Monday, 18 February 2019
Private Members' Business
That this House:
(1) notes that:
(a) 24 March is World Tuberculosis Day, a day to commemorate the precious lives lost due to tuberculosis, a disease that is preventable and curable;
(c) in 2017 alone, 1.6 million people died from tuberculosis worldwide and 10 million people became sick with the disease; and
(d) there is a funding gap of US$1.3 billion annually in tuberculosis research and development and it is critical to develop quicker diagnostic tools, better drugs, and a new tuberculosis vaccine in order to end the tuberculosis epidemic;
(2) recognises that the:
(a) funding that Australia is providing jointly with the World Bank to support testing and treatment in Papua New Guinea is already leading to an initiative to achieve universal testing for tuberculosis in Daru; and
(b) provision of $75 million over five years for Product Development Partnerships in the Indo-Pacific health security initiative accelerates access to new therapeutics and diagnostics for drug resistant tuberculosis and malaria, building on the successes of Australia’s previous investments; and
(3) calls on the Government to:
(b) make an increased financial commitment to the Global Fund at its Replenishment Conference in October 2019.
In speaking to this motion, it is a tragic fact that, although tuberculosis is a preventable and curable disease, 10 million people on this planet develop it every year, of whom about 1.6 million die. TB is a disease that most people thought was a thing of the past and is isolated to small pockets in some more impoverished countries. I for one had also assumed the disease was no longer an issue, but nothing could be further from the truth. My mother was in inflicted with TB in the early sixties and spent a year in the Cairns base hospital. Let me assure you: it had a profound impact on my family.
The reality is TB is the largest infectious disease killer in the world, and what's more worrying are the increasing number of drug-resistant tuberculosis cases worldwide, particularly in the Asia-Pacific region. Drug-resistant TB is more expensive to treat and the survival rate is only half. Multidrug-resistant TB is difficult to diagnose and treat due to the use of old diagnostics and toxic, arduous treatment regimes. Experts have estimated that as many as 75 million additional people will die by 2050 due to the continued development of multidrug-resistant and extensive multidrug-resistant strains of TB. These are very sobering facts.
Last year was a big year for the worldwide TB community. A United Nations high-level meeting on tuberculosis was held on 26 September in the General Assembly of the United Nations, providing the highest-level political platform ever convened to address the TB epidemic. It's fantastic to see the Australian government, led by Foreign Minister Senator Marise Payne, along with several other countries, pledge its support in ending the TB epidemic.
Twelve of the world's 30 highest TB-burdened countries are located in our region, accounting for nearly half of the cases of drug-resistant TB and TB deaths worldwide. The incidence rate of TB in several of our neighbouring countries is very high, particularly in Indonesia, the Philippines, Papua New Guinea and a number of our Pacific island nations.
TB has no respect for national borders. The stark reality is that, with modern travel, TB can be transmitted anywhere in the world in less than 24 hours. Take Papua New Guinea, for example. The distance between our outer Torres Strait Islands and the coastal villages in the western province of Papua New Guinea, which is the boundary of the northern part of my electorate, is less than four kilometres. The known average for TB up there is 432 TB cases per 100,000 people. Sadly, however, this figure is much, much higher, because the majority of TB victims living in Papua New Guinea are dying undiagnosed.
Although TB is on the decline in Australia, there are, sadly, still around 1,400 TB cases every year. The incidence rate of Australian-born cases is lower, at one case per 100,000 people, but relatively higher in Aboriginals and Torres Strait Islanders, with 5.9 cases per 100,000 people. There is an alarming increase in this disease being identified in the Torres Strait, with the majority of patients being treated on Thursday Island and in the Cairns Hospital. Although rates of TB in Aboriginal and Torres Strait communities are small, they are still six or seven times higher than in non-Indigenous Australian-born people. With respect to states and territories, the highest TB incidence rate is in the Northern Territory, with 25 cases per 100,000 people. In Queensland we have 6.2 cases per 100,000 people.
There has never been a communicable disease that hasn't been cured without a vaccine, and this is where our focus should be. I'd like to acknowledge James Cook University in Cairns. Through the Australian Institute of Tropical Health and Medicine, it has established a research group, led by Professor Louis Schofield, that focuses exclusively on the development of a TB vaccine.
No-one should die of TB. It's a disease that has been ignored for too long. It's a disease that can be cured, and it needs to be cured. Australia needs to continue to stand up and be counted, and 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. I'd like everybody here today to take a few seconds to think about this: humans generally blink every three seconds. Every three seconds, someone in the world contracts TB. There is one death from TB every three minutes, all of which can be cured and avoided.
