AIDS, Tuberculosis and Malaria

Lord Collins of Highbury Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating the debate. I also thank him for his lifetime commitment to the battle against HIV and AIDS, and, more importantly, against the prejudice and stigma that all too often hinder treatment and prevention.

The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. As noble Lords have said, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment. About 12.3 million people have been tested and treated for TB. Some 450 million mosquito nets have been delivered. Of the goals it set in relation to its work on HIV, TB and malaria for delivery in 2016, the fund has already achieved 100% of its HIV goal, 115% of its malaria goal, but, regrettably, only 58.5% of its TB goal. As we have heard, despite the huge progress on malaria in particular, still more needs to be done. I was shocked to hear yesterday a DfID scientific adviser state that half the children in high-risk areas still sleep without nets.

The fund is short of its TB targets because countries do not have the capacity to run programmes of the scale of those for HIV and malaria. As the noble Lord, Lord Chidgey, said, the fund provides more than 80% of international financing for TB, more than 20% for HIV and 50% for global malaria. As my noble friend Lord Cashman said, the UK contributed £1 billion to the fund in December 2013, saving a life every three minutes. Again as we have heard, the UK has pledged £1 billion to the Global Fund for the next 2014-16 round, but this funding is capped at a total of 10% of the total sum raised. The US contribution, which is huge, is also capped at 33% of the total funds pledged.

Sadly, as the noble Lord, Lord Fowler, said, the Global Fund is still short of its funding target. Given its importance to the global response to these three diseases, what action have the Government taken to ensure others step up to the mark in this round of funding? Also, if these fail, will the Government commit to disbursing the full £1 billion, regardless of whether other countries pledge or not? As the noble Lord said, the Global Fund has led the way on integrating TB and HIV programmes as recommended by the World Health Organization. When I raised in an Oral Question last December just how integrated DfID’s bilateral HIV programmes were, the Minister agreed to write to me. In fact, in her subsequent letter the noble Baroness stated that DfID,

“responds to partner countries’ health priorities”,

including tackling TB/HIV co-infections. The noble Baroness assured me that DfID will ensure that this approach is followed where we have bilateral TB/HIV programmes.

Of the 28 countries DfID lists as partners, 14 are on the list of high-burden TB countries and two are on the list of high-burden drug-resistant TB countries. In which case, I am concerned as to why TB is not identified as a health priority in any of those countries. Does the Minister accept that DfID could better integrate its TB/HIV programme in its bilateral arrangements and help to build the capacity of national TB programmes? Further, there is a £2 billion a year funding gap for TB that the Global Fund cannot fill. TB is an infectious disease that does not recognise national boundaries. Failure to control the disease in one country can and will lead to resurgence in others that have successfully tackled the disease.

The Global Fund helps countries purchase drugs, diagnostics and vaccines to tackle the three diseases. However, for many conditions, such as paediatric HIV, as we heard from the noble Baroness, Lady Barker, and TB—particularly drug-resistant TB—we do not have drugs of sufficient quality. I conclude by stressing the point I made on Monday in Grand Committee: there is a strong case for DfID to scale up its investment in R&D for TB, HIV and malaria to develop the treatments needed to eliminate these three diseases. I, too, would welcome the meeting suggested by the noble Baroness, Lady Barker, to raise these issues and the concerns of many people.