(11 years, 9 months ago)
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Baroness Hayman
To ask Her Majesty’s Government what progress has been made in combating neglected tropical diseases since the London declaration on NTDs of January 2012.
Baroness Hayman
My Lords, much has been achieved since the signing of the London declaration on neglected tropical diseases a year ago today. Substantial progress has been made in raising awareness of the issues—in that respect I welcome the number of noble Lords who have put down their names to speak in tonight’s debate—and in the fight to control and eventually eliminate the scourge of this group of debilitating and disabling conditions.
They are diseases caused by viruses and bacteria transmitted through snails and worms, flies and mosquitoes. They are found predominantly among poor, rural and semi-urban populations in Africa, Asia and Latin America, with almost half their health burden in sub-Saharan Africa. NTDs cause disfigurement and disability, anaemia, stunting and blindness to hundreds of millions of people worldwide. It has been estimated that among the 1.4 billion people who constitute the poorest in the world today, there is not a man, woman or child who has not, is not or will not be affected by at least one of these diseases. They are not just neglected diseases in terms of research or money: they are the diseases of neglected people.
The London declaration set out an ambitious plan to work towards the control and elimination of NTDs, building on the programme set out by the World Health Organisation. The substantial progress that has been made in the past year has been clearly set out in a series of recent reports from, among others, the WHO and the Bill and Melinda Gates Foundation. Only yesterday, the executive board of the WHO passed an important, comprehensive and authoritative resolution committing the authority to grow the programmes already in place and integrate them further into the health and development agenda.
I do not intend tonight to do the Minister’s work for her by answering in detail my own question as to the progress made over the past year, but I want to emphasise the advantages that have come from the partnership approach of the London declaration: the bringing together of the pharmaceutical companies that have contributed, free of charge, more than 1 billion treatments; the endemic countries, 40 of which have developed multiyear integrated NTD plans; the donors who have committed funds to support delivery of those programmes and increase the resources available for mapping and research; and the academic institutions that are undertaking that research such as the London Centre for NTDs launched today—an important UK initiative—which will concentrate on identifying and supporting best practice and answering the practical operational questions that we need so much to understand.
The commitment to rigorous monitoring and evaluation through the scorecard for the London declaration will track delivery, highlight milestones and targets and help identify priority action areas. This joint working, accountability and transparency is one of the reasons why aid directed to NTDs is so obviously smart aid. It is aid where resources deployed are cost-effective—we come back again and again to the 50 pence per person per year for de-worming programmes—and aid that leverages resources and commitments from endemic countries, private and philanthropic sectors as well as from voluntary organisations and donor Governments.
DfID and the British Government deserve great credit for being, together with US aid, a leader in this field and I pay tribute to the previous Minister at DfID, Stephen O’Brien MP, who provided committed and knowledgeable leadership, without which we would never have got this far. I hope when she comes to wind up that the Minister will have something to say about the Government’s efforts to encourage other countries, particularly in Europe, to allocate resources in this area.
In the few minutes that I have left, I want to talk about the reasons for making NTD control a global health priority and I remind the House of my non-financial interests in the area, particularly as a trustee of the Sabin Vaccine Institute, and to look forward to some of the areas that we need to develop for success in the future.
The value-for-money argument for making NTDs a priority goes alongside the humanitarian argument. Unlike many other diseases, we have cheap and effective tools for alleviating the misery of the disease, disablement and discrimination that these conditions cause. What we need is political will as well as resource. I hope that this debate tonight will contribute in some small way towards that political will.
These are age-old afflictions. Twenty years ago, I chaired the Whittington Hospital in Archway in London. The first health facility on that site was a leper hospital in the 12th century. It was opened and positioned there because it was just beyond the boundaries of the city of London, from which people with leprosy were barred. Much more recently on Ellis Island, emigrants from Europe to the USA were examined by immigration officers for trachoma and sent home if they were found to be infected. This experience of exclusion and discrimination still exists for many in the developing world today.
However, as a global health priority, NTDs have a much shorter history. It is less than a decade since Peter Hotez of Sabin, David Molyneux of the Liverpool School of Tropical Medicine and Alan Fenwick of Imperial College first used the term in biomedical journals and they have been tireless advocates for this cause, alongside Dr Lorenzo Savioli at the World Health Organisation. Despite their widespread prevalence, these diseases have been neglected in multiple ways and for multiple reasons. They have attracted tiny proportions of budgets for treatment from donor Governments or for research from private or academic institutions. Médecins sans Frontières presented evidence last month that only 1.4% of clinical studies undertaken in the past year focused on neglected diseases, although they cause around 11% of the global disease burden.
