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

I move:

That this House:

(1) notes that:

(a) 24 March is World Tuberculosis Day (WTD);

(b) WTD is a designated WHO global public health campaign and is an annual event that marks the anniversary of the 1882 discovery by German Nobel Laureate, Dr Robert Koch, of the bacterium that causes tuberculosis;

(c) tuberculosis is contagious and airborne—it ranks as the world's second leading cause of death from a single infectious agent and left untreated, each person with active tuberculosis disease will infect on average 10 to 15 people every year;

(d) the theme for WTD in 2015 is 'Reach, Treat, Cure Everyone';

(e) in 2013, 1.5 million people died from tuberculosis worldwide with 40 per cent of deaths occurring in countries in the lndo-Pacific region;

(f) Papua New Guinea has the highest rate of tuberculosis infection in the Pacific, with an estimated 39,000 total cases and 25,000 infections each year;

(g) the prevalence of multidrug-resistant tuberculosis continues to increase worldwide—rising from 450,000 cases in 2012 to 480,000 cases in 2013, with more than half of multidrug resistant tuberculosis cases found in our region; and

(h) tuberculosis is:

  (i) the leading cause of death among HIV positive people—HIV weakens the immune system and is lethal in combination with tuberculosis, each contributing to the other's progress; and

  (ii) considered to be a preventable and treatable disease, however current treatment tools, drugs, diagnostics and vaccines are outdated and ineffective; and

(2) recognises:

(a) Australia's resolve to continue 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 as recognised in the WHO End TB Strategy;

(b) the WHO End TB Strategy was endorsed by all member states at the 2014 World Health Assembly and aims to end the tuberculosis epidemic by 2035;

(c) the Australian Government funding of health and medical research is helping to bring new medicines, diagnostic tests and vaccines to market for tuberculosis and other neglected diseases; and

(d) the ongoing support for research and development of new simple and affordable treatment tools for tuberculosis and multidrug-resistant tuberculosis is essential if the WHO End TB Strategy goal is to be met.

Today, 24 March 2015, is World Tuberculosis Day. World Tuberculosis Day is a designated World Health Organisation global public health campaign, and is an annual event that marks the anniversary of the 1882 discovery by German Nobel Laureate Dr Robert Koch of the bacterium that causes tuberculosis. The theme for World Tuberculous Day in 2015 is 'Reach the 3 million: Find. Treat. Cure TB'.

Tuberculosis is a highly contagious and airborne disease. It ranks as the world's second-leading cause of death from a single infectious mosquito, second only to HIV-AIDS, and if left untreated each person with active tuberculosis disease will infect on average 10 to 15 other people every year. For those already infected with HIV, tuberculosis is the leading cause of death. HIV weakens the immune system and is lethal in combination with TB—each contributing to the other's progress. In 2013, 1.5 million people died from tuberculosis worldwide, with 40 per cent of deaths occurring in countries in the Indo-Pacific region. Papua New Guinea has the highest rate of tuberculosis infection in the Pacific with an estimated 39,000 total cases and 25,000 infections each year. Tragically, about three million TB sufferers are missed every year, which prevents these people from receiving essential care and treatment for the disease. Twelve countries account for 75 per cent of missed cases, and South Asia and Africa account for nearly two-thirds.

Through increased awareness and treatment nearly 22 million lives have been saved from TB since 1995, and there has been a 45 per cent decrease in TB deaths since 1990, but there is much more to be done. While TB is considered to be a preventable and treatable disease, current treatment tools, drugs, diagnostics and vaccines are outdated and ineffective. The prevalence of multidrug resistant tuberculosis continues to increase worldwide, rising from 450,000 cases in 2012 to 480,000 cases in 2013, with more than half of multidrug resistant tuberculosis cases found in our region.

The World Health Organisation'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. The Australian government is continuing to work toward 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. The Australian government's funding of health and medical research is helping to bring new medicines, diagnostic tests and vaccines to market for tuberculosis and other neglected diseases. The Minister for Foreign Affairs recently announced an assistance package for Papua New Guinea. The additional funding of $15 million will focus on improving the treatment of drug resistant strains of TB, and brings the Australian government's total assistance package to $60 million to support the control of tuberculosis in PNG. Additionally, Australia's commitment of $200 million over 2014-16 to The Global Fund to fight AIDS, Tuberculosis and Malaria has helped diagnose and treat 12.3 million cases of TB, eight million of whom live in the Asia-Pacific region. The global fund provides 75 per cent of global funding for TB treatment.

