Global TB Caucus
Nick Herbert's speech to the Sudanese National Assembly
Thank you so much for doing me the very great honour of inviting me, a member of parliament in the United Kingdom, to speak at a meeting in your parliament today.
It is a great privilege to be addressing a meeting of such distinguished people: to have yesterday been welcomed to your parliament by your chairman, Professor Ibrahim, the Chair of your Health Committee, to have met many members of parliament, and to have had meetings at the Ministry of Health, with the Council of African Political Parties and with representatives of the Pan-African Youth Union.
It is my first visit to Sudan and, for me, arriving yesterday at your building here and seeing the convergence of the Blue Nile and the White Nile fulfilled an ambition. I had never seen the Nile before and it was a profoundly moving experience.
My interest in tuberculosis dates from when I became a member of parliament thirteen years ago and I visited Kenya. This was before my great friend, Stephen Mule, became a member of parliament and as Stephen would tell you, at the time, things were not going well for TB or HIV/AIDS in Kenya.
What we saw was very troubling. We realised that TB was a neglected disease and people back at home in the UK, in my country, were not talking about TB. They thought this disease had been beaten. Indeed, I thought that this disease had been beaten. My first question at a meeting in a hospital in Nairobi with doctors was to ask: “Why aren’t you vaccinating your people?”
Of course, there is no adult vaccine for TB.
This is the problem: in many countries in the West, people believe that TB has been beaten. But they don’t realise, as we didn’t realise, that in the 1990s this disease that should have been ended when antibiotics were invented came back with a terrible vengeance to claim millions of lives.
Indeed 25 years ago TB was declared a “global health emergency” by the World Health Organisation. Since then 50 million people have died. Let us just reflect on that. That the world can declare something a “global health emergency” and yet, subsequently, 50 million people will die.
This is a disease that is easily and cheaply curable. Since the discovery of antibiotics half a century ago we have known how to beat it and yet we are not beating it. Of course it came back on the AIDS epidemic but we still know how to beat TB, it’s just that we have not committed the world’s resources to doing so.
So, I went back home to the UK parliament and I set up what we call an All-Party Parliamentary Group on Global Tuberculosis, a TB caucus. Back then, we were one of only five TB caucuses in the world.
Four years ago, I realised that we needed to do more to reach out to members of parliament in other countries, to encourage them to set up their own TB caucuses, and to make common cause with us in urging a global fight to beat this disease.
Since that first meeting that was held in Barcelona in Spain, where Stephen and I were two of only 12 members of parliament to launch the Global TB Caucus, since then the Global TB Caucus has grown so that it now has the support of over 2,500 members of parliament worldwide in more than 130 countries.
We have also set up 40 national TB caucuses around the world. Including, I am absolutely delighted to say, here in Sudan where your TB caucus, which has such strong leadership from Dr Nazar, was launched by the chairman of your parliament, Professor Ibrahim, and has done great work as we have been hearing ever since.
Our shared determination is beat this disease. And I would like to set out to you some reasons why it is so essential to take action against this disease now. I want to explain to you why we cannot wait, why we cannot accept the situation of TB being the world’s deadliest disease any longer.
First of all, the most obvious reason, is that there is a humanitarian toll from not tackling this disease.
We know that 1.7 million people are dying every year quite unnecessarily from TB, more than HIV and malaria combined, and nearly half of those deaths are in the continent of Africa.
With much less of the share of the global population than that, Africa is bearing a disproportionate burden of TB and a disproportionate number of deaths. Even here in Sudan, where you have a relatively low level of TB but still a significant one, as we do in the United Kingdom, there were still nearly 6,000 deaths from TB in 2016.
So that is the first reason why we should feel motivated to tackle this disease: people are dying quite unnecessarily. There are many diseases that we can’t beat, there are many conditions that we can only manage even in the best health care systems in the world, but TB is a disease that we can beat, and it is a tragedy and it is wrong that people are dying of a curable disease, and we should not let that continue.
The second reason why I believe that it is essential that we act to tackle TB now is that this disease is exacting an economic toll across the world. And no more so than in Africa. At the current rate of progress, 12.5 million people will die in African over the next 15 years as a result of TB, and that is a significant timeframe because that represents the period in which TB should be beaten: just fifteen years. That is the timetable agreed by the world’s leaders just a few years ago in New York City when they agreed the Sustainable Development Goals.
What’s more, another 47 million people will fall ill over that period. That level of illness across the African continent means that there is an economically inactive population, it imposes a burden on healthcare systems and it is a drag on economic growth.
Across the world we know that the costs of this are huge. So there isn’t just a humanitarian reason to fight this disease, there is an economic one as well.
This applies just as much to Sudan as it does to other countries because in the same period we know that more than 100,000 people will die in Sudan unless better progress is made in tackling this disease and nearly 450,000 people will fall ill.
That is a burden on your healthcare system and it is an unnecessary impediment to your economic growth which is, of course, so important.
The costs of this are huge. The figures indeed are absolutely immense. The cost is not just the numbers of people who are dying but also the cost to the healthcare system and to economic activity.
In Africa, the cost will be USD$300 billion over that period. USD$300 billion, forfeited because of TB alone.
In Sudan it will be nearly USD$2.5 billion over the next fifteen years.
The question that many of us have to answer when we urge action on TB is: “do you not have to commit resources to beat this disease?” Well I ask, what is the cost of not committing those resources now? Can you afford USD$2.5 billion over the next fifteen years because you have not tackled a disease that can be beaten?
