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Howe: Strategies to control TB have failed

SARS & TB Debate in the House of Lords

The coupling of SARS and TB in the noble Baroness's question brings home to us, as she explained so well, the urgency and difficulty surrounding issues of public health. Last week we had quite a full and helpful debate on SARS on the back of the Government's Statement to Parliament. I do not believe that it would be fruitful to go over for a second time all the territory that we covered on that occasion. I said then, and I repeat, that I welcome the measures that the Government have taken to prevent the further importation of the virus into this country and to ensure that if it does arrive, sound protocols are in place to minimise the risk of it spreading.

Yet even in the past few days events have moved on. No new cases of SARS, thankfully, have occurred in the UK. There are signs that in the Far East, with the glaring exception of mainland China, the disease is being brought under control. It would be useful if the Minister could give us an up to date bulletin of new cases recorded in countries around the world over the past week and the progress made in stemming the progress of the disease.

One obvious difference between SARS and TB is that, whereas we know a very great deal about the latter, the same is not true of the former. New facts and new theories are emerging about SARS with every day that passes. We cannot devise robust strategies for controlling the spread of SARS without clearer knowledge of the ways in which the virus can be transmitted; how long the virus survives outside the human body; and who is most at risk of getting it. The precautions that have been taken to date are sensible only in the context of current ignorance.

It is certainly in no one's interests to exaggerate this scare in any way. The CMO has stated that the risk of catching SARS is low, yet, as my noble friend Lady Gardner said, the known facts inevitably change. Only a short time ago we were told that the SARS virus could live for a short time on the button of a lift but that the main route of transmission is through coughing. Now we understand that it can survive for up to 24 hours outside the body and that it can be transmitted via sewage. On top of that it appears that the virus can mutate quickly.

As was said last week, two things above all will help to defeat SARS: flexibility of response and vigilance. Setting aside the difference of view between the Opposition and the Government about making SARS officially notifiable, I believe that the actions that the Government have taken and are taking reassuringly embody those two principles.

What we would do and how we would cope if there were a major outbreak of SARS in this country is another question. The British Lung Foundation has expressed its grave concerns about the shortage of respiratory physicians. A third of all advertised respiratory consultant posts remained unfilled last year: and the number of consultants in the UK per head of population is under half the European average. In simple terms there are not enough chest specialists to cope with the present workload, let alone a bigger one.

That sobering fact, on which I hope the Minister will comment, is relevant to TB, which is now officially a global health emergency. The noble Baroness drew our attention to the steadily rising incidence of TB notifications nation-wide and its worrying prevalence in particular hot spots such as London, where the rate of infection in certain boroughs is higher than in some developing countries. None of us can be complacent in such a situation. Still less can we be complacent in the face of new strains of TB that have proved to be antibiotic resistant. As with SARS, the strategy to counter the spread of TB must be twofold: prevention and containment.

On prevention we have to face the fact that the rise in TB prevalence in this country is attributable principally to Africa and the Indian Subcontinent. Individuals who arrive in this country either through the normal channels or as asylum seekers do not as a rule have to undergo medical screening, as they would have to in many other countries.

I believe that we have to question whether we can continue to justify a policy of blissful ignorance about the health of those who apply to live permanently in the UK. Not to conduct basic checks for serious diseases such as TB or HIV both disadvantages the applicant and overloads the NHS. Compulsory screening of asylum seekers originating from TB hotspots is necessary. That is also the view of, among others, the BMA and the British Thoracic Society.

But TB can of course also be prevented by vaccination. I should be glad if the Minister could say whether she is satisfied with both the availability and the potency of current BCG vaccine supplies. Can she also tell us what has happened to the action plan for TB in London which was promised some time ago and whether the TB Awareness Campaign launched last year by Yvette Cooper has had any success in reaching ethnic minority communities?

In London we must be frank and recognise that strategies to control TB have thus far failed. London has the highest rate of drug-resistant strains and half the entire country's tally of TB cases. The action plan for London is of vital importance and will require both resources and a high level of commitment from all arms of health and social services. That commitment needs to extend across the country to our prisons. DOTS should be central to that. I hope that tonight the Minister will reassure us that there are credible strategies in the NHS to combat and to defeat this most tenacious of human infections.

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