AIDS, Tuberculosis and Malaria

Lord Avebury Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Avebury (LD)]

My Lords, I begin by joining in the congratulations which have been expressed to the noble Lord, Lord Fowler, on his outstanding record over several decades campaigning against homophobia and for the eradication of HIV/AIDS. He continues with this work effectively here in your Lordships’ House, in his book, AIDS: Don’t Die of Prejudice, and in his many speeches and articles on what the world needs to do to eradicate a scourge that my noble friend rightly describes as the greatest public health threat in the world today.

The noble Lord rightly castigated the 80 countries that criminalise homosexuality and the noble Lords, Lord Cashman and Lord Lexden, mentioned Uganda in particular as having an anti-homosexuality Bill currently before its Parliament. It was not for this reason, I think, that we cancelled our budgetary aid to Uganda, but perhaps we ought to review our non-humanitarian aid to all the 80 countries to see whether any pressure can be brought to bear on them through fiscal means.

As has been said, the Global Fund invests some $4 billion a year, of which the UK provides nearly £1 billion as its share. This is a cost-effective partnership, bringing together Governments, civil society, the private sector, philanthropists and patients affected by the diseases. It mobilises programmes run by local experts in 140 countries, avoiding duplication or overlapping.

As your Lordships know, HIV and TB are closely linked and TB is the leading cause of death worldwide for people living with HIV. Last year, the Global Fund provided that all applications for support from countries with high incidences of both diseases should present integrated programmes to qualify for assistance. This is a great step forward in the response to TB, because country HIV programmes have often been significantly more developed than their counterparts that address TB. TB patients will benefit from the greater resourcing, expertise and reach of country HIV programmes. For some reason, DflD currently does not integrate TB into any of its bilateral HIV programmes. This needs to change. I would like my noble friend, when she comes to wind up, to say that we will follow the Global Fund’s example by requiring recipients of our bilateral assistance for HIV/AIDS also to integrate their TB/HIV programming.

There is also a case for the co-ordination of delivery systems for malaria diagnosis and treatment with programmes for TB and HIV. The APPG on Malaria and Neglected Tropical Diseases points out in its latest report that,

“HIV and malaria frequently co-exist and the treatments most commonly used for each are now known to interact with each other”.

This would not be the case, I hope, with the first ever vaccine against malaria, RTS,S, developed over the last 20 years by GSK with additional funding by the Gates Foundation in one of the product development partnerships which are proving to be so successful in addressing the lack of commercial incentive to undertake R&D for vaccines, diagnostics and drugs for neglected diseases of the developing world. Does my noble friend the Minister think that we are likely to be able to eliminate these three diseases by 2030? On malaria, the APPG says that the Medicines for Malaria Venture has,

“the strongest anti-malaria … development pipeline that has ever existed”.

The rollout of the RTS,S vaccine before the end of the decade will be a significant milestone on the road to eradication. However, targets are needed for the post-2015 agenda, which is to be discussed shortly.

For HIV/AIDS, the fast-track approach of UNAIDS to ending the epidemic by 2030 is supported by a strong consensus, according to UNAIDS, which has identified headline intermediate targets for 2020. It recalls that African countries committed in the 2001 Abuja declaration to spend 15% of their budgets on health, but only six of them have met that commitment. Additional funding—the amount not specified—would be needed from donor countries; presumably, as the third-largest donor to the Global Fund, we are entitled to ask our EU partners to step up to the plate and contribute proportionately to their national income, as we do.

In conclusion, I am sorry to note that there was not a word about DfID in the Chancellor’s Autumn Statement, still less any mention of our commitment to the Global Fund over the next five years as we embark on the post-2015 agenda. The fund’s three-year pledging cycle does not fit with our five-year Parliaments, but it would be useful to hear from my noble friend what Mr Osborne has pencilled in for the 2016 round.