 The next item of business is a member's business debate on motion 2874 in the name of Miles Briggs on World Tuberculosis Day 2022. The debate will be concluded without any questions being put, and I'd invite members who wish to participate to press the request to beat buttons or place an arm, the chat function as soon as possible. I invite Miles Briggs to open the debate for around seven minutes, Mr Briggs. Thank you very much, Deputy Presiding Officer, and I'm grateful to be able to bring forward this debate to the chamber today. I thank members from across the Parliament for their support on what is an important public health issue globally, but also potentially increasingly a threat to domestic health security as well. I'd like to start by paying tribute to the Edinburgh Group of Results UK, which campaigns on international development issues, including tuberculosis. I've been working with the group since my election in 2016, and I'm pleased to welcome some of their members today to the public gallery. I've also sponsored a stand just outside the chamber, which I know a number of members have already spoken and engaged with the group. If you haven't already, I hope that there may be a chance after this debate to speak and find out more information. I want to take this opportunity to also note the contribution made by two leading professionals here in Scotland, Dr Helen Stagg, at the Centre for Population Health Sciences at Edinburgh University, and until recently, the chair of UK APTB. For those of you who do not know what that is, it's UK academics and professionals against tuberculosis. Susan Duthy, who is also the lead TB specialist nurse at NHS Grampian, has led on the recommendations of Afghan nationals' TB screening here in Scotland. I'd also like to put on record our thanks to the vital work that is carried out by clinical staff, scientists and civic society in Scotland, and civic society organisations across the country, and globally to deliver on the sustainable development goal that we all signed up to to ending TB by 2030. Deputy Presiding Officer, tuberculosis, for those who don't know, is an incredibly infectious disease spread through coughing. It has killed more people than any other single infectious agent in history, including SARS at Covid-2. TB is curable, but people need support to get through the many months of treatment that are required. As noted in today's motion, around 1.5 million people die from TB every year, and many millions more are diagnosed with the disease. That is a shocking statistic, and that is something that we all need to reflect on. Deputy Presiding Officer, if you were a teenager before 2005—I'm not sure if you were—but you may bear a small circular scar on your bicep. This is a by-product of immunisation against TB and a reminder of the prevalence of the disease in this country at one time. However, the Covid-19 pandemic and its widespread effects on diagnosis and treatment has brought the disease back to the forefront of the policy debate, especially in the context of public health in developing countries. The similarities between TB and Covid—much of the precautionary equipment, treatment centres and services, which are usually the first line of defence for the former—were refocused on the latter. The World Health Organization has suggested that the pandemic has set back efforts to end TB globally by more than a decade. Researchers at Dundee University have received £3.8 million from the Bill and Melinda Grant Foundation to develop treatments that have warned that the impact of the pandemic could lead to a rise in tuberculosis infections around the world, as some patients will simply have gone undiagnosed amid the pandemic. Indeed, as many services across our health landscape diagnosis of TB have dropped, we believe, by 20 per cent in 2020, as access to treatment became increasingly difficult, some projections suggest that progress against TB has also significantly now been set back. Dr Laura Clegghorn at the University of Dundee said that there is a pressing need to develop new treatments for illness, which some wrongly think is a disease of yesteryear, and I agree. As I said earlier, concerningly, across the world, diagnosis of TB dropped by a similar level within 16 countries accounting for 93 per cent of that drop, which suggests that countries that are already at a higher burden of disease have ffaird far worse. Of course, there have been other issues that have led to this protected problem. Fewer people, for example, have been tested for TB and the number attending for tests has been reduced. That might be because of hospitals' fear of contracting TB or because of Covid-19 or people with Covid-19 not being able to go to hospital. As we emerge from the pandemic, this is a problem that we urgently need to tackle, otherwise we risk stepping backwards in the fight against deaths from TB. Of course, this will require a sincere, co-ordinated and multilateral effort, but if the pandemic has demonstrated anything, it is that sometimes the immense benefit that can be gained from proper and targeted investment in global public health in recent years and concerted action has been taken to tackle TB and we need to see that work recovered again. In 2018, for example, we saw the first high-level global meeting on TB producing a declaration of political will that can shape our approach going forward, notably work to close the research and development funding gap. That has, to date, been estimated to be over £1.1 billion. I welcome the £20 million that the UK Government research and development funding has brought forward, and the good portion of that has already been targeted towards global health innovations around this. However, there are still many concerns around research and development, and I hope that we can