Meeting of the Parliament (Hybrid)

Meeting date: Thursday, March 24, 2022

Official Report 1134KB pdf

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World Tuberculosis Day 2022

The next item of business is a members’ business debate on motion S6M-02874, in the name of Miles Briggs, on world tuberculosis day 2022. The debate will be concluded without any question being put. I invite members who wish to participate to press their request-to-speak buttons or place an R in the chat box as soon as possible.

Motion debated,

That the Parliament notes that 24 March 2022 marks World Tuberculosis Day; understands that tuberculosis (TB) remains one of the world’s deadliest infectious diseases, killing 1.5 million people each year; believes that the COVID-19 pandemic has reversed decades of positive progress in tackling TB; understands that there has been uneven progress in the delivery of the commitments made at the UN High-Level Meeting on TB, including efforts to diagnose and treat 40 million people with TB by 2022 and to dramatically increase investments in research; considers that TB is a disease of poverty, with the most vulnerable and marginalised at greatest risk of both TB and drug-resistant TB, including in Scotland; believes that strong international health systems are vital for securing the UK’s domestic health security; recognises what it sees as the importance of the upcoming seventh replenishment of the Global Fund to fight AIDS, Tuberculosis and Malaria in tackling global TB, and notes what it sees as the vital work carried out by clinical staff, scientists and civil society organisations across Scotland and globally to deliver on the Sustainable Development Goal of ending TB by 2030.

12:49  

I am grateful to be able to bring the debate to the chamber today, and I thank members from across the Parliament for all their support on what is not only an important public health issue globally but, increasingly, a potential threat to domestic health security.

I pay tribute to the Edinburgh group of Results UK, which campaigns on international development issues, including tuberculosis. I have been working with the group since my election to Parliament in 2016, and I am pleased to welcome some of its members to the public gallery today. I have also sponsored a stand just outside the chamber, and I know that a number of members have already spoken to and engaged with the group. If they have not done so already, there may be a chance after the debate for them to speak to the group and find out more information.

I also take the opportunity to note the contribution made by two leading professionals in Scotland. Dr Helen Stagg of the centre for population health sciences at the University of Edinburgh was, until recently, chair of the UKAPTB. For those who do not know what that is, it stands for UK Academics and Professionals to End TB. Susan Duthie, who is the lead TB specialist nurse at NHS Grampian, also led on drawing up recommendations on the management of Afghan national TB screening in Scotland.

I also put on record our thanks for all the vital work that is carried out by clinical staff, scientists and civil society organisations, in Scotland and globally, to deliver on the sustainable development goal, which we all signed up to, of ending TB by 2030.

Tuberculosis is an incredibly infectious disease that is spread through coughing. It has killed more people than any other single infectious agent in history, including SARS-CoV-2. TB is curable, but people need support to get through the many months of treatment that are required.

As noted in the motion, around 1.5 million people die from TB every year and many millions more are diagnosed with the disease. That is a shocking statistic and something that we all need to reflect on. Presiding Officer, if you were a teenager before 2005—I am not sure whether you were—you may bear a small, circular scar on your bicep. That is by-product of immunisation against TB and a reminder of the prevalence of the disease in this country at one time.

However, the Covid-19 pandemic and its widespread effects on diagnosis and treatment have brought the disease of TB back to the forefront of the policy debate, especially in the context of public health in developing countries. Because of the similarities between TB and Covid, much of the precautionary equipment and many of the treatment centres and services that are usually the first line of defence for the former were refocused on the latter. The World Health Organization has suggested that the pandemic has set back efforts to end TB globally by more than a decade.

Researchers at the University of Dundee, who received a £3.8 million grant from the Bill & Melinda Gates Foundation to develop treatments, have warned that the impact of the pandemic could lead to a rise in tuberculosis infections around the world, as some patients will have gone undiagnosed amid the pandemic. Indeed, as with many services across our health landscape, we believe that diagnoses of TB dropped by around 20 per cent in 2020, as access to treatment became increasingly difficult.

Some projections suggest that progress against TB has also been significantly set back. Dr Laura Cleghorn of the University of Dundee said that there is a “pressing need” to develop new treatments for the illness, which some people wrongly think of as a “disease of yesteryear” . I agree. As I said earlier, it is a concern that, across the world, diagnoses of TB dropped by a similar level, with 16 countries accounting for 93 per cent of that drop. That suggests that countries that already have a higher burden of disease have fared far worse.

Of course, other issues have led to that protracted problem. For example, fewer people have been tested for TB and the number attending for tests has reduced. That might be due to people’s fear of contracting Covid-19 in hospital or because people with Covid-19 were not able to go to hospital. As we emerge from the pandemic, we urgently need to tackle that problem. Otherwise, we risk stepping backwards in the fight against deaths from TB.