This is partly because of the demographic that they afflict and its lack of purchasing and political power, but also because in public health terms these diseases have been seen as causing morbidity rather than mortality. So the focus in the millennium development goals and elsewhere has been on the big three killers in the developing world—AIDS, TB and malaria. However, there is growing evidence of the important and significant interaction between NTDs and these three diseases.
As well as the obvious overlap in geography and the demographics of co-infection, the data suggest a strong association of exaggerated symptoms, rapid progression of disease and a higher risk of fatality in all three diseases where there is the presence of NTDs. To take just one example, studies in Tanzania and Zimbabwe demonstrate that women with female genital schistosomiasis have a 3% to 4% higher chance of being infected with HIV than those who are free of the disease. If we are to achieve the millennium development goal on AIDS, TB and malaria, we also need to tackle neglected diseases. I hope that the Minister may also say something about encouraging global fund programmes to integrate NTD control, as they have, for the first time, in Togo.
However, progress in achieving other millennium development goals is also impeded by the epidemic of NTDs and its effects on maternal mortality, school attendance and livelihoods. Controlling NTDs is an important component not only of the global health agenda, but of the more general development agenda.
If we are to achieve the ambitious targets set out in the London declaration, we will have to meet many varied challenges, not the least of which is providing the basic building blocks of public health, clean water, sanitation, hygiene and education. These are essential to underpinning NTD initiatives. We need to develop greater capacity to deliver and distribute the drugs that are available, and we need to know more about the best treatment regimes and about synergies with other health programmes, such as the distribution of bed nets and vaccination campaigns. I think that the London centre will be hugely helpful in this respect. We need to mobilise research and development on vector control, which is often a neglected area itself. Evidence from the WHO Global Burden of Disease 2010 study shows that diseases such as leishmaniasis, schistosomiasis and hookworm are unlikely to be eliminated solely through mass drug administration programmes. We urgently need research into the development of new control tools, including drugs, diagnostics and vaccines. We need a good pipeline of innovative products if we are not to be talking, in 20 or 30 years’ time, of re-emerging diseases.
Margaret Chan, the director of the World Health Organisation, has issued a clarion call by saying on the publication of its latest report:
“Overcoming Neglected Tropical Diseases makes sense for economies and development … Many millions of people are being freed from the misery and disability that have kept populations mired in poverty ... We are moving ahead towards achieving universal health coverage with essential health interventions for Neglected Tropical Diseases, the ultimate expression of fairness”.
As we look to the global health agenda post 2015, what better rallying cry could we have?
Lord Sheikh
My Lords, I begin by thanking the noble Baroness, Lady Hayman, for initiating this timely debate. Neglected tropical diseases form a group of 17 diseases, and as one who was born and brought up in Africa, I have seen the effects of some of them. They often affect the poorest of people in the hardest- to-reach areas. Because most of these diseases do not exist in more developed nations, it is easy to forget just how prevalent they are in other parts of the world. They cause death or weaken individuals, putting them at risk of being affected by other conditions. They damage the lives of more than 1 billion people across the globe and cost millions of pounds in healthcare and loss of production.
Large-scale diseases such as malaria and tuberculosis receive worldwide media attention and a great deal of research and funding, including commendable commitments from our own successive Governments. However, it must be acknowledged that in some parts of the world, the combined impact of the neglected diseases is comparable to that of the likes of malaria. We must come to terms with the scale of the task at hand. Some diseases are at risk of spreading further, so it is important that we do all we can to stop that happening.
As with so many of the world’s ills, the key to nipping the problem in the bud will be as much prevention as possible. It is now one year since the London declaration made a call to the world to work together in order to support and realise the World Health Organisation’s 2020 Roadmap on Neglected Tropical Diseases. I was pleased to read the WHO’s second report on NTDs, published earlier this month. It highlights what it describes as “unprecedented progress” made over the past two years. A regular supply of medicines and general worldwide strategic support has resulted in a vast improvement in the health of many people. There now seems to be a much closer focus on simplifying and fine-tuning the logistics of getting medication to as many people as possible in the most cost-effective ways. The outlook has shifted away from instigating the strategy to progressing it in a sustainable way, and the 2020 road map to control or eliminate at least 10 diseases by the end of the decade seems to be firmly in sight.
Today marks the launch of the London Centre for Neglected Tropical Disease Research, which is another huge milestone in taking forward further research and, more importantly, providing a bricks-and-mortar hub for continued global co-ordination. We should all be extremely proud that this global initiative has been based here in London from outset—from the coalition of organisations through to the declaration, and now to the establishment of this centre. The United Kingdom has a reputation for identifying and honouring its moral duty to assist others, and our leadership of this initiative continues that fine tradition. Just last year, our Government committed £195 million to support the control and elimination of neglected tropical diseases. In a wider context, this initiative serves as the perfect example of what can be achieved when people come together and collaborate for the greater good. Governments, scientists, pharmaceutical companies, NGOs, funding agencies and philanthropists have all provided expertise and resources that have resulted in measurable impacts being made in the affected communities.
