Written Statement: Eliminating TB in Wales

As we begin the new year, I wanted to provide an update to Members on our progress towards eliminating tuberculosis (TB) in Wales, in line with the World Health Organisation’s (WHO) vision to have the European Region free of the TB burden by 2030: Tuberculosis action plan for the WHO European Region 2023–2030. Information sheet\.

Wales currently has the joint lowest TB rates in the UK (2.8 cases per 100,000 population[1]) and overall rates have been declining since 2009.

Despite this downward trend, we continue to see some TB-associated deaths every year in Wales and the headline figures hide some increasing risks in TB prevention and control.

Around half of all cases of TB in Wales in recent years have been in people born in the UK, which creates a different set of challenges for detection and control. Cases are generally increasingly challenging and complex, and there is the continued threat of sporadic multi-drug resistant and extensively drug resistant cases.

TB is a potentially fatal disease with major health and social consequences for those affected. It contributes to increasing health inequalities in already deprived populations, and each infectious case represents a transmission risk to their contacts and communities.

Although most TB cases are curable, successfully supporting a single complex

case through treatment can have major resource implications for the NHS and wider public services. Furthermore, strong evidence exists to demonstrate that failure to prevent, diagnose and adequately treat cases can lead to the development of drug resistance, onward transmission of infection and TB outbreaks.

Even a single case of TB can lead to large and difficult-to-manage clusters and outbreaks. In 2018, there were three outbreaks of TB in Wales, all requiring screening of extensive numbers of contacts. The outbreaks had a serious impact on both the affected individuals and NHS resources.

Mass community screening of more than 1,500 people took place in 2019 due to a continuing outbreak with a cumulative total of more than 30 TB cases since 2010.  This long-running outbreak has caused significant public concern, and activities associated with screening continue to this day. In 2020, a second mass screening exercise involving more than 1,000 staff and prisoners was undertaken following a TB incident associated with a prison. 

That rates of TB in Wales have declined since 2009 is largely a tribute to the professionals involved in TB prevention, diagnosis, treatment and control. Given the challenges, we need to ensure there is renewed focus to eliminate TB in Wales.  I have therefore agreed a number of actions will be taken forward:

• We will establish a bespoke TB Elimination Oversight Group to monitor and drive forward progress across Wales. It will report to the Chief Medical Officer under the Health Protection Advisory Group governance arrangements.
• Public Health Wales will re-establish the All-Wales TB Group, which was stood down during the pandemic. Its remit will include consideration and review of evidence including learning from outbreaks, advising on issues such as prioritisation of services and screening requirements for entrants into Wales and the development of guidance to support professionals.
• The first task of the All-Wales TB Group will be to review the Tuberculosis Strategy and Service Specification for Wales to incorporate the valuable lessons learned from both the Covid-19 pandemic and the programmes established to welcome those seeking refuge in Wales.
• The All-Wales TB Group will recommend the updated Tuberculosis Strategy and Service Specification for Wales to the TB Elimination Oversight Group for review and endorsement as a direction of travel in Wales.
• The All-Wales TB Group will develop a National TB Action Plan for agreement by the TB Elimination Oversight Group. This will be regularly reviewed to ensure the agreed actions are implemented.

I will keep Members informed of our efforts to prevent and control TB and our commitment to ultimately eliminate TB as a public health threat. 

[1] Reports of cases of TB to UK enhanced tuberculosis surveillance systems, 2000 to 2021 - GOV.UK (www.gov.uk)