Tackling Infectious Diseases

Virendra Sharma Excerpts

Thursday 20th April 2017 Commons Chamber

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

I beg to move,

That this House has considered research and development on tackling infectious diseases.

I am grateful for this comprehensive debate on an issue that is important for many people across the world. As the sponsor of the debate, I want to set out the issues that need to be raised, say a little about my area of greatest knowledge and allow as many Members as possible, on both sides of the Chamber, to raise the issues that matter most to them.

Tuberculosis, HIV and malaria are the world’s leading infectious killers. In addition to those three big diseases, 1.5 billion people have a neglected tropical disease, and another 1.5 billion are at risk of contracting one. Such people are trapped in a spiral of ill health and debt that blights not just their own lives but those of the people who rely on them. Many of the diseases are chronic and endemic to some of the most deprived communities in the world. Sadly, there is no market for curing these illnesses, because there is no profit to be had from doing so. There is no will to eradicate them, because the value of doing so is considered to be too far away.

But the costs of inaction are far higher than the costs of action. Although globally about $240 billion is spent on health research and development, almost none of that is directed at these diseases of poverty. Because there is no market incentive, procurement is likely to be carried out only by donor and philanthropic organisations, yet the UN has said that investment in treating these diseases can yield returns. For example, it says that every dollar invested in TB care yields a return of over $30.

For many conditions, treatment is a complicated matter requiring a cocktail of drugs taken according to a strict regimen. For too many, that is not possible. New drugs have been slow to come to the market. Antibiotics represent a cure for millions, but since 1990 virtually no new antibiotics have been developed and we know that diseases are becoming resistant. Approximately 700,000 people will die this year because of anti-microbial resistance, known as AMR. By 2050, this could cost 2% to 3.5% of global GDP, or $100 trillion of economic output. It will be a global catastrophe.

Our Government have already taken positive steps, replenishing the global fund with over £1 billion. Some 80% of the funding for the global fight against TB comes from that fund to which we are the second largest donor. I hope the Minister will restate his commitment to the fight. Prevention, diagnosis and treatment through the global fund cannot be the sole solution. It is clear that without new tools we will not meet the commitment made in the global goals to end the epidemics of HIV, TB and malaria by 2030.

At the current rate of progress, it will take at least 150 years to the end the TB epidemic. Moreover, the O’Neill review published last year made it quite clear that AMR will exacerbate this bleak outlook. I am a co-chair of the all-party group on TB. The group recently held an event on TB and AMR, which included contributions from the Minister and Lord O’Neill, who reiterated the review’s conclusion that tackling TB must be at the heart of any global action on AMR. TB already accounts for one third of AMR debts. If left unaddressed, it will by 2050 cost the economy over $16 trillion. As Lord O’Neill said at our event, the cost of investing in new drugs is minuscule compared with the cost of doing nothing. At present, treatment for drug-resistant TB involves an arduous two-year course of 14,000 pills, which can have severe side-effects including permanent deafness, as well as eight months of intravenous injections. It is little wonder that less than half of those who start treatment complete the course. Concerns about AMR are not limited to TB and HIV; it is also an issue of serious concern for other infectious diseases, including malaria.

Of the annual half a million deaths from malaria, most are of children under the age of five in sub-Saharan Africa. Artemisinin combination therapies are currently the frontline treatments against the most deadly malaria parasites. Although the treatments are working well in many parts of the world, there is serious concern that malaria parasites are once again developing widespread resistance to this vital treatment. Artemisinin resistance is spreading in the Greater Mekong area. If it spreads to the African continent, there will be devastating consequences for global control efforts. At the beginning of this year we witnessed, with four patients, the first failed malaria drug treatment in the UK. That was swiftly followed by the detection by researchers in Africa of malaria parasites that were partly resistant to artemisinin.

The Minister will be aware that AMR is one of the topics being considered by the G20 this year. Last year, the G20 tasked the OECD and others with creating a road map on incentivising research and development in relation to new antibiotics. In line with the O’Neill review’s conclusions that TB must be at the heart of the AMR response, will the Minister take steps to ensure that it is prioritised in the G20 discussions on AMR? Will he ensure that the Government push for agreement on new mechanisms to incentivise research and development to tackle AMR and, within that, drug-resistant TB, especially as half of all cases of TB and drug-resistant TB, as well as TB deaths, occur in G20 countries?

