Michael Danby (Melbourne Ports, Australian Labor Party) Share this | Link to this | Hansard source

As stated in the motion, tuberculosis is a disease that is treatable and preventable yet it still claims 1.5 million lives a year. It is unacceptable, I believe, that in the 21st century so many people suffer from such a preventable disease. It is a disease that destroys generations of people, mostly from developing countries in Africa, South-East Asia and the eastern Mediterranean. Recently a group of people from Burma came to my office and told me about the very deep and terrible effects of the mixture of tuberculosis and HIV. Last year, US Secretary of State, Hillary Clinton, stated that tuberculosis is the 'disease of poverty'. She said:

It keeps people from working, stifles economic opportunity and tears at the fabric of societies.

It is a disease that does not distinguish between the young and the old. It destroys families and nations.

In 2009, almost 10 million children were orphaned as a result of parental deaths caused by TB. It is a disease that can be passed on as a result of close contact. Imagine being unable to hug or kiss your children or your loved one for fear of infecting them. Imagine living day to day in the fear that you may infect those around you. Imagine the stigma that comes with being infected with TB/HIV. And imagine being unable to access basic medicine and drugs that could prevent this disease.

In our neighbourhood of the world alone we share half of the global tuberculosis burden. While the majority of TB cases are treated successfully, drug-resistant TB and its co-infection with HIV have created a lethal combination in our area of the world, particularly in developing countries. It preys on weakened immune systems, and, according to Bekele Geleta, Secretary General of the International Federation of Red Cross and Red Crescent Societies, it kills 15 people every hour.

Australia is doing its best in the region to prevent and treat tuberculosis. In Papua New Guinea, we are providing $8 million over four years in support of the health authorities in western province to improve service delivery and treatment to TB patients. As part of this assistance, we are funding World Vision's 'Stop TB in the Western Province' project, raising awareness, training and facilitating TB treatment. We are assisting in Burma, where AusAID co-funds the Three Diseases Fund, which has supported HIV and TB initiatives since 2007. Over this period Australia's assistance has contributed to the registration for treatment of 60,000 new TB patients. In Indonesia, under this government, we cancelled $75 million of Indonesia's foreign debt in return for Indonesia investing $37.5 million in treatment and prevention of TB.

We have to do much to assure people, particularly in Burma, where this particularly toxic mix of HIV and TB is very prevalent, that the Global Fund will continue to have sufficient resources to provide treatment, which our overseas aid and some of the organisations that are working there, like Medecins Sans Frontieres, are almost the exclusive purveyors of, with the Burmese government not being able to provide the kind of health care we would imagine common in this part of the world. Australia is also assisting developing countries like the Solomon Islands, Cambodia, Nepal and Samoa to improve community health services to strengthen their ability to treat and prevent this disease.

We all enter parliament not only to make a difference to the lives of those in our own nation but also to do our part to improve the lives of others abroad. Australia is doing its part to improve the lives of those within our region who suffer from preventable disease such as TB. On 24 March, on World Tuberculosis Day, we should remember those who seek freedom from want, those who live in abject poverty and economic hardship, and those who suffer from preventable disease, and we should re-double our efforts to improve their quality of life. By seeking to improve the lives of others and working with local communities, we are sending forth hope to those who live with this disease. I can only praise the people from Medecins Sans Frontieres who came to visit my office, particularly their chief activist, a Burmese doctor who movingly told me about the role of the Global Fund, which Australia supports, in providing Medecins Sans Frontieres with the ability to act in Burma against this deadly and toxic mixture of HIV and TB. I commend the motion.

Teresa Gambaro (Brisbane, Liberal Party, Shadow Parliamentary Secretary for Citizenship and Settlement) Share this | Link to this | Hansard source

I rise to support this motion by the member for Melbourne Ports. World Tuberculosis Day is on this week, on 24 March. TB is a disease that is preventable, treatable, curable and kills 1.5 million globally every year. That is almost the equivalent of the population of Perth. The reason for that is in part because the most widely used diagnostic tools are antiquated, they are slow and they are not always accurate. The 50-year-old drug regime is only effective with strict adherence to a minimum six-month course of treatment. The currently used vaccines are only partially effective. Tuberculosis is a serious infectious disease and, despite the availability of effective treatment, it remains a major global health problem. TB is also the biggest killer of people living with HIV, accounting for one in four AIDS related deaths. It is a well-controlled and manageable disease in Australia where infection rates have remained stable for more than 20-years, at just over five per 100,000 people.

