Tuberculosis

Kevin Barron Excerpts

Wednesday 27th November 2013 Westminster Hall

[Nick Herbert]

I hope the Minister has noted my hon. Friend’s point, because TB control programmes rely on funding from the global health fund. We need to send that message to the global health fund as it determines resource allocations and to other countries as they consider replenishing their support.

My final point is that although the Government’s support for the global health fund is welcome, it is important to understand that that is not the only thing we need to do if we are to get on top of TB globally. Setting aside the action that needs to be taken domestically—Health Ministers are making progress on what needs to be done through a TB control programme—we cannot rely on the generous commitment to the global health fund for the international effort that is needed.

I want to raise the cause of an important programme run by the Stop TB Partnership called TB REACH, which addresses the problem of the missing 3 million cases to which the hon. Member for Scunthorpe referred. Until we find those who are affected by TB, we have no chance of treating them or getting hold of the disease. The power of TB REACH is that it funds innovative programmes on the ground that are finding new ways to go out and identify the missing 3 million cases. TB REACH has been robustly evaluated and shown to deliver value for money. It is relatively cost-effective, but its funding is coming to an end. TB REACH was largely set up with funding from the Canadian Government and now does not have sufficient funding to identify all the necessary cases. TB REACH has helped to identify some 500,000 cases in the past year, and it needs to do more. If we are serious about the level of the challenge we face, it would be worth while for the Government to seriously consider contributing to the ongoing work of TB REACH to ensure that the programme can survive.

[Mr Kevin Barron (Rother Valley) (Lab)]

Earlier this year I was a member of the parliamentary delegation that visited TB REACH in Awasa, in Ethiopia. TB REACH is doing outstanding work to find those missing people. I concur with the right hon. Gentleman and add my support. Hopefully the Government can find money to put into TB REACH, as it is not funded through the global health fund.

[Nick Herbert]

I am grateful to the right hon. Gentleman, because that is precisely the point I am trying to make. I understand that TB REACH has helped to identify some 750,000 cases of TB and prevent those people from becoming infectious, as they would otherwise have continued to infect others.

The budget of TB REACH is relatively small. It is asking for $40 million a year. In the overall scale of the interventions that the west is now making to control the major diseases of HIV, malaria and TB, the funding is relatively small, although obviously it is not insignificant. The programme is worth while; I therefore ask the Minister to address that point. I have just written to the Secretary of State for International Development and hope to meet her to discuss TB REACH at this important moment, as the programme’s future is being considered.

I am grateful to the Government and to hon. Members on both sides of the House for the interest they have shown in TB. A few years ago, very little interest was shown in the disease, despite the huge interest shown in other international development issues. That has changed. I believe that the work of the all-party group has helped, as have the many non-governmental organisations that are supporting us—in particular, Results UK has played an important role in raising the profile of TB. We have a moral imperative to tackle the disease, and doing so is within our reach. It is now essential that we step up the efforts to ensure that it is not another 100 years before we beat a disease that the west once thought it had beaten.

--- Later in debate ---

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on applying for and securing the debate. We have heard some of the dreadful statistics on TB throughout the world, and I want to spend a few minutes looking in detail at the cost of treating TB when it has not been caught first time round.

Last year, there were an estimated 450,000 cases of multi-drug-resistant TB. It is believed that 10% of those involve extensively drug-resistant TB and are, effectively, impossible to treat. Drug resistance is really a man-made problem resulting from the misuse of anti-TB drugs and the poor management of the disease. Drug-resistant TB can be passed from person to person in the same way as TB that is not drug-resistant. Clearly, early and rapid diagnosis and treatment completion are essential to control TB. As many Members, including my hon. Friend the Member for Scunthorpe, have said, TB is the leading killer of people living with HIV/AIDS and accounts for one in five AIDS-related deaths.

