That this House has considered UN high-level meetings in 2023.
It is an honour to serve under your chairmanship, Mr Twigg. Most of, if not all, the pressing global challenges we face today are not confined to a single continent or country. We have all seen that—including recently with covid-19—when global challenges arise, and the consequences of those challenges are felt more widely than ever before. To face the challenges effectively, we need to use key international forums to incite support among world leaders for solutions that can save millions of lives and improve the lives of billions more.
The UN is a testament to the power of collective global resolve and the only place where 192 countries come together daily to deliberate on pressing global issues. The General Assembly is the main policy making and representative body of the UN, and it regularly calls for high-level meetings on topics of global importance. In that context, we are here for today’s debate.
In September, the UN will host three HLMs on global health topics. The first, on Wednesday 20 September, is focused on pandemic preparedness and response, or PPR. This will be a topical discussion given the recent covid-19 pandemic. On Thursday 21 September, a meeting is being convened on universal health coverage, or UHC—the principle that all people should have access to the full range of quality health services they need, when and where they need them, without financial hardship. Finally, on Friday 22 September, the UN will discuss tuberculosis. As co-chair of the all-party parliamentary group on global tuberculosis, I am particularly interested in the outcome of the final meeting, but all three HLMs are incredibly important for advocates of global health.
The topics being discussed at the UN later this year are all multifactored, and an all-society approach involving more than just the health sector is needed to resolve the issues. The HLM is the mechanism through which to convene all sectors, under the leadership of Heads of Government, to agree a plan of action that all states can implement. Precisely because the meetings call on Heads of Government to engage, they are a powerful mechanism for change. The HLMs fall in the same week as the UN General Assembly, which means many Heads of State will be around the UN, and many will be attending those important meetings. I sincerely hope that the Prime Minister and the Foreign Secretary show that the UK is resolved to tackling PPR, UHC and TB by personally attending all three HLMS later this year. Can the Minister confirm whether they will attend?
Briefly, I will touch on the PPR and UHC meetings before turning to TB. The PPR meeting is a new HLM that aims to improve the governmental and multilateral capacities required successfully to identify and contain a new pandemic. Moving beyond the health sector, the HLM will look at financing, social protections, educational support, and research and development requirements to address future pandemics. The meeting is an important opportunity for member states to commit to the necessary fiscal and policy changes required to prevent a future pandemic.
The UHC meeting follows on from a meeting held in 2019. The 2023 meeting provides countries and stakeholders with the opportunity to reinvigorate progress towards delivering health for all. According to the latest global monitoring information, UHC progress is not on track, and the covid-19 pandemic has taken the world further from the 2019 targets. They include progressively covering 1 billion additional people under UHC with a view to covering all people by 2030. The HLM also sought to stop the rise of catastrophic out-of-pocket health expenditure, and eliminate impoverishment due to health-related expenses by 2030. Catastrophic costs are felt particularly acutely in the TB sector. Nearly 50% of people who receive a TB diagnosis will face catastrophic personal or household costs as a consequence. Concrete action is needed to strengthen equitable health systems, including public health functions that are critical for PPR and TB.
Finally, the UN is holding a follow-on HLM for TB, with the first being held in 2018. That was the first time that TB issues were discussed on such a significant international stage. The 2018 political declaration included a number of targets, which member states agreed to pursue: a commitment to provide treatment and diagnostics to 40 million people, including 350,000 children; a commitment to increase overall global investment in TB to $2 billion per year; and a commitment to end all stigma and forms of discrimination associated with TB.
I congratulate my hon. Friend on securing this important debate. Does he agree with the director of Liverpool School of Tropical Medicine, Professor David Lalloo, who has said:
“As academics, public and global health experts and healthcare professionals, we see the close interrelationship between tuberculosis, pandemic preparedness and response, and universal health coverage”?
Does my hon. Friend also agree that this high-level talk is a good opportunity to take that agenda forward?
Mr Sharma
I thank my right hon. Friend for his important intervention. I agree and will cover those points later in my talk, but I want to put that aside for now. Yes, it is internationally known and accepted that this is an opportunity that every state should take on board.
Those ambitious targets were widely welcomed by civil society groups and TB stakeholders, but the impact of the covid pandemic significantly limited progress. Few of the TB targets were met, and the 2023 HLM is seen as a key opportunity to regain momentum towards eradicating TB by 2030, in line with sustainable development goal 3.3.2.
TB is one of humanity’s oldest diseases. It is caused by bacteria that most commonly impact lungs, but it can spread to other parts of the body. TB is spread from person to person through air droplets, with most TB infections showing no symptoms at all. In fact, 25% of the world’s population is estimated to have latent, or inactive, TB. TB becomes transmissible only when it is activated, which can be triggered by a range of health or social factors,
TB is a disease of poverty. It is more prevalent in poorer communities and can be linked to socioeconomic factors such as lower-quality housing, overcrowding and limited access to health services. TB is closely linked to other health issues, including malnutrition and HIV status. Even in high-income countries, TB is often found in migrant communities; people with alcohol, drug or mental health issues; homeless communities; or people with a history of prison.
