Monday, 20 August 2018
Private Members' Business
That this House:
(1) notes that:
(a) tuberculosis was declared an emergency in 1993 by the World Health Organization and causes more deaths than any other infectious disease—of the more than 10.4 million infected with tuberculosis in 2016, 1.7 million people died; and
(b) drug resistant tuberculosis is one of the most common and deadly forms of all antimicrobial resistance in the world, accounting for a significant number of antimicrobial resistant deaths globally;
(b) Australia has supported global actions to reduce tuberculosis, including through contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, its support to tuberculosis programs in Papua New Guinea and Kiribati, and through the Indo-Pacific Health Security Initiative in our support to Product Development Partnerships and research grants; and
(3) calls on the Government to:
(a) ensure Australia has senior representation at the United Nations high-level meeting on tuberculosis in September; and
(b) commit to support countries in the Indo-Pacific in their efforts for the elimination of tuberculosis.
TB is a disease that most people thought was in the past or was isolated to small pockets of some impoverished countries. TB is one of the oldest human diseases and has been identified in Egyptian mummies. I, for one, also assumed that the disease was no longer an issue, after my mum actually spent 12 months in hospital in 1962. I thought it was a disease that was well and truly in the past. Unfortunately, nothing could be further from the truth. The reality is that TB is the largest infectious disease killer in the world, with 60 per cent of that burden in our Asia-Pacific region. Tuberculosis was declared an emergency in 1993 by the World Health Organization. It causes more deaths than any other infectious disease. In 2016 more than 10.4 million people were infected with tuberculosis. Of those, 1.7 million people actually died.
One of the great challenges in dealing with TB is the complexity of the treatment. Most of us in Australia at some stage of our life would have received the TB vaccine and would have a scar to prove it on our upper arm. I say to you all: don't feel protected. It's not worth a cupful of cold water, to be honest. The current vaccine was developed in 1921. It is totally ineffective, and really it is only a very small cohort of children under the age of five who can expect any sort of protection from it. With the new strains of TB, there's just no way in the world that this can be seen as a way of preventing the disease. However, there have been some very significant advances in diagnostics and treatment of TB. In treatment, through the fantastic work of the TB Alliance, under the leadership of Mel Spigelman and his team, we're now trialling treating patients with drug-resistant TB with four tablets per day and no injections for only six months. Prior to that, it was 25 tablets a day and two injections for up to two years. Little wonder the disease has spread and, of course, morphed into even stronger strains. They're now working on a treatment that will see drug-resistant tuberculosis cured with one tablet in three months. There's still work to be done, of course, in making that happen.
I'd like to congratulate James Cook University in Cairns. Through the Australian Institute of Tropical Health and Medicine, they have established a research group, led by Professor Lewis Schofield, who are focusing on the development of a TB vaccine. There is not a contagious disease that has ever been cured without a vaccine, and so that really is the Holy Grail.
Nobody should die of TB. It's a disease that has been neglected and ignored for far too long. This disease can be cured, but more needs to be done. Australia has supported global actions to reduce TB. This includes contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria. It also includes our ongoing support for TB programs in Papua New Guinea and Kiribati, our support of the Indo-Pacific health security initiatives, and our support of product development partnerships and research grants.
The United Nations has convened its first ever high-level meeting on tuberculosis, due to take place next month in New York. The high-level meeting is the biggest and best opportunity to raise the political priority of tuberculosis. We must ensure that Australia has very senior representation at the United Nations high-level meeting. We must be the ones that lead the charge on this, and not leave it up to others. It's the most significant political meeting that has ever been held on TB, and one I'm very proud to have played a part in making a reality during my three-month secondment to United Nations last year. This is a golden opportunity for Australia to stand up and be counted, and to lead the charge in the fight against TB. We're not talking about a disease in a faraway land; TB is already on our doorstep, with our closest neighbours, Papua New Guinea and Indonesia, recognised as very high-burden countries, as are many other small countries in the Pacific region.
Finally, I would like to thank the countless number of people, and they know who they are, for their ongoing support, guidance and advice to ensure that together we can rid the world of this insidious disease once and for all.
I second the motion. I am pleased to support my friend, the member for Leichhardt, and thank him for putting up this motion once again, and for his commitment and passion for finding a cure for tuberculosis.
