Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Chidgey Excerpts

Thursday 12th December 2013 Lords Chamber

Asked by

[Lord Chidgey]

To ask Her Majesty’s Government what assessment they have made of the impact of the replenishment pledges for the Global Fund to Fight AIDS, Tuberculosis and Malaria, made by world leaders in Washington in early December.

[Lord Chidgey (LD)]

My Lords, at their meeting in Washington at the beginning of this month, world leaders confirmed their pledges on the fourth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund congratulated the UK on demonstrating strong leadership in global health, with a major contribution pledged to the Global Fund for the next three years. The United Kingdom will contribute £1 billion to the Global Fund for the 2014-16 period, the second largest pledge by any Government so far after the United States of America. Dr Nafsiah Mboi, the Global Fund chair, cited the extraordinary generosity and leadership of the United Kingdom since the fund was founded in 2002. She said that this new commitment would underline a transformative step forward for the Global Fund partners in their fight to defeat HIV/AIDS, TB and Malaria, and gave an inspiring model of responsible global partnership.

Perhaps I may say at this stage how pleased I am that my noble friend Lord Fowler is in his place and will be contributing the benefit of his wealth of knowledge on these issues to the debate. I also welcome my noble friend Lord Verjee, who I am delighted to say has chosen to make his maiden speech in this debate. I know that my noble friend is able to speak from his personal experience in these matters and I look forward to his contribution today and to many more in the future.

The United Kingdom commitment to the Global Fund is geared towards encouraging other donors to maximise their own pledges and thus unlock additional funds with each new pledge. Can my noble friend the Minister say in her response what has been the impact so far of the Washington pledges on securing new pledges, or even indications of new pledges, at this time?

In its contribution towards ending world poverty, the United Kingdom is helping to halve malaria deaths in 10 of the worst affected countries by 2015. The United Kingdom has targeted saving the lives of 50,000 women in pregnancy and child birth, and 250,000 new-born babies, as well as helping to immunise more than 55 million children against preventable disease. The Global Fund pledging conference has set a target of $15 billion for the fourth replenishment. So far it has received $5 billion from the USA, the equivalent of $1.6 billion from the United Kingdom, and $612 million from Canada. A number of other pledges, notably from northern Europe, bring the total pledged to date to more than $12 billion.

The Global Fund was created in 2002 as a public-private partnership to raise funds to change the course of HIV/AIDS, TB and malaria. The United Kingdom has now become the second largest donor after the USA, pushing France into third place. Since 2002, the fund has approved more than $23 billion for grants spread over more than 150 countries. The fund accounts for 21% of all international funding for HIV/AIDS, 82% of international funding for TB and 50% of global malaria funding. It is the biggest funder of programmes to prevent, treat and care for people with these diseases. Big strides have been made, with 9.7 million people receiving antiretroviral therapy for HIV/AIDS and a further 30 million mosquito insecticide-treated nets being distributed in the first six months of 2013, making a total of 340 million nets. My noble friend may be aware, however, of disturbing reports that in some areas these bed nets are being used as fishing nets, which is clearly totally inappropriate. Does her department have any details of this departure and the effect it may have on the impact of the fourth replenishment?

The Global Fund’s TB programmes are continuing to expand, with the number of cases being supported now exceeding 11 million. However, the UK could be doing more, to which I shall return later. The UK’s latest £1 billion pledge to the Global Fund will maintain the record of “a life saved every three minutes”. Taking a lead in the worldwide fight against HIV/AIDS, TB and malaria, United Kingdom support over the next three years will deliver antiretroviral therapy to 750,000 people, 32 million more insecticide-treated mosquito nets to protect against malaria, and TB treatment for over 1 million more people. The UK’s allocation to the Global Fund will save a life every three minutes over the next three years and it will dramatically improve the lives of millions of people across the globe. Your Lordships will be aware that there are those who question the efficacy of organisations such as the Global Fund and its ability to channel the generosity of the United Kingdom into effectively combating diseases such as AIDS, TB and malaria. However, serious analysis confirms that the statistics demonstrate incontrovertibly that we can win this global battle on behalf of the poor.

On a human scale, I am sure that noble Lords can recall, like me, witnessing the suffering of those afflicted by these diseases and their like. I think of my visit to a hospice in Soweto in 2004, where volunteers were comforting and caring for patients dying from AIDS. Many were too weak to speak and unable to understand what was happening to them, having been abandoned by their families. Left to die on the streets, they were brought into the hospice by volunteer community workers who had been trained in basic healthcare by a handful of dedicated nurses. Almost 10 years on, thanks to organisations such as the Global Fund, the ravages of AIDS are gradually diminishing, with the hope that they will become something of the past in due course.

More recently, indeed just this summer, under the sponsorship of the charity RESULTS, I visited a district hospital outside Lilongwe in Malawi where small children were being comforted by their mothers as they struggled for breath and literally for life against the advances of pneumonia and TB. Further afield, at village health posts, I watched children being vaccinated by health workers, who were hampered by the fact that the transport of the cold boxes essential for the storage of vaccine was at the mercy of the poorly maintained and therefore unreliable fleet of motorbikes. Just to add to the difficulties, it was a 14-kilometre walk to the health posts for families living in the most remote communities.

Considering the Global Fund’s present challenges and the UK’s responses, it is the case that the poor relation in the three worldwide health campaigns seems to be tackling tuberculosis. TB is contagious and airborne. It is the second most deadly infectious disease in the world, and last year it was responsible for 1.3 million deaths and 8.6 million new cases. TB is the leading cause of death for HIV/AIDS-positive people and is responsible for one in five HIV deaths—that was 320,000 deaths last year alone. TB is estimated to have killed more people than any other pandemic in history, and is developing a drug resistance which makes it more expensive and more difficult to treat, with many more adverse implications and side-effects for patients. An estimated 3 million people a year who develop TB are not officially diagnosed or treated, with no guarantee of treatment outcomes.

The Global Fund has demonstrated that, with investment and leadership, significant gains can be made, but it needs to work with agencies such as DfID to be fully successful. It cannot operate in isolation. DfID can and should invest in issues such as TB which have an impact on health outcomes in the UK. DfID can and should prioritise issues that are important to the UK taxpayer. DfID can and should invest in new and innovative projects that could represent significant steps forward.

TB is a largely neglected disease. Only one new drug has received regulatory approval in 42 years and the old-fashioned BCG procedure offers no protection to adults and cannot be used on people with HIV. Moreover, it does not protect against the most common type of the disease. It is estimated to cost the EU region alone almost €6 billion a year, yet the region accounts for only 4.7% of global cases. Leadership from DfID in a country like the UK could be transformative. It could lift the profile of the disease and show that it is still a major issue, which could lead to additional investment. DfID has provided a model response to malaria, putting it at the forefront of the global aid agenda. The 1.3 million people dying every year from TB and the 8.6 million who suffer from the disease need the level of support and commitment that only an aid agency like DfID can provide.

I should be very grateful if, in her response, my noble friend could address this and the other issues that I have raised.