And, of course TB has already cost Sudan USD$2 billion in lost economic output because of the impact of the disease over the last fifteen years. We must stop that happening again.
So there is a humanitarian reason to act, and there is an economic reason to act. But there is a third reason: security.
We often think of security as being only about the military and defence and policing. And I speak as a former Policing Minister in the UK. But it is not. Today health security is important concern for the future wellbeing of all of our citizens and no more so than because of the risk of drug resistance of which TB already plays a major part.
If drug-resistant TB really takes hold, the figures I have given you for the economic cost to Sudan, to Africa, and to the world, including the western world, will dwarf anything that I have already spoken of.
Indeed the impact would be, without exaggeration, truly catastrophic.
We cannot allow the risk of drug-resistance to continue. There are already 1,200 cases of drug-resistant TB in Sudan every year alone and only half of those are being officially diagnosed or treated. It is a risk that no country should continue to carry.
So for all of these reasons there is a new imperative to act. And the Global TB Caucus is taking action. We have teamed other with other organisations across the world: with the Stop TB Partnership, with UN agencies and the World Health Organization, with the medical and academic fraternities around the world and we have united in saying that there needs to be more action to tackle TB.
And at last this disease is getting the attention that it deserves from our world leaders.
A Summit was held in Moscow in November last year for Health Ministers specifically to talk about how this disease could be tackled.
The issue has got onto the G7 and G20 agendas.
And now there is a High Level Meeting which is being organised in New York for Heads of State and Government which is being held in less than two weeks’ time. Every Head of State and Government in the word has been invited to attend, and many are doing so. The High-Level Meeting will reset the ambition to beat this disease according to the SDG target to eliminate it by 2030.
Let’s be clear. At the current rate of progress TB will not be eliminated by 2030. At the current rate of progress globally TB will not be eliminated for a century. You are making much better progress in Sudan, but you are still not on track to achieve the Sustainable Development Goal target, which you will miss by about eight years according to the rate of progress.
So the HLM will set the ambition again, and indeed it will set new ambitions. It will recognise that the heart of the problem is that we are not diagnosing enough people who are falling sick with TB. And that is exactly what we heard from the expert presenters this morning. We need to do better.
There are 10 million cases of TB found worldwide every year; 2.7 million of those are in Africa but only 50% of those African cases are officially diagnosed.
The picture is similar in Sudan: 20,000 cases of TB were notified in Sudan but a further 12,000 were not.
So every country will have to do better to find these cases of TB: to diagnoses them and treat them. That is the fundamental task that lies ahead of us and the High Level Meeting will set a specific target. It will say that 40 million people worldwide should be diagnosed and treated by 2022, and from that target it is possible to identify a target for every country in the world and what they will need to do to contribute to that global objective.
In Sudan it will mean diagnosing and treating 125,000 patients by 2022. That is an increase of 25% a year over what you are currently achieving.
So, now it is not just words. Now we have a specific target and we know exactly what we need to do to beat this disease. This is no longer just an ambition, it is no longer just a political declaration, it is a target which every country has to meet, and we will be able to measure whether that target is being met or not.
Members of parliament, my esteemed colleagues who are here with me today, we will have a very important role to play: we must hold our governments to account for delivering on these targets because we are representatives of the people who are afflicted by this disease.
I am not despondent about what we have to do to. I believe that it is possible because medicine makes it possible. Yes, we need more, we need a vaccine, we need better drugs, we need better diagnostics and that will come with more resources.
It is vital that every country in the world makes its contribution because, as Stephen said, this cannot just be left to the West, though the West has a very important role to play.
I am proud that the UK plays a very considerable role in the global fight to beat TB. We are one of the very few countries to meet the international target for international development spending, a commitment that we have placed that in law.
Over the last three years we have contributed £1 billion to the Global Fund to Fight HIV/AIDS, TB and malaria which makes the UK the second largest donor to the Global Fund, second only to the United States which is a far bigger country.
I am very proud of the role that the UK is playing in order to help the fight against TB, but every country will have to play its part and African countries will have to do more as well according to their specific situation.
Sudan, for example, has a very important role to play in making the case across the continent for greater action. Next year the African Union will be led by Egypt, and you can use your influence to ensure that when the Heads of State meet, they meet and discuss the full implementation of the High-Level Meeting Declaration, so that Declaration is considered in full by the leaders of every African country.
You are also an important bridge, a bridge between Africa and the Arab world, and an important and influential country in the African Union and the Arab League.
The work you can do to beat TB isn’t just in this room, in this parliament, in this city or in this country, it is across the whole continent.
It is in the difference that you can make, in the leadership that you can show, in the forums that you take part in. That is true of members of parliament, and it is also true of many other organisations, including the Pan-African Youth Union, whose commitment to beating this disease we heard about this morning.
Let me conclude by saying this: TB is a disease that knows no boundaries. It is an airborne disease. TB doesn’t respect a city boundary, it doesn’t respect a national boundary, it doesn’t respect international boundaries. TB anywhere is TB everywhere.
To beat TB we have to work together. It will require a commitment from every country in the world working in unison. This, indeed, is the founding principal of the Global TB Caucus: we are not in this fight alone, when we work together across national boundaries, between national parliaments, we are stronger.
I am sure that we can beat this disease, because we are “together against TB.”