Health: Neglected Tropical Diseases
(10 years, 10 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 in 2012; and how that issue will feature in the post-2015 Millennium Development Goals health agenda.
Baroness Hayman (CB)
My Lords, I am delighted to have the opportunity to introduce today’s debate on progress in combating neglected tropical diseases and I draw attention to my non-financial interests in health and development, particularly as a trustee of the Sabin Vaccine Institute and the Malaria Consortium. I am also delighted that what many would consider an abstruse and minority interest subject has attracted such a large and expert speakers list—and even an equally distinguished audience in the Moses Room—and I look forward to hearing the contributions.
I am also glad to see the noble Lord, Lord Bates, here today as the Minister replying. I welcome him to our world of worms, snails, flukes and flies, the vectors of the group of parasitic and bacterial diseases that are categorised as neglected tropical diseases—NTDs. Of course, these diseases—afflictions such as river blindness, human hookworm and elephantiasis—are not actually part of our world as people who live in rich, developed countries. They are the diseases of the world’s poorest people, predominantly the rural poor. For them, NTDs are far from abstruse or a specialised interest; they are illnesses that affect one in six of the world’s population and blight the development of half a billion of the world’s poorest children.
Although NTDs do not cause as many immediate deaths as AIDS, TB and malaria, they kill, they maim and disfigure and they stunt and disable, causing decades of pain and, often, isolation. These diseases not only have direct effects but also weaken the immune system, cause anaemia, put infected individuals at higher risk of contracting other diseases and impair the ability to resist infection. They increase the risks in pregnancy and childbirth and they can have a negative effect on the efficacy of treatments for diseases such as TB. The link in particular between genital schistosomiasis and HIV infection, particularly in young women, has not been taken seriously enough in the past. Beyond those health effects, NTDs also form a terrible barrier to education and employment. They are not only the diseases of poverty; they are the diseases that cause poverty. Combating NTDs is therefore one of the best routes to cutting the cycle of poverty itself and to the sustainable development that we all seek.
The good news is that, unlike with many diseases, we have many of the tools necessary to combat those afflictions. We know that the combination of mass drug administration and water and sanitation projects, for example, can result in dramatic benefits and reduction in the incidence of disease. With concerted effort, with research into new vaccines, new diagnostics, new insecticides and medicines, with improved mapping and monitoring, with operational research, we could make much more progress. Much of that work is in train in academic institutions, in the voluntary sector and in the countries themselves
The London declaration of 2012, whose second anniversary we mark with this debate, was hugely important, because it brought together funders, both national and philanthropic, pharmaceutical companies that donate the drugs necessary for mass drug administration programmes and endemic countries themselves in an effort to co-ordinate the fight against these diseases. Together with the ongoing support of the World Health Organisation, which has championed this work in recent years, we have seen a significant shift in the global prioritisation of neglected tropical diseases. Their inclusion in the healthy lives goal of the high-level panel on the post-2015 development agenda, published in May last year, was, I believe, a crucial step forward.
I welcome, too, the formation of NTD coalitions, such as the very successful one that we have in the UK, in countries across the world and, particularly importantly, the drawing up of integrated NTD control strategies in endemic countries. The academic and voluntary sector, both of which are so strong in the United Kingdom, have much to offer both in research and in resource. For example, the London Centre for Neglected Tropical Disease Research, which had just been launched when we debated this subject a year ago, works continuously to improve the effectiveness of control measures. We need to know how to do what we do better. Such technical support will be essential for plans such as the recently drawn-up Africa regional NTD strategy if it is to be successful.
As well as technical support, money remains an issue. Even given the relative cheapness—we know that many would argue that treating NTDs was the best bang for your buck that you could get in public health expenditure—and the cost efficiency of NTD control work, given the extensive drug donations, it has been estimated that there is still a £200 million funding gap to be bridged if we are to meet the goals of the London declaration. I am not asking Her Majesty’s Government to meet that gap themselves; they have already been generous and committed in this area. However, I ask the Minister what progress the Government are making in championing investment in NTD work with other key international donor Governments, particularly perhaps France, Germany and Australia.