What is most frustrating for people like me, who have been involved with TB for a long time, is that TB is both preventable and curable. Yet each year, more than 1.6 million people die from TB, including nearly 400,000 children. A lack of political will and inadequate funding continue to limit our ability to eradicate TB. All countries need to do more. There is only one existing TB vaccine. Although the BCG is effective against some serious forms of childhood TB, it provides little protection against the most infectious and deadly forms of adult TB.
There are several promising vaccine candidates in the pipeline. Six vaccine candidates are in phase 3 of the clinical development process—the final phase before the vaccine can be regulated for public use. In fact, just last month, Wellcome and the Bill and Melinda Gates Foundation announced funding to advance TB vaccine candidate M72 through a phase 3 clinical trial. M72 could become the first new vaccine to help prevent pulmonary TB, a form of active TB, in more than 100 years.
Promising vaccine candidates have emerged before and have fallen short, so we need to continue to finance and increase investment in TB research and development to find new vaccines. The Foreign, Commonwealth and Development Office has previously supported the development of new TB vaccines through product development partnerships. However, new PDP funding has been paused in recent years. Can the Minister provide the House with an update on when we might expect new or renewed PDP funding?
It is a pleasure to serve under your chairship, Mr Twigg. I thank the hon. Member for Ealing, Southall (Mr Sharma) for securing this important debate. It is very well timed, as Ministers are agreeing the statements that will go forward to the three high-level meetings on universal health coverage, pandemic prevention, preparedness and response, and tuberculosis, which will all be happening in New York during the same week in September. As co-chair of the all-party parliamentary group for water, sanitation and hygiene, I will focus my remarks on the issues of water sanitation and hygiene as they pertain to the three high-level meetings, and on how we can mark the huge step change ahead by using the meetings to galvanise global commitment to improve health and wellbeing for all and accelerate progress towards universal health coverage globally.
The timing of this debate is very important, because the meetings will result in a number of political declarations that are currently being negotiated by member states. I know that the UK public want to see our Government taking a leadership role in the high-level meetings in order to bring about change in people’s lives, both in the UK and across the world. I thank the Minister for Development, the right hon. Member for Sutton Coldfield (Mr Mitchell), for recently attending a joint meeting of the all-party parliamentary groups for water, sanitation and hygiene, on HIV and AIDS, on malaria and neglected tropical diseases, and on global tuberculosis to talk about a lot of issues that will be discussed at the high-level meetings.
We are so grateful in this country for the NHS, whose 75th anniversary we celebrated just last week, but as we are increasingly entwined in health globally, progress in the NHS can only be helped by progress around the world. The pandemic showed us that in the most stark way. Universal health coverage, which includes water, sanitation and hygiene, will not only save many lives in countries around the world, but save lives here and mean that we are less at risk from future global health disasters.
It is a pleasure to serve under your chairship, Mr Twigg. I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this important debate on the upcoming UN high-level meetings on tuberculosis, pandemic preparedness and response, and universal health coverage.
The year 2023 marks the halfway point for the implementation of the UN’s 17 sustainable development goals, which were adopted in 2015 and are intended to be met by 2030. They include promoting good health and wellbeing, eliminating hunger and poverty, and advancing gender equality. In April, the United Nations Secretary-General warned that
“we have stalled or gone into reverse on more than 30 per cent of the SDGs.”
He called upon all states to
“recommit to seven years of accelerated, sustained, and transformative action”.
I fear that the UK Government are failing in respect of these vital goals, both domestically and internationally. UK bilateral health aid in 2021 was down £620 million—39%—on 2020. That decrease was partly due to reduced levels of spend on the health sector in response to covid-19, but it also reflects wider reductions in the UK aid budget. Domestically, this Government’s programme of austerity—their cutting away of the welfare state and essential services, including the underfunding of our precious and world-renowned NHS—has meant that since 2011, increases in life expectancy have slowed after decades of steady improvement. Inequalities in life expectancy have recently widened: between some of the wealthiest and the more deprived areas of Liverpool, there is a difference in life expectancy of 20 years. One in three people in my great city are experiencing hunger at this moment. As constituency MPs, we are also witnessing at first hand the decimation of local primary care services. The Park View medical centre in West Derby is currently facing closure, a matter that I will be raising with the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), in the House today.
It is a pleasure to serve under your chairmanship, Mr Twigg. I warmly congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate. I recognise his long-standing commitment to international development issues, universal healthcare and global justice, demonstrated in today’s debate, in his co-chairmanship of the all-party parliamentary group on global tuberculosis and in his work on other important issues.
The first debate that I led in Westminster Hall, in June 2015, was on the negotiation and implementation of the sustainable development goals. That debate reflected the general tone of consensus and optimism that there was at the time about the future in the UK and at a multilateral level. Progress had been made toward the millennium development goals; there was a sense of the kinds of intervention that were really making a difference to driving down poverty, improving water and food security and boosting access to health and education; and appropriate funding was starting to be leveraged, not least as a result of UK leadership and the cross-party consensus around meeting the ODA spending target of 0.7% of GNI. Eight years later, however, things are very different indeed.
The UN high-level meetings in September this year must focus minds and galvanise political will if we are to have any hope of meeting the SDGs or of reversing the decline that has begun to happen in some areas. As other hon. Members have said, the sequence of high-level meetings around the UN General Assembly in September indicates at the very least that there is a recognition by world Governments that more action is urgently needed to end tuberculosis, deliver universal healthcare and improve prevention, preparedness and response to pandemics. We have all just lived through one of the greatest global healthcare challenges of recent decades, and we are still living with the ongoing impacts of the covid-19 pandemic on our health services, on the ability of the international community to respond to such crises, and on our response to other diseases and health challenges.