In its pulmonary form TB is easily spread when an infected person simply laughs, coughs, sneezes or even talks. Two billion people globally—one in three people—carry the TB bacilli but only one in 10 of these people will develop active TB in their lifetime. However TB thrives in the conditions of poverty and overcrowding and when people's immune systems are poor, due to things such as very poor nutrition, diabetes and especially HIV.

Many countries on Australia's doorstep have high burdens of tuberculosis. There are more than 400,000 new cases of TB diagnosed in Indonesia annually and in Timor Leste infection rates are 100 times higher than in Australia. In our nearest neighbour, Papua New Guinea, the problems may be even greater. TB in Papua New Guinea has increased by over 42 per cent over the last 10-years and is still rising. The increase is disproportionately large compared to the growth in population over the same period. While it is commendable that AusAID is spending $8 million in the Western Province, it makes the decision by the Bligh Labor government to close the TB clinics in Saibai and Boigu islands even more baffling. The closure of these clinics has the potential for increasing the risk of TB exposure for Torres Strait Islander citizens from inter-island travel by PNG nationals and increasing the risk of multi drug resistance and developing a lack of adequate frontline clinical appropriate TB care.

World TB Day seeks to eliminate TB around the world and generally elimination means achieving an incidence rate of one case per one million of population or lower. Currently the prevalence rate is estimated to be 430 per 100,000 population and the death rate is estimated to be 60 per 100,000 population. Those figures were for the year 2007. The Asia-Pacific region, our neighbourhood, has over half the global TB burden. That is why we must remain strongly committed to responding to the global challenge posed by TB. The Global Fund has pursued a practical program of activities that has delivered noticeable progress in the fight against the disease in the developing world. In September 2007 the former coalition government pledged $135 million over three years following its previous four-year pledge of a total of $75 million since 2004.

Australia has provided $250 million to the Global Fund and is committed to providing a further $170 million by 2013. This year marks the 10th anniversary of the Global Fund to fight AIDS, TB and malaria, and despite the success of the Global Fund in fighting these diseases, saving 100,000 lives each and every month, the funding is at a critical crossroad which puts the organisation's work in great jeopardy and threatens to reverse progress in HIV treatment and prevention. I support the motion and I congratulate the Global Fund and all of the NGOs. I particularly want to acknowledge the work of RESULTS International in fighting to beat this disease. I also acknowledge all of the other NGOs working with the Global Fund to ensure that we cut the rate of this terrible scourge. I wish to acknowledge the great work they have done so far. (Time expired)

Richard Marles (Corio, Australian Labor Party, Parliamentary Secretary for Pacific Island Affairs) Share this | Link to this | Hansard source

I rise to speak in support of the motion moved by the member for Melbourne Ports. I thank him for his contribution tonight and I also thank the member for Brisbane for her contribution in speaking about what is a very important issue, the scourge of tuberculosis. To pick up where the member for Brisbane left off, I acknowledge RESULTS International, a fantastic NGO doing fantastic work in this area by advocating on behalf of those suffering from tuberculosis and by also seeking to have greater money available to fight this disease.

World TB Day will be recognised this Saturday, 24 March. It is estimated that about a third of the world's population has been infected with TB at one point or another in their lives. That includes a large number of Australians. Indeed, my mother has been infected with tuberculosis and has grown up with it. She is not quite sure where it occurred but she believes it may have occurred when she was working as a young social worker in Brisbane in the late 1940s. Senator Cory Bernardi speaks very openly and poignantly about his battle with tuberculosis. So it is a disease that has come to this building. It is something that affects a large number of people across the world but very much in our own backyard.

The vast majority of those who suffer from this disease are in the developing world. Only about five to 10 per cent of people who are infected with TB ultimately develop the disease in a full-blown sense. Since the vast majority of those who develop TB live in the developing world, the disease is very much one of poverty. It is estimated that there are 14 million active cases of TB in the world today. It is estimated that 8.8 million people were infected in 2010 and it is thought that up to 1½ million people died in that year alone because of tuberculosis. In some countries in the developing world it has been estimated that the rates of infection are as high as 80 per cent. But, to give you a sense of the extent to which this is a disease of the developing world, that compares to rates of infection of five to 10 per cent in a place like America.