Is tuberculosis a health issue or is it a social disease? The evidence shows that there's a clear link between TB and inequality. Across the world, the poorest households and some of the most marginalised individuals suffer the highest levels of infectious diseases. And when the poor try to access health care, it's no surprise that they become poorer as a result of the financial strain of the treatment. This medical poverty trap can be seen across those individuals and groups particularly vulnerable to tuberculosis—for example, indigenous peoples around the world suffer from TB at a rate of up to 270 times that of non-indigenous populations. Migrants, the homeless, prisoners and people living with HIV are also especially vulnerable to tuberculosis. Sadly, almost all cases of TB today are both preventable and treatable, and yet it remains a common disease in many parts of the world. As the member for Leichhardt mentioned, it's all too common in our region, particularly on our doorstep in countries like Papua New Guinea.
Nearly 10.5 million people will contract the disease this year, and around 1.7 million of those will die. It's part of a quiet crisis. We don't often see TB in the headlines, and yet the devastation it causes dwarfs that of other infectious diseases. TB is the world's longest-running global health emergency, having been responsible for 50 million deaths since it was declared an emergency in 1993 by the World Health Organization—50 million people have died from what should be a preventable disease. Despite this, the United States government, the largest donor in the fight against tuberculosis, is rapidly scaling back their overseas aid, slashing billions of dollars from the global health and humanitarian aid budget.
TB, as a disease, has always suffered from neglect and a lack of urgency, and this is reflected in the chronic underinvestment in TB care and control in most high-burden countries. India, South Africa and Indonesia are suffering the biggest impacts of this social disease. It's the inequality of access to adequate health services, including fast diagnosis and effective medicines, that means that it is rampant in these countries and others. And yet it is also the lack of nutrition, poor sanitation and unsafe work environments that combine to contribute to TB in 2018.
The World Health Organization is calling for social support and poverty-alleviation strategies for people with TB. This is to help reduce the hidden costs of treatment, reduce stigma and increase TB prevention. Studies have shown that increasing financial pressures associated with TB treatment means that the patient in the household was more likely to abandon treatment, fail treatment or die. Medicines are needed in the crucial fight against tuberculosis and, yet, while they will help win battles, additional financial and social support is required to see that we do win the war against tuberculosis.
We're now moving into a new era of TB treatment, where community based care is playing a more important role, and good work has already been done. TB treatment has saved the lives of 53 million people around the world from 2000 to 2016. Australia has certainly been one of those countries that has made a fair contribution, by supporting global actions to reduce TB, including through support for TB programs in Papua New Guinea, Kiribati and other Indo-Pacific health security initiatives. I was fortunate, as the Parliamentary Secretary for Pacific Islands Affairs, to actually open the TB clinic in Daru in the Western Province of Papua New Guinea, and it's great to see that that facility is not only providing some of those prevention measures but also treating severe cases of tuberculosis.
The United Nations General Assembly is holding the first ever high-level TB meeting on 26 September this year in its 73rd session, and I want to thank the member for Leichhardt for putting this on the agenda in his time at the UN. We call on the government to ensure that Australia's representation at the meeting on tuberculosis is at the highest level possible. We also need a true commitment to the declaration from the UN at the high-level meeting to be shown by increasing resources for TB programs in Australia and within our region.
I commend this motion to the House. I thank the member for Leichhardt for his undying efforts to make sure that tuberculosis is removed from the medical literature as soon as possible. In my time as a medical student, I was given a textbook to read. It's called The Conquest of Tuberculosis, because we thought, when I was a medical student, that we would not have to deal anymore with tuberculosis. It's by Selman Waksman, a microbiologist who actually received the Nobel Prize for developing the streptomycin group, or the aminoglycoside group, of antibiotics that were used in the treatment of tuberculosis. It was thought that this would lead to the eradication of tuberculosis around the world.
