Neglected Tropical Diseases

Tuesday 26th June 2012 Westminster Hall

13:30

[Jeremy Lefroy (Stafford) (Con)]

It is an honour, Mr Williams, to serve under your chairmanship.

I declare an interest as the chairman of the all-party group on neglected tropical diseases. NTDs are a group of diseases that affect more than 1 billion people around the world. They do not have the high profile of malaria, HIV/AIDS or TB—hence the word “neglected”—but they result in disability and death. Even for those who are less seriously affected, they bring chronic conditions that mean loss of income. Such diseases include worms or helminths, schistosomiasis or bilharzia, trachoma, lymphatic filariasis or elephantiasis, and leprosy.

Almost without exception, NTDs are diseases of the poor. They are also curable. The World Health Organisation’s 2010 report found that approximately 90% of their burden can be treated with medicines administered only once or twice a year, and that can sometimes be achieved for as little as 50 US cents. Treating and eradicating those diseases must be at the heart of any programme to tackle poverty. Yet as the title of the debate makes clear, they have been neglected for many years. Institutes such as the Liverpool and London Schools of Tropical Medicine, Imperial College London and the Antwerp Institute of Tropical Medicine, working with researchers and institutes in developing countries, have made great strides in the understanding and treatment of NTDs.

[Chris White (Warwick and Leamington) (Con)]

I congratulate my hon. Friend on securing this important debate, not least because his knowledge of the matter is well recognised. Does he agree that Members of Parliament have a role in highlighting neglected tropical diseases, making the public, the media and policy makers aware of them, and ensuring that we reduce them because they kill millions of people every year?

[Jeremy Lefroy]

I am most grateful to my hon. Friend for making that extremely important point. I will come to the reasons why it is important—particularly with regard to efficiency in the use of aid money, which is a major public policy question.

In recent years, Governments, principally in the UK and the USA, have begun seriously to fund work on NTDs. In the UK, this began under the previous Government with an allocation of £50 million. Earlier this year, the Department for International Development announced a further £240 million over four years, which will supply more than four treatments every second for people in the developing world. I pay tribute to the Secretary of State and his predecessor for recognising the importance of this work. We are especially fortunate because the Minister—I am delighted that he will respond to this debate—has been a champion in the fight against NTDs, both when he was chairman of the all-party group and subsequently as Minister.

Drug companies have also made a great contribution, working with bodies such as the Bill and Melinda Gates Foundation. On the day when the UK announced a fivefold increase in its funding commitment to tackle NTDs as part of a global partnership, all drug companies with NTD drug donation programmes pledged to sustain, extend or increase their programmes to the end of the decade.

For example, GlaxoSmithKline has already donated nearly 2 billion tablets of albendazole for lymphatic filariasis and will continue until elimination is achieved. It is also providing 400 million tablets a year free of charge until 2020 to de-worm school-age children in Africa. Johnson and Johnson is increasing its annual donation of mebendazole to 200 million tablets every year—again, to tackle worms. Novartis is continuing its commitment to providing multi-drug therapy against leprosy in a final push against the disease. Pfizer will continue its donation of drugs for blinding trachoma until at least 2020, as well as donating the drug and a placebo for a study on the reduction in mortality of children treated with that drug. Sanofi, Merck and various other companies are also providing major drug donations.

It is not only drugs that are important, but vaccines. The Sabin Vaccine Institute, in which I declare an interest as a trustee of its UK charitable body, is developing vaccines to treat NTDs around the world.

We have come a long way in tackling such diseases in the past decade. The number of new cases of leprosy reported to the WHO has fallen every year since 2002 from 620,000 to 249,000 in 2008. The number of new cases of human African trypanosomiasis reported to the WHO worldwide fell from 37,000 in 1998 to 10,000 in 2008. However, there is still much to do—and it can be done. Three things are essential. The first is to keep up funding. In the 1960s, malaria was on the retreat, but the world took its eye off the ball and it came back with a vengeance in the 1980s and 1990s. Malaria is now again being tackled, but at a cost of $5 billion to $6 billion a year and after millions of unnecessary deaths.

The lesson is that we need consistency and determination. The UK has rightly decided that eradicating NTDs is one of the best ways to tackle poverty, and we should make that part of our work each year until the work is done. I am not asking for more money. DFID has committed a substantial amount each year for the next four years. However, there should be no uncertainty about future funding. DFID should continue to be a reliable partner over several Parliaments.