I second the motion. I commend the member for Leichhardt on this motion, which draws attention to the terrible disease of tuberculosis. As we all know, because he does a good job, he's the co-chair, with Senator Singh, of the Australian TB Caucus. It is a group of some 20 parliamentarians, including my good friend the member for Macarthur, who is himself a health professional and very passionate about us doing more to combat this deadly disease.
Before going to Timor-Leste, I had assumed that TB was one of these diseases that had been eradicated and was no longer a problem. However, my travels in Timor-Leste and further in our region showed that this was not the case. As set out in the member for Leichhardt's motion, TB is the world's leading infectious disease killer. In 2017, 1.6 million people died from TB and 10 million people became sick. That's a shocking statistic for a disease that is both curable and preventable.
I support this motion because it recognises Australia's contribution to the fight against TB, particularly in our region, particularly in Papua New Guinea and in Timor-Leste. We must do more. The motion calls on the Australian government to monitor progress on meeting UN targets to reduce and eventually eradicate TB, and to increase our financial support of the Global Fund at its replenishment conference in October this year.
I have a particular interest in TB in relation to my electorate of Solomon, in the Northern Territory. Regrettably, we still have confirmed cases of TB in the Territory, but, thanks to the good work of the NT government Centre for Disease Control, the CDC, they are trending downwards from the annual numbers that were in the 30s and 40s in the 1990s to numbers in the 20s more recently. The incidence of TB in the NT Aboriginal population is decreasing, but the rates in people born overseas are increasing.
This is why we need to support efforts to tackle TB globally and particularly in our region. In Papua New Guinea, there were an estimated 33,000 cases of TB in 2015. Timor-Leste has the highest prevalence of TB of any country in our region.
The Menzies School of Health Research in Darwin, in my electorate, is leading a consortium with institutions in Indonesia, Papua New Guinea and Malaysia with the Burnet Institute, of Melbourne, to address the challenges of drug-resistant TB and malaria, which pose major threats to health security in the Indo-Pacific region. This two-year Australian government program called the Tropical Disease Research Regional Collaboration Initiative: Responding to Drug-Resistant Tuberculosis and Malaria in the Asia-Pacific—it's quite a name—aims to strengthen health systems and research capacity, including high-quality operational research, to prevent and contain malaria and TB. This commendable program has a very human focus.
Dr Josh Francis, a paediatrician from Royal Darwin Hospital and the Menzies school, does a lot of work in Timor-Leste. Josh told me of one recent tragic case. He examined a very sick child with seizures, weight loss and fever. Her CT scan showed that she had TB in her brain, one of the more devastating complications of TB infection in children but still treatable if it is picked up early enough. He went to her bedside to see her and her family, but, as he started to examine this young girl, she suddenly stopped breathing. Along with a team of Timorese doctors and nurses, he tried to resuscitate her, but, sadly, she passed away that morning.
This should not have happened. This child had been in contact with TB well before she got sick. If that had been known, she could have had preventive treatment, six months of a medicine called Isoniazid, which could have—
Dr Freelander interjecting—
Thanks for the pronunciation assistance! The member for Macarthur will clarify the pronunciation of that drug. But the point is that it could have prevented any of this from happening. These sorts of cases happen all too often, sometimes diagnosed, sometimes not.
Of course, there are good stories too, cases that are picked up and treated well, and then those afflicted go on to survive and thrive. There's a lot more we can do, and I thank again the member for Leichhardt for putting this forward.
To echo the words of the member for Leichhardt: it is a tragedy that, despite tuberculosis, TB, being a preventable and curable disease, 10 million people on this planet contract it every year, and of those about 1.6 million die. I thank the member for Leichhardt for bringing this issue to the parliament again. The member for Leichhardt shares my interest and passion for Papua New Guinea and our Pacific neighbours, but he also shares another determination: the eradication of TB. It is important that we recognise this disease for what it is: insidious.
That is why 24 March, World Tuberculosis Day, raises awareness about an illness that affects many of our nearby neighbours. Designated by the World Health Organization, this event marks the anniversary of the 1882 discovery by German Nobel laureate Dr Robert Koch of the bacterium that causes tuberculosis. This important annual event is an initiative which acknowledges that a very preventable and treatable disease still claims the lives of more than 1½ million people every year.
