Oral answer (Lords) on Health: Tuberculosis - Nov 29

To ask Her Majesty’s Government what action they are taking to support the global fight against tuberculosis, in the light of tuberculosis being the leading cause of death globally among people living with HIV/AIDS.

The UK is a global leader in the fight against TB and HIV and fully recognises the interrelationship between these diseases. We are the second largest funder to the Global Fund to Fight AIDS, TB and Malaria, which provides treatment for people with TB and those living with HIV. We are accelerating research on prevention and treatment, and strengthening health systems to improve access to quality healthcare, including for TB and HIV.

I thank the Minister for that response. Between 2000 and 2014, implementation of the collaborative TB/HIV activity saved an estimated 8.4 million lives. Will the Minister tell us what steps the Government are taking to ensure that their bilateral investments in HIV programmes support the integration of TB and HIV services, as recommended by the WHO?

As the noble Lord knows, most of our giving, which is very generous, on behalf of the British taxpayer is through the global fund, and we believe that that multilateral body is the most effective way of delivering support. We are the second largest donor to it, giving £1.2 billion in the current round, which is helping to treat 2.2 million people, so we continue to keep that as our focus. Of course, we will keep under review the advice from the World Health Organization about whether there are specific bilateral programmes that we ought to support more.

My Lords, can the Minister update the House on the reply he gave me on 2 November about the serious shortage of TB drugs in Uganda? While he is doing that, could he return to the question asked by the noble Lord, Lord Collins, about the integration of HIV and TB services, as recommended by the World Health Organization? Are we doing that? What are we doing about the $1.3 billion funding gap in research?

I believe that the specific case in Uganda, which the noble Lord raised with me, has now been resolved through the Global Drug Facility. A six-month supply of the drug has been provided, following the closure of the factory in China which was the principal supplier. We keep that under review through the World Health Organization. The noble Lord also asked what more we could be doing in that area to close the funding gap. The Secretary of State, Penny Mordaunt, attended a very successful UN General Assembly high-level meeting specifically on tackling TB at the margins, where a target was set for a level of treatment and funding. At at that event, the Secretary of State also announced further funding, from us, of £7.5 million for the TB Alliance.

My Lords, earlier this year I visited a lab in London that is at the centre of efforts to develop to develop HIV and TB vaccines, run under the auspices of the International AIDS Vaccine Initiative. Since then, breakthrough clinical trials have shown that an effective TB vaccine could be possible but, despite this, the Government no longer fund this work. Yet we know that without vaccines, we will not end the epidemics. Will the Minister revisit this decision so that we can support UK science and deliver on our SDG promise to end TB by 2030?

We work closely with my noble friend at the Department of Health and Social Care on the specifics of vaccines. DfID has funded some candidates for potential vaccines in the past. It is a very long-term project. There is such demand for scarce resources that we have to allocate them correctly, but if there are promising candidates for a vaccine we would very much want to look at the possibility of funding them.

My Lords, I was rescued from the clutches of this disease by wonderful NHS treatment. Does the Minister agree that TB can remain dormant in the human body until a time of great stress or malnutrition? Therefore, it is the combination of drug efficacy and, I am afraid, poverty that can exacerbate this problem.

That is very true, and that is why the vast majority of cases of TB around the world—an estimated 10 million new cases in just the past year, leading to the potential deaths of 1.6 million people—are predominantly in low-income countries, which is also where the UK aid budget is focused most.

My Lords, does my noble friend agree that the greatest barrier to tackling HIV and its comorbidities, such as TB and hepatitis, is the continuing burden of the criminalisation of homosexuality in so many countries, which makes proper health education almost impossible? Will he restate the Government’s strong and very welcome commitment to tackling that scourge of criminalisation?

We will of course do that. I think some 72 countries around the world criminalise degree same-sex relationships to some, and 36 of those are Commonwealth countries. That is why we mentioned that at the Commonwealth Heads of Government Meeting. We have to strike a note of some humility there; in some of the conversations I had at that meeting, it was pointed out to me that the legislation came from British colonial rule. We therefore need to be humble and careful in how we approach the matter, but it is absolutely right that we should highlight that these laws should be changed. They are something from the past and they inhibit the tackling of this prevalent disease.

My Lords, it is good that we are such a major donor to those trying to solve this problem. Nevertheless, as the noble Lord, Lord Alton, pointed out, there is still a huge funding gap. What attempts are being made to draw together international partners to give this a much higher priority, and in particular to ensure that we can fund these relatively low-cost, very effective TB drugs, which are making such a difference?

The best thing we can do is lead by example. That is what we were trying to do in organising the high-level meeting in the margins of the UN General Assembly in September, and we can do that by deciding how we allocate our resource. However, it is for a lot of other wealthy countries to step up to the plate. A commitment was made by all those who attended and signed the political declaration at the UN General Assembly that they would treat 40 million people between 2018 and 2022. If that is to happen, there needs to be an awful lot more money in the system. The UK can do its bit, but other countries need to do more.