At the same time, I should like DFID to encourage other countries to begin or increase support for the work. The USA has been a reliable funder, for which we are grateful. It would be most welcome if it, too, could commit to stable amounts over several years. Then there are donors who have yet to contribute to the work. Will the Minister report on what he is doing to encourage others into the fold?

Secondly, we need to support the countries in which NTDs are endemic, to strengthen their health systems. The most important thing I have learned in the past year as chairman of the all-party group is that it is only through effective grass-roots health systems with committed, trained staff, often backed by community volunteers, that the fight against NTDs is sustainable. One-off treatment campaigns can be effective, and are necessary where systems are weak or do not exist, but the effects will fade unless they are backed up by permanent staff and clinics.

The UK has considerable expertise in working with developing countries to strengthen their health systems, but it is vital that the countries themselves meet their commitments, under the Abuja declaration, to spend 15% of their total budget on health. Few are doing that. I would like the Minister to let hon. Members know what the Government are doing to encourage our partner Governments in those countries to keep to their commitment under the Abuja declaration.

Finally, we need to support research. I have been heartened, as chairman of the all-party group, to see both how closely involved and how generous several pharmaceutical companies have been in tackling NTDs in the way I have outlined. However, we need to work closely with them and the research institutes in the UK and elsewhere to ensure that there is a pipeline of effective drugs for all the relevant diseases. Developing drugs and vaccines and bringing them to market is costly; those who suffer from NTDs cannot afford prices that reflect the cost of the research and development. However, although the market may not justify the cost of R and D, common humanity does, and that is where the British people, through DFID, can make a huge contribution.

We often speak about DFID doing this or the British Government doing that, but it is not they but the British people who are making the work possible, by their commitment to international development. I know that the voices raised against are often loud, but in my constituency of Stafford I have met thousands of people who give up their time and money to support projects around the world—schoolchildren, scouts, guides, community groups, churches and others. When the British people see that it is their support, through donations and taxes, that is helping to improve the lives of millions suffering from NTDs, they should know that they are an essential part of that great endeavour.

13:39

[Pauline Latham (Mid Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Williams. I want to pursue some things that my hon. Friend the Member for Stafford (Jeremy Lefroy) said, and to congratulate him on securing this debate on such an important subject. He dedicates a huge amount of his time to malaria and NTDs through his chairmanship of the all-party parliamentary group.

As vice-chairman of the all-party groups on HIV and AIDS and on malaria and neglected tropical diseases, I have been struck by the emerging evidence that patients suffering from some NTDs are more likely to contract HIV/AIDS or severe malaria. Dr Peter Hotez writes in his manuscript entitled “The neglected tropical diseases and the neglected infections of poverty: overview of their common features, global disease burden and distribution, new control tools, and prospects for disease elimination” that

“in the case of malaria there is a high degree of geographic overlap with hookworm infection…with evidence to show that co-infections of malaria and hookworm result in severe anemia…Similarly, urinary tract schistosomiasis, which occurs in more than 100 million people in Sub-Saharan Africa…commonly results in female genital schistosomiasis that is associated with a threefold increased susceptibility to HIV/AIDS”.

In other words, if we are effectively to tackle the killers—malaria and HIV/AIDS—we need to treat NTDs at the same time. Given that, will the Minister ask the Global Fund to Fight AIDS, Tuberculosis and Malaria to consider embracing NTDs as well? I appreciate that the fund currently faces financial difficulties, with the cancelation of round 11, but it would be a good start if it could acknowledge the importance of tackling NTDs in the fight against malaria and HIV/AIDS, and encourage its donors to support work on NTDs, just as the UK and the USA are doing.

I also emphasise that by tackling NTDs we are not only working with people to improve their health but helping them to pursue their livelihoods, to escape the very poverty that makes it much more likely that they will contract the diseases, which ensures that the millennium development goal of tackling poverty continues to elude many countries. Many NTDs, if untreated, result in chronic disability and, given that most people who suffer from them are likely to be involved in agriculture or manual labour, such disability severely affects their chances of earning a living.

In conclusion, I congratulate the Government on announcing a fivefold increase in UK support for the work in fighting NTDs. It meets DFID’s criterion for tackling poverty and, given the low cost of treatment and the 2 billion people affected in one way or another, it represents very good value for money.