In February I was in India where I met Prime Minister Mr Modi, and I made similar representations there. Only by working with international partners can we make progress against the world’s leading infectious killer and only major airborne AMR threat. In that context, let me say something about the impact that medical technology can have. According to a report produced by the United Nations Secretary-General’s High-Level Panel on Access to Medicines and entitled “Promoting innovation and access to health technologies”,

“Despite this noteworthy progress”—

the development of vaccines and dramatically improved outcomes for HIV sufferers—

“millions of people continue to suffer and die from treatable conditions because of a lack of access to health technologies.”

It is all too easy to focus solely on pharmaceuticals in tackling infectious diseases, but without technology, even the most basic, tackling an outbreak is almost impossible.

I recently heard from representatives of Becton Dickinson, a company that manufactures diagnostic products and lab equipment here in the UK and exports it all over the world. They told me about the measures that we could be taking right now to tackle AMR, including better use of blood testing. We must take steps immediately to improve diagnosis times, and to ensure that the most appropriate antibiotics are administered. BD has been leading research on the development of blood test bottles that counteract the effects of antibiotics so that they can be administered immediately in life-threatening cases. It has also worked on technology to control TB quickly, including new tools that enable the rapid testing and reporting of new second-line drugs for extensively drug-resistant TB. In the event of an outbreak of any infectious disease, timely treatment is crucial, and BD’s work in the field of technology—not just pharmaceuticals—can contribute to the tackling of infectious diseases throughout the world.

I ask the Minister to look more closely at how better use of diagnostics, including blood cultures, can tackle AMR. Some targeted research and development has worked. In 2002, more than half a million children a year were becoming newly infected with HIV; that number has now halved. In 2015, the Government created the cross- departmental Ross fund to invest in research and development in respect of

“drugs, vaccines, diagnostics and treatments to combat the most infectious diseases”.

Although that was a welcome announcement, the fund must be used to complement, rather than to substitute, DFID’s existing commitments on infectious disease research and development, particularly its historical commitment to not-for-profit product development partnerships.

At the APPG on global TB event for World TB day, we heard from Aeras and from the TB Alliance, which have both benefited from UK investment, but developing new tools is not a short-term project. The Minister should reaffirm the Government’s commitment to these partnerships. We cannot afford to step away from them. For example, we currently have one vaccine for TB, the BCG, which dates back to the 1920s and is only moderately effective in preventing severe TB in young children. It does not adequately protect adolescents and adults, who are most at risk of developing and spreading TB.

There are also regulatory issues. It is expected that by 2020 some 70% of those living with HIV will be in middle-income countries and will no longer have access to affordable treatment. The British Government have been keen to come to arrangements that have allowed the countries with the greatest burden a longer time to comply with patent regulations. That positive attitude has not always been shared by the US Administration, and I am worried that the new President will be even less inclined to come to sensible arrangements.

Similarly, as the Government negotiate new trade agreements in the wake of our exit from the European Union, we must ensure access to medicines by protecting TRIPS—trade-related aspects of intellectual property rights—flexibilities. There is growing global momentum on the shortcomings of our R and D model and a number of solutions have been put forward, including the UN High-Level Panel report on access to medicines. The UK must prioritise and plan how to move such recommendations forward, particularly in the lead-up to the World Health Assembly in May. I would be grateful if the Minister could outline in his response whether the UK plans to develop a cross-departmental code of principles for biomedical research and development. That should be based on the recommendations from the high-level meeting on AMR for research and development to be

“guided by principles of affordability”

and ready for the 70th World Health Assembly in May.

We should ensure that R and D leads to health technologies that are affordable and accessible to those that need them. The real game changer will be finding a way to encourage the development of more therapies, new medicines and innovative vaccines. Change will come from a change to the regulatory environment. That cannot be achieved by UK action alone. Could the Minister please commit to ensuring that encouraging DFID best practice is a key plank of future international efforts?

I thank the APPGs that have made this debate possible—those on TB, HIV and Aids, and malaria and neglected tropical diseases. I am keen to hear what my hon. Friends and colleagues have to say, so I will leave it there, although there is sadly so much more to say.

--- Later in debate ---

[Mr Virendra Sharma]

First, I thank colleagues on both sides of the House for their contributions, not only this afternoon but to the International Development Committee and other platforms whenever we have touched on these issues, which affect a large number of disadvantaged groups in poverty.

