World Tuberculosis Day

Jim Shannon Excerpts

Thursday 24th March 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Ealing, Southall (Mr Sharma) for setting the scene extremely well. He has been incredibly helpful with the information he has provided. I have spoken on this subject on a number of occasions in Westminster Hall. The former Member for Stafford, Jeremy Lefroy—he was your colleague, Mrs Murray, and you will remember him—used to bring this issue up, and he always reminded us that TB, while a terrible disease, is in many cases complicated by a combination of HIV and malaria. Again, I support the hon. Member for Ealing, Southall in highlighting this matter, and I ask the Minister to give us an idea of how we can respond in a way that addresses some of the issues.

When I was a child, which was not yesterday, I remember hearing the dreaded—in those days—diagnosis of TB. Yet, when I asked my aide, who seeks out the information for my speeches, to prepare the notes for this debate, her first reaction was, “Surely TB is extinct. It’s no longer an issue—they don’t even give the BCG anymore.” Maybe we need to be more aware of the data the hon. Gentleman referred to; some of the information in the APPG’s report illustrates the importance of this issue. The data is there, and it did not take my aide long to learn that she could not be more wrong. The fact that the younger generation believes there is no such thing as TB anymore does not bode well.

The purpose of this debate is to highlight the issue of TB in the countries where it is a severe killer. The disease is rampant in some parts of the world, and the hon. Gentleman helpfully reminded us that there are rising numbers of TB cases in the United Kingdom as well.

The data is clear. Between 2019 and 2020, there was a 9.2% increase in the number of deaths from TB, and the World Health Organisation predicted that the number of deaths would increase in both 2021—which they did—and 2022. During the same period, the number of people diagnosed with TB, according to the APPG’s report, dropped by 18%. Some 16 countries accounted for 93% of that reduction, suggesting that countries that already have a high TB burden have fared worse than others.

Covid has not been kind to any diagnostic data collection. Before covid, TB was known as the world’s deadliest disease, which it quite clearly is. The information in the APPG’s report refers back to when TB was more prevalent in a different century. Between 1980 and 2012, the UK saw a 1.9% increase in TB cases year on year. The number fell in 2018, but rose in 2019. I know it is not directly the Minister’s remit in the UK, but the debate is about TB, and perhaps she could give us some indication of what has been done to address TB in the United Kingdom to make sure it does not become rampant and a serious issue?

There is a TB action plan for England for 2021 to 2026. The Government have recognised that there is an issue, and it is clear they want to ensure that action can be taken and that we can play our part to ensure that TB does not become the problem it was in the past. We are looking to eliminate TB by 2035 across the world, which would be good.

Again, I am not sure this is a question the Minister can answer directly, and I am happy to have a response from her civil servants, who are always helpful. Have we any indication about TB in England? It is the responsibility of Ministers here, and it is a devolved matter in Scotland, Wales and Northern Ireland. Is it possible to find out if there is any indication of those figures for the regions?

The Centres for Disease Control and Prevention noted that in 2018 1.7 billion people were infected by TB bacteria, which is roughly—this is quite worrying—23% of the world’s population, and the disease claimed 1.5 million lives each year. It is clear where it is prevalent. It is a serious and deadly disease. Of the 10 million individuals who became ill with TB in 2018, approximately 3 million were missed by health systems and did not get the care they needed, allowing the disease to continue to be transmitted. I repeat the question asked by the hon. Member for Ealing, Southall: if those 3 million were missed, how can we ensure that others are not missed? We have to, first, raise awareness through this debate and, secondly, make sure we clearly address the issue of TB in parts of the world where it is most prevalent.

From looking at the information that we were sent beforehand, it is clear that there are parts of the world where TB is more prevalent—China, Pakistan, India, Bangladesh, Indonesia, the Philippines, Nigeria and South Africa. We in the all-party parliamentary group for international freedom of religion or belief hope to visit Nigeria at the end of May, so we will need to make sure we get all our inoculations and so on before we go. One of the things I want to speak about is those who travel from a missionary organisation in my constituency, which is very effective.