13:42

[The Parliamentary Under-Secretary of State for International Development (Mr Stephen O'Brien)]

I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) not only on securing this important debate but on his relentless and consistent commitment to the improvement and survival of all vulnerable people, and in particular children, in many parts of the planet. His commitment, both in his life before Parliament and since taking over the chairmanship of the all-party group on malaria and neglected tropical diseases, carries huge influence and is much appreciated by parliamentarians across the House.

This debate comes at an important moment. While being gracious enough to acknowledge his generous words, I hope that he will be the first to admit that the effort to tackle neglected tropical diseases is very much a combined and collective one. Many people have worked over many years to address this issue, which is one of the most tangible issues that our generation can get to grips with in the field of preventable, avoidable and treatable diseases. NTDs have struggled to compete against the three best-known diseases—HIV/AIDS, tuberculosis and malaria—because they often do not kill. Nevertheless, they impede and imperil the quality of life and well-being of many people in many parts of our planet.

I shall begin by setting the debate in a bit of context, from the coalition Government’s perspective, and I shall then seek to answer Members’ questions. When we came into office a couple of years ago, we made it clear that we wanted to build a different style of international development, one based on dynamic partnerships as well as on the relentless pursuit of results and value for money in the Department’s work. I think that it is accepted as common ground, both here and across the House, that the tackling of global disease, particularly tropical and not least neglected diseases, represents value for money. Our vision for controlling NTDs involved marshalling the evidence that NTD programmes deliver results, to justify increasing our investment considerably over the next few years. We were certainly encouraged and influenced by the very positive reports from across the NTD world, including from our pharmaceutical company partners, the World Health Organisation, the Bill and Melinda Gates Foundation, and indeed the United States Agency for International Development, which was rightly referred to by my hon. Friend.

The UK’s experienced and respected academic community has encouraged us to relentlessly do more. I well remember the many representations that I received when I occupied the chair of the all-party group on malaria and neglected tropical diseases, which my hon. Friend now occupies. The UK academic community’s conviction was, and remains, infectious and undiminished, and I found that their information was an enormously useful body of information to carry with me into office as a Minister.

The coalition Government’s determination to achieve the UN’s target for official development assistance spend of 0.7% of GNP, and to do that by demonstrating life-changing and transformative results to the British public, provided the bedrock for the decision that we have taken. Our conclusion was that a significant increase in the level and scope of our involvement was warranted to improve health outcomes and to reduce poverty, while ensuring value for money in achieving those results.

As my hon. Friend has already said, last October at a joint event with President Carter—whose own personal commitment in this sector has been undoubted throughout his post-presidential career—I pledged that the UK would increase its support to trying to achieve guinea worm eradication by 2015 if others stepped up and were able to help to close the financing gap. The challenge was met in January, when the Bill and Melinda Gates Foundation, His Highness Sheikh Khalifa bin Zayed Al Nahyan, who is the President of the United Arab Emirates, and the Children’s Investment Fund Foundation pledged enough money to close that financing gap.

That was important because, as my hon. Friend indicated, it is necessary to seek to encourage others. It is not just a question of seeking, as it were, to impose any kind of leadership or leverage; it is actually about how we get the best collective effort. That will be the most sustainable part of the process in the future, rather than continually having to renew funding.

That exercise in January was really helpful and it has given us great encouragement in this field. Although it is, of course, early days on the road to 2015, it is not so early that we do not need to make progress. So far this year, the results have indeed been impressive. Only in South Sudan has there been any reported cases of guinea worm this year. There have been 143 cases there, which represents a reduction of 62% compared with the same period last year. Of course that is good news, but we should remain aware of the considerable difficulties of operating in many of the affected countries as we aim to maintain the strong progress that has been achieved so far.

On 21 January, we announced increased support for NTD control measures. That increased support has strengthened the UK’s partnerships with the WHO, with foundations, with other donors and with pharmaceutical companies that make drug donations—donations that are much appreciated and hugely valuable—as well as with the endemic countries and indeed with NGOs. As well as guinea worm eradication, the UK’s NTD package comprises five distinct but integrated strands; I will repeat them, although they were accurately described by my hon. Friend.