address those globally. The first and most obvious are around treatment methods. Innovation will allow us to simplify treatment regimes, allowing them to be more easily deployed in all corners of the world, in contrast to what are currently lengthy and complex treatments for many patients that can take up to over three months. Similarly, we need to see progress on how diagnosis around TB is also improved. We need to be able to do it in a speedy, efficient and simple way. To circle back to my earlier points, Covid-19 has acted as a catalyst around what has been a diagnosis question. I hope that we will see investment around early diagnosis of TB, as we have seen around Covid. Finally, perhaps most important, we need to fund research that will look towards drug resilience and drug resistance. There is a worrying trend that we are all now acutely aware of. In many diagnoses, we are seeing drug resistance and multi-drug resistance to TB. Over 160,000 were recorded last year alone, which is, I think, deeply concerning to our global public health. We know that Scotland is behind also in funding latent TB screening in communities at risk and vulnerable to TB. I hope that, with the minister closing the debate tonight, she can outline what public health initiatives are being developed now to address those concerns, specifically around latent TB screening. To conclude, I am incredibly grateful to members for allowing me to bring forward this debate today and for the opportunity to discuss the issues of public health policy around the world, but also very much around domestic health security. Above all, I hope that today we can present an opportunity for Parliament to reaffirm our collective mission, and that of clinical staff, scientists and civil society here in Scotland and globally to meet the sustainable development goal to ending TB by 2030. Thank you very much indeed, Mr Briggs. I now move to the open debate. I call Emma Harper, who will be followed by Richard Leonard. Emma Harper joins us remotely for around four minutes, please, Ms Harper. Thank you, Presiding Officer. I welcome the opportunity to speak in this debate and congratulate Miles Briggs on securing it. Apologies for not being in chamber today. Miles Briggs has laid out very well the importance of world tuberculosis day 2022, which this year marks the theme, invest to end TB-day lives. Raising awareness is one of the asks and the briefing from results. I met them in Parliament on Tuesday at their stand as well, which is sponsored by Miles Briggs. It is important to raise public awareness about the devastating health, social and economic consequences of TB and highlight the efforts that are being made to end the global epidemic. Presiding Officer, when preparing for this debate, I reflected on Scotland's journey to tackle TB. In 1948, TB was killing one person every two hours in Scotland. For back then, Scotland was virtually the only country in Europe where new cases of TB were continuing to rise unchecked. Although, for ever, the disease of poverty and crowded slums, wealth provided no barrier. Young men and women were particularly at risk, and TB men and gitis was certain death for babies and toddlers. TB patients could spend a year or more recovering and resting in a sanatorium, including at Lochmayben sanatorium near Dumfries. One of my first tutors in nursing college was the first male nurse in Dumfries and Galloway at Lochmayben hospital, Mr David Shankland. Davie taught me and my colleague so much about his time at Lochmayben, helping to support people who were recovering from TB. This was a dreadful time back then, and it was made worse by the appall and stigma attached to TB. The first treatment came along, Streptomycin, and that was one of the first cures that was developed by William Feldman, a Glasgow-born vet. He helped to refine it into a medical form at the Mayo Clinic in Minnesota. I also want to pay tribute to Sir John Crofton for developing the first combined antibiotic regimen, multi-dose, that still forms the basis of TB treatments today. The universities of Edinburgh, St Andrews and Queen Margaret continue the legacy of Sir John today working across continents and disciplines. The drugs were game-changing since then, and in particular, late largely down to our fantastic national health service and vaccination efforts. The situation here in Scotland has absolutely improved. Gotten's example, however, is not replicated across the world. Indeed, according to the World Health Organization's global TB report, 60 per cent of global TB cases come from just six countries, where health inequalities are more prevalent. Those are China, India, Indonesia, Nigeria, Pakistan and South Africa. Although treatments are available across the nations, the problem is largely that, even though doctors routinely advise patients with TB on the importance of following the prescribed regimen, many people do not complete the treatment plan. When patients stop taking TB medication, the risk of developing multi-drug-resistant TB is then even more difficult and more costly to treat. In 2016, the median cost of treating a single patient in a developing country with drug-resistant TB was $9,529, and treatment could last up to two years. New multi-drug combi regimes of 90 to 12 months do exist. They can cost up to £1,000 a person, but maintaining patient compliance for such long periods presents additional challenges. It is not that the patients do not care about their health or burdened by economic constraints. TB must be caused by a stubborn bacterium. It primarily affects the lungs, and it is similar to the high transmissibility of our SARS-CoV-2 virus, but it is poverty that sustains it. Treatment often means travelling long distances to clinics and giving up days wages. Donor agencies and international health