We know that tuberculosis has been present in our communities since prehistoric times. Egyptian mummies have even been found with evidence of tuberculosis. It's been called many names over the years: consumption, galloping consumption, scrofula—a whole list of names. We seem to be in this revolving cycle of appearing to be able to eradicate this disease, but the disease, in the end, wins. Not this time, I think. I think that we have the resources to be able to remove tuberculosis from modern day texts on infectious diseases if we try hard enough, but it requires a lot of effort. The tuberculosis organism is a very clever one. It's able to lie dormant for many years after primary infection and may not become apparent for decades after an initial illness, the so-called primary infection. Secondary tuberculosis can present many decades later in a whole variety of infections, from bone infections to other organ infections, and can present in many ways. The organism itself is able to develop resistance to the antibiotics that are being used. We now have to use triple therapy. We're already seeing some resistance to these therapies in developing countries, where tuberculosis can be a major issue, killing over 1½ million people in 2016.
During a recent trip to Thailand and Myanmar with the Global Fund, it was apparent to me why we were having such difficulty in eradicating tuberculosis. We went to a tuberculosis clinic in Myanmar and saw the patients, often with very active tuberculosis, sitting around in the general waiting areas. Many of them came from outlying villages and many of them were transient workers on construction projects. They would not return for ongoing follow-up and would continue to spread the disease in the country. It is very difficult in a country with very few medical resources to continue with the contact tracing, contact screening and treatment.
The basic tools for diagnosis are no different, really, from when I was a medical student over 40 years ago. We are very poor in developing new technologies that are able to screen and treat people very quickly. The Holy Grail of treatment of tuberculosis will depend on vaccination development, and this will require a lot of resources, which are already being put in place by organisations like the Global Fund and the Bill & Melinda Gates Foundation. Australia must play its part. As has already been mentioned, we have a gateway for multi-drug resistant tuberculosis to enter Australia: from South-East Asia to Papua New Guinea, across the Torres Strait and on to northern Australia. This is a very important issue and one that we must investigate and fund properly.
The member for Leichhardt's motion is very comprehensive in its request to the government, but this is a matter that is now most urgent. We have the tools and the abilities, but we must make sure that Australia plays its part, together with many other countries, such as the United States, Japan, the United Kingdom, France and Germany, who are all investing their resources in trying to finally eradicate tuberculosis. I don't want to see another textbook like this published in my lifetime. I want us to truly make an end for tuberculosis.
Twenty five years ago the World Health Organisation declared tuberculosis a global emergency. Since then, this disease has been responsible for 50 million deaths across the world. Last year, 1.8 million people died from it, more than from HIV and malaria combined. This makes TB the world's longest-running global health emergency. The fact that 25 years ago it was declared an emergency and we still have these appalling statistics—worse than HIV and malaria combined—is a shame for everyone in the world, particularly for a country that prides itself on playing a very active role in international citizenry.
TB is an infectious disease that affects the lungs, causing excessive coughing, high fevers, sweats and weight loss. It's painful, it's deadly and it's contagious, but it's also preventable. TB is often described as a disease of poverty, something prominent in Third World nations without the resources to identify the disease or treat the disease. While countries such as India, South Africa and Indonesia are the most affected, Australia is not immune. I'm sure the member for Solomon, who is in the chamber, will go into detail about how it affects Australia. But I briefly want to touch on the fact that when I was posted to India in the mid-1990s it was a disease you could see on the streets every day, particularly when you went to impoverished areas on the outskirts of the major cities. It was prevalent, it was obvious and it was common. India, South Africa and Indonesia are the most affected countries in the world, but the fact that we have it here in Australia is a great shame for this nation.
In 2016, the Northern Territory Centre for Disease Control revealed that of the nine million new cases of TB around the world each year, about 13,000 were in Australia. Those who are born or who spend their early years in countries with high rates of the disease are likely to contract it, but that infection can spread. TB treatment is free in Australia for anyone who contracts it. When TB is identified, the state and territory public health systems make sure those who seek it receive appropriate treatment, including antibiotics and hospital care. Australia is a low-risk country but it is not exempt from this global emergency, and that is why the World Health Organization has identified Australia as one of the countries with the ability to eliminate TB entirely. Like any other infection, TB is curable with antibiotics. This is the reality and this is why it's a great shame that 1.8 million people die from a disease that is preventable and curable. It's just horrifying to think this is happening in 2018.