I acknowledge the work of Policy Cures, Results and other organisations involved in the fight against TB who marked this year's World Tuberculosis Day with the Minister for Foreign Affairs launching the Australasian Tuberculosis Forum, ATF, which has been established to facilitate greater recognition for the policymakers, clinicians, patients, scientists and public health workers working for tuberculosis control and elimination in our region. The ongoing support for the research and development of new, simple and affordable treatment tools for tuberculosis and multidrug resistant tuberculosis is essential if the World Health Organization's End TB strategy goals are to be met. I commend this motion to the House. (Time expired)

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

I call for a seconder for the motion.

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I am delighted to second this motion moved by the Member for Ryan. Of course, 24 March being World Tuberculosis Day, it is important that we reflect both on the history and on the current policy settings in relation to tuberculosis. At the beginning of the 20th century, tuberculosis was the leading cause of mortality for females in Australia and second leading cause for men. TB claimed thousands of lives in this country every year and accounted for around eight or nine per cent of all deaths. For many who contracted the disease, TB was a long, slow death sentence, from what was referred to unscientifically but accurately as 'consumption.' Those who could afford it, both here and abroad, would often try to beat the disease by fleeing to healthier locations like mountains and the seaside to take the cure and give themselves a better chance of survival. The fine sanatorium buildings that exist to this day in areas like the Blue Mountains or Dandenongs are reminders of a time when TB was prevalent, public health campaigns urged people not to spit in the street, and the only response was isolation, rest and diet.

Antibiotics and improvement in living standards and intensive-screening campaigns, especially in the wake of World War II, all but eradicated the disease here. At the end of that century, not a single fatality was recorded in Australia in 2000. Sadly, unlike other diseases such as smallpox and polio, Australia's success has not been matched by similar outcomes in the rest of the world, and tuberculosis remains in many countries one of the leading causes of death. While there have been significant improvements, according to the World Health Organization, tuberculosis is second only to HIV-AIDS as the greatest killer worldwide due to a single infectious agent, and it is very sad also to note that for many HIV-positive people, because HIV weakens the immune system, TB is a lethal combination for these patients.

In 2013, nine million people fell ill with TB and 1.5 million people died from the disease. Over 95 per cent of these deaths occurred in low- and middle-income countries. Australia continues to record one of the lowest notification rates of tuberculosis, but there are worrying signs that we are once more at risk because of the failure to eliminate the disease overseas and its mutation into a new, multidrug resistant strain.

In October last year, Queensland Health confirmed the first death of an Australian citizen from complications related to this multidrug resistant tuberculosis. The 32-year-old Torres Strait Islander woman died after being admitted to hospital six days earlier and had what was described as a close connection with another Torres Strait Islander woman, who died from MDR TB at the Cairns Hospital in April 2013. The woman was known to travel between Cairns, the Torres Strait and Papua New Guinea. In many ways, sadly, this was inevitable because Papua New Guinea, our nearest neighbour, with intense people-to-people contact, especially across Torres Strait to Queensland, has the highest rate of TB infections in the Pacific, with an estimated 39,000 cases, and 25,000 new infections each year.

TB is a preventable and treatable disease. But PNG is a poor nation that does not enjoy the health standards that we take for granted here. It shows why it is not just in Australia's interest as a good global citizen to continue the fight against TB, but why with even the best health system in the world we cannot be immune to the spread of this disease. More than 85 per cent of notified cases detected here occurred in the overseas-born population, and the current epidemiology of TB in Australia is largely a direct result of the global TB situation. Short of closing all of our borders and placing all Australians who travel overseas in isolation on their return, the only way we can protect ourselves against TB, as we did from smallpox and as we are close to achieving with polio, is to eliminate the disease all over the world.

That is why today, in this motion, we are committing to the WHO End TB Strategy, endorsed by all member states at the 2014 World Health Assembly, to end the TB epidemic by 2035. In our region, we resolve to combat TB by working with our partner countries to build strong and sustainable health systems. As Australia's experience has shown, a strong public health system and a determined effort can beat TB. We also declare our strong support for ongoing funding of health and medical research in Australia which is helping to bring new medicines, diagnostic tests and vaccines to the market, for TB and other neglected diseases. The development of new and simple affordable treatment tools for TB and multidrug-resistant TB is essential if the End TB Strategy goals are to be met. Let us hope that in the not-too-distant future we can look back on TB as a distant memory not just in Australia but across the globe. (Time expired)