Drug-resistant TB develops primarily because it is treated with a number of drugs taken over six to nine months. If medication is taken incorrectly or stopped prematurely, the TB bacteria can re-emerge and become resistant to the drugs used to treat TB. That sometimes happens because of the provision of substandard drugs, because patients do not complete their treatment or because the drugs are available only intermittently.

Multi-drug-resistant TB is a form of TB that does not respond to the standard treatment using first-line drugs and that is extremely difficult and expensive to treat. As I suggested earlier, extensively drug-resistant TB occurs when resistance to second-line drugs develops on top of multi-drug resistance. Drug-resistant TB can take two years or more to treat with drugs that are less potent, more toxic and much more expensive than those used to treat a standard case of TB. The drugs are toxic and are commonly associated with severe side effects, of which permanent deafness is the most common. Almost all of them have limited effectiveness, and most are more than 40 years old, as the hon. Member for Mid Dorset and North Poole (Annette Brooke) said. Fewer than 50% of multi-drug-resistant TB cases are successfully treated and considered cured.

On costs, multi-drug-resistant TB can be up to 450 times as expensive to treat as a standard case of TB. In all 27 high-burden multi-drug-resistant TB countries, the treatment cost is greater than the annual average income. If multi-drug-resistant TB is not correctly treated and develops into extensively drug-resistant TB, the chances of someone being successfully cured are less than one in 10. The world needs to recognise that. Extensively drug-resistant TB patients are practically impossible to treat, but they often remain infectious and capable of transmitting the disease to others. That scenario is often described as a time bomb.

[Jim Shannon]

Everyone is aware of the high prices of the normal drugs, but a number of countries—India is one—can produce similar, effective drugs more cheaply. Should we source those similar, cheaper drugs to help spread the cost?

[Mr Barron]

I am sure that is the case; indeed, the global fund does do that. However, that does not prevent the supply of drugs, even if they are affordable in part, from becoming intermittent. As a consequence, we end up with the more extreme cases of TB.

The UK Government have played a leading role in the response to TB globally, investing in research and development on new tools to tackle TB, supporting efforts to increase the profile of the disease through the Stop TB Partnership and supporting key institutions such as the global fund, which accounts for more than 80% of donor funding to tackle TB in developing countries.

I mentioned in an intervention that I visited Ethiopia earlier this year. I went there with Results UK in the February recess, along with the hon. Member for South Derbyshire (Heather Wheeler), my hon. Friend the Member for Workington (Sir Tony Cunningham) and two Members of the other place. In Addis Ababa, we visited St Peter’s hospital, which is Ethiopia’s national TB referral hospital. With support from the global fund, St Peter’s provides care for TB referral cases and patients with multi-drug-resistant tuberculosis. It also provides care and treatment to people living with HIV/AIDS, which is of course closely linked to TB.

The hospital demonstrated that, with proper funding, low-income countries can use minimal resources efficiently and effectively to respond to the threat of drug-resistant TB. As I said in my intervention on the right hon. Member for Arundel and South Downs (Nick Herbert), we also visited Awasa and looked at the great work TB REACH was doing there to find the missing 3 million cases.

While we were in Ethiopia, we did not look just at TB, although that was our primary aim. We also looked at Ethiopia’s strong planning and innovative response to its human resource crisis. It is using its health extension programme, which quite a lot of our money has gone into developing. Funding to support such successful interventions has been provided by key multilateral organisations, including the global fund and TB REACH. I reiterate that, in addition to what they have done already, the UK Government have put £1 billion over three years into the global fund, and they are much to be credited for that.

Finally, I have travelled the Commonwealth on many occasions over the years. When we were out in Addis Ababa, we had a meeting with DFID—I say this because the Minister is here—and it was one of the most positive meetings I have ever had. The DFID people knew exactly where global fund money and our taxpayers’ money was going: to help people in dire need of an improvement in their health, as well as in their quality of life, through water supplies and things like that. We always hear negative views about what happens to taxpayers’ money when it goes to the developing world, so it is worth putting on record that that was the most positive experience I have had since becoming a Member of the House.