World Tuberculosis Day

Lyn Brown Excerpts

Thursday 24th March 2022 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is an absolute pleasure to serve under your chairship, Mrs Murray. I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing the debate and for his excellent speech. May I say what a pleasure it is to follow the hon. Member for Strangford (Jim Shannon), whom I see in many of the debates I attend? It is a real joy to be here with both those Members, who are really nice, gentle men.

World TB Day is a reminder that this terrible sickness is thriving because of the poverty and inequality that persists in the UK and across our world. TB is deadly: in 2020, it killed 1.5 million people. However, TB is both preventable and curable. The UK, with international partners, has rightly committed to the achievable goal of finally ending the epidemic by 2030. I hope the Government will join the Labour party not only in recommitting to that goal, but in committing the resources necessary to achieve it.

Unfortunately, the goals in the World Health Organisation’s “End TB Strategy” are not even close to being met. We targeted a 20% reduction in incidence, but we have achieved just 11%. We targeted a 35% reduction in deaths, but they fell by only 9%. We aimed to reduce to zero, by 2020, the number of people who face catastrophic costs as a result of TB. Instead, almost half of all people who are infected with TB still deal with catastrophic costs. TB is a disease of poverty, and it keeps people in poverty worldwide.

The efforts of NGOs and many Governments have been powerful and have made a massive difference. The WHO estimates that 66 million lives were saved by TB treatment between 2000 and 2020—but it ain’t enough. The job is not nearly done, and recently, following covid, we have slipped backwards. Does the Minister believe that the sustainable development goal to end the TB epidemic by 2030 has a chance of being met without more resources? As my hon. Friend the Member for Ealing, Southall stated, it will not take eight years to end the TB epidemic; it will take more than 100.

Surely, part of the reason for the limited progress is that we are less than halfway towards the 2022 targets for funding both TB research and universal access to TB prevention, diagnosis and treatment. The largest supporter of action against TB globally is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds 77% of all anti-TB projects. The Global Fund was co-founded by the Labour Government in 2002. After 18 years of work, the Global Fund estimates that its programme has saved 44 million lives. What an extraordinary achievement of the UK leadership that has been. The Global Fund is not just about direct delivery of projects to prevent, diagnose and treat the most deadly diseases. It also helps to build up sustainable healthcare systems and tackle the broader issues of poverty and social exclusion that make TB such a deadly threat that continues today.

Last week, the National Institute of Economic and Social Research found that UK aid spending has clear economic benefits for the UK. That is particularly true of health spending, which can massively increase productivity by tackling long-term conditions. As well as benefiting millions of people and building a fairer and safer world, part of UK ODA spend goes back into the UK economy by boosting exports to developing countries. In total, the cut from 0.7% to 0.5% of GDP will actually cost the UK between £300 million and £400 million in lost exports. If the Government do not stick to their word and return to their manifesto promise, that number will simply grow.

This year the Global Fund needs to have its financing replenished by international partners. As the Minister knows, the UK has previously always been one of the top funders. We give money not just because of the impact on our international reputation and the relationships that we build around the world, and not just because preventing so much human suffering and death is simply the right thing to do. We do it because we in the UK are affected by TB too.

In the UK, just like the rest of the world, people are more vulnerable to TB if they are malnourished, have chronic illnesses like diabetes or are living with HIV. Over 70% of UK cases of TB are in people born outside the UK, but they are overwhelmingly concentrated in deprived communities, with overcrowded and poor-quality housing. That includes my constituency. The cost of living crisis and housing crises will put more people in these vulnerable positions. Unless we tackle poverty and disease throughout the world, our own communities will be affected, too. What do the Government plan to do about that?

Recent England-wide strategies have had some success since 2015 in tackling TB in England, but we know that success had stalled—even reversing slightly—just before the pandemic. We have to recognise that with TB, just as with Covid, none of us is truly safe until all of us are safe. We need international as well as domestic action. That action must go beyond diagnosis and treatment. We must put resources into research, too. There is still just one approved vaccine for TB, even though it remains deadly and destructive; and that vaccine is more than 100 years old, and highly effective only for young children. A new vaccine could save not only millions of lives, but vast amounts of money. Therefore I am hoping that the Minister can reveal how the UK will contribute to vaccine development and other TB research efforts over the coming year.