There has been a consensus in this debate that resources need to be directed at trying to prevent pandemics and get rid of as many diseases as we can. One of the proposals to be considered at the high-level talks is transferring some decision making—the declaration of pandemics, for instance—from nation states to the World Health Organisation. I think that that would be a huge loss of sovereignty and a mistake, particularly as the World Health Organisation is dominated by China and has a huge amount of funding from Bill Gates. Does the hon. Gentleman agree that transferring sovereignty to the World Health Organisation would be a mistake?
With the greatest respect to the hon. Member, I think that that is a point more usefully directed at the Minister, because it is the Government who represent the United Kingdom at the World Health Organisation. I am a believer in popular sovereignty; I would like Scotland to be an independent member of all those international, multilateral institutions, ensuring that the voice of the people of Scotland is heard in those negotiations. There has to be accountability within international mechanisms, and countries that sign up to international treaties ought to do so on the basis of consensus. They should be prepared to implement their commitments. If more Governments were living up to their commitments, perhaps we would not find ourselves in this position.
I understand that the issue that the hon. Member raises is of concern to a number of constituents; I have heard similar concerns myself. It is important that the Government are able to respond to those concerns, and that when international treaties are entered into, full transparency and accountability are built in.
There are interventions that we already know work, without having to reinvent the wheel: access to water and sanitation is one of them; food security is another. Driven by small and sustainable farmers, food security improves nutrition, which improves educational outcomes and boosts gender equality. That helps societies to grow and develop overall, and ultimately generates tax receipts that can be invested back into health and other social services. In all that, there are important lessons to be learned in the way that the world has sought to tackle other challenges, not least HIV/AIDS. Indeed, the ongoing fight against HIV should not be forgotten in these meetings.
At a higher level, investment in research and development and new technologies can help to combat and control the spread of disease. The hon. Member for Liverpool, West Derby (Ian Byrne) spoke about the work that institutions do in his constituency; similar work is going on at the University of Glasgow, and all the institutions work together on many of these issues. Regrettably, we still live in a world where more money is invested in treating hay fever and male pattern baldness—I have some experience of both—than the diseases that affect the poorest and most vulnerable around the world. Global Justice Now points out that between 1945 and 1965, when TB was a significant problem in western countries such as ours, eight different anti-TB drugs were discovered, but once TB was no longer a significant problem in the global north, development stalled, and no new anti-TB drugs were developed between 1965 and 2012. Even today, just 4% of newly approved pharmaceutical products are for neglected diseases that affect low and middle-income countries. That has to start to change, and perhaps there is also a role in that for the WHO and other multilateral organisations.
As always, it is a pleasure to speak in a debate with you in the Chair, Mr Twigg. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing the debate because it could not come at a more important time in the history of humanity. We have heard from three excellent Back-Bench speakers today plus the Scottish National party spokesperson, the hon. Member for Glasgow North (Patrick Grady).
Our first speaker was of course the person that tabled this debate, my hon. Friend the Member for Ealing, Southall, who said that the pressing global challenges are not limited to any continent or nation. That is at the basis and heart of our discussion. In his excellent speech, he also said that the UN is a testament to the power of global human resolve and that that is the context of the debate. The dates of 20, 21 and 22 September are key; they are the foundation of this debate and are very important in the future history of human global health.
My hon. Friend is the chair of the APPG on global TB and he gave an excellent exposition of the importance of tackling tuberculosis. He explained that many Heads of State and Government will be present at the three meetings. Will the Prime Minister, the Foreign Secretary and the Minister for Development be there? I await the Minister’s response. My hon. Friend emphasised that 192 UN member states need to commit to the delivery of health for all and that nearly 50% of people who receive a TB diagnosis will experience catastrophic consequences for them and their families. That is an extraordinary statistic. He underlined that by reminding us that tuberculosis is one of humanity’s oldest diseases and that it is a disease of poverty, closely linked to other factors of poverty. It is preventable and highly curable, but the lack of worldwide political will is preventing us from wiping out the disease, which is a threat to global human health.
We then heard from my hon. Friend the Member for Putney (Fleur Anderson) , who is an expert in issues of water sanitation and hygiene and is co-chair of the all-party parliamentary group for WASH. I have heard her speak before on these issues—one great thing about our Parliament is the number of experts across the House who understand and know their subjects so well. I was delighted to hear my hon. Friend talking about the issues because she knows what she is talking about. She said something very important: this is a matter of strong interest to all our constituents across the country. I have had loads of emails about the subject, as we all have.
It is a pleasure to have you in the Chair today, Mr Twigg.
I am very grateful to all right hon. and hon. Members who have spoken today, particularly the hon. Member for Ealing, Southall (Mr Sharma), who secured this debate. I also pay tribute to him for his work as chair of the all-party parliamentary group on global tuberculosis.
Of course, I am standing in for and answering on behalf of the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is the Minister for Development. I think that he has engaged previously on these issues with the hon. Member for Ealing, Southall.
