Tuberculosis

Nicholas Dakin Excerpts

Wednesday 27th November 2013 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

Let me start in the past. In 1821, Maria Brontë died of consumption. Two of her daughters died of the disease in infancy and her four older children—Bramwell and his famous sisters, Anne, Emily and Charlotte—also died of it. According to the history books, they became

“ill from dampness and terrible living conditions”.

Consumption, or tuberculosis, is a disease that many people believe belongs to the past. Nothing could be further from the truth. TB kills more people in the world today than any other infectious disease. Every day, 3,800 people die from it. Sunday is world AIDS day, so it is worth remembering that TB is the leading killer of people living with HIV. At least one third of the 35.3 million people living with HIV worldwide are infected with latent TB. People co-infected with TB and HIV are about 30 times more likely to develop active TB disease than people without HIV. Given the devastating synergy that exists between the two infections and the impact that they have on people living in the developing world, it is absolutely vital that resources are stepped up now so that we not only effectively tackle TB-HIV co-infection but ensure that the health-related millennium development goals are achieved. The Department for International Development is about to launch its policy review paper on HIV/AIDS. I hope that it will make clear the importance of linking the approaches to TB and HIV, and that it will have clear commitments to tackle those diseases.

In the UK, we can be tempted to believe that TB no longer poses a threat to public health. There is a widespread belief that the BCG vaccine is effective and that today TB only affects other countries. However, in a connected world of global travel, TB is never far away. That came home to me forcibly when an English student returned from foreign travel with the disease and subsequently infected other students attending the college of which I was principal. Students and staff found dealing with the anti-TB drugs to be an ordeal. For a standard, non-drug-resistant case, the treatment regime can require a six-month course of a cocktail of four drugs. Those “front-line” drugs are more than 40 years old now and have unpleasant side-effects. It was a challenge for me as college principal, working with the local NHS, to get people to take the drugs they had to take. It must be an even bigger challenge to help patients in the developing world who not have access to the type of care and support offered by the NHS.

The stigma attached to the disease here was a barrier to patients accessing treatment. In sub-Saharan Africa, the stigma is even greater. Dr Simon Blankley, a Voluntary Services Overseas chest physician working in Uganda, reported that patients could often be locked away in cupboards or forced to leave their villages, and that health care workers were worried for their own health when TB patients were admitted to wards. TB needs to be tackled in a sustainable way that reassures people and builds community resilience. Dr Blankley was able to use a team of VSO volunteers to provide education and reassurance, and to get TB patients in and around Kampala to complete their eight-month course of treatment. The team’s work drastically increased completion rates. He then expanded the work, adding work on TB to the community health education that was already in place. That sustainable approach can be replicated elsewhere.

Dr Mario Raviglione, director of the global TB programme at the World Health Organisation, said just last month, when he launched the WHO’s global TB report in partnership with the all-party group on global tuberculosis, that

“at the current rate of progress, we will not be rid of TB for over a century.”

The efforts of the global health fund and its partners have made fantastic progress against TB, HIV and malaria, and the Government are to be applauded for their recent pledge of up to £l billion for the fund. However, we need absolute urgency, unremitting determination and co-ordinated effort to tackle TB.

[Andrew George (St Ives) (LD)]

I congratulate the hon. Gentleman on securing this debate. I also warmly applaud the Government on the contribution and the commitment that they have made to the global health fund, which continues the work of the previous Government.

The hon. Gentleman mentioned the HIV position paper, which in fact was published only moments ago. He may be disappointed to note that the Government appear not to be putting quite as much emphasis on ensuring that they make the connection between HIV and TB. Will he insist that the Government continue a commitment to TB REACH and other programmes that address that serious problem?

[Jim Dobbin (in the Chair)]

Order. I suggest that when we have interventions, they are short.

[Nic Dakin]

Thank you, Mr Dobbin, and I thank the hon. Gentleman for his contribution. I am sure that the Minister will reflect on his point when he responds to the debate. It reinforces the point that I made earlier about the importance of the Government taking the opportunity to co-ordinate their efforts in relation to both HIV and TB, and the Minister will have heard those points.

[Mr Peter Hain (Neath) (Lab)]

Is my hon. Friend aware that 750,000 TB cases—the most lethal ones—come from South Africa’s gold mines, and contribute 9% of the global total of TB cases, which are often linked to HIV? If so, does he agree that it is vital for the British Government to talk to British-owned companies that are mining gold in South Africa to try to resolve that terrible epidemic?

[Nic Dakin]

I thank my right hon. Friend for that intervention. He is absolutely right that the Government have a leadership role to play both globally and in relation to British companies involved in South Africa and elsewhere. I am sure that the Minister will also pick up on that point when he responds to the debate.

Dr Raviglione said that it would take more than a century to get rid of TB. Waiting a hundred years to get rid of this disease is just not good enough. Dr Raviglione also drew attention to the shameful fact that one in every three TB cases on the planet is not properly diagnosed or treated, which equates to 3 million people every year going undiagnosed, the majority of whom will have infectious pulmonary TB. Many of them are estimated to have drug-resistant strains. That is 3 million people a year going undiagnosed for the past six years—that is not good enough, either. Until everyone in the world with TB is diagnosed and correctly treated, we will never succeed in bringing the global TB epidemic under control and it will continue to blight our world, ruining millions of lives every year.

TB has killed more people than every other pandemic in history combined, by a margin of several hundred million. It is a global disease of the here and now. It affects every country, and every country must have a role to play in tackling it. It requires global leadership from our Government and every other Government. Tackling it requires support and investment through multilateral organisations such as the global health fund, as well as through targeted interventions. We need important technical and co-ordinating agencies, such as the WHO’s global TB programme and the Stop TB Partnership, to work together to enhance co-operation and cohesion across the world’s responses to TB. We need the brightest and the best of the scientific and business communities to work with high-burden countries, in order to step up the fight against this disease and save as many lives as possible.

Consumption, or TB, is a disease of the present. It is a scourge on our humanity and deserves the full force of all our efforts. Although new tools to tackle HIV and TB are badly needed, if we scale up the use of the tools that are already available we have the opportunity to save an additional million lives in the next few years.

I hope that the Minister, when he responds to the debate, will take the opportunity to reaffirm the Government’s commitment to ensuring full replenishment of the global health fund; to continuing to fund TB REACH to a level that allows it to carry on supporting new and innovative projects to find “the missing 3 million”; and to continuing to push for the development and uptake of better diagnosis, treatment and prevention treatments for TB, in a way that can be sustainable.

Finally, let us recognise the work done by all those people across the globe on the front line of the fight against this terrible disease. Their effort is a call to arms for us and a call for us, as policy makers, to step up to the mark and provide them with the tools and the wherewithal to eradicate TB and place it firmly in the past.