Lord Stone of Blackheath
My Lords, my involvement in this area has come about from chairing DIPEx, an online health charity. We publish videos and audio interviews conducted over 10 years of qualitative research into people’s personal experiences of illness by a brilliant team of academics at Green Templeton College, Oxford. Our website, healthtalkonline, was featured last week in the Times as number two in the top 50 websites that “you cannot live without”. We are good at publicity. Sir Tom Hughes-Hallett, the chair of the Institute of Global Health Innovation at Imperial College, has been a great supporter of DIPEx International, and he thought that perhaps our methodology of videoing patients’ experiences might help NTD workers to record and report their effectiveness because they do not get enough exposure; they are neglected. We are looking at that with the institute.
When I met Professor Alan Fenwick, the expert at the Schistosomiasis Control Initiative at Imperial College, he amazed me. The initiative has used its DfID funding to such great effect that it facilitated some 4 million treatments against schistosomiasis in its first year, which was 2011. By 2012 it had reached eight countries and provided 15 million treatments. Similarly, the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine has increased its number of treatments against lymphatic filariasis from 35 million in 2011 to 52 million in 2012. Both are confident that they will further expand their coverage in 2013 and get to Ethiopia, the Democratic Republic of Congo and Cote d’Ivoire.
It is excellent that DfID funding is reaching the poorest of the poor with cost-effective treatments of NTDs, but the world should view addressing these diseases not only within the health context, of course, but also in the important economic context. The Hudson Institute says that about 50 million DALYs—disability adjusted life years—are lost in developing countries to the NTDs alone. The treatment of NTDs is immensely cost-effective on a massive scale. The teams involved in these projects want the correct measurements, graphic representation and feedback loops in place to prove the effectiveness of allocating further huge resources to this work because it pays over the long term. The sources of funding are entitled to know that the route whereby their cash is getting to good causes is providing value for money. If they know that, they can target their funding better and co-operate across the piece, and thence give more. Yesterday evening, Lindsey Wu of Policy Cures described the integration of the malaria vaccine technology road map being co-ordinated by the World Health Organisation. It seeks to involve players at all stages of malaria control and elimination and considers how that can back into early stage vaccine work. This type of holistic approach at all stages goes beyond the lab to deliver the most impact on the ground.
There are, of course, powerful drivers for “commercial” funders to conduct R&D on drugs and thus develop vaccines and diagnostics, but not enough resources are allocated to the less commercial end, which is that of vector control. Millions of people could be prevented from getting these diseases in the first place. Furthermore, more attention is needed on the less exciting areas of operational research, implementation and logistics, as well as an integrated approach to multiple NTDs.
This whole project is amazingly heartening and I urge the Minister to look at the need for well informed, powerfully and graphically presented feedback loops, which could inspire greater integration of funding and bring the successful treatments of these neglected diseases to the attention of the larger world community; thereby supporting these great people working in this field and enabling millions of wonderful individuals in these countries not only to live but to live better lives.
The Earl of Sandwich
My Lords, I thank my noble friend because I know that water fleas, snails, blackfly and many other deadly insects and parasites are still infecting millions with NTDs such as trypanosomiasis and onchocerciasis. “Trips” and “oncho” became part of my vocabulary when I joined Christian Aid 40 years ago. Remembering the WHO mass-spraying campaigns in west Africa at that time, I now feel disappointment that we always seemed to be on the point of eliminating oncho but never quite succeeded.
Agencies specialising in this field have long had the target of “clean water for all”. Water is given a green light in the MDGs but this remains an enormous task —the UN says that 783 million are still using traditional drinking water supplies and one of the most successful agencies, WaterAid, now has 27 country programmes, which last year provided 1.6 million people with safe water and 1.9 million with sanitation. Oxfam and CARE have also been prominent in this field. Coming from the background of the voluntary sector, people like me can sound quite glib in describing the needs of the poorest people—all they have to do is boil their water, wash their hands and follow the advice of the nearest health centre. However, life of course is a little more complicated: the advice may be 50 or more miles away; tradition and culture dominate; and the worms and flies may be too numerous. Education is vital. Water and sanitation must be complemented with child-focused health education that promotes lifelong healthy behaviour.
I have some scepticism about the donations offered by pharmaceutical companies and the doctors they direct, and even control, in developing countries, which undoubtedly gives them a PR advantage. I am also aware of the ill effects of overprescription, which leads to dangerous dependence and painful withdrawal. I remember how subsidiaries of well known pharmaceutical companies in countries such as Bangladesh bought doctors and tyrannised village clinics that did not comply with them. I nevertheless congratulate these companies, and the charities that are contributing to this important campaign. We know that more than 700 million people have been treated for seven diseases and that the numbers treated for soil-transmitted worms have quadrupled in one year, which is nothing but impressive.