organisations have often ignored the context for why people act the way they do. However, we need to work on ways of supporting and investing in the treatment, and I am interested in exploring the possibility of conditional cash transfers that have been used in recent years for medical interventions across the globe and their forms of social assistance programmes aiming to reduce poverty. Apart from extra income, conditional cash transfers allow patients to invest in their health through providing the means to access basic health services or by sending their children to school, which helps to break intergenerational poverty cycles. I am interested in hearing what the Scottish Government's position is on conditional cash transfer schemes and whether any of our international relief funds are supporting CCTs. In conclusion, as this year's theme is invest to end TV, to save lives, perhaps CCTs are a way to invest to do just that. Thank you, Deputy Presiding Officer. Can I thank Miles Briggs for this motion and the words that it contains? If there was a vote, I would vote for it. Today is World Tuberculosis Day, and this week started with World Poetry Day in the opening lines of On The Page by the late Tom Leonard. He said, the local is the international, the national is the parochial, and this national parliament is nothing if it does not look beyond the parochial, if it does not see its place in the world. If we do not understand that we are world citizens with global horizons neither limited by passports nor narrowed by where we happen to have been born, this debate is about our common humanity. Tuberculosis is an old disease. Many of us have family experience of the toll that it takes. My own grandfather growing up in Leeds lost two older brothers and a sister, Florence, and then one by one both of his parents from this deadly disease of poverty. It is why John Wheatley, as a Glasgow Labour councillor, strove not just for slum clearance but for good quality council housing that were, in his words, homes not hutches. Yet, in 2020, over 100 years later, one and a half million people died of this preventable of this curable disease. I am bound to say that if we invested as much in the machinery of peace as we do in the machinery of war, if we invested as much in saving lives as we do in endangering lives, the world would be a far better place. In 2020, the year when TB deaths went up again, world military expenditure in that one year was $1.781 trillion. By comparison, just $5.3 billion was invested in universal access to TB prevention, diagnosis, treatment and care across the globe. That is a ratio of 370 to 1. Healthcare is a human right. I will give it. Stephen Kerr To Richard Leonard giving ways, giving a typically passionate speech, which I agree with. But would he also join with me in paying tribute to the global fund and the work it does across the world, especially in Africa? I have seen firsthand myself the work that is done because of the global funding. Would he also acknowledge the important funders to the global fund, namely the United States, France and the United Kingdom? I think that we need to be internationalists in outlook. As I said in my opening remarks, I think that we need to understand that we are citizens of the world and we have a global responsibility in this respect. Healthcare is a human right, but to be poor in this world is to be too often denied that human right. That is why the director general of the World Health Organization, Dr Tedros Addenham Gabrasus, has said recently that the struggle to end TB is not just a struggle against a single disease. It is also a struggle to end poverty, inequity, unsafe housing, discrimination and stigma and to extend social protection and universal health coverage, because the unnecessary deaths of one and a half million people a year does not just tell us where poverty lies, it tells us where power lies between the global north and the global south, between rich and poor, between the profits of corporations and the lives of people. The World Health Organization has accused big pharmaceutical giants of, in their words, exiting the field of investment in new antibiotics to deal with drug resistance, a major cause of TB deaths. As far back as 2014, AstraZeneca withdrew all early stage research and development for TB malaria and neglected tropical diseases. The biggest pharmaceutical corporation in the world, Johnson and Johnson, deliberately charged developing countries eight times the cost price of manufacture for the newer TB drug, bed aquiline, before a campaign by Medicine San Frontier pressured them to cut it, but that was their first instinct. For big pharma, it is not about the drugs with the greatest clinical or humanitarian value, it is always about the drugs with the greatest monetary and shareholder value. Tuberculosis is a disease of poverty, of inequality and of global power and global priorities. Our job is to build a world where people have clean water and safe shelter, in which no one lives in fear of starvation, where no one dies from a disease for which a vaccine has existed for almost a century. That is the future that we need to build, a better, a just, a more humane world, a future of hope, a future of peace and, I hope, a future of socialism. Thank you very much, Mr Leonard. I now call on the minister to respond to the debate for around seven minutes, Ms Todd. Thank you very much, Deputy Presiding Officer. On behalf of the Scottish Government, I want to thank Miles Briggs for bringing this motion to the chamber on world tuberculosis day. Firstly, let me see that my heart goes out to all of those across the world who have been affected by this terrible disease. Too many lives have been lost to TV here in Scotland and around the globe, and we can't let that continue. This is a