The disease very much affects young adults, who are at the prime of their active lives. Whilst this has a very human impact, it has a very significant economic impact, taking people out of the workforce and dramatically affecting the productivity of people at the most productive part of their lives. When you add to that that in 2009 some 10 million children around the world, largely in the developing world, were orphaned as a result of tuberculosis, you get to understand the critical impediment to development that tuberculosis represents.

More than half the TB disease burden globally is in our part of the world, in the Asia-Pacific region. So it is very much an issue that affects us here in Australia. Australia contributes to fight AIDS, tuberculosis and malaria through the Global Fund, which deals with each of those three diseases. Since 2004 we have contributed $250 million to the Global Fund. By 2013 we will contribute another $170 million.

The Global Fund has spent about $3.6 billion on its fight against tuberculosis. Since 2002, 8.6 million people have been treated by the Global Fund, but the rate is on the increase: 1.3 million in 2008, 1.4 million in 2009 and 1.7 million in 2010. The good news here is that the rates of tuberculosis are on the decline, such that it is likely that we will meet the millennium development goal of halving the mortality rate associated with tuberculosis by 2015, compared with the rate in 1990. In the Western Province of PNG we have had significant amounts of tuberculosis. This is right on the border of Australia and over a four-year period Australia is committing $8 million to the fight against tuberculosis there, working with the authorities. But there remain very significant challenges ahead. The member for Melbourne Ports mentioned the correlation between those infected by HIV-AIDS and those infected by tuberculosis. This is a real issue, as is the issue of multidrug-resistant TB, which is on the increase. It is estimated that only about 12 per cent of cases of multidrug-resistant TB are notified every year, and that has to improve. This is a critical issue. Much is being done but there remain many more challenges in the future. I very much commend this motion to the House. (Time expired)

Jane Prentice (Ryan, Liberal Party) Share this | Link to this | Hansard source

World Tuberculosis Day will be recognised this Saturday, 24 March. It is an important initiative which acknowledges that a very preventable, treatable disease still claims the lives of up to 1.5 million people every year. I rise to speak on this motion today and to thank the member for Melbourne Ports for bringing this issue to the attention of the parliament. Tuberculosis has all but been eradicated in developed countries but, unfortunately, it remains a major global health problem in most developing countries. The Asia-Pacific region, Australia's local neighbourhood, has over half the global tuberculosis cases. More recently, while five of the six regions experienced a reduction in the incidence of the disease, South-East Asia experienced an increase.

Tuberculosis can have very serious effects on human beings. It mostly attacks adults during their most productive working years, which then has a major detrimental effect on local communities as well as the broader society. Currently, more than one-third of the world's population is infected with the TB bacillus, five to 10 per cent of whom become sick or infectious at sometime during their life. The case for early prevention and targeted strategies is very strong as infectious TB sufferers on average will infect between 10 and 15 others each year, contributing to the epidemiological nature of this airborne disease. We also know that when a person is infected by TB bacilli the disease is in the dormant stage, which can last for many years. Their chances of ultimately having active symptoms of TB greatly increase when their immune system weakens. This is why the World Health Organisation calls human immunodeficiency virus, HIV, and TB a lethal combination, with each disease speeding up the other's progress. Combined with HIV, more than 30 per cent of people with the TB bacillus present with symptoms. HIV weakens their immune system significantly, with TB being a leading cause of death in HIV-positive people.

Tragically, the world is now facing a very worrying state of affairs with strains of TB resistant to all of the major anti-TB drugs we currently have in our arsenal. Fifty years ago we did not have a single medication to cure it. Now we are facing the situation where the two most powerful drugs being used are ineffective in cases of multidrug- resistant TB. This poses a serious threat to TB control, particularly in patients who are also infected with HIV. There is an urgent need to invest money and assistance directly to places that need it most. Consequently, through global initiatives, primarily the United Nations Global Fund to Fight AIDS, Tuberculosis and Malaria, the Commonwealth government in the past has been strongly committed to solving this global challenge. It is very important that Australia funds TB control programs and surveillance efforts in neighbouring countries, particularly Papua New Guinea, Indonesia and Burma. In the past, AusAID has provided funds to the Three Diseases Fund, which has now seen testing rates for TB and those who have HIV increase from about 2,000 cases every six months to more than 4,500 cases being tested in the first six months of 2011. Over this period, Australia's funded activities contributed to registration for treatment of 60,000 new TB patients, successful lifesaving treatment of 18,000 new TB cases and 13,000 community based referrals of TB suspected cases to health facilities.