I also thank the Minister for his detailed response. I am sure that there is more to come—we have missed some issues—but I welcome the present Government’s commitment to contributing 0.7% and look forward to that continuing under the future Government, whoever comes back after June. As has been said, the cross-party consensus was achieved many years ago and I am sure that it will continue.

It is unfortunate that this debate has come after the election announcement. When it was secured, a large number of colleagues on both sides of the House were willing to speak in it. Unfortunately they could not be here today, but their spirit and their contributions to other platforms have been recorded and have encouraged us. Thank you for your patience, Madam Deputy Speaker.

Question put and agreed to.

Resolved,

That this House has considered research and development on tackling infectious diseases.

Nepal Earthquake: First Anniversary

Virendra Sharma Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Thomas]

My hon. Friend makes a good point about trade links. Encouraging economic growth within Nepal was important before the earthquake, given the fragility of life for many Nepalese people, but it is particularly urgent now in the wake of the earthquake. World Bank and Government of Nepal analysts estimate that the total cost of the damage from the earthquake is roughly $7 billion, or 706 billion Nepalese rupees.

With the exception of the Kathmandu valley, the central and western regions that have been affected by the earthquake are essentially rural and heavily dependent on agriculture. The quake destroyed the stockpile of stored grains and killed almost 60,000 farm animals. These districts have tended to see larger numbers of households reliant on livestock as their main, or one of their main, sources of income. The widespread loss of that livestock has caused a severe income shock in the short term for many already very poor families. Sadly, inevitably for vulnerable families with fewer assets, limited access to economic resources and a lack of alternative livelihoods, there is a heightened risk of sexual and gender-based violence, human trafficking, child marriage, and child labour. Indeed, I have had representations from Nepalese constituents of mine worried about an increase in the trafficking of young earthquake victims.

If a major earthquake was not tough enough on its own for a country to negotiate, there has been a major cross-party effort to agree a new federal constitution for Nepal. That was finally agreed in January, but it led to a 135-day unofficial blockade of food and fuel across the India-Nepal border, which has made the reconstruction effort even more difficult. It would be helpful to hear the Minister’s assessment of the level of political stability in Nepal and the strength, or otherwise, of its relationships with its two big neighbours. The tensions have, I understand, eased recently. Crucially, the Nepal Reconstruction Authority has been established, which began its work on 16 January.

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

I congratulate my hon. Friend on securing this timely debate, one year after the disaster happened. As hon. Members have said, many faith groups and other charity organisations have raised funds and contributed their knowledge and know-how to help to rebuild the country. Does he agree that tourism, which was the main source of income, was also affected by the earthquake disaster? This is the right time for the Government and other institutions to learn from the disaster that investment in building resilience against future disasters should increase from 6% to 10% of humanitarian aid.

Sustainable Development Goals

Virendra Sharma Excerpts

Wednesday 13th April 2016 Westminster Hall

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

It is a great honour and privilege to speak under your chairmanship, Mr McCabe. I congratulate the hon. Member for Bath (Ben Howlett) on securing such an important debate, and at the right time too.

Friends, in September last year, one could have seen a strange sight on a bright but crisp New York day. An unlikely crowd had been drawn together. I was stood with parliamentary colleagues from around the world at the announcement of the finalisation of the international negotiations. Alongside my colleagues were other, better-known faces: Beyoncé, Coldplay and Ed Sheeran. What could bring such unlikely allies together?

Building on the successes of the millennium development goals, the sustainable development goals have the potential to lift 800 million people out of extreme poverty. That is no mean feat, and on its own would be a success of broadly unmatched effect in global development. I have been campaigning on goal No. 3 in particular, which is to ensure

“healthy lives and promote wellbeing for all at all ages”.

Too many children and older people around the world are left behind when progress is made. That is why I am so proud to have supported our commitment to spend 0.7% of GDP on international development. That commitment has provided long-term stability to the programmes we support. Department for International Development programmes have helped to save the lives of 44,000 women during childbirth and 97,000 newborn babies, and provided food security to 3.5 million people. That is the real effect of the money we spent and an indicator of what a comprehensive, integrated implementation of the sustainable development goals can achieve. Let us make success a reality, rather than just a goal.

The MDGs were plagued with questions; they did not offer a truly international solution to global problems and they created two classes of country. That is why such a diverse group joined together in New York last year. Where the MDGs were successful was in their fight to stop the global increase in the incidence of TB, malaria and HIV and AIDS. We now look to end those three epidemics by 2030. The new global goals are far more worldwide than the MDGs were. They apply not only in developing nations, but here in the UK as well. We are now committed to eradicating TB and HIV and AIDS at home, not just abroad.