We will increase support to fight the other diseases that we are already working to combat, which are lymphatic filariasis, onchocerciasis, schistosomiasis and soil-transmitted helminths.

We will conduct more research, which is absolutely critical. Research was one of the issues that my hon. Friend raised. That research will build on the back of a fantastic track record of research around the world, not least in this country, where we have global centres of excellence. I had the honour and the privilege to be the vice-chairman, in a voluntary capacity, of the Liverpool School of Tropical Medicine, where I saw such research for myself. The London School of Tropical Medicine, other London universities and colleges and many other institutions around the country also carry out research.

We have been seeking to strengthen the capacity of the WHO’s NTD department itself, and now we are able to do so. There are new programmes to control trachoma and visceral leishmaniasis, and an integrated programme approach to tackle a range of NTDs in two high-burden countries because, as my hon. Friend is well aware, there are quite a number of opportunities for synergies in tackling a number of diseases, where one can graft on to the back of some of the interventions for HIV/AIDS, and particularly for TB and malaria, not least because of the bed nets.

In many respects, referring to that issue is a way that I can answer the essential question put by the hon. Member for Mid Derbyshire (Pauline Latham); I am grateful to her for her contribution to the debate. She asked if the global health fund could be extended to tackle NTDs. It is fair to say that even in the current circumstances, which she acknowledged are an impediment, the fund’s focus is on HIV/AIDS, malaria and TB, and even if there were not the current financial readjustments, which we hope will give us a stronger position to go forward and sustain what the fund is best at doing and what it has been tremendously successful at doing in the last 10 years, a focus on NTDs could be a distraction and could start diluting the fund’s efforts, particularly through the country co-ordinating mechanisms, which are the essential mechanism through which delivery is made at country level. What will be important, however, is to look at whether we can give a greater sense of purpose and instruction to the way in which the country co-ordinating mechanisms work to see where those synergies can be captured. In that way, we get the consequential collateral benefit of addressing the NTDs through what is already taking place or could be easily and mechanistically expanded in an easy, practicable, community-based way at ground level up when dealing with HIV/AIDS, TB and malaria programmes. Building on that community health approach should in itself bring benefits to the NTDs. The NTDs themselves tend to be rather more specifically focused and are somewhat more geographically identified than some of those broader-range diseases. We need to be careful, therefore, not to force or to graft something on to them. I take the point seriously, and the answer is probably through synergies.

On 30 January this year, we had the London declaration, which took us a step further and set us the challenging 2020 deadline to demonstrate real progress. The meeting brought together some of the countries most heavily afflicted by NTDs—pharmaceutical companies, donors, academics, foundations and international financial institutions. Together we pledged to focus on 10 diseases, majoring on the five that preventive chemotherapy can control, such as schistosomiasis, and five that fall into the intensified disease management category, including guinea worm and visceral leishmaniasis, and to continue to support research. I hope my hon. Friend is pleased with this emphasis on research about which I am pretty obsessed. I had to give evidence myself yesterday to the Science and Technology Committee, which was not easy.

[Jeremy Lefroy]

I am delighted by the emphasis on research. As the Minister has already said in his speech, the UK is a world leader in research. I have visited the Liverpool school and was mightily impressed by what I saw there. We have also had huge contributions from the London school and Imperial college among others. I am delighted to hear that the Government place such great emphasis on research.

[Mr O'Brien]

As ever, one should back centres of excellence. We are all pleased to acknowledge that. I was pleased to see that the director of the Liverpool School of Tropical Medicine was awarded a CBE in the recent Queen’s honours list.

Essentially, the challenge is set for all of us to work together in a complementary fashion through an overall strategy that allows these diseases to be managed within a country’s primary health-care system—to the extent that there is capacity in the system to work with—and ultimately to be eliminated as a public health problem. National legislatures have an important role to play here in making the case to Health and Finance Ministers on behalf of their constituents.

The session in London was groundbreaking, but after the fine words, the question is how to put them into effect. The first point is that of course we are building on a number of existing partnerships that for years had sought additional resources to expand their range and coverage. The second point, which is an answer to one of my hon. Friend’s questions, is the positive response. In many ways, it also addresses the point made by my hon. Friend the Member for Warwick and Leamington (Chris White) who helpfully reminded us that we must continue with commitment to build awareness among the public. There must be a public buy-in and sense of ownership of this approach. There is the political will within the UK to sustain the support for these tremendous interventions that have such an effect and impact on the most vulnerable in the world. Getting that positive response and support from organisations such as the Children’s Investment Fund Foundation and Geneva Global was encouraging.

