Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694840201181.pdf (Malta)
IT-TNAX-IL LEĠIŻLATURA P.L.

7028 Dokument imqiegħed fuq il-Mejda tal-Kamra tad-Deputati fis-Seduta Numru 382 tas-27 ta’ April 2016 mill-Onor.

Etienne Grech, President tal-Kumitat Permanenti dwar is-Saħħa.

_______________________________ Raymond Scicluna Skrivan tal-Kamra Report by the Standing Committee on Health On Friday 8 April, 2016 the Health Committee chaired by Hon.

Etienne Grech met Rt.

Hon.

Nick Herbert MP, co-chair of the Global TB Caucus.

Rt.

Hon.
Rt.

Hon.

Herbert was accompanied by Mr Matt Oliver, Head of Secretariat of Global TB Caucus.

Hon Claudette Buttigieg and Hon Deo Debattista, members of the Health Committee were present.

Also present was Mr Jason Eades.

The following subject matters were discussed during the meeting: 1.

Tuberculosis Tuberculosis (TB) is a top infectious disease killer worldwide and in 2014 alone, 9.6 million people fell ill with TB and 1.5 million died from the disease.
Over 95% of TB deaths occur in low and middle-income countries.

In 2014, an estimated I million children became ill with TB and 140 000 children died of this disease.

TB is also a leading killer ofHIV-positive people, where in 2015, 1 in 3 HIV deaths was due to TB.

Since it was declared a global health emergency over two decades ago, TB has killed 15 million people, and is now the world's greatest killer, killing more people than HIV, AIDS and Malaria.
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.

TB is spread from person to person through the air and a person only needs to inhale a few of these germs to become infected.

People infected with TB bacteria have a I 0% lifetime risk of falling ill with TB.
However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill. People with active TB can infect 10-15 other people through close contact over the course of a year.

Without proper treatment, 45% ofHIV -negative people with TB on average and nearly all I-IIV -positive people with TB, will die.

2.
2.

Global TB Caucus (attached) Rt Hon Nick Herbert, together with other MPs, was invited by a British NGO to visit Kenya as a part of a cross-party delegation of Members of Parliament from the United Kingdom to view TB and HIV programmes there.

On their return to the UK, the MPs collectively formed an All-Party Parliamentary Group on Global Tuberculosis (APPG TB).
The APPG TB focused on the UK parliament, but similar groups were launched in the USA (the TB Elimination Caucus), in Canada (the HIV and TB Caucus), and in Brazil (the Parliamentary Front Against TB).

Since then the committee has helped to raise the profile of this disease; both in the UK and globally.

The aim of this group is to try and drive more effective action to tackle a disease that is killing 1.5 million people a year.
Delegates agreed to establish a Global TB Caucus and launch the Barcelona Declaration, a political call to arms on TB.

The Global TB Caucus was officially formed in 2014.

3.

Barcelona Declaration (attached) The Barcelona Declaration is the founding document of the Global TB Caucus.

The Declaration is open to any political representative in the world to sign and is a demonstration of support and solidarity for efforts to end the TB epidemic.
It is designed to raise the profile of the disease amongst politicians.

To date the Declaration has been translated into fifteen languages and signed by over 1,000 political representatives from over 100 countries.

The idea of the Barcelona Declaration is that cooperation should be internationally and in each parliament of the world.
Also by means of the declaration, parliamentarians can put pressure to raise the profile of this issue and persuade their own governments that more needs to be done about this disease.

4.

United Nations In September 2015, the United Nations created a new Sustainable Development Goal which was agreed by every country.
Sustainable development goal 3.3 commits that: "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. "

But at the current rate of progress, TB will be beaten in 200 years' time and not in 15 yem-s time as the UN are predicting!

Although rates went down sufficiently to meet the millennium development goal to half the prevalence in 15 years, they are not going down at a sufficient rate.
Unless the rate is brought down at a more rapid rate, this goal will not be met, and millions of people will still die every year.

5.

Treating TB Tuberculosis is treatable and can be curable.

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The treatment is a standard 6 month course of four main drugs, which is difficult to administer and the process is cumbersome as a person is required to go to a health clinic and receive the drugs, which are old fashioned antibiotics as no drugs have entered the frontline regime since 1962.
Health Clinics provide information, supervision and support to the patient by health workers or trained volunteers.

