Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Nye Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Nye (Lab)]

My Lords, I join the noble Baroness in congratulating the noble Lord, Lord Verjee, on his most eloquent maiden speech. I look forward to his future contributions. I, too, am grateful to the noble Lord, Lord Chidgey, for securing this important debate and for his efforts to keep the fund at the forefront of the development agenda.

As the noble Lord said, the fund’s achievements have been remarkable: 6 million treated for HIV; 11 million diagnosed and treated for TB; and 360 million bed nets. I thank the Government for maintaining the support shown to the Global Fund by the previous Labour Government by making such a generous pledge. Although the replenishment campaign is over, the work of replenishing the fund must continue in order to ensure that it reaches its target.

I, too, look forward to the Minister giving us an update on what the Government are doing to galvanise support from other donors to ensure that UK and US money is not left on the table and on what part they are playing to ensure the long-term stability of the funding stream. Only with sustained, long-term funding can you achieve the scale of the interventions needed.

For all these efforts, gaps remain in our responses to these diseases. For 10 years, the UK charity Target Tuberculosis has been working in the field through local partner organisations, focusing on the needs of the poorest communities, who often live in remote locations far from government-led national TB programmes, which receive the bulk of the Global Fund allocations.

Currently the British Government do not engage in any bilateral funding of programmes related to TB, despite the Prime Minister co-chairing a high-level panel report on the post-2015 framework that identified treating TB as the most cost-effective health intervention measured. It returns £30 for every £1 spent. Perhaps the Minister will explain why the British Government do not fund TB-specific projects through bilateral funding.

In October the WHO launched its annual Global Tuberculosis Report in London with RESULTS UK, to which I am grateful for the work that it does and the briefing that it has provided for this debate. The report named five key priorities for beating the TB epidemic. I am going to concentrate on the need to:

“Accelerate the response to TB/HIV”.

Last year 1.3 million people lost their lives to TB. As the noble Lord said, 320,000 of those people were HIV positive. TB is the leading cause of death for people with HIV, yet only just over half of all those who are HIV positive and have TB can access anti-retrovirals. TB preys on a weakened immune system and, without access to anti-retrovirals, TB will progress faster in an HIV-positive patient. Co-infected patients without anti-retrovirals are more likely to die. A priority for reducing the number of deaths from TB and HIV is to scale up the response to co-infection and ensure that everyone with TB is tested for HIV, and vice versa, and given the proper medication.

The Stop TB Partnership, the WHO and UNAIDS stated that 1 million deaths could be prevented among people living with HIV by 2015 if the world implemented simple strategies; that is, everyone with TB gets an HIV test and access to treatment. Worryingly, there remains a huge gap between where we are today and complete coverage of anti-retrovirals for TB/HIV patients, as the noble Lord, Lord Fowler, said. The recent DfID position paper reaffirming its commitment to TB/HIV is to be welcomed.

The fund’s strategy committee has decided that it should do more on TB/HIV. It has mandated that any country with high rates of TB/HIV co-infection that applies for funding for treatment programmes will have to design its programmes in a single unified application. Every country will have to have joint, integrated, co-ordinated programmes for TB/HIV. This could be a huge step forward, as the fund provides 80% of international financing for TB and more than 20% for HIV. I urge the Government to take the lead and to support the Global Fund, not with money this time but by supporting and adopting similar policies and by urging other partners to do the same.

Finally, in a week when the eyes of the world have been on South Africa, there is one other area where we could make a difference. South Africa’s gold mines contribute 9% of the global total of TB cases, which in turn fuel the HIV epidemic in the region. The British Government could show real global leadership and I hope that the Minister will update your Lordships’ House on the Government’s recent meetings with mining companies. The South African Health Minister and chair of the Stop TB Partnership board has called a regional gathering of Health Ministers and mining companies for early next year. The meeting will seek to drive a regional response to the disease. It would show real commitment if the British Government sent a high-level representative to that meeting. This is the kind of leadership that the British Government could and should provide. They have stated that TB/HIV is a priority; now I urge them to prove it.