World Tuberculosis Day

Virendra Sharma Excerpts

Thursday 24th March 2022 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I beg to move,

That this House has considered World TB Day 2022.

It is a pleasure to serve under your chairmanship—if I can use the term—again, Mrs Murray. I am delighted that we have been granted a debate for World Tuberculosis Day on World Tuberculosis Day itself. In that light, I declare my interest as chair of the all-party parliamentary group on global tuberculosis. I am gratified by the presence of Members who have chosen to join us to share their thoughts on this important day.

Before covid-19, TB held the dishonour of being the world’s deadliest infectious disease, with 10 million cases and 1.5 million deaths in 2020 alone. The situation has deteriorated further over the past two years, with the Stop TB Partnership suggesting that the fight to eradicate TB has been set back by more than 12 years. As we emerge from the covid pandemic, we should put the lessons learned over the past two years to work in order to finally eradicate TB.

TB is one of humanity’s oldest diseases. It is caused by bacteria and most often affects the lungs, but can also spread to other parts of the body. TB is spread from person to person through air droplets, and most people infected with TB show no symptoms at all. It is a disease of poverty, found in areas with low-quality housing, poor access to healthcare, overcrowded communities and high pollution. It does not just affect one part of the world or one group of people but can be found in virtually every corner of the planet. In higher-income countries, TB is more commonly found in migrant communities, among people with alcohol, drug or mental health issues, in homeless communities, or among people with a history of incarceration. Most TB cases in England are found in London and the south-east, and on the whole TB remains concentrated in urban areas. In any given year, London accounts for an average of 35% of TB cases in England.

One of the most frustrating aspects of the fight against TB is that we have medicines and vaccines that mean that TB is entirely preventable, and is for the most part curable. That said, many of the tools at our disposal are woefully out of date. For instance, the one TB vaccine that exists, the Bacillus Calmette–Guérin vaccine, celebrated its 100th anniversary last year. Decades of chronic under- funding for TB medicines and research and development mean that we do not have the most up-to-date tools and diagnostics that would enable us to deal more effectively with the threat of TB. That threat is compounded by the rise of drug-resistant and multi-drug-resistant TB—that is, strains of TB that cannot be treated using even the most potent TB drugs. Antimicrobial-resistant TB occurs when people do not take medicines correctly or break from their treatments early. Treating AMR TB is both incredibly complicated and very costly: according to the TB Alliance, someone with AMR TB will have to take as many as 14,000 pills over two years as part of their course of treatment. The O’Neill review found that by 2050 up to 10 million deaths might be associated with drug resistance each year. Around a quarter of these will come from drug-resistant strains of TB.

Domestically, the UK has a positive story to tell on TB. Between 1980 and 2012, the UK saw a near 2% increase in its TB burden year on year; since 2012, the UK has seen a 44% reduction in the number of people who test positive for TB each year, with 2020 seeing the lowest ever recorded incidence rate in England. It should be noted that 2020 was the first year of covid restrictions, which would have had a significant impact on the reduction in TB transmission that year.

TB is much more prevalent in people who are born outside the UK compared with those born in the UK. Between 2018 and 2020, 72.7% of confirmed cases were in people born outside the UK. The rate of TB is 15 times higher for people born outside the UK. These people do not come to the UK with TB, and there is considerable variation by country of birth in the median time between a person’s first entry into the UK and the time of their TB notification. The data suggests that people come to the UK free of TB, but due to poor living conditions and lack of support from the Government, they develop it over time. As I said, TB is a disease of poverty. In the UK, it is most common in more deprived communities and those with social risk factors. I ask the Minister: what more can the Government do to tackle the social determinants and key risk factors that increase the likelihood of someone contracting TB?

The APPG on global tuberculosis led calls for the Government to develop a domestic TB strategy. In 2019, we held an inquiry to examine the success of the Government’s approach. The collaborative TB strategy for England was widely praised by stakeholders for helping to reduce incidence in England by 29%. However, the APPG made a number of recommendations, including to strengthen awareness-raising activities for healthcare workers, secure more BCG vaccines and begin the development of a new strategy.

In 2021 the Government released their TB action plan for England, which outlined five priority areas for the Government, with the recovery from the covid pandemic the highest priority. As the strategy is in its early days, the APPG for global tuberculosis will continue to monitor its implementation and ambition to ensure that TB levels continue to drop in the UK.