As the hon. Gentleman outlined in his commendable speech, as we look ahead to the three high-level UN meetings in September, the debate provides us with a valuable opportunity to highlight the UK’s leading role in working with others to address global health challenges. I am grateful for the contributions made by all Members this morning.
The meetings will focus on pandemic prevention, preparedness and response, universal health coverage, and tuberculosis. They will be a hugely important opportunity to maintain momentum on global health following the covid-19 pandemic and at this critical mid-point for the sustainable development goals. Of course, that will not be easy. Global health is now more than ever bound up with geopolitics, but we will nevertheless be ambitious in our aims while being aware of the challenges involved in negotiating across all member states.
Several Members have asked about prime ministerial attendance. We place huge importance on these meetings, and we will ensure that there is extremely high-level UK representation. I cannot yet confirm who will attend on behalf of His Majesty’s Government as the process is ongoing, but we recognise that this is an extremely high-level and important moment for global health, and we are therefore ambitious.
10:35 am
Mr Virendra Sharma
I am thankful to everybody who contributed to this morning’s debate, which is very important not only here but also for what is going to happen in September. I am thankful to the Minister, too, although many questions need further clarification and I will certainly follow up later.
One thing everybody wanted to know is who will be going to the meetings. The Minister is not clear about that yet, but there are only two months left, and at that level diaries cannot be changed quickly. I hope we will find out who is going sooner rather than later, because that will give people like me and many non-governmental organisations an opportunity to approach or write to those individuals and find the best ways to represent our points of view.
My second disappointment is perhaps not appropriate, but I am a bit disappointed not to have had more contributions from Government Members this morning. I am not saying they are not interested, but that could have further strengthened the argument we are making.
I thank you, Mr Twigg, for your calm and patient approach to taking the debate through. Again, I thank all who contributed.
Question put and agreed to.
Resolved,
That this House has considered UN high-level meetings in 2023.
10:37 am
Sitting suspended.
We also need more new treatments for TB. According to the Treatment Action Group, the UK met 96% of its fair share contribution towards TB research and development in 2021—about £30 million—with fair share measured as spending at least 0.1% of overall research and development expenditures on TB. That funding was used to support innovation at some of the UK’s most prestigious research institutions, including the London School of Hygiene and Tropical Medicine and the Liverpool School of Tropical Medicine. Although the UK might be stepping up to the challenge, it is clear that not all countries are paying their fair share. Will the Minister outline what more the FCDO can do to support UK research and development, especially in the context of TB, and encourage all countries to pay their fair share towards TB R&D?
One of the biggest concerns for TB stakeholders is antimicrobial resistance. TB is a complex bacteria and strains have become resistant to modern antibiotics. One third of all deaths due to complications from antimicrobial resistance in 2021 involved drug-resistant TB. We have some tools to tackle drug-resistant TB, but they are incredibly expensive and are not readily available to all who need them. Medicines such as bedaquiline have cut treatment times for drug-resistant TB in half, but even the UK is struggling to access them. What are the Government doing to increase access to bedaquiline in the UK and abroad?
People with TB also suffer high levels of stigma and discrimination. TB is often associated with factors that can themselves create stigma: HIV status, poverty, drug and alcohol misuse, homelessness, a history of prison, and refugee status. Fear of discrimination can mean that people with TB symptoms delay seeking help, making it more likely that they will become seriously ill. Stigma around TB can also make people reluctant to stick with their course of treatment for fear of being “found out”. By taking treatment irregularly, people risk developing drug resistance.
The TB community has not sufficiently contested the views that reinforce TB stigma. Such an approach has previously delivered positive outcomes in the context of HIV. Countries and donors need to implement locally managed, gender-responsive and well-financed TB programmes to help overcome the stigma and discrimination associated with TB infection, so can the Minister tell the House what the FCDO is doing to help eliminate the stigma and discrimination experienced by many TB-affected actors?
Although TB is getting its own high-level meeting in September, it also has implications for both pandemic preparedness and universal health coverage. Strengthening health systems to better detect and respond to respiratory infections is crucial to PPR, as experts agree that it is likely that the next pandemic will be respiratory in nature. TB programmes are well placed to help identify new respiratory pandemics, as they are already actively involved in the treatment, diagnostics and surveillance of respiratory diseases. The ability to respond effectively to new respiratory pathogens relies on strong infection prevention and control infrastructure, an experienced and well-compensated health workforce with expertise in managing complex respiratory infections, and access to the latest medical tools and equipment.
Much of the infrastructure needed to respond to the TB epidemic already exists. However, as we saw during the covid-19 pandemic, such programmes are quickly repurposed to respond to emerging pandemics, with significant negative impacts for people with a TB infection. More needs to be done to strengthen TB programmes, surveillance and diagnosis as the fundamental pillar of PPR. Does the Minister believe that greater investment in TB programmes, diagnosis and surveillance will help the world prepare for the next novel pandemic?
UN high-level meetings on global health matters used to be unheard of. The HIV/AIDS HLM in 2001 was the first ever global health-focused HLM. Another was not held until 2011, but this has changed over the last decade. There are now years when multiple global health issues are discussed simultaneously, as is the case this year. It is a direct response to the number of global health issues that have impacted on the world over the last 10 years. The UN recognises that a new approach is needed to help address the barriers holding back progress in global health. The upcoming high-level meetings are a perfect opportunity to reinvigorate momentum and encourage global action to face the challenges of the 21st century together.
