Baroness Suttie writes: All governments must act on tuberculosis threat

December 15, 2014 3:54 PM
Originally published by UK Liberal Democrats

Like all 13 or 14 year olds of my generation in the UK I had my BCG vaccination while I was at High School. I remember that we all compared our scars for months afterwards. We believed at that time that TB - like smallpox - could be eradicated from our society.

TB, or consumption, was supposed to be an illness of poverty of times gone by. In Victorian Britain it was known as 'the silent killer' and as many as one in four deaths was attributable to TB. So high was the TB death rate, in fact, that TB has been estimated to have killed more people than any other infectious disease in human history.

Last Thursday I instigated a short debate in the House of Lords on what the Government is doing to reduce rates of TB in the UK. Baroness Sarah Ludford also spoke in the debate and focussed on the particularly high incidence of TB in London and Baroness Judith Jolly replied for the Government.

While great progress has been made against the disease in the West, globally, TB is as deadly as ever. The latest estimates from the World Health Organisation are that the disease kills 1.5million people every year. To put it into context, TB kills nearly as many people every single day as have died from Ebola since March.

London is regarded as the TB capital of Western Europe, with some parts of the capital having rates equal to those in sub-Saharan Africa. The BCG, the vaccine with which we are all so familiar, provides far less protection that many think and offers very little protection at all to adults.

TB is infectious and airborne. When patients start treatment they become less infectious. If there is a delay in diagnosis, they remain infectious for longer, allowing the disease to progress and develop more severe symptoms and so exposing others to the risk of transmission. So the first thing we must tackle is delayed diagnosis.

I am pleased that Public Health England and NHS England have, together with a number of other stakeholders, drawn up a Collaborative TB Strategy for England. This Strategy acknowledges that:

"An additional factor that frequently delays diagnosis is the lack of TB awareness among health professionals and appropriate training among social care staff."

In short, it is a problem that high-risk populations as well as many health care professionals currently are insufficiently well informed about TB.

Last Thursday the first report from Jim O'Neill's AMR (Anti-Microbial Resistance) Commission was published. His Commission has been set up to look into the dangers of drug resistant infections, or "superbugs". The report estimated that anti-microbial resistance could cost the world economy $100 trillion over the next thirty-five years and cited TB as a major driver of that cost. In this context it is no overstatement to say that MDR-TB is a threat to social and economic well-being across the world.

Every time I have spoken to a TB patient or a healthcare professional, the conversation turns to the terrible treatment burden and the awful side-effects. Patients have told me of the risk of losing their hearing, or blindness, liver damage, and suicidal urges. Health care experts have explained the very real dilemma of having to put a MDR-TB patient on treatment, knowing the misery that the drugs can bring.

In the 21st century it is simply unacceptable that a patient should face the choice between a disease that could kill them, and a treatment that could leave them permanently disabled.

I am proud that the UK government is the second biggest public funder in global health R&D in the world. The concordat between DFID and the Medical Research Council is practically unique among the developed world. Yet there is much more that can and should be done.

At the root of our global failure to develop new TB drugs and vaccines and is a simple truth: people who suffer from TB are usually poor and do not offer a market of sufficient scale to incentivise pharmaceutical companies to invest in R&D. Or, to put it more crudely, the commercial market model has failed TB patients.

In the face of this market failure, governments must act. The UK government could do even more than it currently does. We need to reclaim that thought-leadership and work with leading donors around the world to drive a new global consensus on overcoming the market failure in R&D for global health.

The response to the global HIV epidemic has been one of the greatest examples of the world responding to a global health threat. And Ebola has gripped the attention of the world's media, and rightly so. If politicians, if the media, if governments continue to be largely silent as TB kills millions every year we will never be rid of the disease, not in the UK, and certainly not all around the world.