Tuberculosis

Baroness Suttie Excerpts

Thursday 11th December 2014 Grand Committee

Asked by

[Baroness Suttie]

To ask Her Majesty’s Government what plans they have to reduce the rate of tuberculosis in the United Kingdom over the next 10 years.

[Baroness Suttie (LD)]

My Lords, I am very grateful to have the opportunity this afternoon to raise the extremely important subject of tuberculosis in the United Kingdom, and I am very grateful to colleagues for agreeing to take part in this debate.

Like all 13 and 14 year-olds of my generation in the UK, I had my BCG vaccination while I was at high school. I remember that we all compared our scars for months afterwards. We believed at that time that TB, like smallpox, could be eradicated from our society. TB, or consumption, was supposed to be an illness of poverty of times gone by. In Victorian Britain it was known as the “silent killer” and as many as one in four deaths were attributable to it. So high was the death rate, in fact, that TB has been estimated to have killed more people than any other infectious disease in human history.

Shortly after I was appointed to this House, I became involved with the APPG on TB. Much to my surprise, I quickly had many of my preconceptions shattered, as I learnt that TB has not, in fact, disappeared and remains a very real problem. While great progress has been made against the disease in the West, globally TB is as deadly as ever. The latest estimates from the World Health Organization are that the disease kills 1.5 million people every year. The Lancet estimates that TB kills more people than any other single infectious agent worldwide. To put it in context, TB kills nearly as many people every single day as have died from Ebola since March.

TB today is not the same disease it was 100 years ago. Our failure to develop new drugs or to properly apply the ones we have has given TB bacteria the chance to evolve new, drug-resistant strains. The issue of drug-resistant TB is particularly pertinent today, following the first report from Jim O’Neill’s AMR commission. The report estimates that antimicrobial resistance could cost the world economy $100 trillion over the next 35 years, and it cites TB as a major driver of that cost. In this context, it is no overstatement to say that MDR TB is a threat to social and economic well-being across the world.

A growing percentage of global cases are resistant to our best drugs. Patients diagnosed with multidrug-resistant or MDR TB face two years of treatment, taking 14,000 pills, which are often associated with permanent and debilitating side-effects and which have only a 50% chance of cure.

In June this year, I took part in a delegation to Romania looking into the Romanian experience of the treatment and prevention of TB. Romania has the highest incidence of TB in the EU. At one clinic, I spoke to a young mother of two children who had been diagnosed with MDR TB. She had already had half of one lung removed and was expecting an operation imminently to remove a section of her other lung. She was struggling with the harsh regimen of drugs for her disease and constantly felt unwell and nauseous. She was also deeply worried for her two young children, who were in the process of being tested to see whether they, too, had MDR TB.

Of course, this debate today is not about global TB; it is about TB in the UK. London is regarded as the TB capital of western Europe. Some parts of the capital have rates equal to those in sub-Saharan Africa. The BCG vaccination with which we are all so familiar provides far less protection than many think and offers no protection at all to adults.

I would like to focus briefly on three key areas: education and awareness; testing and diagnosis; and tackling the problem at source—namely, developing new and better medication and a vaccine that works. TB is infectious and airborne. When patients start treatment, they become less infectious. If there is a delay in diagnosis, they remain infectious for longer, allowing the disease to progress, and develop more severe symptoms, thus exposing others to the risk of transmission, so the first thing we must tackle is delayed diagnosis.

I am pleased that Public Health England and NHS England have, together with a number of other stakeholders, drawn up a collaborative TB strategy for England. I also note that this strategy acknowledges:

“An additional factor that frequently delays diagnosis is the lack of TB awareness among health professionals and appropriate training among social care staff”.

In short, it is a problem that high-risk populations as well as many healthcare professionals are currently insufficiently well informed about TB. Earlier this year when I visited Romania with RESULTS UK, we went to a prison outside Bucharest which had an impressive TB education programme that far surpasses anything I have encountered in this country. Will the Minister outline our existing TB awareness programmes, particularly in prisons? We are not going to reduce delays in diagnosis unless we make people aware that TB is a genuine threat to public health across the UK.

Of course, there are other ways to reduce delays between the onset of symptoms and the diagnosis of the disease. Find & Treat screens up to 10,000 people a year in the UK. It works with some of the hardest-to-reach people and yet has a treatment success rate higher than the national average. In fact, the service is of such sufficiently high quality that the clinical lead, Dr Alistair Story, who I met a few months ago, has been asked by the World Health Organization to participate in a working group exploring how to eliminate TB in low-burden countries. Yet the Find & Treat service is on an uncertain financial footing and, although seeking to expand, is unable to do so. Will the Minister commit to seeing the work of Find & Treat first-hand and support it in its efforts to scale up?

Find & Treat is also behind a project that I visited in North London known as Olallo. Olallo offers accommodation and social support for homeless patients receiving drug-resistant TB treatments. Patients receive free lodging, food, education and skills training to support them in finding permanent employment. The project is an exemplary demonstration of how we can support those with chaotic lifestyles. As a model it could also save us money. The average cost of treating a TB patient in a hospital is £500 a day, and even more in a negative-pressure isolation room, whereas hostel accommodation with all the additional social support can cost between £60 and £80 a night. Will the Minister detail what the Government are doing to support and expand projects like Olallo?

Finally, I would like to speak briefly about TB treatment. Every time I have spoken to a TB patient or a healthcare professional, the conversation has turned to the terrible treatment burden and the awful side effects. Patients have told me of the risk of hearing loss, blindness, liver damage and suicidal urges. Healthcare experts have explained the very real dilemma of having to put an MDR TB patient on treatment, knowing the misery that the drugs can bring. In the 21st century it is simply unacceptable that a patient should face the choice between a disease that could kill them and a treatment that could leave them permanently disabled.

I am proud that the UK Government are the second biggest public funder in global health research and development in the world. Investments and product development partnerships, such as Aeras and TB Alliance, are life-saving. The concordat between DfID and the Medical Research Council is practically unique in the developed world and yet there is much more that can and should be done. At the root of our global failure to develop TB drugs and vaccines is a simple truth: people who suffer from TB are usually poor and do not offer a market of sufficient scale to incentivise pharmaceutical companies to invest in research and development. To put it more crudely, the commercial market has failed TB patients. In the face of this market failure, Governments must act. The UK Government could do even more than they currently do. We need to reclaim that thought-leadership and work with leading donors around the world to drive a new global consensus on overcoming the market failure in R&D for global health.

The response to the global HIV epidemic has been one of the greatest examples of the world responding to a global health threat, and HIV has lots of advocates and celebrity supporters. Ebola, too, has gripped the attention of the world’s media, and rightly so.

I mentioned at the beginning of my remarks that TB was once known as the silent killer. If politicians, the media and Governments continue to be largely silent as the disease kills millions every year we will never be rid of the disease, not in the UK and certainly not around the world. I very much hope that the Government will lead the way to reverse this situation.