Drug-resistant Tuberculosis (Developing Countries)

Jim Fitzpatrick Excerpts

Tuesday 4th June 2013 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you presiding in the Chair, Mr Caton. I will try to get through my remarks as quickly as possible, as a couple of other hon. Members would like to make a contribution and the Minister, whom it is good to see in her place, has very kindly indicated that she would be happy to hear them.

After making a few brief comments on tuberculosis and drug-resistant TB globally and in the UK, I will raise three important points that I hope the Minister will be able to address: support for the Global Fund to Fight AIDS, Tuberculosis and Malaria; investing in innovation; and the need for a national strategy in the UK to include an international target. However, before raising those issues, I would like to make a few observations.

The Minister recently met the all-party group on global tuberculosis to discuss its report, “Drug-Resistant Tuberculosis: Old Disease—New Threat”. Much of what I will speak about today is focused on the conclusion and recommendations of that report, which makes constructive recommendations that are evidence-based. I thank Mr Simon Logan, co-ordinator for the all-party group, for his assistance in preparing my remarks for today’s debate.

Tuberculosis in the UK reflects the global reality. TB is one of the world’s most common deadly infectious diseases. In the 1970s, my wife was a junior hospital doctor. Her consultant told her that by the time she became a consultant, TB would have disappeared, like polio, due to BCG, mass X-ray and drug treatment. How wrong can you be?

One third of the world’s population has latent TB, but only a small percentage goes on to develop the active form of the disease, which makes them sick and can kill if not treated. Unfortunately, little progress has been made towards eliminating TB in the UK—there are about 9,000 new cases each year—and global progress is painfully slow. The disease remains an urgent public health problem around the world, and we now face a new threat—drug-resistant strains that are significantly more expensive and difficult to treat. It should be said that both are curable, albeit with a long course of antibiotics. TB does not get the profile that the death and destruction it causes warrant. This is a serious issue, and we must do more to tackle it. It is not only a moral obligation; it is in our national interest.

The first line of defence against drug resistance is appropriate management of TB and the strengthening of the World Health Organisation’s standard treatment, called directly observed therapy, to prevent resistant strains from developing. However, we also need to take steps to tackle this threat head-on, as it is often airborne and can be passed from person to person in the same way as normal TB.

Rates of drug-resistant TB appear small in terms of the global burden of the disease, accounting for 440,000 of the almost 9 million new cases each year, but only about 10% have access to diagnosis, and the financial and treatment burden is substantial. The number of people affected is increasing and so is the cost. Patients have to take 15 to 20 tablets a day for up to two years to be cured of this more extreme form of the disease and they often experience horrible physical and psychological side effects as a result. It is also on the rise in the WHO European region, particularly in eastern Europe. Almost 80,000 cases occurred in the European region in 2011, accounting for nearly one quarter of all DR-TB cases worldwide.

The UK is not immune to this problem. London has the highest TB rate of any capital city in western Europe, and resistant strains of the disease have gradually but significantly increased since 2000. In my constituency, there are 61 cases of TB per 100,000 people. That is in Tower Hamlets. Neighbouring Newham, which I used to represent before the boundary changes in 2010, has double that amount, giving it the highest rate of TB in the UK. It is comparable to that in some high-TB-burden developing countries. To put that into context, the UK average is 14 cases per 100,000 people.

The threat that this public health concern presents to the UK recently led the chief medical officer for England, Dame Sally Davies, to warn that antimicrobial and infectious disease resistance poses a serious threat. One of her key recommendations was for the Government to campaign for it to be given a higher profile and priority internationally. In that regard, financing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria plays a crucial role in funding programmes for diagnosing and treating TB in low and middle-income countries. The global fund accounts for almost 90% of international TB funding. For many countries, there would not be a response to TB without the global fund’s support.

[Sir Tony Cunningham (Workington) (Lab)]

The hon. Member for South Derbyshire (Heather Wheeler) and I were on a visit to Ethiopia and visited St Peter’s hospital there. I asked what percentage of the funding for the drugs came from the global fund, and it is 100%—without it, people would die.

[Jim Fitzpatrick]

My hon. Friend reinforces the point that I have just made about how important the global fund is. As I am sure the Minister is aware, the global fund is asking donor Governments, such as the UK Government, for new funding in this replenishment year, and the UK Government have a crucial role to play in ensuring that that process is successful.

In the history of the fight against TB, there have been periods of urgency and periods of innovation, but only rarely have urgency and innovation come together. The rise of this new extreme form of the disease has given a new sense of urgency to global TB efforts, and after a decade of focused investment in TB innovation, we have a promising pipeline of new drugs, diagnostics and vaccines.

