Global Health (Research and Development)

Gavin Shuker Excerpts

Tuesday 8th July 2014 Westminster Hall

[Gavin Shuker (Luton South) (Lab/Co-op)]

I am grateful, Mr Streeter, for your chairmanship and for your maths, which has allowed a good period of time in which to express the Opposition’s support for the work of the all-party group, and for the Minister’s response.

The debate has been well informed and well attended, and there were welcome speeches by people who are hugely knowledgeable about the field. I want to refer to the disease that is predominant among those we have been discussing, and some of the recommendations in the report. I also want to consider structural and systemic issues about the delivery of effective care.

It is crucial in such debates to avoid becoming too fixated on high-level statistics and market processes, or too absorbed in the clinical mechanics of disease prevention and control. As my right hon. Friend the Member for Neath (Mr Hain) pointed out, in his hugely passionate speech, that absorption can cause us to forget the lived reality for the many people who have those terrible diseases. Death from tuberculosis, and life with it, is horrible. Cavities form in the lungs, causing bleeding, or resulting in pus-filled infection, blocking vital airways and causing difficulty in breathing. Each breath becomes a battle, because tuberculosis weakens the body and causes weight loss so extreme that, to the outsider, it can appear as if the body is literally consuming itself. When it affects children, it can mean that a child of six weighs 8 kg, which is barely the weight of a newborn baby. Long-term pulmonary damage, collapsed vertebrae, brain damage, lesions so severe that they change the structure of the body: that is the reality. Those are just some of the complications that survivors of the disease face, in addition to the stigma that besieges this disease of poverty and proximity.

As many right hon. and hon. Members have said, tuberculosis continues to ravage the lives of millions of people worldwide. There were 8.6 million new infections in 2012 alone. There are regions of the world

“teetering on the brink of a tuberculosis epidemic”.

If it is left unchecked over the next 20 years almost 1 billion people will be newly infected with TB; 200 million will develop the disease; and 35 million people will die of it. Given that it is curable, that is an unforgivable tragedy. That situation—alongside malaria, HIV, dengue, yellow fever, rabies, sleeping sickness, river blindness, leprosy and many others on the World Health Organisation’s list of neglected diseases—is a spur for our timely, if not overdue, debate.

As Members have pointed out, fundamental market failures have meant that the development of affordable and accessible treatments has simply not been prioritised in the way it should have been. In the past 40 years, just one Food and Drug Administration-approved TB drug has been introduced to market, compared with 15 FDA-approved products introduced for hay fever. Yes, hay fever is debilitating and it is certainly an uncomfortable irritation for many people, but it is not a global killer.

The inquiry and report that sparked today’s debate offer a number of pragmatic solutions that could underpin the currently failing commercial model or support the development of alternative structures and models for product development. It is crucial that these recommendations receive the attention they deserve.

The Department for International Development is already a world leader in research and development for global health, which this Government have prioritised in their parliamentary term, just as the previous Labour Government did in their last parliamentary term. It is vital that DFID’s reputation is maintained and further enhanced if the threats of pandemic proportions posed by these neglected diseases are to be abated.

The Prime Minister’s welcome recent announcement on antibiotic resistance and the £1 billion UK commitment to the Global Health Fund must also be celebrated, but such leadership must be shown across the board. A focus on research and development must not crowd out other important health care considerations. For example, the World Health Organisation’s recommended approach to tuberculosis—commonly known as directly observed treatment, short-course, or DOTS—requires daily supervision by a qualified health professional. That is an impossibility for the 2 million Somalians who have no access to health care services, or even for the 8 million Somalians who have access to such services but for whom it takes an average of four hours’ travel to reach them.

Moreover, research and development alone will not address the issue of those people who might never be diagnosed. They are prevented from accessing basic medical assistance because of poverty, stigma or discrimination. They are also isolated from the respite that decent health care can offer and, in the case of communicable diseases, they are unknowingly or helplessly infecting those around them. For these people, the urgent need for universal health care coverage is clear.

The UK death rate for TB is admittedly high in some areas. As many Members have highlighted in today’s debate, TB is a disease that shows no respect for national boundaries. Nevertheless, the reason the UK death rate for TB is low in comparison to other nations is down to the progress made by our NHS, which is undoubtedly my party’s greatest legacy. The NHS is a world-leading health care system built on the principles of fairness, providing high-quality and accessible health care that is free at the point of use.

In addition to responding to the specific recommendations of the report, I invite the Minister to set out how the UK will ensure that the laudable goal of universal health care coverage, which this Government have signed up to, will remain on the post-2015 development agenda, because it is only when we achieve universal health care coverage that the links between disease, poverty and inequality can begin to be broken.

If the main earner in a family becomes ill, the family can be driven even deeper into poverty; disease destroys their ability to earn money, or even their ability to subsist through work. That problem is compounded by the direct medical costs that patients face—such as consultation fees, drugs, diagnosis or hospitalisation—or by the indirect costs associated with ill health, such as travel to the nearest health centre, or increased nutritional or heating needs. Children miss out on school because of illness, or have to earn money to compensate family incomes that have fallen when parents or siblings become sick. So, in considering what support to give, it is essential that we not only look at the specific diseases that have been mentioned but at the mechanisms for delivering treatment.

The gendered impacts of ill health must not be ignored either. Women and girls are not only less likely to seek help, but are often saddled with caring responsibilities on top of their existing work loads. Frequently, they are even expected to give up their own work or education, undermining their chance to reach their potential, which traps the most vulnerable in cycles of poverty, disease and poverty again.

The ability to enjoy free access to health care services as envisaged by universal health care coverage would not only ensure access to treatment but would increase medical visits, which would raise the rates of diagnosis that the report makes clear are crucial in the fight against communicable diseases.

A holistic approach to health requires going beyond even universal health care coverage to include consideration of water and sanitation, inequality, housing and education, so it is clear that the challenges faced by the world in responding to the needs identified in the report are massive. However, it is only in adopting such an approach that we can be clear about the true impact of the neglected diseases that we have been discussing today, and about how we can address them.

We face some of the gravest global health care challenges of our time. Addressing them will require a co-ordinated international effort, and I am sure that the efforts of the hon. Member for St Ives (Andrew George), who I congratulate on securing this debate, will go a long way towards holding our feet to the fire and ensuring that we do address them.