Stop TB Partnership

Speech by Clare Short

OPENING STATEMENT BY MS CLARE SHORT, SECRETARY OF STATE FOR INTERNATIONAL DEVELOPMENT, UK AT THE MINISTERIAL CONFERENCE ON TB & SUSTAINABLE DEVELOPMENT

THURSDAY 23 MARCH

I am delighted to participate in this landmark conference and, in opening this session on "Improving health: a catalyst for development", to give my views on TB and development.

This conference comes at an important time. There is increasing recognition that improved health is essential for development. It used to be thought that out of the fruits of development, we would be able to afford healthcare. But that view is mistaken. Health and development are inextricably linked. Poverty contributes to ill-health, and increasingly we understand how ill-health contributes to poverty. People who are poor become ill. This makes them unproductive and family members sell what they have to pay for healthcare. And ill-health makes them poorer and stops them improving their lives. Thus the poor need the chance to improve their health in order to be able to improve their economic well-being. Better health contributes to greater economic security and growth.

It contributes directly to decreasing poverty by improving quality of life, expanding opportunities and safeguarding livelihoods.

We face the challenge collectively to achieve the international development target of reducing by one half the proportion of people living in extreme poverty by 2015. This requires a response across all sectors. In the health dimension we must address four key challenges: creating the environment to enable people to lead healthier lives; tackling the priority problems of the poor; investing in effective and efficient health systems; mounting a more effective response to HIV/AIDS, of key relevance also to TB.

Communicable diseases account for the greatest share of the disease burden of the poor. They represent barriers to development. Investment in tackling them will pay dividends in healthier people and healthier economies. The focus is on the big three: HIV, malaria and TB.

Let’s look at TB. When I look at TB, I see a scandal. We have had the means to diagnose TB for over 100 years, and drugs to treat TB for 50 years. Yet TB remains a leading infectious killer of adults. 95% of the annual global toll of two million TB deaths and eight million new TB cases occur in developing countries.

TB is a global problem. Just when we thought TB had gone away in the West, it bounced back in the 1990s, with increasing cases in many cities, including London and New York. The global TB burden persists because of poverty and the widening gap between rich and poor, the impact of HIV and failure to ensure all TB patients get quality diagnosis and treatment.

We have a window of opportunity to act now. The time is ripe, with increasing political commitment and availability of resources, to apply on a large scale what we know about how to tackle TB. The window will close if we delay. Failure to ensure the proper treatment of all TB patients is generating drug-resistant TB and converting a treatable epidemic into an untreatable epidemic. Only one in five of all TB patients worldwide are properly diagnosed and treated.

What are the consequences of delays in rolling out the TB control strategy? A greater impact of HIV-related TB and drug-resistant TB. A bigger and more severe epidemic. Greater human suffering and death. Greater social and economic costs. A continuing barrier to development.

We can do much more using currently available tools. However, TB suffers from a legacy of neglect. The tools are old. On diagnosis, nothing beats microscopy for detecting the infectious cases, but this is 19^th century technology. On treatment, no new TB drug has come on the market since rifampicin in the 1970s, so we’re stuck with treatment lasting at least six months. On prevention, BCG vaccine was invented in 1921 and is great for protecting children, but 80 years later we’re still waiting for a vaccine which is truly protective against infectious pulmonary disease. We need to invest in developing better tools: better diagnostics, better drugs, better vaccines.

How to meet these challenges? The global problem of TB requires a global solution. A global partnership of governments, civil society, industry and researchers. The Stop TB Initiative allows partners to work together effectively, ensuring maximised opportunities for synergy and minimised duplication of effort.

What has DFID done about TB? We support WHO’s TB efforts. Bilaterally, we support programmes in high-burden countries, such as India, countries badly affected by HIV, such as South Africa and Malawi, and countries where drug-resistant TB is rife, such as Russia. Earlier this year we co-sponsored the Cape Town meeting which launched the Global Alliance for TB Drug Development. We support research activities, mainly in Africa and Asia. Since 1996 we have supported a world-leading programme of TB operational research in Malawi.

We now need to build on this contribution to develop a more coherent and comprehensive response for expanding and maximising the effectiveness of DFID’s efforts, in partnership with others.

Our response to TB needs to link in with our response to HIV, especially in sub-Saharan Africa. Our support to the Africa Partnership on HIV/AIDS provides an opportunity to ensure a high priority for tackling TB as the most important HIV-related disease, and to strengthen the link between HIV prevention and care.

We want to work more effectively with our partners. Therefore I am pleased to announce that DFID intends to strengthen our collaboration with the Stop TB Initiative. We want to increase our support to partners with particular strengths (eg WHO in policy leadership, the Global Alliance for TB Drug Development). We want to invest strategically, making a bigger and more effective contribution to tackling TB.

I am confident that this Ministerial Conference represents a turning point in efforts to increase political commitment to TB control among the governments of the 20 countries with the highest burden of TB and among development agencies. Increased political commitment is a prerequisite to strengthening national responses to TB.

We can ensure this conference will be a turning point, by developing strategies for sustainable financing, resource mobilisation and partnership building. And when we’ve all gone home, translating them into action. Action to tackle TB, action to tackle poverty. We have the potential to consign TB to the dustbin of history. Let’s just do it.