Two thirds of healthcare facilities in the world’s least developed countries, and half of those globally, do not have access to hygiene facilities. To put that in perspective, if my local hospital or GP surgery did not have running water it would be closed down, yet half of facilities around the world do not have that access to safe water. One result is that every minute a newborn dies from infection caused by a lack of safe water and an unclean environment. Healthcare workers and patients increasingly turn to antibiotics in the absence of clean water, resulting in the misuse of antibiotics and increased resistance.
Antimicrobial resistance directly caused 1.27 million deaths globally in 2019 and contributed to an additional 4.95 million. That makes it a bigger killer than HIV/AIDS or malaria. By 2050, the death toll is predicted to have climbed to 10 million deaths annually. The UK Government have predicted that antimicrobial resistance will be the leading cause of death in the UK by 2050. TheLancet has called it an “overlooked pandemic”. But it can be addressed right now through increased water, sanitation and hygiene in healthcare facilities around the world, which would save lives immediately: it is a good value-for-money investment and could be the huge step change that we need to see.
The common thread running through all three high-level meetings is the need to prevent and treat infections effectively. Infection prevention and control, and the vital necessity of water, sanitation and hygiene, are essential to preventing infections in the first place. Treatment is, of course, important, and if the infections are bacterial, antibiotics are vital, so we need to protect the antibiotics that we have.
Recently, the APPG for water, sanitation and hygiene and the APPG on antibiotics produced a report called “Prevention first”. We took evidence from the World Health Organisation and experts around the world about the need to curb the spread of antibiotic resistance. We found that a lack of hygiene means that doctors and nurses are unable to wash their hands before and after touching patients; new mothers are unable to clean themselves or their babies; and health workers and patients do not have a safe and hygienic toilet in their healthcare facilities. That causes repeated disease outbreaks, which need to be treated with antibiotics, contributing to that resistance around the world.
Not only would greater water, sanitation and hygiene save lives immediately, but it would buy us time to develop new drugs and protect our scientific investments. It has the power to achieve safer primary healthcare services and improve health outcomes. There are lives that could have been saved by the simple act of washing, having clean water and being cared for in a clean environment by people who have washed their hands, yet women are still giving birth in environments that do not have clean water, and healthcare workers are suffering disproportionately as a result. Ensuring that all healthcare facilities in the 46 least developed countries have access to reliable water, sanitation and hygiene will cost the equivalent of just 3% of health spending in these countries. That can be a key topic at the high-level meetings.
Investment in global WASH should be seen as an insurance policy to protect UK public health, the NHS and our scientific investment, because most resistant infections treated by the NHS originated elsewhere in the world, particularly in low and middle-income countries. Tackling that problem is critical to UK public health and protecting our NHS. Healthcare-acquired infections already cost the NHS at least £2.1 billion a year, and that cost will go up as infections become increasingly resistant to antibiotics. Better alignment on antimicrobial resistance action between the Foreign, Commonwealth and Development Office and the Department of Health and Social Care could maximise our impact on UK and global health outcomes.
In a world of so many seemingly intractable problems, it is clear that with more investment, action and political resolve in the high-level meetings we can solve the financing gap for WASH in healthcare facilities by the end of the decade. Healthcare leaders can afford to collectively mobilise the annual $355 million in domestic financing and $600 million in external financing needed to support those countries. That would save millions of lives and make universal health systems dependable. There is a clear price tag, and it is not unaffordable. We must adequately fund WASH in healthcare facilities to tackle antimicrobial resistance.
As a result of the previous high-level meetings and lots of in-country work by local campaigns, many countries have costed roadmaps for WASH in healthcare facilities in place and ready to be funded. They have worked out exactly what needs to be done, but political leadership in those countries and by the UK and other allies is urgently needed. The UK Government have led on the issue previously and are well placed to drive it globally.
The UK Government recognise the necessity of improved WASH services globally to promote global health, but the steep decline in UK bilateral aid for WASH—a cut of about 80%—raises concerns about the UK’s commitment to the sector. For most of our constituents, it is a no-brainer that the UK Government should fund aid for clean water services and hygiene, but the UK Government are not backing their commitment up with financing.
I have several questions for the Minister as we face these three important high-level meetings on universal health coverage, pandemic preparedness and tuberculosis. The first is simple: who is going? Who will be representing the UK Government—representing us—at each of the high-level meetings? I and many others here and across the country hope that there will be high-level attendance at the meetings.
Secondly, will the Government prioritise WASH in healthcare facilities in meetings with peers from low-income countries during the high-level meetings to encourage domestic investment in that area as a cost-effective, high-impact investment to advance global health security and strengthen progress towards universal health coverage?
Thirdly, will the Government identify opportunities to host bilateral meetings or small roundtable events around the high-level meetings to bring together like-minded donor Governments, global health initiatives and private finance partners to discuss investment and actions to achieve universal access to WASH in healthcare facilities? We must show leadership in the actions we take around the high-level meetings.
Finally, will the Government make antimicrobial resistance and WASH in healthcare facilities a key priority within the UK’s negotiating points and ministerial speeches at the three high-level meetings? Will they protect and strengthen WASH in healthcare facilities language in the political declaration documents?
