Global Fund image for websiteOn Tuesday 4th June, All-Party Parliamentary Group on Global Tuberculosis member Jim Fitzpatrick MP (Labour, Popular and Limehouse) secured a debate on the rising rates of drug-resistant (DR) TB in developing countries. This was the first time that a debate had been held specifically on the infectious disease that, despite being curable, continues to kill 1.4 million people each year.

There are estimated to be almost nine million cases of TB each year, just over six hundred thousand of which are the more extreme drug-resistant strain of the disease.

The numbers will come as a shock to many, given the perception that TB was confined to the history books long ago. Unfortunately that is not the case. Even here in the UK rates of the disease have been rising since the 1980’s with around nine thousand new cases each year.

TB has been around for a long time, it is the greatest infectious killer in human history eclipsing all other pandemics, and is now evolving into an even tougher advisory. Drug-resistant (DR-TB) forms of the disease can take four times as long to treat as ‘normal’ TB cases and cost up to 450 times more in developing countries. So while DR-TB cases account for less than 10% of the global burden of the disease, the cost to treat it is, quite frankly astounding.

If this was not bad enough, very few people who contract DR-TB have access to diagnosis or treatment, meaning that the disease continues to spread.  It can be passed from person to person as it is often airborne.

In a globalised world it is clear that this problem requires a global response. Mr Fitzpatrick sought to raise exactly this point and highlighted a number of key recommendations from the recent APPG TB report Drug-Resistant Tuberculosis: Old Disease – New Threat which highlighted steps the UK could take to meet this new threat. They included:

1.       Strengthen the Global Fund by doubling the UK’s contribution

International donor funding, including the majority of the UK’s response to TB in developing countries, comes almost entirely through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

In 22 high TB burden countries, six are totally reliant on funding from the Fund and for another 15 it accounts for two thirds of their budget.

In order to scale up access and treatment for DR-TB, which remains woefully low, the resources that the Global Fund has at its disposal needs to increase.  The UK Government has a key role to play in the replenishment of the fund, having been a key driving force behind recent reforms.

Recommendation: The Government should at least double its contribution to the Global Fund to address the threat of TB and DR-TB. This announcement should happen as soon as possible to help leverage more from other donor governments in this important replenishment year.

2.       Invest in innovation – through TB REACH and continued investment in Research and Development into new tools to tackle TB

The Government has shown real leadership in support of developing new badly needed tools to tackle TB under successive Governments. This should continue.

Some of these tools have come to market, including new rapid diagnostics. Despite this, there are still three million people each year that fail to access diagnosis and treatment for TB, which includes a large portion of people with drug-resistant strains.

We need to accelerate our efforts to diagnose TB by rolling out new technologies and it is clear that we need to think outside the box.

One way of doing this is through TB REACH, a Stop TB Partnership hosted initiative that gives small grants of up to one million US dollars to find and treat those who don’t have any access to TB diagnosis or treatment. It is an incubator for innovation and pushes the frontiers of technology working closely with DFID funded UNITAID.

In short: TB REACH goes where others can’t and shows governments and donors how to reach the unreachable. Critically it often demonstrates with data what projects could be scaled up.

Recommendation: The Government should become a donor to TB REACH, beyond its contribution of core funding to the Stop TB Partnership that does not cover this, to maximise its investments in both UNITAID and support the expansion of new diagnostic tools to detect, and ultimately treat, cases of TB in addition to the work of the Global Fund. The level of funding allocated should be directed by the evaluation of the Stop TB Partnership later this year.

3.       National strategy for TB in the UK and the importance of a Global target

A national strategy for TB has never been developed despite the public health risk the disease presents. The UK has seen rising rates of tuberculosis since the 1980s and DR-TB increased by 26% in the last year alone.

Recommendation: Given the clear link between global and UK rates, the Government should set a specific target on their contribution internationally to tackling DR-TB as part of a comprehensive TB strategy, led by Public Health England.

In response the Parliamentary Under Secretary of State for International Development, Lynne Featherstone MP, congratulated the Hon member on securing the debate and said that DR-TB was an important issue that the UK Government takes very seriously.  Responding to the points in turn the Minister stated:

1.       The UK Government remains committed to supporting the Global Fund to Fight AIDS, Tuberculosis and Malaria, given the significant impact it has on implementing programmes to address the three diseases. A future increased contribution to the Global Fund was dependent on an internal evaluation of reforms that the multilateral had undertaken -due to be published in July.

2.       A. The Department for International Development (DFID) recognise the importance of research and development of new tools to tackle TB. Supporting R&D into new tools has been a long standing position of DFID. Funding for TB R&D programmes is due to be announced later in the year.

B. DFID recognise the significant impact that TB REACH has had and the valuable work it does in helping those who don’t have access to diagnosis and treatment to receive it. The UK Government will consider the request to fund TB REACH directly as part of its review of the Stop TB Partnership later in 2013.

3.       DFID will input into the process, and will work with the partners on their strategy, to produce national and international policy and to ensure that there is co-ordinated action on domestic and global approaches to reducing rates of TB.