World TB Day

Nicholas Dakin Excerpts

Wednesday 27th March 2019 Westminster Hall

[Nick Herbert]

This is an interesting debate, but I disagree with my hon. Friend. The drugs are not in the pipeline, because the return on investment for these companies is insufficient in the first place. I do not think that they are sitting on drugs that are available for wealthier people, which, if pressed, they could simply roll out to poorer people. There is an insufficient quantum of investment in research and development. I will come on to that point. I do not think that the need can be met by the private sector alone.

I believe that there are three key reasons why we need to take more action against this disease: humanitarian reasons, economic reasons and reasons of global public health. The humanitarian reason is that so many people are dying needlessly from this disease and falling sick. The figures speak for themselves.

The economic reason is that this awful loss of life and this illness are a drag on economic success in the poorest countries, hindering their development. There will also be a serious economic impact if we fail to tackle the disease. By 2030, it is estimated that if the current trajectory of TB continues, that will cost the world’s economies $1 trillion. Some 60% of that cost will be concentrated in the G20, and it will be caused by the 28 million deaths over that period. That is a terrible statistic, because that is the period over which tuberculosis is meant to be beaten according to the sustainable development goals. The United Nations set those goals four years ago, and said that the major epidemics—AIDS, malaria and TB—would be beaten in 15 years’ time. We have just 11 years to go. On the current trajectory, TB will not be beaten for well over 100 years. There will be a further 28 million deaths during that period alone, as well as huge economic costs.

The global public health reason is the susceptibility of tuberculosis to drug resistance, because of the old-fashioned drugs that are used to treat tuberculosis. People who take the drugs do not continue with their treatment and it is a very serious fact that there are well over 500,000 cases of drug-resistant TB in the world. The highest burden is actually in the European region. Only one in four people who have drug-resistant TB can access treatment.

We know that there are 3.5 million missing cases of TB every year that are simply undiagnosed, accounting for one in three sufferers. The proportion is much higher for drug-resistant TB, where 71% of people are missing. This constitutes not only a humanitarian issue, but a serious risk to global public health, because this is an airborne, highly infectious disease.

[Nic Dakin (Scunthorpe) (Lab)]

The right hon. Gentleman is making a very powerful case. He has just said that because so many cases are undetected, the risk is compounded. That is an important issue, which needs tackling urgently.

[Nick Herbert]

I strongly agree with the hon. Gentleman. I commend the work he does on the all-party parliamentary group on global tuberculosis, which I have the honour to co-chair with my friend, the hon. Member for Ealing, Southall (Mr Sharma). The big problem is all of these undetected cases. We need to find and then treat millions more people.

There is hope. Last September, the UN convened the first high-level meeting on tuberculosis, which passed a strong declaration that recommitted the world to meeting the sustainable development goal target to beat the disease, and that specifically set a new target of diagnosing and treating 40 million cases of TB by 2022—a very tight timetable. It is vital that efforts are stepped up immediately so we can meet that new, ambitious target. It will require a significant increase in the level of spending on TB programmes globally from nearly $7 billion to $13 billion and on tuberculosis research and development from $700 million to $2 billion a year.

Two key issues arise from those ambitious new commitments, the first of which is accountability. How are we going to hold the world’s nations to account for their commitments at the high-level meeting? I mentioned that the world has already declared TB a global health emergency and has already set the sustainable development goals. The problem is that we keep talking about the disease but not delivering a sufficient global response to beat it, so accountability is crucial.

Among the problems with the otherwise good declaration passed at the UN is that independent accountability was struck out, but it is vital, because we have to hold countries’ feet to the fire for what they have committed to do. Accountability can take multiple forms: it can be done through bilateral relationships; intergovernmental platforms at the G20, the G7 and the Commonwealth; a further review of the UN high-level meeting and the commitments made; or international institutions such as the World Health Organisation. I must say, however, that if the WHO’s existing mechanisms had been effective, we would not be in this position.

My first point to the Minister, who I welcome to her place, is that the UK has a vital role to play in ensuring that there is more effective, sharper and independent accountability for the targets set at the high-level meeting. Without that accountability, I fear that we will not meet those new targets, and if we do not, we do not have a chance of beating the disease within the set timeframe.

The second issue is that we cannot escape the fact that we will need additional resource to meet the ambitions and that must come from the countries affected, particularly middle-income countries, which must find the resources to deal with it. We have seen a huge improvement in the response in India, for example. Resource must also come through multilateral institutions, particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria, through which comes 70% of all international funding for TB. The UK can be proud that it is the third-largest contributor.