Just after DfID announced its fivefold increase in support for the NTD programme—which is to be warmly welcomed, alongside the US contribution—the Lancet asked, a year ago, whether increased funding for neglected tropical diseases really made poverty history. It pointed out the risks of undermining healthcare systems and of relying on volunteers, the gaps in the knowledge of combination drugs, and the limits in the evidence base for these drugs. Mass campaigns, although necessary to meet the MDGs, can at the same time take staff away from fragile healthcare administrations.
I have consulted Save the Children, which of course is well aware of the importance of tackling the NTDs with major campaigns. However, its key message is that, as the communities affected are often those excluded from health services, any work to ensure sustainable access to NTD prevention and control interventions should always be integrated with the strengthening of comprehensive health systems for sustainable change. Does the Minister agree with that and will she ask DfID to ensure that health workers who get involved in these interventions are always adequately remunerated, trained and motivated to support them as part of a package of essential services?
The Lord Bishop of Derby
My Lords, I, too, thank the noble Baroness, Lady Hayman, for securing this debate on a very important topic and, as we have heard, a very neglected one. There are great signs of engagement and creativity, as noble Lords have said, but the statistics and effects are absolutely horrifying. I want to develop the point that has just been made about an integrated and sustainable approach. For medical intervention and investment to be effective—I think the noble Baroness used the term “smart aid”—there has to be an embedding in the local culture. Often, there have been ways of handling these things for many years, and it is not easy for western medicine to come in with all its technology and suddenly change the situation. In fact, an article in the Lancet in March 2012 provided evidence of the hostility to this kind of intervention because people in the local community did not understand it and were threatened by it. The article said that it was important, alongside the medical intervention, to enable what it called “behavioural change” and an “integrated biosocial approach”.
I want to give an example of that and encourage the Minister, and our own investment from this country and the work of the London centre, to take this approach seriously. I declare an interest as a trustee of Christian Aid, and it is good that there are other Christian Aid supporters here. Christian Aid commends what it calls a “community health approach”, which is local, joined-up and sustainable. It has four aims: to respond to local priorities; to integrate the approach to the various diseases and health issues; to develop a local health system; and to involve local people and local resources.
I will give your Lordships an example. A cross-border malaria initiative in Zambia was launched by Christian Aid and a number of partners in July 2010. So far, 100 local people have been identified, engaged and trained up to work as volunteers to enable this integration of the care response and its embedding in the local community. That is the kind of approach that I think we must commend and invest in.
I have two other quick points. Resourcing is crucial. Although it is not the main topic of this debate, I cannot resist reminding noble Lords that before Christmas we debated the issue of tax justice. Much of the wealth that is created in countries where these tropical diseases are prevalent is through tax avoidance schemes and is taken out of the country to where it cannot be taxed to provide local resources for a local response. We need to recognise that that is part of the picture.
Finally, I will say something about vigilance. In the 1960s, sleeping sickness was virtually eradicated in Africa, but by the 1990s, it was beginning to return. There is a frightening pattern in a lot of aid and welfare interventions that almost get there but somehow do not quite integrate and create something sustainable. The problem then creeps back. That is why I commend to the Minister, and ask her to take very seriously, this approach of community health, which is local, sustainable, joined-up and able to build a system so that the approach to neglected tropical diseases will be a lasting and effective one.
Lord Trees
My Lords, the debate today is to mark the first anniversary of the London declaration on neglected tropical diseases. I want to celebrate that important initiative and the considerable progress that has been, and is being, made to control and eradicate these diseases. However, I also want to emphasise that we cannot yet be complacent. The job is not finished and there is much to do, even though the way forward is largely clear.
The NTDs are now getting the attention they deserve because they afflict huge numbers of people in the poorest countries of the world—the so-called “bottom billion”. These diseases are inextricably bound with poverty. It contributes to these diseases and these diseases, in turn, contribute to poverty. Their control is an essential step in the achievement of several key millennium development goals. These diseases, which include many with bizarre, exotic and frightening names such as Kala-Azar, Chagas disease, sleeping sickness, elephantiasis and river blindness, are for the most part chronic and persisting infections, which may eventually kill but which in many cases simply—but seriously—disable, disfigure and stigmatise. The effects are pervasive and extensive in the societies in which they occur.
Another of their characteristics is that many can be treated, controlled and even eradicated with tools that we already have. These are the low-hanging fruit of tropical diseases. The costs of making progress are relatively low and the benefits are huge, as has been said by several speakers. It is very much to the credit of the WHO, the Gates Foundation, various NGOs, scientists and healthcare workers throughout the world, and of course, the London declaration, that these diseases are now being tackled in a concerted and coherent way. The contribution of the UK to this global effort is huge. DfID has played a very substantial part, as have many scientists, medics, vets and healthcare workers based in our universities and in our two schools devoted to tropical medicine and public health in Liverpool and London.