In 2015, TB re-emerged as the world’s leading infectious killer. It led to 1.5 million deaths in a single year. The Global Fund works across all countries ravaged by TB and is key to the fight to end the epidemic. It has saved about 17 million lives through its interventions so far, and perhaps 5 million more can be saved this year alone. More than 75% of all the financing in the global TB fight comes from the Global Fund. Sadly, however, at the current rate of investment, it looks as if we will only end TB in 150 years—not by 2030.

[Mrs Helen Grant]

On finance, does the hon. Gentleman agree that for all the goals to be achieved, which is what we want, we need to convert billions of pounds into trillions of pounds in aid? Does he agree that, in order to do that, much more work needs to be done to engage the private sector and make the most of the private capital market?

--- Later in debate ---

[Mr Sharma]

I thank the hon. Lady for her intervention. She is a proactive member of the International Development Committee and we all agree that a partnership is needed, with Governments, the private sector, the third sector and all non-governmental organisations working in the field coming together to find a solution and the resources, which will be a huge amount.

The Global Fund needs replenishment. As part of our implementation of the SDGs, I want to see a commitment to keep the fund well supported. In the last round, we pledged £1 billion and, in line with most donor nations, we need to increase that by 20% to keep up with the aims of the goals to eliminate the diseases by 2030. The fund has the chance not only to eradicate infectious diseases, but to save a further 8 million lives by 2019.

The new SDGs offer a better way forward, and our Prime Minister threw his support behind them in New York. Implementation must be universal—universality is what makes the SDGs as promising as they are. The British Government should not merely choose a few goals and targets to focus on; all 17 goals and 169 targets should guide our strategy. However, this is not just an international development issue, because the SDGs work even more broadly than that. Along with, I am sure, others present in the Chamber today, I want to see the Cabinet Office given the role of co-ordinating the work across not only DFID, but the Department of Energy and Climate Change and the Department for Business, Innovation and Skills. We are falling behind other countries, but we can do better, and co-ordinating action across Government to fulfil the promise of the Prime Minister’s words in September is how we do that.

[Several hon. Members rose—]

Oral Answers to Questions

Virendra Sharma Excerpts

Wednesday 16th March 2016 Commons Chamber

[Mr Hurd]

I congratulate my hon. Friend on his persistent and tireless work in this area. I was with the senior team at the Global Fund the other day in Geneva to discuss it. I have no doubt about its commitment in the face of that challenge. I hope my hon. Friend takes some pride in the fact that the British Government continue to lead in this area, with the recent refresh of the commitment to spend £500 million a year in the battle against malaria in all its forms.

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

TB is the world’s leading infectious killer. The Global Fund provides more than three quarters of international finance to fight that epidemic. As we approach World TB Day on 24 March, will the Minister call on all Governments around the world to come together to ensure that the Global Fund’s replenishment target of $13 billion is met as a minimum?

[Mr Hurd]

I thank the hon. Gentleman for throwing a spotlight on a huge killer, on which we are not making enough progress. We are proud that the UK is the third-largest donor to the fund that provides, as he said, 70% of the funding around the world to combat that disease. It is critical, therefore, that the replenishment of that fund is a success and that other countries step up to the mark so that we can bear down on that unacceptable death rate.

Tropical Diseases

Virendra Sharma Excerpts

Tuesday 27th October 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Stafford (Jeremy Lefroy) on securing this important debate at the right time.

Since I first entered Parliament in 2007, I have been committed to development and healthcare issues. As a boy growing up in India, I saw the debilitating effects of malaria and parasites such as hookworm. Such conditions are not blind; they affect the very poorest in society. Developing nations face a competitive disadvantage. The west and the more developed nations have mostly eradicated such debilitating, but not necessarily life-threatening, diseases, but the countries with the greatest need often lack even the most basic tools for curing neglected tropical diseases.

I was proud to be in New York last month with four of my colleagues here in the Chamber for the global launch of the sustainable development goals. I pledge my support to two goals in particular: goal 3, on health and wellbeing for all people; and goal 5, on achieving gender equality and empowering all women and girls.