In late 2011, a number of institutions here launched the UK Coalition against NTDs as a collaborative partnership between UK organisations actively engaged in research, implementation and capacity building for NTD control at scale. Bringing considerable experience to bear on lymphatic filariasis, schistosomiasis, guinea worm and avoidable blindness are at the forefront of the push for integration, especially at the country level, with country and other developmental partners. Its aim is to expand the numbers of organisations and sectors committed to supporting NTD control.

What has happened over the past five months? The UK has agreed with WHO on how to strengthen its NTD department capacity. That is important, as the department plays the key role of convening and setting standards, as well as helping ensure that the donated drug supply matches and meets demand. My Department has made considerable progress in developing the new trachoma and visceral leishmaniasis programmes, as well as programmes for an integrated approach to tackling neglected tropical diseases in two countries.

Expanding programmes to tackle neglected tropical diseases is an international effort. We are working closely with colleagues, particularly in the United States Agency for International Development, the World Bank, WHO and the Bill and Melinda Gates Foundation, to ensure that we continue to seek effective mechanisms for tackling such diseases while working through health systems, for example by exploring mass drug administration through schools and the role of improved water and sanitation.

Working collaboratively in-country is high on the agenda, as is developing strategies for working in challenging countries with heavy NTD prevalence, such as Nigeria, the Democratic Republic of the Congo, which the Select Committee on International Development recently visited, and South Sudan, where I was recently. That will reinforce value for money and avoid duplication, which is vital to increasing impact.

Binding together all that work is our relentless focus on the achievement of results. Our bold decision to maintain development spend at 0.7% of gross national income at a time of UK spending austerity brings with it an obligation to demonstrate to our constituents as well as to those benefiting from our programmes that the money is being extremely well spent.

The results of our investment will be huge. By 2015, UK support will help to protect more than 140 million people from neglected tropical diseases and the suffering, disability and death that they may cause. To do so, we have increased our financial investment and cumulative spend from £50 million to £245 million by 2015. Our investment provides a platform for expanding our work with the NTD community. With them, we can build on partnerships for change among international agencies, Governments, academic institutions, non-governmental organisations, corporations, national Ministries of Health, and most of all with people who live where the road ends. Increasing Government commitment through increased domestic resource provision is the starting point for sustainability, including strengthening the systems that deliver health services.

I pay tribute to a vast range of academics, campaigners, NGOs and parliamentarians. Within just two years of the formation of the coalition Government, we have made a massive step up. There is cross-party recognition of a commitment to scale up over the past couple of years, I am pleased to say, in the context of our overall commitment to international development on behalf of the British people, whose broad generosity we are able to express through such innovative programmes.

We must recognise and accept that there is a risk of failure. Although we think that the interventions are well proven and their value for money will be great, as my hon. Friend the Member for Stafford said, there was a reverse on malaria in the past. I have just returned from the Sahel, where we were considering nutrition, a completely separate issue. Part of the challenge is that as we achieve success, the pictures will not be on our television screens. Being able to sustain it means committing continuing resources at the same if not greater levels. We must retain the political will to do the right thing through early interventions that work, making the political case all the tougher. Therefore, having champions such as my hon. Friend and the two colleagues who have joined him today is vital as part of the broad coalition of interest, which will ensure that we have the greatest impact in our generation for the most deliverable solutions for some of the greatest need in the world.

My hon. Friend the Member for Stafford asked about vaccine development, which he knows I support strongly, in many respects, for all diseases for which it is possible. We all wait with bated breath to hear whether the first vaccine for a parasite-borne disease, malaria, will become an effective element in the toolbox against that disease and for the control of its transmission. Our support for vaccine development, particularly for neglected tropical diseases, is given primarily through the drugs for neglected diseases initiative and through Tropical Diseases Research at the WHO. Working collaboratively through those institutions, we harness the greatest expertise. Of course, as with all vaccines, we need proof that it really works in adults and children effectively and efficaciously. It is rare to find a vaccine that is an absolute solution rather than just a tool in the box.

14:00

Sitting adjourned without Question put (Standing Order No. 10(11)).