I am grateful to be able to raise the issues that matter to constituents across the country. We have an important opportunity ahead. With several weeks to go before these meetings, now is the time to build these issues into achievements so that we can be proud of the UK’s leadership at the meetings in September.
I want to say a few words about the United Nations high-level meeting on tuberculosis, which the Liverpool School of Tropical Medicine has carried out significant work to combat globally. In 2021, 10 million people fell ill with TB and 1.6 million people died. TB diagnosis rates fell by 18%, which indicates not that cases are falling but, worryingly, that fewer cases are being detected by health systems. Alongside that, 450,000 new cases were diagnosed of multi-drug resistant TB—strains of TB that are resistant to modern antibiotics—yet multi-drug resistant TB treatment dropped by 17%, which indicates a reduction in diagnosis and detection.
Improving access to and quality of primary health care, including increasing the capacity, capability and equity of the health workforce, is crucial to delivering universal health care, reaching more people with TB and ensuring outbreaks of novel pathogens can be detected quickly. TB is both preventable and curable, yet people are still dying from TB because of a lack of political will and a consequent lack of funding to address the epidemic. Analysis also indicates a significant fall in TB diagnosis in 2020 and 2021 due to the pandemic. As the World Health Organisation says, funding is less than half of what is needed.
Senior governmental engagement with the UN high- level meetings is vital to ensure that they are successful. Will the Minister please provide an update today on his engagement with the drafting of the political declarations for the three upcoming United Nations high-level meetings? Will he update us on his engagement with the TB high-level meeting process to date and outline what more the FCDO can do to support UK research and development, especially within the context of TB? Finally, can the Minister explain why the Government have taken the disastrous political decision to cut international aid spending and why they have relentlessly pursued an austerity programme domestically, all of which is profoundly impacting the health and wellbeing of millions of people in the UK and around the world and preventing progress towards the crucial United Nations sustainable development goals?
As the points that have been made in this debate suggest, the spread of tuberculosis is perhaps the largest of those challenges, not least because it encapsulates so many aspects of the other two areas of focus for the high-level meetings. TB has overtaken covid to become, once again, the deadliest of all infectious diseases. That is, at least in part, a factor of the lack of access to basic healthcare and sanitary provision in so many parts of the world. The rise of drug-resistant TB raises the prospect of widespread infections, perhaps even to epidemic, pandemic or endemic proportions.
None of the solutions to these challenges is rocket science. If we were prepared to spend political and financial capital, we would be able to address the challenges and make more rapid progress towards all the sustainable development goals. Key interventions at a community level, ideally community-led, in developing countries and here at home can make some of the biggest impacts.
As the hon. Member for Putney (Fleur Anderson) rightly says, access to water, sanitation and hygiene is a basic human right that ought to be respected. It is demonstrably effective in reducing the spread of disease and therefore reducing reliance on antibiotics and the growth of antimicrobial resistance in relation to TB and a range of other diseases. I fully endorse the report that she highlighted, and I congratulate all those involved in producing it.
From today’s contributions, it is clear that none of the actions or outcomes needed from the high-level meetings is particularly novel or surprising. Various Members have made a good case for the levels of funding that are needed, and the Government, rather than yawning, need to listen to them. There was a habit, especially among the Government’s predecessors, to announce money—£100 million for this, £1 billion for that—but those were just nice round figures. United Nations agencies and international stakeholders have analysed what is actually needed to meet the research goals, meet the delivery objectives and set targets for the amounts to be funded. That is what the Government ought to focus on. The question at all these meetings is whether world leaders will step up; for us here today, that means whether the UK Government are prepared to step up.
Of course, the Government would be stepping up, regrettably, from a lower standing than back in 2015, when the SDGs were first negotiated. Indeed, the UK helped to lead the negotiation process, but it has now taken a back seat. By the admission of the Minister for Development, the right hon. Member for Sutton Coldfield (Mr Mitchell), the UK is no longer the development superpower that it used to be, and it is trying to stretch a significantly reduced aid budget that has been further diminished by the smash-and-grab raid on FCDO resources perpetrated by the Home Office to fund its failing and unlawful anti-asylum policies.
That is the first big and clear ask for the Minister today: the Government simply need to put more money into the system and get back on track to 0.7% as quickly as possible. Within that, they have to prioritise the most effective interventions. They have to recognise the importance of the multilateral system and the effectiveness of initiatives such as Gavi and the Global Fund to Fight AIDS, Tuberculosis and Malaria, especially where work is delivered at a community level and with community empowerment and involvement in decision making. The Government have to be committed to a genuinely universal rights-based approach to the provision of healthcare and pandemic preparedness. Flexibility has to be built into trade and intellectual property, for example, so that profit never comes before people and the planet. There must also be a recognition of digital rights, privacy and the security of individuals’ data. In all of that, there has to be political leadership. Like every other Member who has spoken today, I would be grateful if the Minister could suggest who the Government will send to the meetings. Will it be a Secretary of State, or at the very least the right hon. Member for Sutton Coldfield, who speaks on development issues in Cabinet?