Tuberculosis has been all but eradicated in developed countries; however, it remains a major global health problem in most developing countries. Twelve of the world's 30 highest TB-burden countries are located in our region. These countries account for nearly half of all cases of drug-resistant TB and TB deaths worldwide. Our closest neighbour, Papua New Guinea, experiences one of the highest rates of this highly contagious and airborne disease in the Pacific: 432 cases per 100,000 people. Australia does not escape the impact, with more than 1,000 cases reported each year.
TB has no respect for country borders, and the presence of TB in our region, particularly in PNG, is a significant health threat to Australian residents. In 2015, Papua New Guinea was struck with an estimated 33,000 cases of tuberculosis. To put that into perspective, that is equivalent to the population of the city of Gladstone, Queensland. Treatment of this disease is not without challenges, especially for those who live in remote regions like Papua New Guinea. The standard short-course TB therapy is six months in length. This involves 28 pills each week. However, for patients with drug-resistant TB, treatment is considerably longer: 20 pills a day, plus injections for three years.
Currently, more than one-third of the world's population is infected, five to 10 per cent of whom become sick or infectious at some time during their life. The case for early prevention and targeted strategies is very strong, as infectious sufferers on average will infect between 10 and 15 others each year, contributing to the pandemic nature of this disease. We do know that a person may be infected with TB bacilli in the dormant stage for many years, ultimately having active symptoms when the immune system is weakened. Even with the aid of modern medicines and technology, not all cases can be successfully treated. This very concerning position means that there are strains of TB which are resistant to all of the major anti-TB drugs we currently have at our disposal. The prevalence of multi-drug resistant tuberculosis continues to increase worldwide. The World Health Organization's End TB Strategy was endorsed by all member states at the 2014 World Health Assembly, and aims to end the tuberculosis epidemic by 2035, with full elimination by 2050.
In 2018, the former Minister for Foreign Affairs, Julie Bishop, announced that four product development partnerships would receive $75 million in new medical research funding from 2018 to 2022, two of which will focus on TB. This funding will be used to accelerate the development and adoption of better diagnostic tools and testing protocols for TB, and research new TB drugs and treatment regimes, including drug-resistant TB.
I segue to YWAM medical ships, which have joined the fight by helping to improve access to diagnosis and treatment in PNG's rural areas. They have continued to provide health services to villages and health workers in very remote parts of PNG. And the Australian government is continuing to work towards combatting the challenge of tuberculosis in the region and the need for discovery, development and rapid uptake of new tools, interventions and strategies to achieve this goal.
I acknowledge the work being undertaken by organisations like Burnet Institute and the Global Fund in partnership with the PNG government and the Reef and Rainforest Research Centre. We need to work together and pool our research. To continue the fight against tuberculosis, I call for a heightened commitment as a country to increase our efforts to fight this crippling disease. I commend this motion to the House.
I'd like to commend the previous speakers, the member for Ryan and the member for Solomon, but most of all and in particular the member for Leichhardt, who has been a champion of the cause of eradication of tuberculosis for a number of years, and is doing all he can to promote this cause in the parliament and outside the parliament.
Tuberculosis is caused by an organism called Mycobacterium tuberculosis. There are other mycobacteria. One of the better known mycobacteria similar to the tuberculosis mycobacteria is Mycobacterium leprae, the cause of leprosy, which has all but been eradicated through most of the world. In the case of tuberculosis, when I was a medical student we assumed that tuberculosis was all but eradicated. In fact, I have a textbook here written by Selman Waksman, a name that you're probably not familiar with. Selman Waksman got the Nobel Prize for the development and discovery of streptomycin, one of the primary antibiotics used to treat tuberculosis. In this book he quotes someone as saying:
If I had tuberculosis … this idea, formerly terrifying, no longer makes anyone tremble ... antibiotics have appeared, sanatoria have disappeared; as far as the public is concerned the problem is solved; the disease has been conquered.
That was in 1964. Unfortunately, that has not proven to be the case. Whilst we know that tuberculosis is now more common in the developing world, it was formerly a disease in the developed world and its recurrence in the developed world, like Australia, is a major concern.
Many famous people died from tuberculosis, including Jane Austen, Emily Bronte, George Orwell, Andrew Jackson, the seventh American president, Vivien Leigh, Frederic Chopin, Muhammad Ali Jinnah, the founder and first President of Pakistan, Franz Kafka, Eleanor Roosevelt, John Keats and DH Lawrence. Even King Tutankhamen was said to have died from tuberculosis.