Last year in Australia, 52 Australians lost their lives—that is, 52 lives lost in a First World nation with free first-class health care—to a preventable, treatable and curable disease 25 years after it was declared a global health emergency. It is the responsibility of every government with the ability to help to do so. Australia must join the world in recognising TB as a public health priority. When the United Nations General Assembly meets on 26 September, it will hold the first high-level meeting on tuberculosis. This is an essential step in the right direction to addressing TB throughout the world. Labor calls on the Turnbull government and those opposite to ensure Australia's representation at this UN meeting at the highest level. This government must commit to the declaration from the UN by increasing resources for TB programs in Australia as well as towards development of effective tools for diagnosis, for treatments and for vaccines. It is estimated that unless the world acts immediately, we could be faced with 14 million deaths from TB, costing a cumulative US$5.5 trillion. We need to be part of the solution.
I congratulate the member for Leichhardt for continuing the conversation on TB. He has been a long-term advocate for as long as I have been in this place, which is three terms. I want to acknowledge members and senators from both sides for speaking out to help end this global health emergency, and I encourage the Turnbull government to make the highest-level representation on this issue at that September meeting of the UN. It is vitally important for those millions of people.
I also rise to support the motion of the member for Leichhardt. I'm pleased to be joining with him and my friends—the member for Kingsford Smith, the member for Macarthur and the member for Canberra—on this. The member for Leichhardt is the co-chair of the Australian Tuberculosis Caucus and, together with Senator Lisa Singh, runs a cross-party group of 20 parliamentarians focused on building Australian support for ending TB as a global epidemic. As the member for Canberra was saying, now is the time for mobilisation. It would be good to see more members from the other side getting behind this but, nonetheless, I thank the member for Leichhardt and commend him on his continued work in this area.
TB is a worldwide problem, particularly in the Asia-Pacific region, in our country and also in the place that I represent, the Northern Territory. In 2015, TB killed 1.8 million people globally—that is a shocking statistic. It's the world's greatest infectious disease killer. It's a disease that certainly hasn't gone away.
In our region, it's a serious problem: just across the Torres Strait and Papua New Guinea, there were an estimated 33,000 cases of TB in 2015. In another of our near neighbours, where I've spent a quite a bit of time, Timor Leste has the highest prevalence of TB of any country in our region. I want to commend the Australian groups—including Maluk Timor, Menzies School of Health Research and the Burnet Institute—who are working alongside the national TB program in Timor Leste to improve early case detection, recognition of drug-resistant TB and the prevention of TB in children.
TB is described as a disease that is a problem in developing countries, and that's true, but we should not overlook the fact that it is still a problem here at home in Australia. My electorate of Solomon, the northern capital of Australia, is in the Northern Territory where we still have cases of TB reported annually. The stats are much lower than those reported in other countries, such as PNG, but are still significant. Thanks to the good work of bodies such as the NT government Centre for Disease Control, these stats are trending downwards. Confirmed cases of TB in the Northern Territory have declined from annual numbers in the 40s and 30s in the 1990s down to the 20s more recently. This year so far, 11 cases have been confirmed, and rates of TB incidence in the Northern Territory between 2000 and 2015 have been approximately 17 cases per 100,000 population—that is, about three times the national average.
The rates of TB in the NT Aboriginal population are decreasing, which is good news, but, unfortunately, the rates in those born overseas is increasing. This highlights the need to tackle TB globally and for Australia to support countries in our region in their efforts to eliminate TB. The decline of TB in the Aboriginal population has followed years of hard work in TB control measures, contact tracing and high priority given to support and completion of curative treatment.
Contact tracing is crucial. TB infection can occur when a person with TB coughs, spits or even laughs. The risk of infection through contact with a person with infectious TB can be as high as 50 per cent. Hence the need to trace the people with whom the infectious person has been in contact. This has been a high priority for NT Centre for Disease Control staff, working in conjunction with hospitals and primary care providers. When a contact person is tested and shows as positive, treatment is provided that can prevent the contact from going on to get TB and is an important measure in working towards TB elimination. In the Territory, the mobility of Aboriginal community members presents a challenge for tracing and screening. and it's vital to provide services to diagnose cases, educate about TB transmission and support the follow-up of contacts and completion of treatment for patients.
I support this motion. It's important that Australia supports global action to eradicate TB, but it's also important for us here in Australia. I commend the member for Leichhardt on his work.