It is clear that to address rising rates of drug resistance, action is needed at national and international levels. The all-party group recently published its report, which was the culmination of more than six months’ work consulting world-leading experts on steps that the Government could take to help to address the increasing threat of drug-resistant TB. I shall highlight three key recommendations from the report, and I would be grateful if the Minister focused on those in her response.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this important issue to Westminster Hall for debate. A group of children and young people from Swaziland were recently in my constituency. They were a Christian choir, and every one of those children had AIDS. In Swaziland, 40% of people have AIDS. Does he feel that we need to address such issues at the highest level? That choir is an example of what can happen when medication is available; if they can survive AIDS and TB, they can make a contribution to their country and ultimately across the world.

[Jim Fitzpatrick]

I agree with the hon. Gentleman, and I am sure that the Minister will repeat that agreement on the positive outcomes that result from appropriate treatment.

First, the report recommends that we strengthen the global fund by doubling the UK’s contribution. International donor funding, including the majority of the UK’s response to TB in developing countries, comes almost entirely through the global fund. In 22 high-TB-burden countries, six are totally reliant on the fund and in another 15 it accounts for two thirds of their budget. To scale up access and treatment for DR-TB, which remain woefully low, the resources the global fund has at its disposal need to increase. The Government have a key role to play in the replenishment of the fund, having been a key driving force behind the recent reforms it undertook. I commend the Government for that policy. What are their thoughts on our contribution to the fund to address the threat of TB and DR-TB? A lead from the UK should happen as soon as possible, to help leverage more from other donor Governments in this important replenishment year.

Secondly, the report recommends investment in innovation through TB REACH and continued investment in research and development. The Government have already shown leadership in support of developing new, badly needed tools to tackle TB—a policy of successive Governments that I hope will continue. Some of those tools have come to market, specifically new rapid diagnostics, but despite that, 3 million people each year still fail to access diagnosis and treatment for TB, which includes a large portion of people with drug-resistant strains. We need to accelerate our efforts to diagnose TB by rolling out new technologies, and it is clear that we need to think outside the box. TB REACH is one way to do that.

As the Minister knows, TB REACH is a Stop TB Partnership-hosted initiative that gives small grants of up to $1 million to find and treat those who do not have access to TB diagnosis or treatment. It is an incubator for innovation and pushes the frontiers of technology. It works closely with DFID-funded UNITAID. In short, TB REACH goes where others cannot and shows Governments and donors how to reach the unreachable. Critically, it often demonstrates with data what projects could be scaled up. The Minister may wish to express a view on whether she agrees with that assessment. Beyond their contribution of core funding to the Stop TB Partnership, which does not cover TB REACH, I ask that the Government become a donor to TB REACH, to maximise their investments in UNITAID and support the expansion of new diagnostic tools to detect and ultimately treat cases of TB, in addition to the work of the global fund. The funding allocated should be directed by the evaluation of the Stop TB Partnership later this year. I will be interested to hear her view on that recommendation.

Thirdly and finally, I want to mention a national strategy for TB in the UK and the importance of a global target within that. A national strategy for TB has never been developed, despite the public health risk the disease presents. The UK has seen rising rates of TB since the 1980s and DR-TB increased by 26% in the past year alone. I welcome that the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) indicated that her Department is supporting Public Health England to develop a strategy. I bumped into her before the Division and thanked her for her leadership on the matter, in which I have a constituency as well as a personal interest. I was recently invited to a seminar, organised by the Barts and Royal London TB unit, by Dr Veronica White, the consultant in respiratory medicine. Unsurprisingly, it is the biggest TB team in the UK and does sterling work locally and nationally.

With all that in mind and given the clear link between global and UK rates, will the Government set a specific target on their contribution internationally to tackling DR-TB as part of a comprehensive TB strategy, led by Public Health England?

[Andrew George (St Ives) (LD)]

I thank the hon. Gentleman for highlighting the all-party group on global tuberculosis, which it is my privilege to chair—I am not paid. Not only does the work on TB help to deliver the Government’s international development objectives, but it is also in Britain’s interest to get it right.

[Jim Fitzpatrick]

The hon. Gentleman makes a critical connection between our national interest and the international case, which the Minister and her team acknowledge. I am grateful that she is here. I look forward to her response. I thank her and her officials for the excellent work that they have been doing on this subject. I know that members of the all-party group are also grateful for the engagement that she and her team have had with them, and we look forward to it continuing.