As we have recently and sadly seen with polio eradication, conflict can threaten to destroy the painstaking work of decades. When countries experience violence and civil wars, health programmes and the benefits that they provide to the poor and the marginalised are threatened. Through the Malaria Consortium, I know of the situation in South Sudan. There, it is working on DfID-supported programmes and bringing long-standing expertise in malaria to bear on programmes to combat neglected tropical diseases. We have discussed in your Lordships’ House before the issue of not working in silos in this area. Members of the charity’s staff had to be evacuated during the recent violence and have only just been able to return. I pay tribute to the courage and commitment of the very many—both local and international—NGO workers throughout the world who continue to operate in extremely difficult and often dangerous circumstances. On the specifics of South Sudan, I understand that the DfID NTD programme, though not the malaria programme, is on hold because of the perceived continuing dangers. I wonder whether the Minister could give any indication today, or perhaps in writing, of when that programme might be restarted.
I return to the issue of a post-2015 millennium development goal. Combating NTDs punches above its weight in broader health and wider development terms. We need to renew and reinvigorate our commitment to research, prevention and treatment programmes. By integrating existing strategies such as mass drug administration with broader public health programmes such as those on water, sanitation and education, we not only enhance the effectiveness of those strategies but start to build from the bottom up the sort of universal health coverage and health systems needed to underpin development. Therefore, I end by congratulating the Government on the leadership that they, together with the United States, have given so far and I urge them to ensure that NTD control features in the final formulation of the sustainable post-2015 health agenda.
Lord Stone of Blackheath (Lab)
My Lords, it was the passion and expertise of the noble Baroness, Lady Hayman, that brought me into this world. More than 200 million individuals in Africa are infected by schistosomiasis, causing malnutrition, stunting, anaemia and eventually early death through liver disease and bladder cancer. Dr Alan Fenwick and his team at the Schistosomiasis Control Initiative at Imperial College run huge and detailed programmes that reduce all this enormously. I declare a non-financial interest as a trustee. His team and I are concerned first with the humanitarian effects and alleviating suffering. I am there not as a medic but to see that the charitable moneys are used cost effectively—and they certainly are.
In Africa, in 10 countries that receive aid from us, 50 million people lose their ability to work each year to these diseases. Even if they each earn a dollar a day, this amounts to $18 billion a year lost through disability. DfID is currently investing £50 million over five years towards the control of schistosomiasis and intestinal worms. For this amount, we will be heading to eliminate these infections in two of these countries and, for an estimated £50 million more, we could approach elimination in another four of these countries. It will take longer in the larger countries such as Ethiopia and DRC, but I was in Egypt only this weekend, where they have demonstrated that it can be done.
Since the London declaration in January 2012, we have certainly taken several positive steps. Donations from the pharmaceutical industry have increased. GSK and Johnson & Johnson have donated more de-worming medicines, and more than 700 million people every year receive albendazole either for lymphatic filariasis control or worm treatment or both. Merck has increased its donation of praziquantel from an annual 25 million to 250 million tablets in 2016, enough to treat 100 million children every year. But this is not elimination.
The member states of the 2012 World Health Assembly adopted a resolution to try to eliminate schistosomiasis where feasible by 2020. All that is being done will help to reach elimination in some countries but not without technical assistance and supplementary funding. In addition, DfID has doubled its support and between 2011 and 2016 we will assist Governments in the 10 countries to deliver 200 million treatments. Mindful business people have stepped in, such as Luke Ding, who manages his philanthropy through Prism the Gift Fund, where I am a trustee. We administer the giving by individuals such as Luke and by large foundations by helping them to gift significant amounts to charities cost effectively. Luke made a donation last year of £275,000 to assist SCI in general and our programme in Madagascar.