Although the domestic situation is better, internationally we are miles behind where we need to be. In 1993, the World Health Organisation elevated TB to the level of “global emergency”, marking the first time that an infectious disease had been given that distinction. At the time, the WHO noted that TB kills more adults each year than any other infectious disease—more than AIDS, diarrhoea, malaria and other tropical diseases combined. Never in the history of medicine has one disease caused so many deaths yet remained so invisible. While the global outlook for TB has improved since 1993, many of the same underlying issues continue to affect the fight to eradicate it in 2022.

Even before the outbreak of covid-19, the international community was seriously off target to meet the goals set out at the 2018 United Nations high-level meeting or those set out in the sustainable development goals. SDG 3.3 calls for the international community to eradicate TB globally by 2030, yet at the current pace it will take more than a hundred years for that feat to be achieved. The WHO’s 2020 TB report—the last report before the covid-19 pandemic—highlighted just how far behind the international community was on its targets. For instance, the international community set the target of reducing TB incidence by 20%, between 2015 and 2020, but achieved only a 9% reduction during that period. There was a target to reduce the number of TB deaths by 35% during the same period, but we have seen only a 14% reduction. In the coming years, as the full impact of the covid pandemic is felt around the world, we expect the numbers to rise significantly.

Between 2019 and 2020, the number of people diagnosed with TB globally fell by 18%. Although that may seem like a positive development, we must approach it with caution. We know that the TB burden has not decreased, so a decrease in the number of positive tests suggests there are even more people with TB who do not know they have it. In the same period, the number of people treated for drug-resistant TB and TB-preventative treatments went down 15% and 21% respectively. The similarities between covid and TB meant that at the outset of the pandemic, many TB services were repurposed to deal with the emerging pandemic. Between June 2020 and August 2020, the Global Fund’s TB programmes experienced “very high” disruption as a consequence of covid. By May 2021, TB services delivered by the Global Fund were the most disrupted of the three diseases it works directly with.

The fight against global TB suffers from chronic underfunding. Between 2019 and 2020, global spending on TB diagnostics, treatments and prevention services fell by 5%. Even with that reduction, global spending on TB in 2019 was less than half of what was needed to make meaningful change in the fight to eradicate TB. The 2021 G-FINDER report showed that global investment in TB research and development totalled $684 million, down by $33 million—4.6%—from its record high in 2019. However, the Stop TB Partnership estimates that $2.16 billion is required annually to develop and deliver new tools, such as diagnostics, vaccines and medicines, that can end the TB epidemic.

The United Nations will host the next UN high-level meeting on TB in 2023. It is highly unlikely that between now and then, the international community will be able to meet the ambitious TB targets it has set itself. That meeting must serve as a rallying call for the world to act to eradicate TB before the end of the decade. To achieve this, we need more money for innovative TB vaccines, medicines and diagnostic tools. It is time for the international community to put its money where its mouth is in the fight to eradicate TB globally. I ask the Minister, in advance of the UN high-level meeting, what more can the UK Government do to regain momentum towards achieving the TB targets set out in the UNHLM and the SDGs?

The UK provides no bilateral official development assistance funding for TB. Instead, the Government work through multilaterals, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Historically, the UK is the third largest sovereign donor to the Global Fund, providing over £1.4 billion to the fund since 2002. The Global Fund is the world’s largest financier of TB prevention, diagnostic and treatment programmes, accounting for 77% of all TB financing globally. The Global Fund invests more than $4 billion each year to support programmes run by local experts in more than 100 countries. By its own estimate, the work of that innovative multilateral has saved more than 44 million lives since 2002 and it has overseen a 46% reduction in the number of deaths from AIDS, TB and malaria in the countries in which it operates.

In September this year, the Global Fund will host its seventh replenishment conference in the United States. The final pledged amount at the conference will fund the Global Fund’s work over the next three years. It is vital that the Global Fund is generously replenished so that we can regain the ground and momentum lost in the previous two years. According to the Global Fund, the impact of the pandemic has led to a 33% increase in the global AIDS, TB and malaria burden.

In our report released earlier today, the APPG on global tuberculosis calls on the UK Government to increase our pledge in line with the increase in the global burden. The UK can and should play a leading role in the replenishment process by bringing together our friends and partners around the world to commit generously and showing that we remain a leader in the global health field. Will the Minister outline what more the UK Government can do to ensure that our allies and partners around the world contribute generously to the next replenishment of the Global Fund?

In November 2020, the Chancellor of the Exchequer announced that the Government would no longer spend the statutory 0.7% of gross national income on official development assistance. The decision amounted to a £4.5 billion reduction in the UK’s ODA budget, although the full impact of the cuts is yet to be recognised. I must declare my interest: I am also a member of the International Development Committee, so I am wearing the hats of two bodies.