That will, of course, require a sincere, co-ordinated and multilateral effort, but if the pandemic has demonstrated anything it is that immense benefit can sometimes be gained from proper and targeted investment in global public health. In recent years, concerted action has been taken to tackle TB and we need to see that work being recovered.

In 2018, for example, we saw the first high-level global meeting on TB. It produced a declaration of political will that can shape our approach going forward. Notably, it identified work to close the research and development funding gap. To date, that has been estimated to be more than $1.1 billion. I welcome the £20 million of UK Government research and development funding. A good portion of that has already been targeted towards such global health innovations.

There are still many concerns around research and development, and I hope that we can address those globally.

The first and most obvious concern is about treatment methods. Innovation will allow us to simplify treatment regimes, allowing them to be more easily deployed in all corners of the world, in contrast to what are currently lengthy and complex treatments for many patients that can often take more than three months.

Similarly, we need to see progress on diagnosis of TB. We need to be able to do it in a speedy, efficient and simple way. To circle back to my earlier points, Covid-19 has acted as a catalyst to the diagnosis question, and I hope that we will see investment around early diagnosis of TB, as we have seen around Covid.

Finally, and perhaps most importantly, we need to fund the research that will look at drug resistance. We are all acutely aware of a really worrying trend—a rise in drug-resistant or multidrug-resistant TB. More than 160,000 cases were recorded people last year alone, which is deeply concerning for global public health.

We know that Scotland is also behind in funding for latent TB screening in communities at risk and vulnerable to TB. I hope that the minister who closes the debate can outline the public health initiatives that are being developed to address those concerns around latent TB screening.

To conclude, I am incredibly grateful to members for allowing me to introduce the debate today, and for the opportunity to discuss these issues of public health policy around the world and of domestic health security.

Above all, I hope that today can present an opportunity for Parliament to re-affirm our collective mission and that of clinical staff, scientists and civil society organisations in Scotland and globally to meet the sustainable development goal of ending TB by 2030.

Thank you, Mr Briggs. We now move to the open debate.

12:57  

I welcome the opportunity to speak in the debate, and congratulate Miles Briggs on securing it. I apologise for not being in the chamber today.

Miles Briggs has laid out very well the importance of world tuberculosis day 2022, which this year marks the theme “Invest to End TB. Save Lives”. Raising awareness is one of the asks in the briefing from Results UK. I met its staff in Parliament on Tuesday at their stand, which Miles Briggs sponsors. It is important to raise public awareness about the devastating health, social and economic consequences of TB and to highlight the efforts that are being made to end the global epidemic.

When preparing for the debate, I reflected on Scotland’s journey to tackle TB. In 1948, TB was killing one person every two hours in Scotland. Back then, Scotland was virtually the only country in Europe where new cases of TB were continuing to rise unchecked. Although forever the disease of poverty and crowded slums, wealth provided no barrier. Young men and women were particularly at risk and TB meningitis was certain death for babies and toddlers. TB patients could spend a year or more recovering and resting in a sanatorium, including at Lochmaben sanatorium near Dumfries.

One of my first tutors in nursing college—Mr David Shankland—was the first male nurse in Dumfries and Galloway, at Lochmaben hospital. Davie taught me and my colleagues so much about his time at Lochmaben, helping support people who were recovering from TB. It was a dreadful time back then, which the appalling stigma that was attached to TB made worse.

Streptomycin—the first treatment and first real cure—came along, developed by William Feldman, a Glasgow-born vet who helped refine it into a medical form at the Mayo clinic in Minnesota.

I want to pay tribute, too, to Sir John Crofton for developing the first combined antibiotic multidose regimen that still forms the basis of TB treatments today, and to the University of St Andrews, the University of Edinburgh and Queen Margaret University, which continue Sir John’s legacy today, working across continents and disciplines.

The drugs were game changing and, since then, largely down to our fantastic NHS and vaccination efforts, the situation here has improved.

However, Scotland’s example has not been replicated around the world. According to the World Health Organization’s “Global tuberculosis report”, 60 per cent of global TB cases come from just six countries, where health inequalities are more prevalent. Those countries are China, India, Indonesia, Nigeria, Pakistan and South Africa.

Although treatments are available across those nations, the problem is largely that, even though doctors routinely advise patients with TB about the importance of following prescribed regimens, many people do not complete their treatment plan. When patients stop taking TB medication, they risk developing multidrug-resistant TB, which is even more difficult and costly to treat. In 2016, the median cost of treating a single patient with multidrug-resistant TB in a developing country was $9,529, and treatment could last up to two years. New multidrug regimens of nine to 12 months exist, but they can cost up to $1,000 per person, and maintaining patient compliance for such a long period presents additional challenges. It is not that patients do not care about their health but that they are burdened by economic constraints.

