Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Tuesday 4th June 2013 Lords Chamber

Asked By

[Lord Fowler]

To ask Her Majesty’s Government what action they are taking to support the global fund on HIV and AIDS, tuberculosis and malaria.

[Lord Fowler]

My Lords, this short debate is about the importance of the global fund. I saw the global fund at its beginning, when Richard Feachem was the director. Over the past decade it has developed into one of the chief means of combating HIV/AIDS, tuberculosis and malaria around the world. It has helped in the dramatic progress that has been made, particularly in the past five years, and that progress has been truly dramatic. In HIV, the number of people on anti-retroviral treatment worldwide has increased from 1.4 million in 2007 to 4.2 million today. In 2007, there were almost 3 million TB cases detected and treated; today the total is 9.7 million. In 2012, a cumulative 310 million nets were distributed, compared with only 46 million five years ago.

The result is that, with all three diseases, a record number of people are now receiving treatment. To give the example of HIV/AIDS, which I know best, well over half of the people in sub-Saharan Africa who need anti-retroviral treatment are now receiving it. Incidentally, that is probably a bigger proportion than for some countries now in eastern Europe—it just shows how the balances change—whereas for TB in sub-Saharan Africa, the figures for those being successfully treated are higher than for HIV.

Not all these improvements, it should be underlined, can be put down to the global fund. National Governments make a massive contribution themselves. I was in Cape Town a month or two ago and, to take South Africa as an example, it finances much of its own programmes. The years of neglect have been followed by an inspired effort by the South African Department of Health. The result is that, over the past five or six years, life expectation has already improved and increased by something like five years. Furthermore, we should never forget the massive contribution that the United States makes bilaterally through the President’s emergency fund—a fund started, incidentally, not by Bill Clinton but by George Bush, which will stand as a tribute and lasting memorial to him. If it was not for the United States, I think that the world would be in a terrible mess as regards these funds. So we can say, so far so good.

However, there is another way of looking at the figures. We can also look at the death toll from these diseases now, and we can look at the new infections that are taking place every day throughout the world, not just in Africa. The most recent figures show 2.7 million deaths from AIDS and TB-related causes, and 660,000 deaths from malaria and related causes. By any standard, that is a devastating loss of human life. Here we come to the crunch point. I pay tribute to the increases in financing that there have been, but if financing continues just at its present level, the prospect is that there will be many more new HIV infections and fewer TB patients receiving care. In other words, we risk going backwards. One reason for that is the growth taking place in the world population; another is the particular nature of HIV. For some diseases it is possible to give a course of treatment, for a patient to recover and for his place to be taken by a new patient; but HIV is not remotely like that. There is still no cure. It is a lifelong condition. Patients stay on that treatment and, other things being equal, the cost will rise as new cases come forward for treatment.

That is not to say that we should not seek further efficiencies in programmes. We should certainly do that. Incidentally, as far the global fund is concerned, in spite of some of the criticism that it has had, it actually has a very good record in this area. I remember seeing an example of that in Kiev in the Ukraine, where the global fund took the decision that the Government should hand over their responsibility in various aspects to an NGO, the HIV Alliance. The result was a dramatic reduction, an economy, in drug costs. The costs of the antiretroviral drugs which were being bought came down by something like 25 times.

We also need to persuade national Governments to increase their direct contributions to their own epidemics. It is certainly not enough for some countries to rely as heavily as they do on outside finance. Of course, when that happens it is fuel for those who argue—wrongly, in my view—that international aid should be cut back, but let us remember that this is not the easiest time to make that case and to ask Governments to add to their aid programmes. The fact is that however you look at it, it is very much in everyone's interests that the budget for the global fund is increased. The fund is a vital part of the world’s fight against three killer diseases. If we start to go backwards, that obviously affects the lives of millions of people around the world but, more, it also means that the epidemics continue to spread. That in its turn will mean even more money to combat them and bring them under control.

The global fund has estimated that over the next three-year period of 2014-16, it will need something like $15 billion—a substantial increase, certainly, on what is now being spent. However, if the result can be a decisive and irreversible improvement, that is a very considerable prize indeed for the world. No one seriously doubts the global fund’s figures; most significantly, they are not challenged by the United States, which is by far the biggest donor in the fund. That was confirmed to me last week when I was in Washington talking about these things.

What we in this country therefore now await is the British Government’s response. When I was Health Secretary, I harboured an ambition to make the United Kingdom a model of how a nation should respond, particularly, to HIV. We have made progress along that road but I think that no one would say today that it is a model. We spend, for example, far too little on prevention and on publicising not only the threat of HIV but the way in which it can be combated. However, we have maintained a good record in our contribution to the global fund. I hope that the Minister will now be able to put some more flesh on those bones. The US has set an example; we need also to set an example.

I have two last points. First, I very much hope that the global fund will continue to support the efforts to develop a vaccine for both HIV and TB. We have seen what a vaccine can achieve on polio and there are some encouraging signs, as in Thailand, that the prospect of developing a vaccine is not as far-fetched as some critics argue. The problem is that the development time for a vaccine is far in excess of the lifetime of any Government or three-year programme. It is nevertheless a goal which is most certainly worth pursuing. I say that in particular because of my second point. What stands in the way of so much progress in these areas is stigma and discrimination. A further effort is most certainly required there. Stigma infects gay and lesbian people, those with HIV and those with TB. It means that many people around the world are reluctant to come forward for testing. A vaccine would cut through all that. It is therefore, again, a goal which is worth pursuing.

If I may say so, tonight there has been a historic vote in this House. We have sent out a clear message that we in this country believe in equality of treatment for all. That was a massive message, which was underlined by the majority. I believe also that we are united, irrespective of which way we voted on that debate, on the criminalisation of homosexuality being abhorrent. I hope that that message goes out equally strongly, but I put it to the Minister that it would be even better if tonight she could set out the British Government’s plans to help the global fund fight one of the most important health battles that the world now faces. That is a historic battle and this country could make an important and valuable contribution to it.

--- Later in debate ---

[Lord Fowler]

My Lords, I thank the Minister very much for what she has said. I particularly thank everyone who has taken part in the debate. It has necessarily been a short debate, but the speakers have brought in virtually all the areas of the global fund: AIDS, tuberculosis and malaria. In addition, the point has been made very strongly about the stigma that attaches to a number of these areas and which stands in the way of testing and is therefore totally counter- productive.

I thank the Minister for her reply. I think I will need to look at it with a little more care. She went very rapidly at one stage when I thought she was getting to the point of pledging herself to doubling the contribution, but I do not think that quite came. I thought she made the case entirely for doubling the contribution, so I was not sure why she did not go that final bit, but there we are. I live in optimism.

In all seriousness, the pledge has been made a number of times and it is getting just a wee bit dog-eared. I do think it is rather important that if the Government want to set an example, get some credit for what they are doing and have some influence, they should make a firm pledge and make it stick. However, I thank the noble Baroness for her reply and I thank everyone who has taken part.