely delighted that, with all his wide experience—as the noble Baroness, Lady Hayman, outlined—he chose to make his first speech in this debate, which I am answering. It is also excellent that so many noble Lords who have such an outstanding track record in this area, especially my noble friend Lord Fowler, have contributed. I thank noble Lords who paid tribute to what we are doing, especially my noble friend Lady Tonge, as I know how very hard won is her praise.

As noble Lords made clear, AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2012 alone, AIDS killed 1.6 million people, malaria 627,000 and TB 1.3 million. However, great 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 to 1990 levels. Just 10 years ago, the world struggled to respond to HIV, TB and malaria, and access to key prevention and treatment interventions was very limited—as noble Lords will remember. This picture has now been transformed and the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a major part in this. Since 2002, Global Fund-supported programmes have detected and treated 11.2 million TB cases and distributed 360 million treated nets. Some 6.1 million people living with HIV are now receiving antiretroviral therapy thanks to the Global Fund. That is truly a remarkable achievement.

However, as my noble friend Lord Fowler and the noble Lord, Lord Collins, pointed out, we must not give up now and cannot be complacent. Improvements are not uniform in all countries. As my noble friend Lady Tonge said, resistance to effective medicines is a growing threat. Devastating rebounds can occur quickly. That is why we must redouble our efforts and increase our commitment. As my noble friend Lord Fowler made clear, we now have a historic opportunity to make a decisive impact on these diseases. We have effective tools to prevent and treat them and an unprecedented global commitment to transform the three diseases into manageable health problems rather than national and global emergencies.

Last week at the Global Fund’s replenishment conference in Washington, donors pledged $12 billion. That is the largest amount ever pledged—a 30% increase on the amount pledged at the 2010 replenishment conference. But $12 billion is only the start: the fund aims to raise a further $3 billion over the next three years to bring this to $15 billion and make the most of this historic opportunity. The UK is playing a groundbreaking part in that, as noble Lords noted. We are committing £1 billion—provided that that is not more than 10% of the total replenishment value—to encourage other donors to come forward and meet the target. Developing countries, civil society and the private sector also have crucial roles to play. Last week the Gates Foundation announced that it would provide up to $200 million to match other donor commitments. We hope that that will encourage new partners, including private contributors, to join the global effort.

I assure my noble friend Lord Chidgey and the noble Baroness, Lady Nye, that we are working very hard to ensure that others follow suit. That is why the UK, the US and the Gates Foundation have made our contributions conditional. The most important role, of course, will be played by the countries themselves: designing effective national strategies; using funds transparently and well; and providing the bulk of financing from their own domestic resources. It was notable and historic that Nigeria participated in Washington as an equal partner, committing $1 billion for investments in treatment, care and prevention for Nigerian people affected by the diseases.

The noble Baroness, Lady Hayman, asked about the broader health sector support for the Global Fund. Clearly, the focus of the Global Fund is on the three diseases, but there has been a widespread understanding of the effect that it has on other diseases and the importance of ensuring that action in one area is supported by action in another, and that it is important to look across the sector. Whether it is neglected tropical diseases or family planning, to which the noble Baroness, Lady Tonge, referred, it is recognised that these areas interplay.

The noble Lord, Lord Fowler, asked about key populations. We strongly support a public health approach to key populations affected by HIV, including men who have sex with men, sex workers and injecting drug-users, that respects human rights and addresses the stigma and discrimination that they face. It is very important that that is recognised.

Of course, we wish to see the money spent effectively. On the misuse of bed nets, I can assure my noble friend Lord Chidgey that the World Health Organisation’s World Malaria Report 2013, which was launched yesterday, estimates that 86% of people who had access to a bed net used it to protect themselves from getting malaria. We are supporting efforts to maintain and increase that.

On TB, we are committed to the global goal of halving deaths from it by 2015. Various noble Lords mentioned this. The noble Baroness, Lady Nye, suggested that there were no TB-specific bilateral programmes. The majority of UK funding for TB treatment is through the Global Fund, but we are providing bilateral funding to TB-specific programmes in a number of countries, including South Africa, Burma, Nigeria and India. In August, we announced support for nine public-private partnerships, including FIND, the TB alliance and Aeras. These partnerships will help fund crucial work on developing new and more effective tools to prevent, diagnose and treat TB, in addition to our spend through the Global Fund.

In addressing my noble friend Lord Shipley on TB REACH, I will say that we have reviewed its external mid-term evaluation and agreed that it has successfully funded innovative approaches leading to additional TB cases being detected among high-risk populations and in high-burden countries. Besides supporting it through the Global Fund, DfID also supports TB REACH through our £53 million annual core support to UNITAID.

The noble Baroness, Lady Nye, spoke of integrated approaches to tackling TB and HIV, which is something that her noble friend Lord Collins put to me the other day. DfID has been leading in this area, and we have been strongly involved in the recent Global Fund requirement for countries burdened by the two diseases to put forward a unified and integrated application for joint TB/HIV programmes. This is a strong signal that disease-specific initiatives will not address TB/HIV co-infection alone. That is also highlighted in DfID’s HIV position paper review, which has just been published, because we recognise the importance of co-infection.

In terms of working in the extractives industry, which the noble Baroness, Lady Nye, also brought up, we are working with the Government of South Africa, the Chamber of Mines and the World Bank to expand the quality and access of TB-related services, including TB control and treatment referral across borders. There are some other details, which I can provide to her.

We now have to ensure that we use the funds pledged at the recent conference, and those that will follow, as we seek to meet the $15 billion requirement for the Global Fund. We have to make sure that these funds are used in the most effective way possible, so that we achieve the greatest impact from the money contributed. The UK will continue to work closely with the Global Fund to ensure: that we are financing the highest-impact interventions; that we are increasing funds to the lowest-income or most fragile countries with the greatest disease burdens; that we are focusing interventions on the most at-risk populations, using the latest epidemiological evidence to target disease hotspots in country; and that we are using funds to support implementation of robust national disease strategies with full country ownership.

We will ensure that the Global Fund implements and builds on its new systems of governance and risk management, so that no one is denied access to life-saving treatment due to a loss of funds through fraud and corruption. We must not forget the importance of shaping markets and reducing costs, and have made huge strides already in this area, which I think that noble Lords are familiar with. But with continued work, we believe that further sustainable price reductions are possible, so that more lives can be saved for every £1 raised.

The $12 billion pledged in Washington is the start of a process towards full replenishment and achieving the maximum impact from $15 billion. This in turn is part of something bigger, with vital contributions from other donor sources, the private sector, civil society, and, most importantly, from the countries themselves. Working together in a true global partnership with clear goals and targets and unwavering national and global commitment is the only way to end the death and suffering caused by HIV/AIDS, malaria and TB.