TB may be caused by a stubborn bacterium, which primarily affects the lungs. It is similar to our SARS-CoV-2 virus in its high transmissibility, but it is poverty that sustains it. Treatment often means travelling long distances to clinics and giving up a day’s wage. Donor agencies and international health organisations often ignore the context for why people act the way they do.

We must work on ways in which to support and invest in treatment. I am interested in exploring the possibility of conditional cash transfers, which have been used in recent years in medical interventions around the globe. They are forms of social assistance programmes that aim to reduce poverty. Apart from providing extra income, conditional cash transfers allow patients to invest in their health through providing the means to access basic health services or to send their children to school, which helps to break intergenerational poverty cycles. I am interested in hearing the Scottish Government’s position on CCTs and whether any of our international relief funds support them.

As this year’s theme is “Invest to End TB. Save Lives”, perhaps CCTs are a way to invest to do just that.

13:02  

I thank Miles Briggs for lodging his motion and the words that it contains. If there were to be a vote on it, I would vote for it.

Today is world tuberculosis day, and this week started with world poetry day. In the opening lines of “On the page”, by the late Tom Leonard, he said:

“The local is the international,
The national is the parochial”.

This national Parliament is nothing if it does not look beyond the parochial, if it does not see its place in the world and if we do not understand that we are world citizens with global horizons, neither limited by passports nor narrowed by where we happen to have been born. This debate is about our common humanity.

Tuberculosis is an old disease. Many of us have family experience of the toll that it takes. Growing up in Leeds, my grandfather lost two older brothers and a sister, Florence, and then, one by one, both his parents to this deadly disease of poverty. Tuberculosis is the reason why John Wheatley, as a Glasgow Labour councillor, strove for not just slum clearance but good-quality council houses that were, in his words, “homes not hutches”. Yet, in 2020, more than 100 years later, 1.5 million people died of this preventable, curable disease.

I am bound to say that, if we invested as much in the machinery of peace as we do in the machinery of war, and if we invested as much in saving lives as we do in endangering them, the world would be a far better place. In 2020, the year when the number of TB deaths went up again, world military expenditure in that one year was $1.781 trillion. By comparison, just $5.3 billion dollars were invested in universal access to TB prevention, diagnosis, treatment and care across the globe. That is a ratio of 370 to 1. Healthcare is a human right.

I am grateful to Richard Leonard for giving way, as he is giving a particularly passionate speech, which I agree with. Will he join me in paying tribute to the Global Fund and the work that it does across the world, especially in Africa? I have seen at first hand the work that has been done because of the Global Fund.

Will he also acknowledge the important funders of the Global Fund, such as the United States, France and the United Kingdom?

We need to be internationalist in outlook and, as I said in my opening remarks, we need to understand that we are citizens of the world and have a global responsibility in this respect.

Healthcare is a human right, but to be poor in this world is to be too often denied that human right. That is why the director general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, recently said:

“The struggle to end TB is not just a struggle against a single disease. It’s also the struggle to end poverty, inequity, unsafe housing, discrimination and stigma, and to extend social protection and universal health coverage.”

The unnecessary deaths of 1.5 million people a year do not just tell us where poverty lies; they tell us where power lies: between the global north and the global south; between rich and poor; and between the profits of corporations and the lives of people.

The WHO has accused big pharmaceutical giants of, in its words, “exiting the field” of investment in new antibiotics to deal with drug resistance, which is a major cause of TB death. As far back as 2014, AstraZeneca withdrew all early-stage research and development for TB, malaria and neglected tropical diseases. The biggest pharmaceutical corporation in the world, Johnson & Johnson, deliberately charged developing countries eight times the cost price of manufacture for the newer TB drug bedaquiline, before a campaign by Médecins Sans Frontières pressured the company to cut the price, but that was its first instinct. For big pharma, it is not about the drugs with the greatest clinical or humanitarian value; it is always about the drugs with the greatest monetary and shareholder value.

Tuberculosis is a disease of poverty, of inequality and of global power and global priorities, so our job is to build a world where people have clean water and safe shelter, where no one lives in fear of starvation, and where no one dies from a disease for which a vaccine has existed for almost a century. That is the future that we need to build: a better, just, more humane world—a future of hope, a future of peace and, I hope, a future of socialism.

13:08  

On behalf of the Scottish Government, I thank Miles Briggs for bringing the motion to the chamber on world tuberculosis day.