Statistics show that in 2020, there was an estimated total of 1.5 million TB-related deaths. Some 1.3 million of those were among HIV-negative people, up from 1.2 million in 2019—again, a worrying trend—and an additional 214,000 were among HIV-positive people. I referred earlier to a former Member, Jeremy Lefroy, who always spoke about three things: HIV, malaria and TB. People who have both TB and HIV when they die are internationally classified as having died from HIV; maybe the data needs to be corrected to ensure we have a fuller picture of what the issues are. The combined total is back to 2017 levels, and an estimated 230,000 children died of TB in 2019, including children with HIV- associated TB. Of those children, 194,000 were HIV-negative and 36,000 were HIV-positive. As most of us know, HIV/AIDS affects immune systems, so those infected with TB unfortunately have little defence against it.

In countries such as Eswatini—formerly Swaziland—where the AIDS incidence rate is one in four people, TB is a real and present danger. I have a particular interest in Eswatini because a church in my constituency, Elim church, has a very strong mission there. The church works in Eswatini, as well as in Zimbabwe, and it is confronted with these health issues all the time. It fundraises heavily to support those two countries—Eswatini in particular—and it sends money, drugs, food, and all the other help it can, which clearly makes a significant difference to the lives of the people out there. My constituency always supports those things, and the help its people give is vital.

A lot of work has been carried out by international bodies in the fight against TB. The incidence of TB in Eswatini has fallen gradually from 1,010 cases per 100,000 people in 2001 to 309 cases per 100,000 in 2020, so there has been some positive change as a result of the work of non-governmental and missionary organisations such as the Elim church mission, headquartered in Newtownards in my constituency. That is a victory we can all claim, and it must be replicated in the Congo, where the incidence rate sits at over 440 per 100,000. There are parts of the world that are not shown on the map in the report, so there are other places where there is work to be done. While I understand the rationale behind not vaccinating all our children, families who travel to these countries from Newtownards, for example, need to be aware that they face a risk and should consider getting vaccinated before they go. Obviously, we will also take note of that when we make our journey to Nigeria at the end of May, God willing.

As the hon. Member for Ealing, Southall referred to, we are now encountering drug-resistant TB. Maybe the Minister will be able to give us some indication of how she and our Government are partnering with the World Health Organisation to combat drug resistance. There has been a significant reduction in the number of people treated for drug-resistant TB and with TB-preventative treatments, which are down 15% and 21% respectively, so this is clearly a massive issue that needs more focus than it is currently receiving. We must fund more research into solving this difficult and worrying problem. I ask the Minister again, in a constructive and positive way, what extra moneys have been set aside for R&D to ensure that we can do these things?

I will conclude because I am looking forward to hearing from the shadow Minister, the hon. Member for West Ham (Ms Brown), and especially from the Minister. The shadow Minister takes a particular interest in this matter, and like me and the hon. Member for Ealing, Southall she wishes to see giant steps forward. We aim high with the purpose of trying to change things.

Giving the BCG vaccine to children has reduced TB, but that most certainly does not mean that the disease has gone away. I am thankful for having had the opportunity to highlight that, and to put it to the Minister that the gift of combating the disease lies in our United Kingdom of Great Britain and Northern Ireland and in other developed nations. Will we give that gift or will we choose to accept that we have only eight cases per 100,000 people and leave it there? I sincerely hope not.

I respectfully, honestly and beseechingly ask the Minister to assure every one of us of the steps that we are taking and will take in the near future to combat this dreadful disease. The document that the hon. Member for Ealing, Southall gave me beforehand refers to the Global Fund to Fight HIV, Tuberculosis and Malaria. That is a battle that we all have to fight together. I hope that we have done our part today to help in that battle to eradicate tuberculosis across the world. We in this House, in this great United Kingdom of Great Britain and Northern Ireland, must ensure that, through our Minister and our Government, we deliver for the people who need it. That is what our debates are always about: others.