All this is great. We know that we could reach elimination with economic development and better water and sanitation, which could be done by pulling together British and American aid programmes to work synergistically across Africa. With an additional sum of £200 million for 2014 and 2020, we would have the guaranteed funding for the programme for the integrated control of schistosomiasis in sub-Saharan Africa, or ICOSA. We could expand coverage and move towards the WHO target of elimination of schistosomiasis in particular and the other NTDs in the poorest rural communities in Africa. That sounds a lot of money, but noble Lords should remember that the successful elimination would save 50 million DALYs—disability annual lost years—which would mean $18 billion a year saved for ever more. Will the Minister meet us and our partners to plan how this might be organised?
Lord Chidgey (LD)
My Lords, first I must apologise because I have come to this debate with a finely honed speech of just three minutes to find that I actually have four. I could spend that being rude to people, but I shall promise not to. There will be some extra time at the end that noble Lords might want to share among themselves, if they are a bit worried about the length of their speeches. Anyway, here comes my three minutes.
The London declaration in 2012 on neglected tropical diseases set a target for control and eradicating at least 10 of these devastating diseases by 2020. The commitment was to sustain, expand and extend programmes that ensure the supply of drugs and other interventions to help to eradicate these 10 diseases. International donors such as DfID could address this by explicitly targeting NTD programming at the poorest and most marginalised populations. When the Minister replies, I hope that he can comment on that and on what DfID’s role will be.
In the list of NTDs, Guinea worm disease caught my attention because, in my relative youth, I worked for some years in the rainforests and mountains of Guinea in west Africa. Tropical diseases flourished there, but never once did I come across Guinea worm.
As some noble Lords may know, Guinea worm is a parasitic infection contracted by drinking contaminated water containing water fleas harbouring infective Guinea worm larvae. Inside the human’s abdomen, the larvae mate and female worms mature and grow. They grow as long as three feet or more and, after a year of incubation, the worm creates a lesion in the skin and slowly emerges from the host person’s body. The contamination cycle begins when the victims immerse their limbs in water to ease their agonising pain, stimulating the emerging worm to release larvae into the water and begin the cycle all over again. Guinea worms can be removed by winding them around a small stick and manually extracting them in a slow and painful process which can take several weeks.
Through the intervention of the Carter Center and its partners, cases of Guinea worm have been reduced by more than 99.9% since 1986. In 2013, only approximately 150 cases were reported, mainly in South Sudan. Guinea worm disease is on track to be only the second disease in history to be eradicated after smallpox. Sadly, this is only one success.
However, it is worth comparing to the situation with tuberculosis. As far as I am aware, about 20 years ago TB too was believed to be on the point of eradication. I am not a medical man and I am not sure, but that is what I recall. Somehow that initiative was lost and now TB is the second most deadly disease in the world. It is estimated to have killed more people than any other pandemic in history. It is shocking to find that only one new TB drug has been developed in the past 42 years.
Even more troubling is that a signatory to the London declaration on NTDs appears to have effectively abandoned that commitment. According to a recent edition of the Times, AstraZeneca, the UK’s second largest drug company, has confirmed it will no longer carry out early stage research into NTDs, TB and malaria. It will be focusing instead on making products that attract big profits. It seems to be effectively turning its back on the poor.
The NTDs affect the achievement of almost all millennium development goals. There is unquestionably a case for strengthening NTD control and elimination programmes and for the inclusion of NTDs within the health goal in the MDG framework. Do the Government accept this case? In so doing, they would recognise the plight of more than 1.4 billion desperately poor people blighted by NTDs.
Lord Patel (CB)
My Lords, I declare an interest as a chancellor of the University of Dundee, which has a drug development unit that focuses on finding treatments for five of the key neglected tropical diseases—human African trypanosomiasis, Chagas disease, visceral leishmaniasis, malaria and tuberculosis—and which has only recently announced a potential drug for the treatment of malaria.
However, today I wish to speak not about drug development at Dundee—fantastic though it is—but, in the few minutes that I have, about why a focus on neglected tropical diseases should be given priority in women’s health and gender equality in the millennium development goals post 2015, alongside HIV/AIDS, nutrition, access to contraception and poverty reduction.