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

First of all, I would like to commend the member for Ryan for her ongoing advocacy on this issue. World TB Day aims to build public awareness that tuberculosis remains an epidemic in much of the world, causing the deaths of nearly 1.5 million people each year, mostly in developing countries. In our neighbour PNG, which lies within just four kilometres of Australia, the islands of Saibai and Boigu have the highest burden of TB in the Pacific region. While it is difficult to estimate the rates of drug-resistant tuberculosis, it is considered to be endemic in PNG. Of approximately 23,000 cases reported in 2013, sadly, 28 per cent are people under the age of 15. In fact, my long interest in tuberculosis stems from 2010, when nine-year-old Violet Ausi was brought on an eight-hour dinghy trip from Daru to Australia by her father to get treatment that she could not get in Papua New Guinea.

Ignoring this problem or hoping it will go away is just not an option. Yesterday, I was pleased to host an event with Policy Cures and Results International to raise awareness of this killer disease. I would like to mention the courageous speech that was given by a young Filipino girl, Louie Zepeda, who was 25 years old and working as an architect in Manila when she contracted multidrug-resistant tuberculosis meningitis. Louie told us of her 24-month, gruelling treatment, where she swallowed over 14,000 pieces of medication and endured terrible side effects, including paralysis, Parkinson's symptoms, depression and the prospect of infertility. Louie was eventually cured, but the toxic treatment left her blind. In her words, she felt 'worthless'. It took a lot of soul-searching for her to find a new purpose in life, but she is now a qualified architect, she has a master's in disability policy, she is married, she has a daughter called Zoe and she is a passionate advocate for tuberculosis patients. Her story really struck home. Not only did I learn that tuberculosis is not just a disease of the lungs but Louie's story showed how tuberculosis can strike healthy, active, professional people and change their lives forever. In her case, it was a disease of the brain which affected her optic nerves and caused her blindness.

TB is not just a social tragedy; it is also an economic tragedy. That event with Louie was followed by last night's launch of the Australasian TB Forum here in parliament. I would like to thank Dr Stenard Hiasihri, from Western Province, for his insights into being a doctor in PNG and treating tuberculosis patients. His comment that tuberculosis is 'Ebola in slow motion' really said it all. His experiences in having to diagnose patients using out-of-date technologies and then struggling to administer toxic drugs for anywhere between six months and two years reinforces that we must get effective vaccines, better diagnostics and more-efficient treatment. To that end, it is very welcome news that our foreign minister has pledged $30 million over three years to help bring new diagnostic tests and drugs to the market to tackle drug-resistant tuberculosis and malaria.

I have spoken many times in this place about the failure of the previous system, where millions of dollars were thrown at this problem with no accountability and no focus on outcomes. This government's direction is a breath of fresh air. At a local level, I have been working with Sheriden Morris from the Reef and Rainforest Research Centre on a $1.85 million pilot project that will establish four service platforms in key villages along the Western Province coastline of Papua New Guinea. This project will be up and running by the end of this month, focusing on water and food security, sanitation, and a secure base for community health workers. I am looking forward to continuing to advocate for this project so that stage 2 can get underway sooner rather than later.

To conclude, the theme for World Tuberculosis Day in 2015 is 'Reach, Treat, Cure Everyone'. It is ambitious, but it has to be. As Dr Hiasihri and Louie Zepeda said yesterday: 'Imagine our children growing up in a world without tuberculosis.'

Terri Butler (Griffith, Australian Labor Party) Share this | Link to this | Hansard source

Like the member for Leichhardt, I acknowledge World Tuberculosis Day, which is today, as a reminder that tuberculosis, the most prevalent airborne disease, infected approximately nine million people and took 1.5 million lives in 2013. I also note the member for Leichhardt's advocacy in respect of tuberculosis. I am aware that a member of the school community from my old high school, which is in the member for Leichhardt's electorate, has been directly affected by tuberculosis, and there are reports of more being tested today. So my thoughts are with those members of the community in Far North Queensland who are facing tuberculosis—a disease that this day marks as an important reminder that we need to eradicate tuberculosis around the world.

Over two billion people are currently infected with the tuberculosis bacteria. Not everyone who is exposed to tuberculosis will get sick, because most healthy people are able to fight off the bacteria. But people with compromised immune systems, such as people who are undernourished, have diabetes or are living with HIV, have a much higher risk of developing active tuberculosis. In some cases, people do not respond to treatment because they have a strain of tuberculosis that is resistant to antibiotics. When tuberculosis is resistant to two or more types of antibiotics, it is referred to as multidrug-resistant tuberculosis. This is an issue that a number of people are grappling with, and of course amongst those people I pay tribute to the medical professionals, health professionals and administrators in Queensland's public health system who, among many other people in the world, are facing this challenge.

