HIV (Developing Countries)

Lord Herbert of South Downs Excerpts

Wednesday 19th December 2012 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing the debate and on drawing attention to the continuing importance of these issues. [Interruption.]

[Hugh Bayley (in the Chair)]

Order. I must interrupt the right hon. Gentleman early in his speech, because there is a Division in the House. I suspend the sitting, and I ask Members to get back as quickly as possible. We will resume as soon as those who are here have returned to their places.

Sitting suspended for a Division in the House.

On resuming—

[Nick Herbert]

As I was saying before I was interrupted, I am grateful to my hon. Friend the Member for Mid Derbyshire for securing the debate and for raising the issue of tuberculosis. It is often the orphan disease, in terms of public attention and understanding in this country. Nowadays it is possible to hear people say that they believe TB is resurgent, and that betrays a certain attitude—that somehow the disease is relevant only when it occurs in this country, where we believed we had it beaten, whereas there continue to be 1.5 million unnecessary deaths a year globally, because of a disease that is, essentially, easily and cheaply treatable. That is relevant to this debate in the context of TB and HIV co-infection, which is a particular problem.

At least one third of the 34 million people living with HIV worldwide are infected with latent TB, and TB is the leading cause of death among people living with HIV. It accounts for one in four HIV-related deaths. In fact, last year, some 430,000 people died of HIV-associated TB. In 2005, when I was first elected, I joined a party that included my hon. Friend the Member for St Ives (Andrew George), who is now the chair of the all-party group on global tuberculosis, on a visit to Kenya, indirectly sponsored by the Bill and Melinda Gates Foundation, to go and see the problem. The success of the visit was that it drew the importance of TB to the attention of a few of us. Afterwards, we founded the all-party group, and since then we have continued to try to raise the profile of the need to deal with that disease. I had to step down as co-chair of the group when I became a Minister, but I am pleased to have resumed my interest since stepping down from the Government.

There are things that we still need to draw attention to, in connection with the problem, and I want to raise a couple of them. First, anyone who doubts the importance of focusing on HIV and TB together, and ensuring diagnosis of both diseases, need look no further than sub-Saharan Africa. There were more than 1 million HIV-positive new TB cases globally in 2011, but around 79% of those patients live in sub-Saharan Africa. That is the only World Health Organisation region that is not on track to meet the millennium development goal for TB, which is to halve the 1990 prevalence and mortality rates by 2015. We need attention on that region and on that incidence of co-infection. It is highly unlikely that the target will be met, because of the negative impact of the HIV epidemic. For the world as a whole, reaching the 2015 prevalence and mortality rate targets will be possible only if TB control efforts, and funding for those efforts, are sustained.

The Government have a clear understanding of the importance of an approach based on the possibility of co-infection, and the need for integrated programmes of diagnosis and treatment. Their position paper on HIV, published in May last year, recognised that, which is welcome. The Government’s major contribution, in particular through multinational channels such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, is also welcome. A considerable portion of it is invested in TB interventions.

There are two things that I want to draw to the attention of my hon. Friend the Minister. The first relates to diagnosis. It is striking that the diagnostic ability and treatment for HIV are much further ahead than they are for TB, yet TB is a more easily and cheaply treatable disease. Why is that? It is straightforwardly because HIV is a disease that affected the west, and TB was a disease that the west believed had gone. Its attention was therefore not on it. The resources and money that were invested in necessarily trying to deal with the terrible and growing problem of HIV were not directed in the same way at TB. Therefore, the diagnosis of TB is not as quick as it should be, and the treatments go on for an extended period, with old-fashioned drugs that must be taken on a continuous basis; if they are not taken in that way, the problem of drug-resistant TB arises—and that is a killer and particularly difficult to deal with.

When people living in poverty are far from the facilities that they need to travel to repeatedly for diagnosis and to get drugs, there are no incentives to get the diagnosis and continue to take the drugs for an extended time. Something that should be cheaply and easily dealt with is not, and that accounts for the numbers of deaths. That is why programmes that improve diagnosis are welcome.

I want to draw the Minister’s attention to the TB REACH programme, which is a WHO initiative that gives small grants of up to $1 million to find and treat those who have no access to TB diagnosis or treatment. It is an incubator for innovation. It pushes the frontiers of mobile phone technology in health, and the deployment worldwide of rapid diagnostics. Even if my hon. Friend cannot answer today—I know she has a lot to get into her response—perhaps she would just consider the power of the TB REACH programme, and the support that the Government might be willing to give it in future.

The second issue that I wanted to raise was diagnosis and vaccination. The first thing that people in the west tend to say about TB is “Surely there is a vaccination available for it.” People know about vaccinating children in this country. However, the vaccination is not available for adults; if a vaccination were available, in developing countries, there would not be such a problem, and there would not be deaths on such a scale. Research and development of a vaccination is therefore as important as R and D of improved diagnostics. It is particularly important for the growing threat of drug-resistant TB, which is not so easily and cheaply dealt with, and can indeed be a killer, evading all medical treatment, including what might be available in the west. My second question to the Minister is therefore this: what support are the Government giving to TB vaccine development, which would be so important in heading off the incidence of the disease and save a large number of lives every year?

On the wider debate about why it is necessary to maintain public spending on international development and aid, there are few better examples than the successful spending of money, through the global fund and directly, on programmes doing very simple things—providing the diagnostics for TB and securing treatment. The intelligent organisation of those programmes to address TB and HIV co-infection is particularly important. We should hold TB up as an example of a disease that we in the west believed we had conquered, but that we are now concerned about, because it is coming back. We can treat it relatively easily, but we have ignored the fact that every year it killed 1.5 million in the rest of the world. We should be concerned about that, too.