In 2020, the APPG wrote to the then Foreign Secretary, the right hon. Member for Esher and Walton (Dominic Raab), highlighting that any cuts to the UK’s aid budget would have a significant impact on global health research, severely limiting international public-private partnerships that have been developing new and innovative medicines to tackle the world’s deadliest infectious diseases. Not only does the cut to the ODA budget threaten future research and development funding, but it jeopardises research capacity built up over a decade. The Government must commit to the restoration of the UK’s R&D funding on global health issues so that the UK can remain a leader in developing the tools that will bring an end to deadly epidemics.

The APPG on global TB’s most recent report called for the Government to commit at least 5% of ODA to research, and to ensure spending for TB research does not fall below the 0.1% of gross domestic expenditure on research and development between 2020 and 2025. Will the Government commit to restoring TB R&D funding so that the UK can remain a leader in developing the tools necessary to end the TB epidemic? In November 2021, the Chancellor of the Exchequer announced that the Government are to invest £20 billion in R&D funding by 2024-25. The Government should commit a sizeable portion of that funding to the development of new diagnostic tools and vaccines for the fight to eradicate global TB. How much of the £20 billion committed to R&D in the autumn spending review will be used to end TB epidemics?

In the last few days there have been concerning reports in The Daily Telegraph and Devex that the Foreign Secretary is planning to make substantial cuts to health, humanitarian aid and climate change ODA spending. I share the sentiments of the Chair of the International Development Committee, who called this potential move “illogical”. Does the Minister agree that if the UK is to remain a respected leader and a reliable partner in the global health community, the Foreign, Commonwealth and Development Office and the Foreign Secretary must not reduce their ODA health spending?

I want to briefly mention the situation in Ukraine and its implications for the fight against global TB. Ukraine has one of the highest drug-resistant TB burdens in the world, with nearly one third of all new TB infections there having some level of resistance. Some 22% of Ukrainians who contract TB also have an HIV co-infection, and TB is the leading cause of death among Ukrainians living with HIV. The Global Fund has been providing drug procurement facilities in Ukraine since the Russian invasion. It released $30 million in emergency funding, including $15 million to support the continuity of HIV and TB prevention, testing and treatment services in Ukraine. Peter Sands, executive director of the Global Fund, has said:

“We are extremely alarmed by the devastating effects on peoples’ lives in Ukraine. Ensuring patients affected by the conflict can continue to access prevention and treatment services is our immediate priority.”

The UK has played a leading international role throughout the Russian invasion of Ukraine. What additional humanitarian support can the UK offer Ukraine to ensure that the war does not lead to a significant rise in TB or HIV in the country?

TB remains a global killer, but it is almost unrecognised, except where it blights lives. In my years of political activism, I have seen Governments commit multiple times to ending TB. I have heard warm words of concern, but they fall by the wayside as Ministers change—I hope that will not happen here—and new fashions rise and fall. I hope we can finally be the Parliament that gets a grip on global TB and acts for the good of all.

--- Later in debate ---

[Mr Sharma]

I thank hon. Members, but I am a bit disappointed that not many joined us for such an important debate. As a Member, I can understand that people’s priorities are different on a Thursday afternoon and when there is a one-line Whip in place. However, I am grateful to the hon. Member for Strangford (Jim Shannon) for joining us, and I thank my hon. Friend the Member for West Ham (Ms Brown) for contributing on behalf of the Opposition. I am pleased to hear a conciliatory tone from the Minister—given the sensitivity of the issue, sometimes misunderstandings can arise.

From the APPG’s point of view and my personal point of view, we are here to work together and support the Minister and the Government to ensure that we achieve our goals, so the most important thing is understanding how we can best work together. I am glad that the Minister pointed to that partnership role in her contribution. I am also grateful for her announcement of £6 million for TB REACH, and I am sure that more will come in the future.

I will not repeat what I have already said. As no solution can be found overnight, it will be a long struggle. I have been in a TB campaigning role for more than 25 years. Before I joined Parliament, I was a local councillor and involved in TB activism, and I look forward to working with the Minister and the Government —not only so we can eradicate TB in Britain, but so we can be the best partners in eradicating TB globally.

Thank you, Mrs Murray, for the way you have chaired the debate; although you have not been under a lot of pressure, I thank you for giving me the longest time to contribute.

Question put and agreed to.

Resolved,

That this House has considered World TB Day 2022.