AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Thursday 11th December 2014 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what action they are taking to support the Global Fund to Fight AIDS, Tuberculosis and Malaria.

[Lord Fowler (Con)]

My Lords, one of my major purposes in raising this short debate is to emphasise a crucial point about public health across the globe. Currently there is vast concern about Ebola, and rightly so. It must be met with all the resources at our disposal. But at the same time we must not forget the even greater challenge posed by the three diseases that the Global Fund was formed to fight—AIDS, TB and malaria.

The figures for deaths tell their own story. In 2013 an estimated 1.5 million people died from HIV/AIDS; 584,000 people died from malaria, and an additional 1.1 million people died from tuberculosis. The burden is heaviest in sub-Saharan Africa, where an estimated 90% of all malaria deaths occur, and—this is perhaps the most disgraceful statistic—in children under five. So, currently, three diseases account for more than 3 million deaths a year, to add to the mountainous totals over the past 25 years. AIDS is an example: the death toll so far is 35 million people. In addition, 36 million people are living with HIV, and in 2013 almost 200 million cases of malaria, and 9 million new tuberculosis cases, were detected.

Having said that, I do not want to downplay or understate the progress made, or the vast contribution that the Global Fund, and the President’s fund from the United States, have made. Without them the world would be in even greater crisis. The latest figures for the Global Fund show that 7.3 million people are on antiretroviral therapy for AIDS. It has tested and treated, or helped to test and treat, more than 12 million people for TB, and has distributed 450 million insecticide-treated nets to protect families against malaria. We have therefore made vast progress since those dismal and tragic days in the 1980s, when AIDS patients died and there was absolutely nothing we could do about it. I pay tribute to the clinicians, the nurses, the volunteers, and all those working for NGOs, throughout the world, who have made this progress possible.

Now we come to what is perhaps the most difficult challenge for any Government. In spite of the progress made, much more needs to be made, and it needs to be made urgently. As UNAIDS says in its latest report, only about three-fifths of countries have risk reduction programmes for sex workers, and 88 countries report that fewer than half of men who have sex with men know their HIV status. Most countries fail to provide drug substitution therapy, or access to sterile needles and syringes for people who inject drugs—even though that is something we started in this country back in the 1980s. Again, most disgracefully of all, antiretroviral treatment for children lags very substantially behind that for adults.

Not all the steps to combat these factors imply increased financial help. If the 80 countries that currently—and disgracefully—criminalise homosexuality were to reform that policy, we would take a massive step forward and reduce one enormous barrier to testing and treatment around the world. There is no question but that that could have a profound effect. I very much hope that in this debate the Government will underline their determination and commitment to do as much as they can to persuade those countries to reform their legal processes.

Just as certainly as that, sustained and increasing financial help is necessary from the nations of the world. Here I pay tribute to the Government for honouring the important pledge, made by Andrew Mitchell when he was Secretary of State for International Development, to add a further £0.5 billion for the Global Fund, as long as other nations join in. There is a slight question about that at the moment, because the total aimed at has not been reached.

Having just praised the Government, if I had a criticism of them it would be that that message about the increased aid should be made loud and clear. At the recent international AIDS conference in Melbourne, where there were Ministers and civil servants—it is by far the most important meeting in the AIDS calendar—we could manage no Minister or civil servant from DfID, and as far as I know, unless he attended very secretly, no British high commissioner. And that was in a Commonwealth country. We need to explain to the world what we are doing and why, and not allow other countries to paint us in terms of the British policy of the Victorian years.

I shall make one last point. With AIDS, antiretroviral drugs have saved millions of lives, but I wonder whether we should put all our eggs in one basket. I believe we should take heed of the warning given today by the review of drug resistance set up by the Prime Minister. Drug resistance can have a profound effect on HIV, TB and malaria. According to Jim O’Neill, who headed the review, drug-resistant infections already kill hundreds of thousands of people a year globally, and by 2050 that figure could be more than 10 million.

There will be further reviews, and I see that it is said, and emphasised, that the role of vaccines to prevent infections, in particular, will be examined. I declare an interest at this point, as a board member of the International AIDS Vaccine Initiative, a non-profit organisation, based in New York, dedicated to developing a vaccine for AIDS. It has been consistently supported by both parties—although this Government’s recent decision to cut help from £10 million a year to £1 million a year in one slash has not exactly helped. I could say more, but I will not, unless I am provoked, because the point I am making is a rather broader one than that.

Vaccines can take, and almost always have taken, decades to develop. This is not necessarily a natural area for Governments, with their four-year time limits—and perhaps even less so for Ministers, whose time limits are usually rather shorter than that. That is why it is so significant that the President’s fund in the United States, which obviously has a much longer timescale, is now devoting a small part of its substantial resources to research into prevention and vaccines. That is an extraordinarily important move and underlines the importance of prevention. Following that, I wonder whether the Global Fund should not do exactly the same thing and provide a more certain source of finance as well as underlining the crucial importance of prevention as well as treatment. That is the point about moving in that direction.

The Global Fund has made amazing progress but it is dependent on government resources from and around the world. The message for all those Governments is: for goodness’ sake, don’t stop now, for we are dealing with three of the main killer diseases in the world today.