Australian governments have previously been able to contribute to the important progress occurring in Papua New Guinea, with whom we share a common border. We are providing an initial $8 million from 2011-12 to 2014-15 to improve service delivery and treatment for TB patients in Western Province. We are also helping World Vision stop TB in Western Province, a project which aims to train staff, facilitate treatment and promote community awareness. I regret, however, to inform the House that earlier this year the federal government turned its back on the region, and Papua New Guinea in particular, when the federal Labor government and state Labor government of Queensland decided to cancel the visiting TB clinics in Queensland. There are deaths caused by TB in the Torres Straits, which the government has decided to completely ignore. Eight million dollars of new funding is all well and good, but if we want to see long-term improvement in Papua New Guinea this government should not cut effective programs at the same time. I call on the government to reinstate this program for Papua New Guinea nationals. One of the millennium development goals is to reduce the prevalence and death rates of TB by 50 per cent in 2015, relative to 1990 levels, and to eliminate TB as a public health problem by 2050. The World Health Organisation believes this can be achieved due to the dedication and very hard work being done through organisations such as the global fund to Fight AIDS, Tuberculosis and Malaria. It is vital, therefore, that Australia continues to contribute to that fund and other programs in our local region. We must continue to support World Tuberculosis Day and similar programs, so that many more millions of people can enjoy a healthy and happy life, and one free from tuberculosis.

Andrew Leigh (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

Burmese patient Aung Naing Do described his experience of tuberculosis in the following terms. He said:

I started suffering from this illness in 2006, so it's taken five years for me to get treatment and overcome it. During that time I had to wait a year from being diagnosed with MDR-TB to getting on the treatment programme. And all that time, I was feeling worse and getting weaker by the day.

I was bedridden towards the end of the wait, coughing all the time and with constant shortness of breath. I couldn't even walk from the clinic to the main road without stopping about ten times. I had to stop work in the hairdressing salon—I didn't have the strength even to sweep the floor.

Aung Naing Do said he had a tattoo on his hand, that means 'perseverance' and got it at a Pagoda festival at the age of just 15. He went on to say:

I had tinnitus, joint pain and stiffness of joints, along with abdominal discomfort and loss of appetite. I felt full all the time, even when I hadn't eaten. Even though I did not want to eat, I forced myself to eat. I forced myself because I knew I needed to have nutritious food. I began to have a noisy song in my right ear that just wouldn't go away. It was so loud, and I still have it now. If I close my left ear, I have trouble hearing. I just kept looking at my tattoo to remind myself of what I had to do and what was required of me. I feel like a much stronger person now.

Stories like these are so common around the world. Tuberculosis is a major killer. It is in fact the most common killer of people with HIV. So tackling tuberculosis is critical in its own right, but also in the fight against AIDS.

I was privileged last June to attend the Partnership Forum of the Global Fund to Fight AIDS, Tuberculosis and Malaria, held in Sao Paulo in Brazil. I want to thank Bill Bowtell, an Australian, for getting me involved in that event. There I learned a great deal about the global fund's work to fight TB. The global fund is only about a decade old, but it now contributes two-thirds of TB funding worldwide. It is one of the so called vertical funds, which operate by focusing on particular issues in the development space and working to raise awareness and raise resources. But a major challenge for the global fund is striking the right balance on accountability. It turns out that if you want work in the countries that face the greatest disease scourges in the world, they are almost invariably some of the most corrupt countries in the world. The global fund sets high accountability standards, as it should, but it critical that donor countries recognise that working in a disease-ridden environment often means working in a corruption-ridden environment.

I am pleased that there is a bipartisan consensus in this place to raise Australian aid spending to half a per cent of gross national income. I trust that that will continue. It is too easy to take cheap pot shots at aid programs operating in corrupt environments, but to do so is to undermine the very people that we seek to help.