The UK currently invests £536 million in eliminating malaria. The Department for International Development has much to be proud of, but neglected tropical disease funding is being reassessed at the end of this year. NTD funding has to be protected and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, increased where possible. If there is not a predominantly decent level of health across the globe, how can the world face the challenges of the 21st century? Speaking selfishly, if we meet global malaria targets by 2030, we will not only have saved more than 10 million lives but increased global economic output by $4 trillion. That represents a huge new market for British goods, manufacturing and know-how.

Some 44 million households worldwide, representing more than 150 million people, face catastrophic healthcare costs that can cripple them financially. If we can prevent such cruel, horrible diseases from developing, we can free millions of women and girls from lives of servitude when they have to care for sick and ill family members. They will be able to go to school, receive an education and be fully equipped to participate as full members of our society. The life-changing effect of the drugs we support can be immense, and the cost can be just a few pence. The burden of NTDs and malaria traps so many in a spiral of debt, sickness and poverty. We have much to offer, having gained so much ourselves, but although we have done so much, there is much left to do. I hope that by 2050 people will no longer be trapped in poverty spirals driven by sickness. Hopefully, we will help them to become full members of society.

I support the questions put by the hon. Member for Stafford to the Minister. If the Minister can answer all those questions, it will not only satisfy people but give confidence to wider society that the Government are committed to what they have already paid for.

Violence Against Women and Girls

Virendra Sharma Excerpts

Thursday 23rd January 2014 Westminster Hall

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

It is a pleasure, Mrs Brooke, to serve under your chairmanship and to follow such an informative speech from the hon. Member for Mid Derbyshire (Pauline Latham). I congratulate the Select Committee on International Development on its report on violence against women and girls and the Government on their continued efforts to tackle the problem internationally, as well as nationally.

I served on the International Development Committee a few years ago when we went to Nigeria, Bangladesh and other places. We witnessed violence against women, child abuse, forced marriage, under-age marriage and poor education, especially for girls, with lack of water and sanitation in girls’ schools, which was provided in other schools. We witnessed that discrimination. I miss the work of the Committee, and I will certainly try to return to it so that I can contribute to its work.

After today’s news that a 20-year-old woman was tied to a tree and gang-raped in India, allegedly on the orders of village elders, the issue of violence against women and girls is particularly poignant; the utmost importance of addressing this critical issue has been highlighted again. As a member of the all-party group on population, development and reproductive health, I want to draw attention to the importance of family planning and sexual and reproductive health and rights when tackling violence against women and girls.

Violence against women has been called the most pervasive yet least recognised human rights abuse in the world. As many as one in three women in the world have suffered some form of abuse, most often by someone she knows, including her husband or another male family member. Any such abuse can leave deep psychological scars and damage the health of women and girls, especially their reproductive and sexual health, and sometime results in death or leaves them permanently disabled, ruining their lives.

The effects of violence on a woman’s reproductive health can be profound, from unwanted pregnancies and unsafe abortions to complications from frequent, high-risk pregnancies and sexually transmitted infections. Gender-based violence is sustained by a culture of silence and a denial of the seriousness of the health consequences of abuse. In addition to individual harm, those consequences exact a social toll and place a heavy burden on health services. Gender-based violence is sustained by silence, so women’s voices must be heard and every effort must be made to enable women to speak out against it, and to get help when they are victims of it.

The Government should be congratulated on hosting the family planning summit in July 2012. Global leaders united and pledged $2.6 billion to provide 120 million women in the world’s poorest countries with access to contraception by 2020, and the UK announced £500 million in aid.

Currently, more than 200 million women and girls in developing countries do not have access to modern methods of contraception. The inability to choose and access family planning will cost many of those women their lives. I urge the Government to ensure that part of their pledge is dedicated to making emergency contraception available to victims of sexual violence to alleviate some of the suffering and SRHR problems it causes.

Access to modern contraceptives can help prevent an estimated 600,000 neonatal deaths. In 2012, an estimated 291,000 women and girls in low and middle-income countries died from pregnancy-related causes; 104,000 of those pregnancies were unintended. Investing in SRHR is cost-effective. Money spent on modern contraception helps save more in maternal and newborn health care and is a strong tool for moving towards gender equality and female empowerment. It helps tackle violence against women and girls and its devastating effects.

As well as ensuring access to family planning and SRHR, I urge the Government to strengthen advocacy on gender-based violence in all our country programmes in conjunction with other United Nations partners and non-governmental organisations. We must integrate messages on the prevention of gender-based violence into information, education and communication projects and conduct more research on gender-based violence.