We're now seeing the emergence of a multidrug-resistant tuberculosis bacteria. If I can take a step backwards, the treatment of tuberculosis—or consumption or the white plague, as it was previously known—included screening high-risk people, early detection and treatment, and vaccination. There is a vaccination called the BCG vaccine which is partially but by no means completely successful. Treatment regimens these days require multiple antibiotics, often up to a dozen tablets a day for six months. In multidrug-resistant tuberculosis, treatment may take up to three years. Imagine trying to manage tracing contacts and maintaining contact with medical personnel over a three-year period in a place like Myanmar, the highlands of New Guinea, Laos, Cambodia or Thailand. It is extraordinarily difficult. So treatment regimens these days in developing countries are very difficult. It's very hard to get compliance and it's very hard to do carrier tracing and follow-up of patients.
Our research focus now needs to be not only on better treatments and funding proper follow-up and tracing programs in developing countries but primarily on developing a vaccine that will be successful and easily transportable and usable in developing countries. Australia has been very good at providing funding for research, but we need to step up because this is not just a problem in the developing world; this is a problem in the developed world. We are now seeing an increased number of people with tuberculosis coming to Australia requiring treatment, not only in northern Australia but sometimes in other parts of Australia as well, with our migration and transport systems. So it's a problem for the whole world.
I support the member for Leichhardt and his call for the Australian government to increase its funding for the global fund and institutions like the Kirby Institute to try to improve our chances of having a vaccine developed in the next few years so that we can finally eradicate this terrible, dreadful disease which has been a scourge in times past. We don't want to see it come again.
I rise to add my voice in support for the member for Leichhardt's motion, and I'm pleased to have the opportunity once again to speak on the important topic of the fight against tuberculosis. As has been noted, 24 March will be World Tuberculosis Day, commemorating the anniversary of German Nobel laureate Dr Robert Koch's 1882 discovery of the bacterium that causes TB. World TB Day is an important opportunity to increase awareness of the plight of those suffering from TB and those at high risk. It's an opportunity to remember those who have passed, to educate others about TB and to focus on further action.
I often describe Australia as a sanctuary in many ways, and it does mean that sometimes we can have the luxury of taking some things for granted. We need more Australians to be aware, as the member for Leichhardt so eloquently said in his speech, that tuberculosis is still a major problem around the world and especially right on our doorstep. It's a major challenge in many neighbouring friendly countries which are just a short flight away from our homes in Brisbane and the rest of Queensland.
Steady progress has been made recently in the fight against TB. There are measurable declines in the number of new infections and deaths, yet TB remains a stubbornly persistent and deadly challenge. Tuberculosis is now the leading infectious disease killer in the world. It kills more people than HIV and malaria combined, and partially that's a consequence of the fact that more significant progress has been made in the prevention and treatment of malaria and HIV which stands in stark contrast to the situation with TB.
In 2017, 1.6 million people died from TB worldwide with a further 10 million becoming sick with the disease. While those global numbers are trending down—and I estimate that's about five to 10 per cent lower than the numbers we were talking about here just two years ago—these are still very significant numbers of people who are sick with TB. We need to remember that half of those cases do come from nearby countries in our Asia-Pacific region—countries like PNG on our doorstep are the hot spot in this fight against this terrible disease. We also need to be aware that drug-resistant TB, specifically, is a growing threat to public health around the world.
There's estimated to be a $1.3 billion shortfall in funding for the research and development we need to see in the fight against TB. So, I continue to participate with many of my colleagues here in the Global TB Caucus and work with the groups at the forefront for the fight against TB from research to on-the-ground delivery. I've had the opportunity to see for myself the difference that targeted Australian assistance is making for the benefit of humanity in our region, and other recent events should reinforce the importance of Australia continuing to focus on playing a strong role in building the resilience and the future of our friends and neighbours in the near Pacific.
I want to congratulate the member of Leichhardt, Warren Entsch, for his longstanding leadership in this area and for encouraging me and many others here today to get involved as well as the other speakers for their generous comments; and also the member for Ryan for her longstanding advocacy for our Pacific neighbours.
I was obviously very pleased with this government's previous commitment back in 2016 of $220 million towards the Global Fund to Fight AIDS, Tuberculosis and Malaria. That was a 10 per cent increase in funding on previous rounds and, when the next round is due later this year at the replenishment conference in October, I do hope—in fact I call for—for Australia to make an increased financial commitment to the Global Fund. It's helping to bring in new medicines and diagnostic tests to market, and this research and development are vital so that new simple and affordable treatment tools for TB and multidrug-resistant TB can be developed. If support dries up, our goals of the End TB Strategy will not be met.