Another hugely important factor has been the donation of drugs by major pharmaceutical companies to this programme. Drugs to the value of $2 billion to $3 billion a year are being donated by big pharma; this is an altruistic gesture that is not always fully appreciated. As a vet, it gives me satisfaction that a lot of these drugs were initially developed for the control of worms in animals. A staggering 700 million tablets are administered each year to school children in developing countries to control enteric worms, and that is just one example. All of these efforts have resulted in a substantial reduction in the incidence of infection and disease, and put the goals of controlling and eradicating many—if not most—of the 17 targeted NTDs by 2020 within reach.
However, there is still a need for an estimated $2 billion to sustain this effort to achieve these goals. That is a lot of money. Currently only 0.6% of overseas development assistance for health globally is being allocated to NTDs. Some $2 billion spread over 7 years among the wealthiest nations of the globe, given the huge return, is surely not only a desirable, but also a necessary investment. Fit and healthy people can work to feed themselves, their families and, their populations and they can contribute to the economic and social progress of their countries which in turn reduces conflict and migration.
There is still a need to develop new products and technologies to continue supporting the development of healthcare systems, health services in endemic countries and particularly systems for delivery of drugs to the point of need. We need to ensure clean water supplies and good sanitation. Notwithstanding that, we now have many of the tools we need. It is the appliance of science, the delivery of what we have, that is the major challenge. Given that there are freely available drugs for many of the NTDs, it is a responsibility we all share to apply these tools to achieve the global benefits. If we fail to do that—to satisfactorily deal with the low-hanging fruit—what hope have we to tackle more complex or technical health problems facing the world?
Lord Rea
My Lords, I thank the noble Baroness, Lady Hayman, for bringing this important subject before the House. I was stimulated to take part because half a lifetime ago I worked with children in Lagos, Nigeria, for two and a half years and met with some of these diseases. They can have a debilitating effect by causing anaemia, malnutrition, impairment of immunity or renal failure. Most of them have a secondary host, or vector, which spreads the infection. These include a number of insects and other organisms which have been referred to and described by other speakers. I think noble Lords would agree that nobody living in the Western world would tolerate being exposed to any of these pests. However, people living in poor housing with no clean water or sanitation cannot guard against them. In this context, I would echo the noble Baroness, Lady Hayman, in asking the Minister how far vector control for NTDs other than malaria is being addressed by any of the programmes supported by DfID.
People suffering from these tropical diseases are also subject to the full panoply of other universal infections, such as pneumonia and diarrhoea, which are more likely to be severe because of lowered immunity, caused by one or other NTDs, and associated malnutrition. While welcoming the international initiatives that have been praised by everybody, I have a slight caveat, as did the noble Earl, Lord Sandwich. Anthropologists Tim Allen of LSE and Melissa Parker of Brunel point out in the Lancet that, welcome though treatment of NTDs is, the mass administration of drugs gives rise to a danger that these vertical programmes can undermine already fragile and overstretched healthcare systems. However, I think that with care, co-ordination and collaboration this can be avoided. In fact, if properly managed, these programmes can actually strengthen primary care.
Populations receiving mass medication often do not understand why tablets are being given to everyone, including those with no symptoms, and may not understand or accept scientific explanations of the causes of NTDs. The two anthropologists I mentioned write:
“The availability of tablets is not enough ... dealing with NTDs in a sustainable way will involve a range of factors including behavioural change. Imagining that mass drug administration ‘will make poverty history’ is unrealistic”.
I think that the leaders of the current interest in conquering NTDs are fully aware of this, and I certainly feel that this was given evidence by the excellent research papers that were given at the School of Hygiene and Tropical Medicine this afternoon. As someone who has worked at the grass roots, the observations of the two anthropologists need to be taken into account; they have the ring of truth.
I would like the noble Baroness to reassure me if she can that the generous funding going to mass treatment of NTDs is not diverting DfID researchers away from the longer-term, but ultimately much more sustainable, objective of relieving poverty and improving health by strengthening health systems, improving nutrition, ending illiteracy and providing clean water and sanitation. Mass administration of drugs can set the ball rolling, but only through these wider means can NTDs be sustainably controlled and eventually eliminated.
Lord Patel
My Lords, I, too, thank the noble Baroness for initiating the debate and for other reasons which will become quite obvious in a minute. Much of the debate implies that we have treatments available for a lot of these diseases. That is far from the truth. We have some treatments available for some of the diseases, and none for others. In some cases, those that are available are highly toxic and, more likely than not, will kill the patient. We need more research in developing cheaper, more effective drugs. We also need a long-term strategy for the eradication of these diseases.