This year marks the replenishment of the Global Fund. If we are to have a hope of meeting those TB targets, it is vital that it is replenished to a higher level than before. The investment case requires a pledge of $14 billion from the world’s countries, which will be combined with an increase of nearly 50% in domestic investment, so the money will also come from individual nations. That would suggest that the UK needs to commit £1.4 billion, which is an increase on the £1.2 billion it gave last time. That is the minimum that will be required to meet the Global Fund’s strategy targets and is proportionately the same as the UK previously gave, at about 13% of the budget.

I know other hon. Members want to speak, so I will make one final point. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is no longer here, said, new drugs will be essential. New drugs for tuberculosis have become available only relatively recently; there have been no new drugs for more than 40 years. Most people do not know that we do not have an effective adult vaccine for tuberculosis, and no epidemic in human history has ever been beaten without one. We have to be able to meet the new targets for an increase in research and development, which includes providing public funding.

Again, the UK has a vital role to play because of the strength of our pharmaceutical sector and what we already do on research and development. We need a specific plan to implement a research strategy; we need to establish a baseline for countries to ensure that they are funding their fair share of research and development; and we need to establish a mechanism to co-ordinate that spend. Otherwise, again, countries will talk about the research and development gap, but never do anything to close it.

We should not need to be here. This is not a disease that we should have to talk about any longer—frankly, it is a moral disgrace that we still are. It is a needless loss of life. Many problems confront modern Governments, some of which are nearly intractable. This is not one of them. This disease can be beaten. We have known how to do that for more than half a century and, with new tools, we could do it better. In the words of the Stop TB Partnership’s campaign for World TB Day last Sunday, “It’s time” to beat this disease.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

I start by congratulating the right hon. Member for Arundel and South Downs (Nick Herbert) on spelling out how important this issue is. I also pay tribute to everybody worldwide who is working in one way or another to fight TB, whether it is on research or on the frontline of dealing with TB and finding people, supporting them and curing them of this terrible disease.

I was fortunate enough to visit Cambodia with RESULTS UK some years ago and saw the fantastic work going on, with partners from across the world working with the Cambodian health authorities to try to reach people suffering from this disease, to tackle it and root it out, but it is a forever challenge.

When I mention TB to people in everyday parlance, they believe that it is a disease of the past—a disease of the 19th century—and are surprised when I point out the fact that it is the biggest killer in the world today. We should be ashamed that that is the case because, as the right hon. Gentleman said, with the proper will, effort, focus, determination and drive, this disease could be sorted. The resources are there to tackle it. It is a matter of purpose, intention and marshalling our forces. That is partly what this debate today is trying to do.

One third of the world’s population is infected with the tuberculosis bacterium, which is a shocking figure. Annually, more than 10 million people become ill with TB, resulting in 1.6 million deaths. As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) has just pointed out, the UK has a higher incidence of TB than we would wish. We have a higher incidence than the USA or other western European countries, with hotspots in places such as London, Leicester, Luton, Birmingham, Manchester and Coventry.

Indeed, when I was principal of a sixth-form college in Scunthorpe, there was an outbreak in the town, which first focused my mind and made me understand the process of ridding a small community of the disease. It is difficult and requires a lot of work. That brought home to me how much it needs sorting, because TB is an airborne disease and adults with pulmonary TB are the main transmitters, which makes it particularly problematic to root out.

We need a safe and affordable vaccine urgently and we need the significant investment in research worldwide to deliver it. As the right hon. Member for Arundel and South Downs pointed out, that can be done with the proper effort. There are loads of reasons to explain why that is not currently happening but, as has been said, a specific research strategy needs to be put in place and funded.

The Minister is an excellent Minister, and I know she will be very much on board and well-researched already. She has an opportunity to contribute to the global leadership in this process. We are six months from the next UN high-level meeting on TB and the time for replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria is fast approaching. The last UN high-level meeting on TB had lots of positives, but there were also areas where we could have asked for a bit more regarding the accountability that we would like so that people own the process and take it forward.

As the right hon. Gentleman pointed out, if the UK can commit to the £1.4 billion that is needed from us over the next three years to up our global game, that would be the UK playing the role that it has always played—one of global leadership, in a way that partners can stand alongside—and I am sure the Minister would want to be part of that. By making those strides, we will begin to make the strides that are necessary to get rid of this terrible disease, one that we should not still have and that is curable—one that is get-riddable. We need to do that and we need to do it now.