About 480,000 people are estimated to have multidrug-resistant tuberculosis globally, and this number is increasing; it increased from 450,000 in the preceding year. Clearly, significant action is required to face the global epidemic of tuberculosis and to deal with the challenges posed by multidrug-resistant tuberculosis. That is why when Results International visited me in this parliament very recently, Maree Nutt of Results and her colleagues spoke to me about the importance of taking real action to combat tuberculosis by doing things like investing in research and development to combat tuberculosis. You cannot rein in multidrug-resistant tuberculosis without improved drugs, improved diagnostics and improved vaccines. A lack of investment in research and development can result in unnecessary suffering and death. So donors and implementing countries must increase funding at different stages from basic research to clinical trials, because I am told there is a $1.3 billion annual gap in funding for new tools to stop the spread of tuberculosis. Of course, current tuberculosis programs require improvement. I am informed that more can be done to mitigate the spread of drug resistance by using current tools more effectively. I am also informed that once someone is on treatment they stop being infectious. This is really important because as the member for Ryan, the mover of this motion, said: a person who is infectious would infect on average 10 to 15 other people. So, clearly, it is really important that we reach all people with tuberculosis to ensure that the infectiousness is curbed and, in turn, curbing infectiousness will curb drug resistance. That means, like everything, that resources are needed, and those resources need to be appropriate—at a level that can make sure that everyone is reached. That means necessarily increasing political support and money for national tuberculosis programs. Worldwide, I am told, tuberculosis detection and treatment programs are underfunded by US$2 billion per year. That is a significant challenge for countries around the world as they grapple with this epidemic.

The Global Fund to Fight AIDS, Tuberculosis and Malaria has supported 12.3 million people to receive tuberculosis treatment, and eight million of those have been in the Asia-Pacific region—in our region. Recently, the global fund reported that it has received US$2 billion in project proposals globally that meet its criteria but that cannot be funded from existing resources. That means that funding commitments need to be made. Like the other speakers in this debate, I do welcome the government's announcement yesterday that they will provide $30 million over three years to aid those effected by tuberculosis and malaria—although I would note that a number of organisations have raised concerns with me about aid cuts more generally, and that is an issue that needs to be addressed.

Teresa Gambaro (Brisbane, Liberal Party) Share this | Link to this | Hansard source

I rise to support this motion on World Tuberculosis Day. I want to thank the member for Ryan. She is to be commended for her continuing diligence in highlighting this issue. Indeed, her passion in ensuring continuing awareness of this issue is well known to the House, and she, along with me, many of our other parliamentary colleagues and the member for Leichhardt, Hon. Warren Entsch, have been tireless in pursuing this issue on behalf of his constituents in Far North Queensland and in consideration of the welfare of our nearest neighbours in Papua New Guinea.

As I informed the House on 20 March last year, TB is not a distant problem for Australia. None of us should be complacent and think that TB is a disease of the last century and that it not relevant to us here in Australia, particularly in Queensland and to Queenslanders. Australia is committed to supporting our neighbours combat tuberculosis and to strengthening critical health systems that get more than half of the world's TB cases that occur in the Indo-Pacific region. The importance of this is underlined by the fact that a country right on our doorstep, Papua New Guinea, has the highest rate of TB infection in the Pacific.

I am on record in this House as saying that in the 21st century we should be aiming for zero TB deaths throughout the world and throughout the Indo-Pacific region. On World TB Day, today, we should reflect on the need to show our commitment to properly funding the global fund in this fight to ensure that TB becomes a disease consigned to history.

That is why I am really proud to acknowledge the efforts of the Minister for Foreign Affairs, Hon. Julie Bishop MP, in securing the Australian government's pledge of $200 million to the global fund Global Fund to Fight AIDS, Tuberculosis and Malaria's fourth replenishment for 2014-16. The global fund provides around 75 per cent of the global funding for TB. In the Asia-Pacific region, the global fund has supported treatment of more eight million cases of TB. On 18 June 2014, when launching the government's aid policy, the foreign minister announced a commitment of up to $30 million per annum from 2014-15 for health research for development, including medical research. It is this focus and the emphasis on medical research that is particularly important. For far too long, our approach to tackling the scourge of TB has been based on diagnostic tests that are almost 100 years old and are tragically outdated, and some of those treatment regimes are outdated as well. This is why Minister Bishop's announcement included further support for product development partnerships to develop new drugs, vaccines and diagnostic tests for high-burden diseases in our region.