--- Later in debate ---

[Vicky Ford]

I thank the hon. Lady for her excellent question. I understand the urgency of getting the details agreed, but, as she knows, there has been a restructuring in the FCDO because of the changing situation that we now face, given the geopolitical impact of Russia’s illegal invasion of Ukraine. It is important that we continually assess how best to use our structures to reflect different global challenges to enable us to deliver for the UK. As I said, we maintain a strong commitment to improving global health, and I understand the importance of getting the numbers agreed. We cannot do everything, but we will get the numbers as soon as possible.

Research was mentioned in the opening speech. The UK is a global leader in the funding of TB research. We continue to support academics and industry to develop the evidence, and new technologies and approaches to diagnose and treat TB. We have been a critical investor in product development partnerships to combat infectious diseases, including TB, for many years. The FCDO has supported the Foundation for Innovative New Diagnostics to develop a new PCR-based technology to test for TB, which is now available in more than 140 countries worldwide, including in the NHS.

Our investment also helped the TB Alliance to develop new combinations of drugs that significantly reduce the severity of side effects and the length of treatment from over 18 months to six months for drug-resistant TB, and even shorter for drug-sensitive TB. UK funding is bringing partners together to solve critical problems. For example, through support to British Investment International, MedAccess, the Clinton Health Access Initiative and Unitaid have secured a lower price for an innovative short-course TB preventive therapy.

As a further demonstration of our commitment to invest in the fight against TB, I am pleased to announce £6 million of funding for TB REACH, which will support piloting innovative ways to hunt down and treat millions of missing TB cases. I am pleased that the US and Canada are also backing that fantastic work; only through joined-up efforts with our partners will we meet our target to eliminate TB. The UK Government are one of the largest bilateral funders of TB research and development globally, and we continue to invest in research and development, including developing new tools and approaches to tackle TB.

The hon. Members for Ealing, Southall and for West Ham spoke about the situation in the UK. With an eye on the global picture, it is important not to lose sight of the challenge that TB presents here in the UK. As in other countries, we see that the disease often affects the most marginalised and vulnerable people. We are investing in early detection and treatment, including genome sequencing, which can help to detect drug resistance and clusters of transmission.

As the hon. Member for Ealing, Southall said, the UK has a TB action plan for England, which will run for five years from 2021 to 2026. It was jointly launched by the UK Health Security Agency and NHS England, and it sets out the work that will support year-on-year reductions in TB incidence in order to move England towards its elimination target. It includes specific actions relating to underserved populations.

[Jim Shannon]

I thank the Minister for her positive responses; we are greatly encouraged. I do not expect to have an answer today, but will she let us know the number of TB cases in Scotland, Wales and Northern Ireland compared with England?

[Vicky Ford]

I will get back to the hon. Member with the impact on Northern Ireland. England is one of the few countries that routinely use genome screening for diagnosing and detecting drug resistance and clusters of transmission. The technology was pioneered in the UK and is routinely used in England, Scotland and Wales, but I am not sure about Northern Ireland.

People born outside the UK account for more than 70% of TB notifications, so the UK has a latent TB infection screening programme that detects new migrants with latent inactive TB. That early detection and treatment reduces the chances of a reactivation of the active disease. The Government’s additional £36 billion investment in the health and care system over the next three years will also support TB detection and treatment.

I was born in Northern Ireland, so it was heartening to hear the hon. Member for Strangford (Jim Shannon) speak about the relationship between his constituents and the people of Eswatini and Lesotho—two countries that I visited in, I think, my second week after taking on my current role. It is important that we support smaller countries as well as larger countries, and the Global Fund is working in both Eswatini and Lesotho. I assure the hon. Member that we work globally to tackle the risk factors for TB, including poverty and malnutrition.

To conclude, the UK will continue to work with partners to pioneer scientific breakthroughs, to invest in detection and treatment, and to strengthen health systems globally. That is the only way that we will make tuberculosis a thing of the past.