Lastly and most importantly, I appeal to the Government to call for the new millennium development goals framework to include a target on universal access to sexual and reproductive health and rights and a stand-alone goal on gender equality and women’s empowerment. The matters that we are discussing are of great urgency. We have a moral duty to defend the vulnerable and to ensure that human rights for all are protected.

Tuberculosis

Virendra Sharma Excerpts

Wednesday 27th November 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dobbin; I thank you for giving me the time to speak in the debate. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on securing the debate, which is close to my heart, as I am the co-chair of the all-party group on global tuberculosis. I also congratulate and thank the many agencies and non-governmental organisations that work in this field, which have helped to raise the issue and bring it to the top of the world agenda.

There is an urgent need to address TB worldwide, but we must not forget that it is still a big concern in the UK, where the rate of TB cases is the highest in western Europe, with 9,000 cases last year alone. My constituency has the second highest rate in the country—156.8 cases per 100,000 people, roughly six times higher than the UK average and equivalent to the rate in Tanzania. It is important to remember that TB is very much a public health threat in parts of the UK, and that it affects people’s health every day, often with long-lasting consequences.

One of the key barriers to treating and eliminating TB in this country is stigma. TB is an airborne, infectious disease, which is deemed incurable and is associated with poverty. Many people are reluctant to tell their families, partners and community when they have the disease, which means they are much less likely to be treated. In the UK, stigma is a barrier that prevents people from seeking treatment when they start to feel ill. It also makes it difficult for health workers to identify other people who might have been exposed, because patients are often reluctant to admit to the possibility of their having infected others.

We cannot afford to ignore TB. It needs to be prioritised and talked about so that people do not feel marginalised and ashamed. We need to ensure that they are aware that TB can be treated and that they seek treatment when they fall ill.

We have a great health centre in Southall that offers TB screening, diagnosis and treatment. However, a third of patients in the area had a delay of more than three months between symptom onset and diagnosis. Although the proportion of people completing treatment was similar to the London average, slightly more were lost to follow-up.

We need to support social outreach projects in high-risk areas as a means of engaging directly with the community, rather than wait for people to come to the health services. That will help to raise awareness and stymie stigmatising, and will enable us to diagnose and treat TB earlier in at-risk communities. Case finding needs to be an active process to ensure that cases of TB do not fall between the cracks and remain untreated.

On a local and community level, outreach projects are crucial, but it is essential that we also have a national strategy on TB. The all-party group on global tuberculosis led the way in calling for a national strategy on TB. It is encouraging that Public Health England is currently developing such a strategy, which will be published in 2014. The national strategy will drive best practice throughout the UK’s clinical and social care for TB, but we must ensure that it is closely integrated with other Government policies on TB, including those of the UK Border Agency and the Department for International Development.

An interdepartmental ministerial group on TB performed that task at the turn of the century, but unfortunately it produced only one report before folding. That group should be revived. TB affects a wide range of Departments, and efforts must be made to enhance co-operation and co-ordination across their policies and interventions to provide the most effective response to TB in this country. A formalised, recognised structure with appropriate support is the best way to make that happen.

TB has been neglected for too long. It is a disease that people do not talk about and have forgotten, which increases stigma and reduces the likelihood that those in need will receive treatment and care. The UK does not need to commit finances to make a difference to how the disease is perceived, but it does need to show leadership and commitment domestically and abroad. It can do that by reaffirming that TB is a serious threat and a priority, and by committing to a local community strategy accompanied by a national, co-ordinated interdepartmental approach.

[Jim Dobbin (in the Chair)]

I have enjoyed the debate very much. In a former life, I worked in an infectious diseases hospital, specialising in TB.

Oral Answers to Questions

Virendra Sharma Excerpts

Wednesday 12th June 2013 Commons Chamber

[The Prime Minister]

I am happy to receive the information from my hon. Friend. It is important that we get Britain’s exports up. If we moved from one in five of our small and medium-sized enterprises exporting to one in four, we would wipe out our export deficit altogether, so I am happy to get my office to look at the information she has.

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

Q10. The accident and emergency department at Ealing hospital is one of four that the Prime Minister is closing in north-west London. I welcome the Health Secretary’s review, but with waiting times at a nine-year high, ambulances being diverted and the risk of unnecessary deaths, will the Prime Minister acknowledge that the closures are not a serious option if the NHS is safe in his hands?