I shall speak specifically about two helminth infections—hookworm infections and schistosomiasis. These are the two key infections affecting women living in poverty in Africa and elsewhere today. Nearly 40 million women of childbearing age and 7 million pregnant women per year are infected, leading to increased maternal, neonatal and infant mortality, not to mention increased morbidity. Further, more than 10 million women suffer from genital schistosomiasis. Apart from causing much pain and distress, this condition also is linked to horizontal transmission of the HIV/AIDS virus and is a possible major factor in the AIDS epidemic. Hence, it is important for the control of HIV/AIDS, particularly in Africa.
It is believed from research carried out that highly vascular and CD4+ cell-enriched patches in the cervix or elsewhere in the female genital tract may provide host entry routes for sexually transmitted HIV, although other mechanisms are plausible. There is an urgent need for expanded studies. If this is shown to be true, it would be a major case, allowing millions of young women who are infected to control HIV/AIDS. Such findings are therefore critical for designing potential intervention strategies of the future.
A recent publication by Hotez and Whitham in the American Journal of Obstetrics & Gynaecology—I am an honorary fellow of the college—highlights in detail the problems and the solutions. An urgent expansion of mass drug administration, not only to children but to women of childbearing age, for the eradication of hookworm and schistosomiasis is needed. Current programmes hardly reach a third of the children in Africa and less then 10% of young girls, particularly women. Millennium development goals post 2015 should include new policies and advocacy of neglected tropical diseases, including the elimination of helminth infection, which is possible, and better alignment. Control of these infections to HIV/AIDS and malaria control is what is required, hence the need for the inclusion of neglected tropical diseases in the millennium development goals post 2015. I hope the Minister will ensure that the UK will support that.
Lord Sheikh (Con)
My Lords, I am interested in this subject as I was born and brought up in east Africa. I have seen how the diseases that we are discussing today affect the lives of people. I thank the noble Baroness, Lady Hayman, for initiating this debate.
I applaud this Government’s continued commitment to international aid. Combating disease is a crucial part of this programme. We are now marking the two-year anniversary of the historic London declaration on neglected tropical diseases. Neglected tropical diseases affect more than a billion people throughout the world. They often affect the poorest people in the hardest-to-reach areas. The combined personal and family suffering also translates into wider economic hardship, trapping communities in a cycle of poverty. Eliminating NTDs is thought to be one of the most cost-effective and comprehensive ways to achieve development goals and eliminate poverty. Therefore, it is important that work to combat NTDs is absorbed into wider-scale initiatives on poverty.
Prevention is also a key principle. Measures such as better health education, greater nutrition and the provision of safe drinking water will help to reduce cases in the first instance. We must celebrate the progress that has been made in a number of ways. We have made political progress. Last May, 32 countries took part in deliberations during which the World Health Assembly adopted a resolution on all 17 neglected tropical diseases. This resolution calls for more effective financing and implementation of prevention and eradication programmes. It makes important references to increasing access to treatments. I am proud that the United Kingdom strongly supported this resolution and has pledged to continue playing an important role in this respect.
We have made progress on awareness. Neglected tropical diseases are receiving more coverage than ever before and are firmly on the international agenda. The engagement and generosity of pharmaceutical companies must also be noted. We now have all the treatments required to control and eliminate the seven most common NTDs. These account for over 90% of the global burden.
Although we have made progress, though, we must of course not be complacent. It is still necessary to further increase and maintain this progress if we are to reach our target. The millennium development goals expire in 2015. This provides us with a perfect opportunity to renew and accelerate the focus on eradicating NTDs. In its report last summer, the High-level Panel of Eminent Persons on the Post-2015 Development Agenda included the reduction of NTDs as part of its recommended goal of ensuring healthy lives.
In my view, the 2020 road map for the elimination of at least 10 diseases by the end of the decade is firmly in sight. It is very ambitious but I believe that it can, and I hope will, be achieved.
Lord Alton of Liverpool (CB)
My Lords, I, too, pay tribute to my noble friend Lady Hayman for her assiduous and indefatigable commitment to the elimination of neglected tropical diseases. I should mention that I am a patron emeritus of the Liverpool School for Tropical Medicine, which is one of the partners in the Global Network for neglected tropical diseases and is a leader in NTD research. I am also a patron of a project providing clean water in Turkana and a health project in Ghana.