Without support, treatment can be difficult and the disease can spread.

The vast majority of TB cases can be cured when medicines are provided and taken properly.

Between 2000 and 2014, an estimated 43 million lives were saved through TB diagnosis and treatment.

6.
6.

Drug-resistant TB If a person stops taking TB treatment, there is a risk of drug-resistant TB, which is not only a risk to the person concerned, but is a risk to other persons as well, as similar to TB it's an air borne infectious disease.

If a person is diagosed with drug-resistant TB in a developing country, it is a death sentence.

In a developed country, it can be treated with dtugs that are very expensive to take and with serious side effects.
If dmg-resistant TB were to take hold, it could pose quite a serious threat; not just to developing countries but also to developed countries.

Dmg resistance flared up in Eastern Europe, because they have a history of using ineffective drugs.

Although in many cases, dtug resistance happens because people just don't complete the six month course of antibioticsm as after a few months taking the drugs, they start to feel better and that's the danger, which gives rise to resistance.

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Concerned about the rising levels of drug resistance, whereby microbes evolve to become immune to a known drug, the UK Prime Minister David Cameron setup a review to analyse the global problem of antimicrobial resistance (AMR) and propose concrete actions to tackle it internationally.

TB is a big part of this potential risk.


Studies has shown that the cost to the world's economies if drug resistance TB takes off in all its forms, including in relation to TB, could run into tens of billions of dollars which in the course of the next few years, could be very substantial indeed.

7.
7.

The Local Set-up Although migrants, who enter Malta by boat, are screened for TB on their arrival and have been so since a number of years, all other foreigners who enter Malta legally, including persons who come to work, are not screened.

According to national statistics, there were no Maltese persons who were found to have the drug-resistant TB but cases of drug-resistant TB were found in Malta of Eastern Europeans and a person from the Far East.
There were no reported deaths associated with TB in Malta.

In the last five years, the number of persons who were found to be TB positive, were quite significant.

Cases are for both Pulmonary and Extrapulmonary Tuberculosis.

Year 2011 2012 2013 2014 2015 Cases (Pulmonary/Extrapulmonary) 33 41 51 47 32 8.
Malta's EU Presidency Malta will be having the Presidency of the European Union in 2017 and should take the opportunity that the European Union be persuaded to do more in the area of anti-microbial resistance.

While health is a reserved matter for domestic governments, a lot can be achieved tluough cooperation and raising the profile of these issues.

The European Union can make an important contribution to the need for more research and development.
The European Union can help to raise the profile of these issues and to drive more effective action; particularly because of the risk of anti-microbial resistance, which TB can be a big component.

9.

Recommendations The Rt Hon Nick Herbert, co-chair of Global TB Caucus, proposed a number of issues for the consideration of the committee.
Rt Hon Herbert suggested the following recommendations: 1) that members of the Health Committee encourage the Maltese Parliament so that a cross-party committee discussing Tuberculosis be setup; 2) that Members of Parliament from the Maltese Parliament, sign the Barcelona Declaration and become members of the Global TB Caucus, ' ,, '' ,, 3) that the key priority is the push to update the TB, HIV and Hep C Policy Framework, and 4) during the European Union Presidency in Malta, the issue of anti-microbial resistance should be high on the agenda to draw out the particular role and risk of Tuberculosis.
The Chairman and the Committee members took favourable note of the above-mentioned recommendations and informed Rt.

Hon.

Nick Herbert that they shall be presenting a report to the Speaker of the House and the Minister for Health. '

GLOBAL TB CAUCUS THE BARCELONA DECLARATION We, the undersigned, as political representatives of various peoples of the world, recognising that every man, woman and child should be able to live their lives free from the tyranny of disease, HEREBY DECLARE: 1.
That tuberculosis (TB) has killed a greater number of people than any other infectious disease in human history and continues to be responsible for 1.5 million deaths a year, often affecting the most vulnerable, and that it should be a global political priority.

2.
2.

That the current rate of progress in combating TB is too slow, such that the disease will remain a threat to the social and economic wellbeing of millions of citizens around the world for centuries to come, and that accelerating progress against the disease should be recognised by all governments to be in the interests of all.

3.
3.

