UN High-level Meetings in 2023

Debate between George Howarth and Virendra Sharma

Tuesday 11th July 2023 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I beg to move,

That this House has considered UN high-level meetings in 2023.

It is an honour to serve under your chairmanship, Mr Twigg. Most of, if not all, the pressing global challenges we face today are not confined to a single continent or country. We have all seen that—including recently with covid-19—when global challenges arise, and the consequences of those challenges are felt more widely than ever before. To face the challenges effectively, we need to use key international forums to incite support among world leaders for solutions that can save millions of lives and improve the lives of billions more.

The UN is a testament to the power of collective global resolve and the only place where 192 countries come together daily to deliberate on pressing global issues. The General Assembly is the main policy making and representative body of the UN, and it regularly calls for high-level meetings on topics of global importance. In that context, we are here for today’s debate.

In September, the UN will host three HLMs on global health topics. The first, on Wednesday 20 September, is focused on pandemic preparedness and response, or PPR. This will be a topical discussion given the recent covid-19 pandemic. On Thursday 21 September, a meeting is being convened on universal health coverage, or UHC—the principle that all people should have access to the full range of quality health services they need, when and where they need them, without financial hardship. Finally, on Friday 22 September, the UN will discuss tuberculosis. As co-chair of the all-party parliamentary group on global tuberculosis, I am particularly interested in the outcome of the final meeting, but all three HLMs are incredibly important for advocates of global health.

The topics being discussed at the UN later this year are all multifactored, and an all-society approach involving more than just the health sector is needed to resolve the issues. The HLM is the mechanism through which to convene all sectors, under the leadership of Heads of Government, to agree a plan of action that all states can implement. Precisely because the meetings call on Heads of Government to engage, they are a powerful mechanism for change. The HLMs fall in the same week as the UN General Assembly, which means many Heads of State will be around the UN, and many will be attending those important meetings. I sincerely hope that the Prime Minister and the Foreign Secretary show that the UK is resolved to tackling PPR, UHC and TB by personally attending all three HLMS later this year. Can the Minister confirm whether they will attend?

Briefly, I will touch on the PPR and UHC meetings before turning to TB. The PPR meeting is a new HLM that aims to improve the governmental and multilateral capacities required successfully to identify and contain a new pandemic. Moving beyond the health sector, the HLM will look at financing, social protections, educational support, and research and development requirements to address future pandemics. The meeting is an important opportunity for member states to commit to the necessary fiscal and policy changes required to prevent a future pandemic.

The UHC meeting follows on from a meeting held in 2019. The 2023 meeting provides countries and stakeholders with the opportunity to reinvigorate progress towards delivering health for all. According to the latest global monitoring information, UHC progress is not on track, and the covid-19 pandemic has taken the world further from the 2019 targets. They include progressively covering 1 billion additional people under UHC with a view to covering all people by 2030. The HLM also sought to stop the rise of catastrophic out-of-pocket health expenditure, and eliminate impoverishment due to health-related expenses by 2030. Catastrophic costs are felt particularly acutely in the TB sector. Nearly 50% of people who receive a TB diagnosis will face catastrophic personal or household costs as a consequence. Concrete action is needed to strengthen equitable health systems, including public health functions that are critical for PPR and TB.

Finally, the UN is holding a follow-on HLM for TB, with the first being held in 2018. That was the first time that TB issues were discussed on such a significant international stage. The 2018 political declaration included a number of targets, which member states agreed to pursue: a commitment to provide treatment and diagnostics to 40 million people, including 350,000 children; a commitment to increase overall global investment in TB to $2 billion per year; and a commitment to end all stigma and forms of discrimination associated with TB.

[Sir George Howarth (Knowsley) (Lab)]

I congratulate my hon. Friend on securing this important debate. Does he agree with the director of Liverpool School of Tropical Medicine, Professor David Lalloo, who has said:

“As academics, public and global health experts and healthcare professionals, we see the close interrelationship between tuberculosis, pandemic preparedness and response, and universal health coverage”?

Does my hon. Friend also agree that this high-level talk is a good opportunity to take that agenda forward?

[Mr Sharma]

I thank my right hon. Friend for his important intervention. I agree and will cover those points later in my talk, but I want to put that aside for now. Yes, it is internationally known and accepted that this is an opportunity that every state should take on board.

Those ambitious targets were widely welcomed by civil society groups and TB stakeholders, but the impact of the covid pandemic significantly limited progress. Few of the TB targets were met, and the 2023 HLM is seen as a key opportunity to regain momentum towards eradicating TB by 2030, in line with sustainable development goal 3.3.2.

TB is one of humanity’s oldest diseases. It is caused by bacteria that most commonly impact lungs, but it can spread to other parts of the body. TB is spread from person to person through air droplets, with most TB infections showing no symptoms at all. In fact, 25% of the world’s population is estimated to have latent, or inactive, TB. TB becomes transmissible only when it is activated, which can be triggered by a range of health or social factors,

TB is a disease of poverty. It is more prevalent in poorer communities and can be linked to socioeconomic factors such as lower-quality housing, overcrowding and limited access to health services. TB is closely linked to other health issues, including malnutrition and HIV status. Even in high-income countries, TB is often found in migrant communities; people with alcohol, drug or mental health issues; homeless communities; or people with a history of prison.