[The Prime Minister]

As the hon. Gentleman knows, the Health Secretary has asked the Independent Reconfiguration Panel to conduct a full review of the proposals, and it will submit its advice to him no later than mid-September. Let us be absolutely clear: whatever decision is reached, the proposals will not be due to lack of central Government funding. North-west London will receive £3.6 billion, which is £100 million more than the previous year. Of course, if we had listened to the Labour party, which said that more NHS spending was “irresponsible”, his hospitals would be receiving £100 million less.

Oral Answers to Questions

Virendra Sharma Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Duncan]

I assure my hon. Friend that things are just a little bit better than he says. The latest data from a highly regarded national survey suggest that 55% of people in Nepal have access to safe latrines. Despite total child deaths having almost halved in the past 10 years, child deaths from poor water and sanitation are still unacceptably high. Our programmes will help to avert 3,500 child deaths and should ensure that 110,000 more people have access to safe latrines by 2015.

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

In light of the fact that there will be elections in Nepal very soon, what assistance are we providing for good governance there?

[Mr Duncan]

The hon. Gentleman hits on a most important point. At the moment, there is constitutional and governmental deadlock in Nepal. When I was there, we were doing our utmost as an influential friend of Nepal—as I hope the UK can continue to be—to help to break the deadlock and ensure either that a new constituent assembly is formed or that there are elections, and each can facilitate and assist the other.

Millennium Development Goals

Virendra Sharma Excerpts

Tuesday 3rd July 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship on this important issue, Mr Bone. I thank the Minister in advance for responding to my concerns, and I thank hon. Members for attending the debate.

An estimated 24 million children worldwide grow up without parental care. In some regions, as many as 30% live apart from their parents, and research suggests that that figure is increasing. Every child deserves to grow up, to go to school and to live their childhood free from hunger and disease, exploitation, abuse and violence. Experience has shown that this happens best when children are loved and cared for in a family setting.

The millennium development goals have focused global efforts to improve the lives of the world’s poorest people, yet many of the crucial targets are in danger of not being reached by 2015. That would have a devastating impact on the well-being of children throughout the world. Failure to provide proper care and protection for children is hindering progress in achieving many MDGs. Future development goals, which are currently being developed, need to recognise and eradicate those mistakes.

There are huge gaps in child protection systems around the world. Such systems are crucial to ensuring the protection of children who are without parental care. Therefore, addressing child protection in the MDGs and the successor framework is key in supporting the rights of such children. I will outline how children’s rights to care and protection are the missing link in achieving the MDGs. Children without the care and protection of their family are particularly vulnerable and hard to reach.

I want to cover two issues related to the MDGs: the importance of including protection and care concerns in efforts to monitor the MDGs; and the need to address the absence of an explicit reference to child protection and care in the current MDGs, if the post-MDG framework is to be effective in improving children’s well-being in the future.

MDG 1 aims to end poverty and hunger. Children who are in the care of the state, either in residential care or in detention, may fail to receive adequate food, despite the obligation on Governments to provide it, while children who are not in conventional households, such as those living on the streets, in migrant families, or in child-only households, are often excluded from social protection schemes. Poorly designed social protection systems are, at best, failing to reach children who are without adequate care and protection, and, at worst, actively encouraging family separation or child labour. In South Africa and Ukraine, payments to foster or extended family carers mean that children will be in better resourced households if parents give them up to other forms of care.

[Anas Sarwar (Glasgow Central) (Lab)]

I congratulate my hon. Friend on securing this important debate. In an answer to a parliamentary question I tabled, I was surprised to discover that the Department for International Development does not have a dedicated child protection policy. Does my hon. Friend think that that is something DFID should have, signalling post-MDG intentions?

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[Mr Sharma]

I thank my hon. Friend for that appropriate intervention. I am sure that the Minister has taken note and will respond to it. I agree with my hon. Friend and share his concerns.

MDGs 2 and 3 seek universal education and gender equality. In its 2012 annual report, DFID acknowledges that to meet the target of universal primary education, efforts need to shift to the hardest-to-reach children. Education for all will not be achieved unless the current widespread exclusion of young married girls and children in extended family care, prison or work is addressed. Children who have lost both parents are 12% less likely to be in school than other children. The vast majority of children living and working on the streets do not attend school, while children in detention often have no access to formal school during their sentences. For the 13.6% of children who are child labourers, including a quarter of children in sub-Saharan Africa, combining work with school often has a negative impact on learning achievements, with long working hours preventing children from attending school at all.