As we have heard, this autumn there will be a replenishment of the Global Fund. Will the UK continue as the third-largest funder? I hope that the Minister can give clear assurances on that today, because the rumours are that the existing priorities of global health, combating global heating, and conflict prevention could be dropped. Those are all areas where the UK does excellent work, with support across the House, but we hear that all will be slashed to the bone. Reportedly, the decision to make those brutal cuts will be made by the Foreign Secretary alone, ignoring warnings and advice from both inside and outside the Department. I desperately hope that those rumours are not true, that the Minister will reassure us today, and that those assurances will be borne out by the international development strategy.

I know that the Government will say that they are focusing on women and girls, and that that justifies any cuts. Labour proposes a feminist approach to international development; we see efforts towards gender equality worldwide as a massive priority. Half a million women die of TB every year. Waits for diagnosis and treatment are generally longer for women than men, and TB is a massive risk during pregnancy. The Minister must recognise that global health funding protects women and girls and advances gender equality. So does action against the climate emergency, as the Minister knows, because she was at a meeting in New York about that issue just last week. Will a comprehensive equalities impact assessment be published, so that all hon. Members can see some analysis—as well as the Government’s own PR—about these cuts?

I want to say a little about another area of global health where the UK was a leader—the neglected tropical diseases that affect 1.7 billion people globally and, as with TB, primarily the poorest and most disadvantaged. Until last year, the Department for International Development funded a programme called Ascend—Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases—providing lifesaving treatments and strengthening health systems. As we know, that is vital for eliminating diseases, including TB, in the long term. Ascend delivered more than 350 million preventive treatments, fighting diseases that cause everything from blindness to organ damage to death. But last April, Foreign, Commonwealth and Development Office funding to Ascend was cut, leaving a funding hole of about £100 million. Because of that cut, 100,000 people across east Africa and south Asia did not receive planned care for the horrific symptoms, and the social and economic consequences, of elephantiasis.

How many more proven programmes will be cut if global health is no longer a priority? How much more will our reputation for leadership in this field be damaged? What will happen to the Department’s health-system-strengthening approach, launched with such fanfare just three months ago? Most importantly of all, Minister, how many more lives will be blighted by preventable diseases if the rumoured cuts go ahead? How many more years will the progress that we have made on eradicating TB be set back?

[The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Vicky Ford)]

It is an absolute pleasure, Mrs Murray, to serve under your chairmanship.

I start by thanking the hon. Member for Ealing, Southall (Mr Sharma) for securing this debate on this incredibly important topic. I pay tribute to him for his long-standing advocacy for action on TB, including as co-chair of the all-party parliamentary group on global TB. I also thank the other hon. Members for their contributions today. I will try to respond to many of the points that have been raised.

Every year on World TB Day, it is important to reflect on the impact that tuberculosis has on people across the world. We are reminded of the devastating cost of this deadly disease. We are continuing our efforts to combat it, by investing in services worldwide to prevent, test for and treat TB, funding cutting-edge research to fight TB locally, and working to strengthen healthcare across the world and at home. I will set out further details on this work during my speech.

First, however, it is important to understand the scale of the challenge that we face. Despite the fact that TB is preventable and treatable, it continues to have a devastating impact. It is truly shocking that every day more than 4,100 people die from it: mothers and fathers, and sons and daughters. Thousands of families are torn apart daily. TB kills more people each year than malaria and AIDS put together. In Africa, it is the leading killer of people with HIV. And as the Opposition spokeswoman, the hon. Member for West Ham (Ms Brown), pointed out, TB is particularly harmful to women, especially pregnant women, causing complications and increasing both maternal and infant mortality rates.

As hon. Members have pointed out, TB preys on some of the world’s most vulnerable people. The hon. Member for Ealing, Southall mentioned Ukraine. In Ukraine, TB has the potential to add to the horrific impact of Putin’s illegal invasion. Ukraine already had the fourth-highest incidence of TB in Europe and Putin’s war is disrupting medical care, which heightens the risk of the disease spreading. The UK and the rest of the international community will continue to support the Ukrainian Government and people, including with medical supplies. We also welcome the Global Fund’s announcement of an additional $15 million of emergency funding to Ukraine, which will support the continuation of HIV and TB prevention, testing and treatment services. However, I also want to be really clear that the best way to prevent deaths from TB and other diseases in Ukraine is for Russia to stop this illegal war.