More Australians deserve to know, as the member for Macarthur eloquently and generously said before, that Australia's funding here does form one of the cornerstones in the global fight to eradicate TB. On top of the support that Australia provides in a bilateral way to our close neighbours and friends in countries like PNG and Kiribati, we're providing funding jointly with the World Bank, for instance, to support testing and treatment and an initiative to achieve universal testing in Daru in PNG, and $75 million for product development partnerships in the Indo-Pacific Health Security Initiative. It was very good to see the foreign minister in Brisbane a bit over a year ago announce the package of measures and initiatives that comprise that initiative. We must continue to build on this legacy into the future.
I, too, would like to join with my colleagues to commend and congratulate the member for Leichhardt for his constant advocacy on this issue for many, many years. He is keeping it at the forefront of our conversations and keeping a focus on it amongst colleagues here. That is vitally important, particularly given the statistics we've heard during the course of today's discussion. I also want to thank him and commend him for his leadership on this issue. There are others on the other side of the chamber, and on this side, who have also shown leadership on this, but the member for Leichhardt has actually been at the forefront of this and the lead champion. I congratulate and thank him.
I want to also thank the member for Leichhardt for bringing this motion forward because it highlights the work that is being done and what we still need to do to both prevent the spread of TB and cure people from this insidious preventable disease. Because TB is largely non-existent in Australia, many people do not know or remember what the symptoms of TB actually are—and the speech from the member for Macarthur was very useful in reminding us of those symptoms.
This disease has a long history. It was recognised in the Middle Ages and the Renaissance periods, during the 17th and 18th centuries and beyond. With medical science advancing over time, we did have TB on the run for a while. But then the drug-resistant variety of the virus emerged, causing the World Health Organization to declare a global health emergency in 1993. While TB is largely wiped out in Australia, in Asia more than 8,000 cases are diagnosed across the continent and archipelago every day. That's not every week, that's not every month; it's 8,000 cases every day.
TB is known as the disease of the poor, spreading through overcrowded neighbourhoods and poorly ventilated homes and workplaces. Importantly, for Australia, it is our closest neighbours to the north who are detecting the largest growth in new cases of TB. The World Health Organization has reported a 32 per cent increase in Papua New Guinea, a 17 per cent increase in both Bangladesh and Sri Lanka, a 13 per cent increase in Nepal, a 12 per cent increase in Timor-Leste and a seven per cent increase in Indonesia.
When diagnosed, the treatment regime is intensive, requiring a person to commit to a full six-month daily treatment program. As the member for Macarthur has mentioned, that can last up to three years. For most of us living here in Australia, where we have universal Medicare, completing a health program like this sounds like an easy thing to do. But imagine not having access to world-leading health care or having to make a choice between earning a living and seeking medical treatment. This is the choice that many people in our region affected with TB have to make each and every day. The poverty of many people means that they either do not seek treatment in the first place or discontinue treatment halfway through, usually after starting to feel better. The risk to people who discontinue treatment is the possibility of contracting a more serious drug-resistant strain of TB. The WHO's statistics show that someone who does not seek treatment or discontinues it halfway through will go on to infect 10 to 15 more people over the course of a year.
The prevalence of this insidious disease means we must help our neighbours and we must act now. We must take action now. That's particularly the case in terms of vaccinations but most importantly in terms of transportation of those vaccinations. There are a number of NGOs that are coming up with fabulous, flexible solutions to allow those vaccinations to be transported in non-refrigerated vehicles in little eskies. For anyone who is interested in this disease and supporting this cause, I encourage them to get behind the fundraising for these little eskies that deliver fresh vaccinations to really remote regions.
Last year I met with representatives from Results, who spoke about the need for Australia to be represented at the inaugural UN high-level meeting on TB, held in New York last year. I wrote to the Prime Minister, and he confirmed Australia would be represented. The outcome of that meeting saw a pledge to reach 40 million people with treatment by 2022, a goal to secure $13 billion in annual new funding, and a commitment by the US government to increase impact and support countries to reach everyone.
Next month, on 24 March, we will mark World TB Day. This is a day dedicated to raising public awareness and, also, highlighting what actions need to be taken. With a renewed global commitment to act on TB, the theme of this year's World TB Day is 'It's Time'. It definitely is time.