International recognition of the links between child labour and education have not translated into policy change on the part of many Governments. To get education for their children, the only option for some families, who are in poverty or are far from a school, is to send their children away to live in institutions that provide education but are detrimental to their well-being in other ways. Long distances to school mean that some children have to find alternative accommodation, making them vulnerable to exploitation and abuse.

MDG 4 addresses child health. The widespread use of residential care for children under three places many children and infants at greater risk of dying young. In Russia, official statistics suggest that the mortality rate for children under four years old in residential care is 10 times higher than that of the general population. In Sudan, of 2,500 infants admitted to one institution in a five-year period, only 400 survived. There are currently at least 8 million children in residential care, with evidence to suggest a growth in this form of care in many countries in the former Soviet Union, sub-Saharan Africa and south Asia.

Finally, MDGs 5 and 6 address maternal health and combating HIV/AIDS. Ensuring that children have adequate care and protection is essential for improving maternal health and combating the spread of HIV. Preventing early marriage is essential for stemming the spread of HIV and preventing girls from becoming mothers at an early age when the risks of maternal and child mortality are highest. Trafficked children, child domestic workers and other working children often face sexual abuse. An estimated 2 million children, mainly girls, are sexually exploited in the commercial sex trade each year. Street children are often sexually active at a very young age.

Early sexual activity has profound implications for maternal and child health. Forced sex and limited power in relationships mean that girls without adequate care and protection often face early motherhood, with severe consequences for the health of both young mothers and babies. Pregnancy-related deaths are the leading cause of mortality for 15 to 19-year-old girls. Those who give birth aged under 15 are five times more likely to die than women aged over 20. Babies born to young mothers are also less likely to survive. Early and often forced sexual activity among children lacking adequate care and protection increases the risk of HIV infection. Lack of control over contraceptive use, inadequate knowledge of reproductive health, frequent sexual activity and having sex with often older husbands all result in such children being more vulnerable to HIV infection and other sexually transmitted diseases.

Children on the streets are often discriminated against by service providers and unable to access health care or advice about contraceptive use. DFID is committed to achieving education for all, including the most hard-to-reach groups. What is it doing to ensure that children who are outside parental care receive an education, and that their parents do not have to make agonising choices between schooling and care and protection?

DFID makes substantial investments in social protection programmes around the world. What is it doing to ensure that social protection reaches the most vulnerable and is designed in a way that keeps families together and does not push them apart? Through its commitment to achieving the MDGs, DFID is working to reduce child and maternal mortality and the spread of HIV. What is it doing to reduce separation from parents and deal with the abuse and exploitation that is so often the cause of dangerous early pregnancy and HIV infection?

DFID is focusing more on fragile and conflict-affected states and is working to mitigate the negative effects of climate change. What is DFID doing to ensure that, in dealing with preparedness and responses to conflict and disasters, emphasis is put on preventing families separating and on protecting children whose families are torn apart by war?

It is important that DFID ensures the development of indicators of impacts on children who are outside parental care and/or facing situations of abuse or exploitation.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

Will my hon. Friend give way?

[Mr Sharma]

I am sorry, I shall continue.

DFID must invest more in appropriate, integrated child protection systems that adhere to the UN guidelines for the alternative care of children. The Prime Minister has recently been appointed co-chair of the UN Secretary-General’s high-level panel, looking at what comes after 2015 when the targets for the millennium development goals end. The first presentation of the panel’s work will be made in September.

The coalition Government recognise the importance of strong families in improving the lives of children in the UK, yet in their work in the developing world not enough is being done to keep families together. The UN is co-ordinating a global process to develop a post-MDG framework and there is an opportunity for the UK to influence the process, and the outcomes of the development of these goals, by promoting specific reference to children’s rights to care and protection in any framework and by ensuring that extra effort is made to consult hard-to-reach children, so that their voices are heard in the global debates on a framework that could shape their future. I should like the Minister to address his Department’s role in those two areas.

The post-MDG framework should include specific targets on children’s protection and care, for example, by measuring reductions in numbers growing up in large institutions, in detention, in harmful child labour, living and working on the streets, or experiencing violence, abuse or neglect in homes and schools. A consideration of children’s protective rights will also help to ensure the equitable achievement of the millennium development goals. Only through a consideration of such basic rights will it be possible to make wide-reaching and sustainable progress in efforts to alleviate child poverty, increase access to education, improve maternal and child health, and reduce the spread of HIV and AIDS.