So far, we have succeeded in eradicating one disease: smallpox. We may succeed in eradicating guinea worm disease and possibly polio, but we are a long way from eradicating the others.
I am currently chancellor of the University of Dundee. I mention this because the University of Dundee has received funding from the Wellcome Trust in the fight against neglected parasitic diseases, including support for a multimillion-pound partnership with GlaxoSmithKline to discover new drug treatments. I have been associated with the University of Dundee since the day I went there as a medical student—I would hate to say how long ago that was. The Drug Discovery Unit at Dundee will work with the GSK discovery unit in Spain, and the goal of the collaboration is to develop safe and affordable treatments for Chagas disease, leishmaniasis and African sleeping sickness. The partnership aims to deliver at least one treatment for one of these diseases in the next five years.
These parasitic diseases afflict millions of people worldwide and are collectively responsible for about 150,000 deaths every year. The drugs that are available are difficult to administer, have toxic side-effects and are not always effective due to the drug-resistance of some of the parasites. We have made significant progress towards the development of a new treatment for African sleeping sickness over the past five years and there have been promising results in identifying potential treatments for leishmaniasis.
Currently we have a portfolio of discovery projects in various stages of development in African sleeping sickness and visceral leishmaniasis. We have several types of compounds with promising activity in animal models. The next step is chemically to modify these molecules to find the optimal balance of drug-like properties for clinical trials.
Having an industry-experienced, multidisciplinary drug discovery team is very important and this public/private partnership is critical in developing drugs for these neglected diseases. A report published by the London School of Economics and Political Science, called The New Landscape of Neglected Disease Drug Development, found on the basis of vast amount of empirical data that the PPP approach brings together the best skills of the public/private partnership, and that currently there is very little investment of public money for the development of drugs for neglected tropical diseases. The report points out a surprising lack of policy incentives to support PPPs, which have become a cornerstone of both large and small pharmaceutical companies’ involvement in neglected disease R&D, and adds that some of the incentives on offer could well be counterproductive.
It is important for the Minister to take on board that if we as a country are going to be successful in developing drugs for these diseases, there needs to be more support from public money so that we develop public/private partnerships.
Lord Crisp
My Lords, I, too, congratulate my noble friend Lady Hayman on securing the debate and her commitment to this whole area. I also congratulate the Government on their championing and funding of this area. It is another great example of UK leadership in development. I agree with my noble friend that Stephen O’Brien provided really knowledgeable leadership and commitment in this area.
I have a non-financial interest as chair of the trustees of Sightsavers, an organisation that treats and provides surgery to more than 20 million people suffering from, or at risk from, neglected tropical diseases every year. I am delighted that we have been supported by DfID to lead a global survey of blinding trachoma, which will take us into 30 of the poorest countries in the world. Noble Lords will not be surprised to learn that with that background my comments are going to be about the two diseases that particularly affect eyes: onchocerciasis and blinding trachoma.
I want to make four simple points. First, while I agree with my noble friend Lord Patel that there is much research to do, when it comes to these two diseases—and others—we know what to do. It is well documented, researched and deliverable. We can rid the world of these diseases and we can do so sustainably.
Secondly, the way in which this whole programme around NTDs is developing is an example to other areas of health and, indeed, development. First, there is wonderful co-operation, which my noble friend Lady Hayman mentioned, but that co-operation is not new; it did not start a year ago. Co-operation has been going on at all levels around these two eye diseases for more than 25 years; indeed, Merck has provided free drugs for these eye diseases for the past 25 years.
In addition, in Africa there has been developed a process called community-directed treatment, which relates directly to what the right reverend Prelate the Bishop of Derby said earlier. We in Sightsavers are in touch with 100,000 community volunteers in villages who deliver these pills. It was developed in Africa; it was not actually developed by western medicine, it was developed by Africans as a way of reaching people in the community. What is interesting is that we can use that network not only to treat people with the eye diseases—indeed, ivermectin happens to treat lymphatic filariasis as well as onchocerciasis—but to deliver other drugs. We as an eye organisation are involved with others in delivering treatments for a whole range of different things. The third way in which this is such a good example is that surgery is often delivered by non-medical staff, and there are examples of how you can do things very effectively by being radical and innovative.
My third point is, as again the noble Baroness said in starting off, that this is smart aid; it works. This should be publicised; it should be communicated. Who can argue with 50p to stop people going blind? That is what we are talking about.
My final point is the sustainability one that has been brought up by a number of people. These are diseases of poverty and indeed, as we have heard, of neglected people. They are linked to things like clean water and weak health systems. So my questions to the Minister are very simple. First, what is DfID doing to integrate its policies around neglected tropical diseases with its policies on water and sanitation? Secondly, how is it going to make sure that the strengthening of health systems will be part of the post-2015 development agenda?