My heart goes out to all those across the world who have been affected by this terrible disease. Too many lives have been lost to TB here in Scotland and around the globe, and we cannot let that continue. TB is a disease that, in the majority of cases, is treatable and curable. We must keep making progress towards the end of this epidemic.

With that in mind, I acknowledge the work that is being done across the world to support the WHO’s end TB strategy and the United Nations sustainable development goals. I also highlight the fantastic work being done by the Global Fund, a partnership endorsed by the G8 that was developed to accelerate the end of TB, AIDS and malaria as epidemics. In 2020 alone, the Global Fund facilitated the treatment of 4.7 million people with TB. Since its inception in 2002, there has been a 28 per cent reduction in the number of TB deaths, excluding HIV-positive cases, in the countries in which the Global Fund operates. Although it is undoubtedly the case that there is still more to be done, we should all be incredibly proud of the strides that have been taken to reduce the impact of TB across the world.

Closer to home, I want to touch on the work that is being done here in Scotland. As a Government, we take tuberculosis very seriously: we are fully committed to eradicating the disease in Scotland. For more than 20 years, we have monitored the disease through the enhanced surveillance of mycobacterial infections scheme, which ensures that we have access to up-to-date data on case numbers, treatment, outcomes and drug resistance patterns.

In 2011, the Scottish Government published “A TB Action Plan for Scotland”, which set out key recommendations on TB care and control. In the years since the publication of that plan, there has been a sustained reduction in the number of TB cases across Scotland. Case levels remain well within the target of less than 10 cases per 100,000 people that is set in the World Health Organization’s end TB strategy.

However, as a Government, we know that we cannot become complacent. We must acknowledge that, as the numbers fall, TB cases in Scotland are becoming more complex. The patients we are seeing are often from underserved population groups. They might not have been born in the UK or they might be infected with a drug-resistant strain of the infection. To address the complexity of the TB landscape, the Scottish health protection network established a TB multidisciplinary network, which brings together experts from across the country.

In 2017, the network published “TB Framework for Scotland”, which was built on the foundations of the TB action plan. It set out an approach of supporting progress towards key TB outcomes, including a reduction in the health inequalities gap that affects those who are diagnosed with TB.

The Covid-19 pandemic put the brakes on much of the good work on TB in Scotland, as vital resources were redirected. I am happy to report that meetings of the implementation group have now recommenced, and I am confident that good progress will be made towards the outcomes that have been identified.

In addition, a reference service for whole-genome sequencing of TB is now live in Scotland. That service will allow the NHS to much more rapidly predict resistance to anti-TB drugs and to assess strains to allow better investigation into clusters of the disease.

To respond to Miles Briggs’s specific point, we acknowledge the issues around latent TB screening. We are actively working with multiple partners to understand what more can be done in that area. I am waiting for a paper on exactly that issue—I expect it to be with me quite soon.

Although there is more work to be done here in Scotland, I am proud of what we have achieved so far. However, as is the case in every health debate, we must acknowledge the effect that the Covid-19 pandemic has had on the fight against TB, not just here but further afield. Across the globe, every area of healthcare has been impacted by the pandemic, and TB is no exception. There has been a reduction in testing; essential resources such as labs and healthcare workers have been diverted to fight Covid-19; and there have been significant declines in the number of TB cases that have been successfully treated.

Despite that, there is hope. Emergency funding from the Global Fund is helping countries to fight TB alongside Covid-19. Investment in health workers and in tools and systems to combat airborne diseases is increasing.

The challenge is huge. We must remember that we are emerging from a pandemic that has taken a massive toll on our communities, our people and our health services, but I know that, if we harness the collective purpose that has been so evident in the past two years, we can succeed. As the situation surrounding Covid-19 continues to improve, much-needed resources will be rerouted back into the fight against TB.

Of course, I recognise that meeting the 2030 target will require concentrated and focused effort, and that we must act quickly to make up for lost time. Although progress has been made, I know that our work is far from done. That is why the Government remains committed to supporting the sustainable development goal of ending TB by 2030. We will continue to work with Public Health Scotland and other colleagues to drive that work forward.

I extend my sincere thanks to all those who have worked so tirelessly to reduce the impact of TB on lives across the world. This debate has been an excellent opportunity to highlight the fantastic work that is being done to reduce the impact of TB. It has also allowed us to take stock and to consider how we can move forward.

The Covid-19 pandemic has left its mark, as it has on so much of our lives. We will harness the learning and the togetherness that have been so evident in the past two years as we move forward. I commit to continuing to strive for a future in which TB is eliminated here in Scotland and across the world.

That concludes the debate.

13:15 Meeting suspended.  

14:00 On resuming—