Finally, I am always encouraged by the number of constituents who raise global justice, access to healthcare, tackling poverty and the sustainable development goals with me. People in Glasgow North and across Scotland want to play their part in building a world where everyone has the opportunity to flourish free from hunger and disease, and right now they do not see the UK Government stepping up to help to make that vision a reality. That is why more and more of them are realising that an independent Scotland would have its own representation at these high-level meetings, and that it could set 0.7% as a floor, not a ceiling, for aid spending. Perhaps they will conclude that the best way for Scotland to play its part will be to take its own place as an independent member of a community of nations.
We then heard from my hon. Friend the Member for Liverpool, West Derby (Ian Byrne) who talked with passion about his city and again emphasised that this is not just an academic issue—this is not a matter for UN high-level meetings alone. It matters to our constituents and that is why we are here today. The hon. Member for Strangford (Jim Shannon) is normally in this Chamber; this is the first debate I have taken part in for years without him being present. I hope someone will pass that message on to him. We have heard some excellent contributions, and I have certainly increased my knowledge of the issues. I hope we all have.
As we have heard, the UN will hold three high-level meetings in the week of the UN General Assembly this year. In our polarised world, with conflict raging on the edge of Europe, I think it is important that we reach consensus wherever possible. That is why dialogue on tackling tuberculosis, preparing for the next pandemic and ensuring universal health coverage is vital to our collective human future. Given that those issues could have impacts on every corner of the globe, it is important that the meetings succeed and result in a political declaration that member states can agree and properly implement. That collective work starts today—here in the House of Commons.
Perhaps the closest issue in our own memories and to our own interests is pandemic preparedness. The covid-19 pandemic impacted everyone across the UK and almost everyone across the world. We know that in our country 212,000 people tragically died as a result of the virus, that many businesses were forced to close, that children lost millions of hours of teaching time and that NHS waiting lists remained far too long. It is worth reminding colleagues that it did not have to be that way and that the mismanagement of the pandemic’s aftermath by this Government has played a part in the problems that continue within our country.
The UK was badly prepared for a pandemic. NHS waiting lists were at record levels even before covid-19 came on the scene and at that time we already had 100,000 staff shortages in our health service and 112,000 vacancies in social care. Such a complete lack of readiness for an earth-shattering event such as the covid-19 pandemic must never be allowed to happen again.
Even after the Government had been warned in 2016 that the NHS was not prepared for an influenza pandemic, they continued to reduce stockpiles of personal protective equipment and the number of hospital beds. With that in mind, does the Minister believe that this Government are best placed to negotiate a political declaration on pandemic preparedness with our allies and colleagues at the United Nations, and what assessment have our allies made of our lack of preparedness for the covid-19 pandemic?
Labour is committed to putting the UK on a better footing at these high-level meetings by championing our domestic agenda and our NHS. The next Labour Government will deliver a new 10-year plan for the NHS, including one of the biggest expansions of the NHS workforce in our history. That includes doubling the number of medical school places to 15,000 a year, training more GPs, more nurses and more health visitors each year. We will also harness our excellent life sciences and improve technology in order to reduce preventable illness.
Secondly, the meeting on universal health coverage is welcome and a long-overdue follow-up from the 2019 meeting, which is another impact of the covid-19 pandemic. Universal health coverage is not on track and targets have not been reached. As we in the UK have the luxury of our NHS, which guarantees free treatment for all who need it, we have a huge part to play on the international stage on universal health coverage. Our history shows that the UK can be a leader in reducing healthcare-related poverty and can work with the world’s most vulnerable people to ensure that they also have access to free medical treatment in their own countries. Again, given this Government’s complete mismanagement of our NHS, does the Minister believe that his Government’s failures put us in a good place to take the lead on such issues at the United Nations?
Finally, I want to touch on the global fight against tuberculosis, which my hon. Friend the Member for Ealing, Southall so carefully and brilliantly explained. TB is still a global killer. In 2021, it killed 1.6 million people, even though fewer people are now diagnosed with the illness. However, the more that TB spreads globally, the more it may have an impact on these shores, as many speakers have outlined. That is why it is vital that we assist those countries that are struggling in the fight against TB, particularly Bangladesh, the Congo, Pakistan, Sierra Leone and Uganda, among many others. What steps is the Minister taking to ensure that we play our part in tackling TB abroad and what benefits does that have for us at home?
As the shadow International Development Secretary, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), made clear in a previous debate on these issues, the task of negotiating an effective international treaty on pandemic preparedness will be a historic task, but we simply must achieve it. Such a treaty will save hundreds of thousands of lives in the future and will provide the foundation for sustained global economic recovery. We need to show our allies and fellow members of the United Nations that we in the United Kingdom are seriously committed to tackling these issues, and I believe that that work starts here. That is why this Government must urgently get a grip of the many NHS crises that have engulfed our country over the last 13 years.
Let me turn to the content of the three substantive meetings. First, it is vital to achieve and maintain UHC at home and across the world, and strong, resilient and equitable health systems are at the heart of our approach. The hon. Member for Putney (Fleur Anderson) asked about the integration of WASH. We are supporting WASH within UHC through the international taskforce on WASH in healthcare facilities, our new WASH systems for health programme, and bilateral programmes in Malawi and Nepal. We have also integrated WASH in the UK action plan for antimicrobial resistance, recognising its role in responsible antimicrobial stewardship. I hope that attends to some of the hon. Lady’s questions.