Lord Collins of Highbury
My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate. Although neglected tropical diseases are the most common infections among the world’s poorest communities, they receive little attention in the media. As we have heard, while they are not always fatal, their effect on individuals and communities can be devastating. They disproportionately affect the world’s poorest and most vulnerable people and are a serious impediment to economic development in many developing nations.
There is no doubt that the coming together of the global health community in January 2012 to plan a new way forward for achieving a world free of these devastating ailments was a historic occasion. The commitment to the control or elimination of 10 NTDs in line with targets set by the World Health Organisation marked the beginning of a new and co-ordinated effort.
As we have heard, the lives of millions of people have improved since the launch of this plan. However, more resources and political will from all Governments will be needed if we are to achieve the WHO’s 2020 goals. The control and elimination of NTDs is feasible through mass drug administration but failure to also address the underlying causes, including the environmental conditions that contribute to their spread, such as clean water, improved sanitation initiatives and vector control, will make this task almost impossible.
The barriers and risks to achieving the WHO targets include: conflicts and the consequent movement of people; population growth; vector or intermediate host control; resistance to medicines and pesticides; expectations overtaking science; inadequate support for research; and, of course, climate change. We still have a world where some 780 million people are without adequate sanitation and safe drinking water; 40% of those without access to improved water sources live in sub-Saharan Africa, where many of the NTDs are prevalent. The biggest challenge is in India, where more than half the country’s population—625 million people—are without basic toilet facilities.
An integrated approach is essential if we are to meet the WHO targets. As we have heard from the noble Earl and my noble friend, there are other risks attached to promoting mass drug administration, including the undermining of already fragile and overstretched healthcare systems and the difficulties involved in relying on volunteers to assist with drug distribution in targeted communities.
However, schemes such as the Bangladesh Ministry of Health and Family Welfare’s Little Doctors programme are shining examples of how education, public health and drugs can be combined effectively. In addition to providing regular treatment, the programme teaches students from upper grades to assist teachers with de-worming days. The Little Doctors also share hygiene and other health messages with their classmates and families to help prevent reinfection.
To ensure that the objectives of the London declaration are delivered, we need clear government strategies. I, too, would like the Minister to explain what action the Government are taking to improving access to clean water and improved sanitation. What steps are being taken to build healthcare capacity and generally to improve public health and education in the target areas?
Baroness Northover
My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate and for all her work in this area. Her passionate and expert speech and those of other noble Lords remind us how important it is to tackle the so-called neglected tropical diseases. They blight the lives of more than a billion people, cause disability, disfigurement, stigma and an estimated half a million deaths annually in some of the poorest countries in the world. They cause terrible suffering and perpetuate dire poverty. The noble Baroness, Lady Hayman, spoke of diseases of neglected people. That is a good way of describing them.
Last year, as noble Lords have mentioned, we made a fivefold increase in our commitment to this area and we are maintaining that support to ensure that these diseases and those who suffer from them are neglected no more. This is an area in which some of our outstanding institutions, such as the Liverpool School of Tropical Medicine, the London School of Hygiene and Tropical Medicine and Imperial College, are playing a leading role. Various noble Lords mentioned that the London Centre for Neglected Tropical Disease Research has formally opened this afternoon at the London School, which everybody is extremely pleased to see. The noble Lord, Lord Patel, spoke of the work being done in Dundee and of the importance of public/private partnerships, something which DfID strongly supports and has built into its approach to tackling NTDs.
As the noble Baroness, Lady Hayman, the noble Lord, Lord Sheikh, and others have said, there is partnership across a number of organisations here. The pharmaceutical industry is playing a vital part in this regard. We are also working with the World Health Organisation, the Bill & Melinda Gates Foundation and the US Agency for International Development.
One year on from the London launch, I am grateful to the noble Baroness, Lady Hayman, and others for the tribute that they have paid to the step change that DfID has made in this area. Like the noble Baroness, the noble Lord, Lord Crisp, and others, I pay tribute to my honourable friend Stephen O’Brien, the former Parliamentary Under- Secretary of State for International Development, for his leadership here, as well as to all the others who played their part in the London declaration. I pay tribute, too, to the various organisations, including those led by the noble Baroness, Lady Hayman, and noble Lord, Lord Crisp, who have worked for a long period in this area.
I can assure noble Lords that DfID now expects to reach more than 140 million people who suffer from NTDs by 2015. Since the London declaration, the UK has launched a programme to complete the global mapping of trachoma; agreed a programme to take an integrated approach to tackling NTDs in Nigeria, one of the highest-burden countries in the world; and helped the World Health Organisation strengthen its NTD staffing and improve its co-ordination of the kala-azar programmes in south Asia and east Africa.