In February 2015, the Australian government also announced a $15 million package for the support of TB control in PNG's National Capital District and Western provinces. That was made up of $10 million for the TB response in the NCD from that 2014-15 period to 2016-17 for case funding, early diagnosis, effective treatment and care and support; and $5 million from 2014-2017 towards drug-resistant TB control initiatives in Western Province. This support will focus on effective management of drug-resistant TB in hospital and community settings. When you look at it, Australia's commitment for TB control to Papua New Guinea has amounted to some $59.7 million from 2011 to 2017.

I want to thank the member for Leichhardt, who was here earlier, for his constant vigilance in this area. Australia has refurbished the Daru General Hospital TB ward and outpatient service blocks, and constructed a purpose-built 22-bed TB ward. I want to thank him very much for his constant work in this area.

I have no doubt that our refocused efforts in combating TB in our region and the increased priority on medical research is the correct approach. In this regard, I want to thank the member for Ryan for this motion. I want to thank the member for Leichhardt, for his relentless advocacy on this issue, and Minister Bishop and all of the members who have spoken today on World Tuberculosis Day. Hopefully we will make these initiatives a reality.

Laurie Ferguson (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

It is indeed timely that this resolution is before the Federation Chamber today, because, as other speakers have mentioned, it is World Tuberculosis Day and there has been the foundation forum here today to discuss the issues related to it, but also because the respected NGO RESULTS visited many members over the past week. RESULTS, whilst critical of the government's reduction in foreign aid, in discussions with me certainly praised the government's three-year package of $15 million towards combating tuberculosis. They further noted, on 5 February, in congratulating this initiative:

However, failure to address the lack of effective diagnostics, drugs and vaccines will continue to result in major long-term human and economic costs …

They also cite the reality that there is not only the impact upon the individual and the local society. Where you have a situation where it is the third main cause of women's deaths in the 15- to 44-year-old age group, there is the impact on young children of losing their mothers. But this is also, of course, an economically important problem facing the world. It is estimated by RESULTS that $1 trillion to $3 trillion over the next 10 years will be lost in regard to the world economy. The World Bank has further estimated that a loss of productivity of four to seven per cent of GDP in a significant number of nations is the result of the presence of tuberculosis.

Whilst it has been around with us since 7000 BC, and whilst we have of course had some major improvements in this country, it is no accident that four of the six speakers on this particular motion come from Queensland, because this problem in Papua New Guinea in particular—and, on a broader front, the Pacific—is such that it is having an impact on this country in regard to the reported instances of it. Papua New Guinea has had an alarming growth of 47 per cent over the last decade in the number of reported cases. We are talking about a situation where, as other speakers have indicated, between 1.4 and 1.7 million people—there are different estimates—die from this each year, and nine million new cases are reported. Due to the collapse of the health system in Papua New Guinea—and we have had various speakers in this parliament before a variety of committees testifying to that—the situation in Papua New Guinea is alarming, and it will have an impact on this country because of cross-border movement.

The micro-organism can survive in a dry state for many weeks, which is part of the problem we face. First-line drugs must be taken for six to nine months, and if that is not fulfilled then we have the very serious growth of strains that are not liable to be combated by the multidrug attacks on it.

The situation now is that we have an international strategy from the World Health Assembly which indicates that the World Health Organization is seeking to eliminate tuberculosis in countries with low levels of the disease, targeting 33 countries and territories where there are fewer than 100 TB cases per million population, aiming to have fewer than 10 new TB cases per million in these countries by 2035, and total elimination by 2050. That is commendable; that is worthwhile. However, as indicated by a variety of speakers, in our particular part of the world, in the Pacific, and also in Africa, it is endemic in certain countries. While it has fallen by 40 per cent in number of deaths since 1990, the number of new cases are in decline. It has proved extremely resilient.

I commend the speakers in their efforts to highlight the problems of this disease. It is interesting that two Nobel Prizes over history have been given in the field of combating tuberculosis, but obviously we still have a very real issue.

In conclusion, I hope the member for Bowman is not indicating the use of props at a later stage in the next debate. It would be quite alarming.

Honourable Member:

An honourable member interjecting—

Laurie Ferguson (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

Oh, more than one person. I commend this resolution. It is great to see this initiative, particularly by Queensland members, who are more centred on this issue than other parts of the country. There have been initiatives by Results and by the World Health Organization—they certainly are to be supported—and the recent voting and money by the government is to be commended.

Debate adjourned.