That drug-resistant TB demonstrates a collective failure to address the disease properly, imposing an often unbearable burden of treatment on patients and threatening to setback progress against the disease at the grave cost of millions oflives, and that it should be the focus for urgent action.

4.

That the current drugs for TB treatment are inadequate, that vaccines and diagnostics are insufficient, and that the commercial market for pharmaceutical development has failed TB patients.

5.
5.

That TB imposes on patients a triple burden, combining the devastating health impact of the disease itself, the harsh burden of treatment, and the isolation of social exclusion driven by stigma and fear, and that these problems should be be addressed holistically by national health programmes.

6.
6.

That TB co-infections such as HIV and diabetes compound the challenges faced by patients during treatment, hindering efforts to reduce rates of disease and increasing the mortality and morbidity associated with TB, and that healthcare systems should integrate programmes for key co-infections.
We therefore commit to use all the means at our disposal to urge sustained action from our governments, to secure the necessary international and domestic resources to combat TB, and to press for the prioritisation of the disease on political agendas, specifically: 7.
To demand that every patient, regardless of who they are, where they live, or their ability to pay, shall have access to quick, accurate diagnosis and high quality treatment, and that TB diagnosis and treatment never result in the impoverishment of patients or their families.

8.
8.

To call for a model of research and development that is driven by public health need and will support and enhance existing pipelines of desperately needed new drugs, diagnostics and vaccines, to ensure that new treatments are accessible and affordable for the patients who need them.

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" 9.
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" 9.

To insist that patients and vulnerable groups are placed at the heart of the response to the disease, supporting the engagement of communities and civil society groups in every aspect of TB prevention, detection, and treatment, puncturing stigma and giving patients a stronger voice in the response to the epidemic.
And to this effect WE HEREBY AGREE to establish a new global parliamentary caucus to press for a more effective response to the TB epidemic, working with official organisations including the World Health Organisation, UNIT AID, the Global Fund, the Stop TB Partnership, the Union and UN AIDS, and with non-govermnental organisations across the world, reaching across political and geographical divides and seeking to build commitment in our own countries and beyond, to secure an end to the TB epidemic within a generation.
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" Terms of Reference for [name of country] TB Caucus Prepared by: Global TB Caucus Secretariat 1.

The [name of country] TB Caucus exists to "raise the profile of the global TB epidemic and to accelerate progress towards the elimination oft he disease."

2.

Membership of the [name of country] TB Caucus is open to any parliamentarian from any political party in [name of country].

No political representative can be excluded from membership of the Caucus and participation in its activities.

3.
3.

The [name of country] TB Caucus does not have the authority of the [name of parliament], and is not an official parliamentary bodies.

Groups should avoid presenting themselves in such a fashion as to be confused with official committees.

4.

The [name of country] TB Caucus is strictly prohibited from taking outside funding from any organisation which has the sole purpose of gaining access to Members of Parliament.
It should be made clear to any donors that such funds as are received by the Caucus do not confer any special privilege on the donor beyond the general benefits received from a high political profile of TB.

5.

Members shall receive no reimbursement or recompense for their membership of the group.

Time devoted to the group is entirely voluntary.

The only exception to this is overseas travel, when Members may have their costs covered by sponsoring organisations.
All such details must be declared to the relevant authorities in full and in a timely fashion.

6.

The [name of country] TB Caucus will hold such meetings as deemed interesting by the officers and are relevant to their campaigns.

The Caucus will hold an Annual General Meeting {AGM) for the purpose of electing new officers.

7.

The [name of country] TB Caucus is led by its members for its members.

Members of the Caucus elect 'officers' to lead the work of the group.
These officers should reflect the cross party nature of the group.

Any member may nominate themselves to be an officer ofthe group, election is contingent on winning a simple majority of the votes present at the Annual General Meeting.

8.

The officers of the national Caucus may appoint a secretariat that will support the work of the group.
The secretariat's duties include {but are not limited to): event organisation, meeting Members of Parliament, and supporting the activities and interests of the officers.

This position receives no public funding, but the officers may choose to fundraise to support the post.

9.
9.

The [name of country] TB Caucus will seek to strengthen ties with other such groups around the world in the pursuit of its overall goal of eliminating the TB epidemic and will select an individual {or individuals) to attend regional TB Caucuses or the Global TB Caucus meetings as appropriate.

Date: 04/12/15 '.

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