People’s eyes are open to the need for robust, equitable health systems following the pandemic, so now is the time to raise global ambition. We are pushing hard for firm global commitments to achieving UHC by 2030, with country-led commitments to take tangible steps forward. We have three priorities here. The first is to prioritise universal coverage of quality primary health care, which is instrumental in ending the preventable deaths of mothers, babies and children. The World Health Organisation estimates that scaling up primary health care could save 60 million lives.
Secondly, nobody should be pushed into extreme poverty because they cannot afford to pay for healthcare, although that was the case for 381 million people in 2019, even before the pandemic struck. It is our priority that a commitment to reversing that trend is made at the meeting. Thirdly, we are working hard to secure commitments on steps to tackle the global shortage in health workers, which is predicted to stand at some 10 million by the end of the decade.
Alongside those objectives, we will continue to press for other UK priorities. Those include championing and protecting sexual and reproductive health and rights, and promoting joined-up action across nutrition, water, sanitation and hygiene, as I mentioned, as well as climate and the environment, to support good health.
Let me turn to the meeting on pandemic prevention, preparedness and response. We must act on the lessons of covid-19 to protect future generations, and we will use the meeting to drive forward that vital commitment. Again, we have three priorities here. The first priority is to recommit states to the negotiations in Geneva on a legally binding pandemic instrument, which is due to be agreed in mid-2024. An ambitious instrument could transform global health security by delivering the changes necessary to withstand health threats.
Let me address concerns about the instrument head-on: nothing we agree will impact on the UK’s sovereign decision making on issues such as lockdowns or domestic vaccine roll out. The Government believe that a new instrument could help to speed up the sharing of information among member states on potential pandemic threats, and help to set out the “rules of the road” for future responses.
We also need to increase the financing available for pandemic preparedness. That is one of the best investments we can make, given the extraordinary costs of responding. The UK is therefore a proud investor in pandemic preparedness, including through the new pandemic fund, which will invest in products in lower income countries to improve their resilience to future health threats. We are pressing the multilateral development banks, including the World Bank Group, to do more to stretch their balance sheets in that area. We also want national Governments in low and middle-income countries to put more of their tax receipts into strengthening health systems and supporting universal health coverage and pandemic preparedness. Our third priority is to drive efforts towards a global commitment. We will be drawing up a playbook for responding to future pandemics, so that our successors have a guide to follow when the next one strikes.
Tuberculosis has been a significant theme of the debate. We will use the TB high-level meeting to galvanise a global political commitment to end that disease by the end of the decade. Work toward that goal was, of course, severely off track even before covid, and we have now seen two successive years of rising cases and deaths. TB kills more people than any other infectious disease, and drug-resistant TB is a leading cause of deaths related to antimicrobial resistance. A successful TB declaration at the meeting would incorporate quantitative targets and mechanisms for accountability, and commitments on financing and action. We have made good progress in pushing for a strong declaration, with clear targets and accountability mechanisms, to be adopted at the high-level meeting. We are working hard to secure high-level political attendance at the September meeting, especially by leaders of countries with high incidence of TB. We want to secure game-changing new commitments to action on the provision of TB services and investment in research and development.
We remain committed to championing progress on universal health coverage so that everyone everywhere has access to the essential health services they need without risk of financial hardship, including following a TB diagnosis. We want to ensure that, in the TB high- level meeting and the declaration, countries recommit to tackling the stigma and discrimination faced by people with TB. The UK is providing £1 billion over the next three years to the Global Fund, which will help to save more than 1 million lives around the world and will tackle TB stigma and discrimination.
Of course, the covid-19 pandemic highlighted the importance of continued investment in infectious disease research and development, as well as public health capacity, such as surveillance laboratories. It showed the importance of existing public health infrastructure when responding and adapting to new infectious disease outbreaks, which will be another theme at that meeting.
On product development partnerships, currently we are planning the FCDO’s future investment in global health research. As part of that, we will renew our investment in that area, including in product development partnerships and other organisations. We expect to announce more details during the latter half of 2023. Of course, the UK continues to play a world-leading role in research and innovation to combat TB. We are a strong supporter of product development partnerships and a world leader in life sciences. We are keen to see a global increase in the funding for TB research, so we are encouraging those who can do more to do exactly that.
The hon. Member for Ealing, Southall asked about Bedaquiline. The UK supports work to develop new treatments for TB and improve global access to them. Our funding for the TB Alliance supported the development of a new drug regime that includes Bedaquiline for treating drug-resistant TB. We will lay the foundations for ambitious outcomes at next year’s high-level meeting on antimicrobial resistance.
The three high-level meetings in September are a hugely important opportunity to maintain momentum on global health following the covid-19 pandemic and at this critical juncture for the sustainable development goals. We will push for the meeting on universal health coverage, to revitalise a national political commitment to delivering that goal. We will focus on ensuring that the meeting on preventing and responding to pandemics drives strong engagement and outcomes, particularly towards the negotiation of a legally binding international instrument in Geneva.
We will use the meeting as an opportunity to reignite the political commitment to get us back on track towards ending tuberculosis, backed by targets and mechanisms for accountability. In all of these meetings, we will place a clear emphasis on strengthening health systems, which is vital to achieving our aims.