What is most frustrating for people like me, who have been involved with TB for a long time, is that TB is both preventable and curable. Yet each year, more than 1.6 million people die from TB, including nearly 400,000 children. A lack of political will and inadequate funding continue to limit our ability to eradicate TB. All countries need to do more. There is only one existing TB vaccine. Although the BCG is effective against some serious forms of childhood TB, it provides little protection against the most infectious and deadly forms of adult TB.

There are several promising vaccine candidates in the pipeline. Six vaccine candidates are in phase 3 of the clinical development process—the final phase before the vaccine can be regulated for public use. In fact, just last month, Wellcome and the Bill and Melinda Gates Foundation announced funding to advance TB vaccine candidate M72 through a phase 3 clinical trial. M72 could become the first new vaccine to help prevent pulmonary TB, a form of active TB, in more than 100 years.

Promising vaccine candidates have emerged before and have fallen short, so we need to continue to finance and increase investment in TB research and development to find new vaccines. The Foreign, Commonwealth and Development Office has previously supported the development of new TB vaccines through product development partnerships. However, new PDP funding has been paused in recent years. Can the Minister provide the House with an update on when we might expect new or renewed PDP funding?

We also need more new treatments for TB. According to the Treatment Action Group, the UK met 96% of its fair share contribution towards TB research and development in 2021—about £30 million—with fair share measured as spending at least 0.1% of overall research and development expenditures on TB. That funding was used to support innovation at some of the UK’s most prestigious research institutions, including the London School of Hygiene and Tropical Medicine and the Liverpool School of Tropical Medicine. Although the UK might be stepping up to the challenge, it is clear that not all countries are paying their fair share. Will the Minister outline what more the FCDO can do to support UK research and development, especially in the context of TB, and encourage all countries to pay their fair share towards TB R&D?

One of the biggest concerns for TB stakeholders is antimicrobial resistance. TB is a complex bacteria and strains have become resistant to modern antibiotics. One third of all deaths due to complications from antimicrobial resistance in 2021 involved drug-resistant TB. We have some tools to tackle drug-resistant TB, but they are incredibly expensive and are not readily available to all who need them. Medicines such as bedaquiline have cut treatment times for drug-resistant TB in half, but even the UK is struggling to access them. What are the Government doing to increase access to bedaquiline in the UK and abroad?

People with TB also suffer high levels of stigma and discrimination. TB is often associated with factors that can themselves create stigma: HIV status, poverty, drug and alcohol misuse, homelessness, a history of prison, and refugee status. Fear of discrimination can mean that people with TB symptoms delay seeking help, making it more likely that they will become seriously ill. Stigma around TB can also make people reluctant to stick with their course of treatment for fear of being “found out”. By taking treatment irregularly, people risk developing drug resistance.

The TB community has not sufficiently contested the views that reinforce TB stigma. Such an approach has previously delivered positive outcomes in the context of HIV. Countries and donors need to implement locally managed, gender-responsive and well-financed TB programmes to help overcome the stigma and discrimination associated with TB infection, so can the Minister tell the House what the FCDO is doing to help eliminate the stigma and discrimination experienced by many TB-affected actors?

Although TB is getting its own high-level meeting in September, it also has implications for both pandemic preparedness and universal health coverage. Strengthening health systems to better detect and respond to respiratory infections is crucial to PPR, as experts agree that it is likely that the next pandemic will be respiratory in nature. TB programmes are well placed to help identify new respiratory pandemics, as they are already actively involved in the treatment, diagnostics and surveillance of respiratory diseases. The ability to respond effectively to new respiratory pathogens relies on strong infection prevention and control infrastructure, an experienced and well-compensated health workforce with expertise in managing complex respiratory infections, and access to the latest medical tools and equipment.

Much of the infrastructure needed to respond to the TB epidemic already exists. However, as we saw during the covid-19 pandemic, such programmes are quickly repurposed to respond to emerging pandemics, with significant negative impacts for people with a TB infection. More needs to be done to strengthen TB programmes, surveillance and diagnosis as the fundamental pillar of PPR. Does the Minister believe that greater investment in TB programmes, diagnosis and surveillance will help the world prepare for the next novel pandemic?

UN high-level meetings on global health matters used to be unheard of. The HIV/AIDS HLM in 2001 was the first ever global health-focused HLM. Another was not held until 2011, but this has changed over the last decade. There are now years when multiple global health issues are discussed simultaneously, as is the case this year. It is a direct response to the number of global health issues that have impacted on the world over the last 10 years. The UN recognises that a new approach is needed to help address the barriers holding back progress in global health. The upcoming high-level meetings are a perfect opportunity to reinvigorate momentum and encourage global action to face the challenges of the 21st century together.

Swaminarayan School Closure

Debate between George Howarth and Virendra Sharma

Wednesday 18th July 2018 Westminster Hall

[Mr Sharma]

I thank my hon. Friend for that contribution, which speaks for itself. I fully agree with him that the contribution that the school has made to society in general is great.

I will fight to ensure that the Hindu community of west London continues to have its needs met, despite the closure of an essential part of that community. The end of the Swaminarayan School is a great loss, but we are not lost. The community will continue to call for what it needs, and the Hindu community in west London is stronger than ever.

[Mr George Howarth (in the Chair)]

Before I call the hon. Member for Harrow East (Bob Blackman), by leave of the mover of the motion and the Minister, I strongly remind him that the Minister has to have adequate time to reply. Bob Blackman.