As the hon. Gentleman also mentioned, the covid pandemic has continued to take a toll on people’s lives and it has had a knock-on effect on the work to combat TB. In 2020, deaths from tuberculosis increased for the first time in a decade. However, we have also seen an 18% decrease in the number of people being diagnosed with TB, because the pandemic disrupted TB services and people’s ability to seek care.

It is vital that we continue our efforts and work with partners to boost access to essential services, in order to prevent and treat this disease, and that we continue improving global surveillance systems, so that we can detect and respond to outbreaks quickly.

As all the hon. Members who spoke today have mentioned, the World Health Organisation’s TB strategy has set out the global scale of the ambition to end the TB epidemic by 2035. We continue to strive towards that target and have strongly supported work to deliver it. In fact, the UK helped to establish the Global Fund to Fight AIDS, Tuberculosis and Malaria more than 20 years ago. We have remained a strong supporter ever since, contributing more than £4.1 billion to it. The Global Fund has made a huge difference over the past two decades, saving an incredible 44 million lives. It will continue to play an important role and I welcome the focus in its latest investment case on supporting health systems and global health security.

Many Members mentioned reductions to official development assistance. We all know that the economic situation is deeply challenging and that was a very difficult decision to make, but it was also a temporary decision. We are committed to returning to 0.7% as soon as the situation allows, and I remind Members of the positive statements that the Chancellor made about that in his autumn Budget. We remain committed to improving global health, and are looking at our work in a number of areas to ensure the best configuration to deliver our priorities.

International development remains a core priority. It is integrated across the FCDO, including across the country network, and developmental priorities will continue to be embedded in multiple areas. We are reviewing the Global Fund’s recently released investment case and considering what commitment we can make for the seventh replenishment, but I cannot provide details on that now.

[Ms Brown]

I have listened very carefully and I am not as dismayed as I thought I might be. Will the Minister let me know when she might be in a position to give us details on that spend? As she will appreciate, there is real anxiety out there.

[Vicky Ford]

I thank the hon. Lady for her excellent question. I understand the urgency of getting the details agreed, but, as she knows, there has been a restructuring in the FCDO because of the changing situation that we now face, given the geopolitical impact of Russia’s illegal invasion of Ukraine. It is important that we continually assess how best to use our structures to reflect different global challenges to enable us to deliver for the UK. As I said, we maintain a strong commitment to improving global health, and I understand the importance of getting the numbers agreed. We cannot do everything, but we will get the numbers as soon as possible.

Research was mentioned in the opening speech. The UK is a global leader in the funding of TB research. We continue to support academics and industry to develop the evidence, and new technologies and approaches to diagnose and treat TB. We have been a critical investor in product development partnerships to combat infectious diseases, including TB, for many years. The FCDO has supported the Foundation for Innovative New Diagnostics to develop a new PCR-based technology to test for TB, which is now available in more than 140 countries worldwide, including in the NHS.

Our investment also helped the TB Alliance to develop new combinations of drugs that significantly reduce the severity of side effects and the length of treatment from over 18 months to six months for drug-resistant TB, and even shorter for drug-sensitive TB. UK funding is bringing partners together to solve critical problems. For example, through support to British Investment International, MedAccess, the Clinton Health Access Initiative and Unitaid have secured a lower price for an innovative short-course TB preventive therapy.

As a further demonstration of our commitment to invest in the fight against TB, I am pleased to announce £6 million of funding for TB REACH, which will support piloting innovative ways to hunt down and treat millions of missing TB cases. I am pleased that the US and Canada are also backing that fantastic work; only through joined-up efforts with our partners will we meet our target to eliminate TB. The UK Government are one of the largest bilateral funders of TB research and development globally, and we continue to invest in research and development, including developing new tools and approaches to tackle TB.

The hon. Members for Ealing, Southall and for West Ham spoke about the situation in the UK. With an eye on the global picture, it is important not to lose sight of the challenge that TB presents here in the UK. As in other countries, we see that the disease often affects the most marginalised and vulnerable people. We are investing in early detection and treatment, including genome sequencing, which can help to detect drug resistance and clusters of transmission.

As the hon. Member for Ealing, Southall said, the UK has a TB action plan for England, which will run for five years from 2021 to 2026. It was jointly launched by the UK Health Security Agency and NHS England, and it sets out the work that will support year-on-year reductions in TB incidence in order to move England towards its elimination target. It includes specific actions relating to underserved populations.