disease that, in the majority of cases, is treatable and curable. We must keep making progress towards the end of this epidemic. With that in mind, I want to acknowledge the work that has been done across the world to support the WHO NTV strategy in the UN Sustainable Development Goals. I also want to highlight the fantastic work that has been done by Global Fund, a partnership that was endorsed by the G8 that was developed to accelerate the end of TB, AIDS and malaria as epidemics. In 2020 alone, Global Fund facilitated the treatment of 4.7 million people with TB. Since its inception in 2002, there has been a 28 per cent reduction in TB deaths, excluding HIV-positive cases in the countries in which the fund operates. Although there is still undoubtedly more to be done, we should all be incredibly proud of the strides that have been taken to reduce the impact of TB across the world. Closer to home, I want to touch on the work that has been done here in Scotland. As a Government, we take the issue of this disease very seriously. We are fully committed to eradicating TB in Scotland. For over 20 years, we have monitored the disease through the enhanced surveillance of mycobacterial infection scheme, ensuring that we have access to up-to-date data on case numbers, treatment outcomes and drug resistance patterns. In 2011, the Scottish Government published the TB action plan for Scotland, setting out key recommendations on TB care and control. In the years since this plan was published, there has been a sustained reduction in TB cases across Scotland. Case levels remain well within the target of less than 10 cases per 100,000 people set in the world health organisations and TB strategy. However, as a Government, we know that we cannot become complacent. We have to acknowledge that, as numbers fall, TB cases in Scotland are becoming more complex. The patients that we are seeing in Scotland are often from underserved population groups. They may not have been born in the UK, or they are infected with a drug-resistant strain of their infection. To address the complexity of the TB landscape, the Scottish Health Protection Network's TB multidisciplinary network was established, bringing together experts from across the country. In 2017, the network published a TB framework for Scotland, built on the foundations of the TB action plan. It set out an approach to support progress towards key TB outcomes, including a reduction in the health inequalities gap of those who are diagnosed with TB. The Covid-19 pandemic put the brakes on much of the good work around TB in Scotland, as vital resources were redirected. However, I am happy to report that meetings of the implementation group have now recommenced, and I am confident that we will see good progress towards the outcomes identified. Additionally, a reference service for the whole genome sequencing of TB is now live in Scotland. That service will allow the NHS to much more rapidly predict resistance to anti-TB drugs and to assess strains to allow better investigation into clusters of the disease. To respond to Mylesbury's specific point, we acknowledge the issues around latent TB screening, and we are actively working with multiple partners to understand what more can be done in that area. I am awaiting a paper on exactly that issue, which I expect to be with me quite soon. Although there is more work to be done here in Scotland, I am proud of what we have achieved so far. As in every health debate, we have to acknowledge the effect that the Covid-19 pandemic has had on the fight against TB, and we have to acknowledge the impact that that pandemic has had on the fight against TB, not just here but further afield. Across the globe, every area of healthcare has been impacted by the pandemic, and TB is no exception. We have seen a reduction in testing. Essential resources such as labs and healthcare workers have been diverted to fight Covid-19. There have been significant declines in the number of TB cases that have been successfully treated. Despite that, there is hope. Emergency funding from the global fund is helping countries to fight TB alongside Covid-19, and investments in health workers and tools and systems to combat airborne diseases are increasing. That is a huge challenge, and we must remember that we are emerging from a pandemic that has taken a massive toll on our communities, our people and our health services. However, I know that if we harness the collective purpose that has been so evident in the last two years, we can succeed. As the situation surrounding Covid-19 continues to improve, much-needed resources will be re-routed back into the fight against TB. Of course, I recognise that meeting the 2030 target will require concentrated and focused effort, and that we have to act quickly to make up for lost time. Although progress has been made, I know that our work is far from done, and that is why this Government remains committed to supporting the sustainable development goal of ending TB by 2030. We will continue to work with Public Health Scotland and other colleagues to drive this forward. Let me finish by extending my sincere thanks to all those who have worked so tirelessly to reduce the impact of TB on lives across the world. This debate has been an excellent opportunity to highlight the fantastic work that has been done to reduce the impact of TB, and it has allowed us to take stock and consider how we can move forward. The Covid-19 pandemic has left its mark as it has on so much of our lives, but we will harness the learning and the togetherness that has been so evident over the past two years as we move forward. I commit today to continuing to strive for a future where TB is eliminated here in Scotland and across the world. That concludes the debate, and I suspend this meeting of Parliament until 2pm.