Last year, the UK Government offered to increase and extend their support to guinea-worm eradication, provided that others stepped in to help close the financing gap. Noble Lords will be pleased to hear that the Bill & Melinda Gates Foundation, the United Arab Emirates and the Children’s Investment Fund Foundation rallied to this call. The programme now has the funds that it needs to achieve eradication. That will be a stunning achievement. I can assure the noble Baroness, Lady Hayman, that we continually encourage other donors to contribute.
In 2012, fewer than 600 new cases of guinea-worm disease were reported in just four countries, Chad, Ethiopia, Mali and South Sudan—almost half the number of cases in 2011. This trend is very positive, but it is clear that there is no room for complacency. The endemic countries’ health systems and regional security are fragile—noble Lords have made reference to that. The Mali conflict remains a significant threat to the eradication timeline and the success of the global campaign.
Meanwhile, DfID continues to develop and expand the UK’s support for taking NTDs in three distinct but integrated ways. They are: additional support to control elephantiasis, river blindness and bilharzia, building on a number of existing successful partnerships; driving more research—to which the noble Baroness, Lady Hayman, referred—to increase our knowledge of NTDs and improve delivery and effectiveness in addressing them; working on new programmes to help control kala-azar and trachoma, as well as a programme which takes an integrated approach to tackling a range of NTDs in South Sudan. I assure the noble Lord, Lord Rea, that we will include vector control in the design of our work on kala-azar. The noble Lord, Lord Stone, asked about feedback loops. I can assure him that we realise that good monitoring and evaluation are key to this area and we check that treatments get to those who need them. We check to make sure that we are making progress in controlling and eliminating these diseases and are getting best value for money for the funds committed. I seem to recall the noble Lord raising this matter at an APPG meeting that I spoke at and my putting him in touch with DfID. I hope that that takes things further forward.
Expanding our involvement requires a collaborative international effort and response. We are working closely with colleagues, particularly in USAID, the World Bank, WHO and the Bill & Melinda Gates Foundation, to improve mechanisms for tackling these diseases. National Governments are key partners, too, particularly in mass drug administration through schools and communities and in efforts to improve water and sanitation services. We recognise the importance of joining all that up.
In the UK, it has not just been the Government responding to the challenge; there has been a positive response also from organisations, particularly in the private sector. This includes the Children’s Investment Fund Foundation and Geneva Global. I particularly appreciate the all-party parliamentary group’s support for the UK Government’s work on NTDs and for the opportunity that it gave me to speak at the launch of its annual report in November.
Noble Lords will also be pleased to hear that a number of institutions in the UK have formed the UK Coalition against Neglected Tropical Diseases as a collaborative partnership in research, implementation and capacity building. It is at the forefront of the push for integration, especially at the country level with national and other developmental partners.
The NTD community is adjusting to the post-London declaration situation. The WHO annual report makes clear how we have all stepped up and the challenges for tackling NTDs globally from 2013. These challenges include the need for increasing ownership by Governments in the affected countries. National Parliaments have an important role to play here in making the case to Health and Finance Ministers to increase domestic resource provision.
The noble Baroness, Lady Hayman, and others asked about integration of work on NTDs. The noble Baroness asked in particular about integration with the Global Fund. As she knows, the Global Fund in its support for health systems, which has developed over the years, makes a contribution beyond malaria, AIDS and TB. It is vital that all these approaches are integrated—the right reverend Prelate made this point very strongly—so that each element supports the other.
In this regard, I concur with the point made by the noble Earl, Lord Sandwich: mass campaigns need to strengthen and underpin fragile health systems. The right reverend Prelate illustrated that very point. I assure him that drugs for NTDs are delivered by volunteer community health workers, and that that is used to help to strengthen health systems. The noble Earl, Lord Sandwich, the noble Baroness, Lady Hayman, and the noble Lords, Lord Crisp and Lord Collins, referred to water and sanitation as connected issues. Indeed they are, and we are well aware of that. I assure noble Lords that the increase in funding for NTDs is additional to DfID’s existing health, water and sanitation commitments. Integrating with the health system is an important tenet for NTD programmes to help to strengthen that effectiveness and improve sustainability. If we maintain that approach, those diseases can be eradicated, as the noble Lord, Lord Trees, said. We are determined to carry that through—just as we are in sight of eradicating polio, and as we did with smallpox, to which the noble Lord, Lord Patel, referred.
We have grasped a fantastic opportunity here to make a real difference to the lives of those affected by these diseases. In 2013, the task is to finalise remaining programmes, monitor the portfolio closely, continue to promote integration and work with others to expand the donor base and endemic country commitment.
Noble Lords have pointed out that these are diseases of poverty and that we must tackle poverty across the board. They are right, and that is how we view this task. This is indeed about tackling poverty, and we welcome noble Lords’ contribution in this key area.