I commend to the House a report from Medecins Sans Frontieres which speaks eloquently about the challenges of tuberculosis, particularly in countries like Burma, where there is prevalence more than double the regional average and nearly three times the global average. The report refers to the importance of investing in ensuring that we tackle tuberculosis in Burma and also notes that the cancellation of round 11 of funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria does limit opportunities to expand treatment for HIV and tuberculosis and its drug resistant forms until 2014. My experience with the Global Fund to Fight AIDS, Tuberculosis and Malaria suggests that Australia should continue to increase our contributions to the global fund. We should do so because it is one of the most cost-effective ways of saving lives. Fighting AIDS, tuberculosis and malaria is a top priority for Australia. I commend the work of the global fund and I commend the member for Melbourne Ports for bringing this important motion before the House.

Mike Symon (Deakin, Australian Labor Party) Share this | Link to this | Hansard source

There being no further speakers to this motion at this time, the Federation Chamber will suspend proceedings.

Sitting suspended from 20:16 t o 20:19

Warren Entsch (Leichhardt, Liberal Party) Share this | Link to this | Hansard source

Mr Deputy Speaker Symon, I apologise if my absence delayed proceedings; I was speaking in the other place and it took me a moment to get across. I would like to associate myself with this debate about tuberculosis. There is no doubt about it; it is a very serious infectious disease, which, despite the availability of effective treatment, remains a major global health problem. Although it is preventable, TB remains a problem through much of the world, mostly in developing countries. In 2010 the World Health Organisation estimated there were over 1.5 million current TB cases and 8.8 million new cases coming forward.

Being parochial as I am, I would like to focus on tuberculosis and the risks that we face here in Australia. The northern boundary of my electorate of Leichhardt is only a couple of kilometres from the mainland of Papua New Guinea, and Western Province in Papua New Guinea is seriously afflicted by this disease. Tuberculosis now consumes 13 per cent of all hospital bed days, second only to obstetric cases, and is the cause of 11 per cent of all deaths in Western Province. Currently, more people in Papua New Guinea contract tuberculosis than become infected with HIV. If the condition remains untreated, a person with infectious tuberculosis of the lungs potentially infects an extra 10 to 15 people every year.

Regrettably there is a disproportionately large incidence of tuberculosis in children in Papua New Guinea; almost 30 per cent of reported tuberculosis cases are within the age group of birth to 14 years. Such high levels of tuberculosis diagnosed in children indicates active transmission of tuberculosis within communities. There is also increasing evidence of a new strain of drug resistant tuberculosis. Only the other day, a social worker at Cairns hospital asked me if I could assist in the repatriation of a young lass, Violet Ausi, who has been at the Cairns Base Hospital now for a number of years while she was treated for drug resistant tuberculosis. Unfortunately her mother had already passed away; she was being cared for by an aunt. She is 12 years of age and been away from her village for almost three years. She has only just managed to get clearance.

A little while before that, it was a gentleman from the Western Province, Aniba Petru. I had to organise a function for him. He had lost three of his children and his wife to the disease. In an effort to save his 13-year-old daughter, he took an 8½ hour dinghy voyage to Saibai Island and was transferred to Cairns. Unfortunately, his daughter died two weeks later of tuberculosis. He ended up in there for four months, being treated for the disease. He had no resources to be able to take his daughter home. She had been kept in a mortuary for 4½ months. Through the very generous support of individuals within my community, I was able to raise money for him to take his daughter home and give her a decent burial.

This is the real human face of the disease, and it is becoming more and more prolific in our area. I think it is critically important. Recently there was a government decision to not continue to fund the tuberculosis clinics in the Torres Strait. I am working very closely with the minister for health at the moment in the hope that we can reinstate and reverse that decision.

Recognition needs to go to people like Dr Graham Simpson, Dr Leslie Everard, Professor Ian Wronski and Julian Waring. These are people at the front line. These are the people out there, trying to sort this problem out, trying to provide the services that are needed. We certainly need a lot more in the way of funding if we are going to take on this challenge. If we do not deal with the problem on our front doorstep, unfortunately, because of the contagious nature of the disease, it will certainly spread further into our community.

Debate adjourned.