As recently as 27 January, former Ghanaian President John Kufuor was in London to mark the anniversary of the 2012 declaration. He rightly says:
“There is no silver bullet remedy to helping a country break the cycle of poverty, but investing in the health of its population offers one of the best options for unlocking economic potential”.
Scaling up integrated NTD control and elimination strategies is considered one of the most cost-effective ways to reduce global poverty. Virtually all of the “bottom billion”, the 1.4 billion people around the world who are living on less than $1.25 a day, are afflicted with one or more of the seven most common NTDs: elephantiasis, hookworm, river blindness, roundworm, whipworm, trachoma and snail fever. NTDs disable, debilitate and perpetuate poverty and in worst-case scenarios they can kill. They cause blindness, huge swelling in appendages and limbs, severe malnutrition and anaemia—all brilliantly highlighted, I might add, in the END7 Youtube video featuring Eddie Redmayne and others.
Those afflicted include more than 500 million children. In a randomised controlled trial in Ethiopia, researchers found that consistently treating trachoma halved childhood mortality, while a study in Kenya demonstrated that deworming children leads to a 25% decrease in school absenteeism. Compare the cost of one cup of coffee at Starbucks, which can range from £1.75 to £3.50, to the fact that just 30p—or 50 cents, half a US dollar—per person per year is all that is needed to treat and protect one person against all seven NTDs. This in turn averts malnutrition, improves education outcomes, improves maternal and child health, reduces new cases of HIV and sets the stage for sustainable economic development. In Africa, the entire at-risk population could be treated for £250 million or less annually. Yet efforts to control and eliminate NTDs receive less than 2% of total global health funding, and the elimination of many of the NTDs will not be achieved without significant investment in water and sanitation interventions. Such an approach should surely be central to post-2015 objectives, and I hope that we will hear from the Minister on this.
I am particularly concerned that the 2013 report of the Sustainable Development Solutions Network, An Action Agenda for Sustainable Development, does not mention NTDs. Surely that should be rectified. I hope that the Minister will comment on that.
Many of the curses that afflict us cannot be conquered but NTDs can. These ancient diseases can and should be a thing of the past, and it is not misty romanticism or idealism to talk of a world free of NTDs for the next generation. This is achievable, and we would be failing millions, and failing our duty, not to do it. My noble friend therefore deserves our thanks for keeping this issue on the agenda, and the United Nations and development agencies should be lobbied by parliamentarians and Governments the world over to make this achievable objective a reality. I hope that the Minister will tell us that the Government are committed to doing precisely that.
Baroness Warwick of Undercliffe (Lab)
My Lords, I, too, thank my noble friend Lady Hayman for introducing this timely debate and for her continued commitment to bringing this important subject to our attention.
The promises made by the pharmaceutical companies, global health organisations and government representatives in the London declaration two years ago were truly admirable. They were intended to be game-changing and I am delighted to hear from my noble friend that the drug donations, research and development funding and co-operation are making real inroads in the attempt to control, eliminate or eradicate the 10 named NTDs by 2020. The promise of the pharmaceutical companies under the London declaration to donate many more drugs, worth hundreds of millions of dollars a year, was a wonderful step but, as Dr Margaret Chan, director-general of the World Health Organisation, said at the time, drug donation is one solution but not the only solution.
In my four minutes, I will stress the importance of our investment in research into NTDs and highlight the work of some of our health-focused universities and their major contribution to development. The UK is a hub of research excellence, with many academics from different institutions all contributing to the fight against NTDs. Their work has global impact and changes the lives of some of the poorest people on the planet. The breadth of UK academic expertise and research in this area is world-leading. It covers anthropology, public health, basic science, epidemiology, clinical medicine, mathematical modelling and operational research.
Two institutions leading the way are Imperial College and the London School of Hygiene and Tropical Medicine. Together with the Natural History Museum, they last year formed the London Centre for Neglected Tropical Disease Research. The centre’s research builds on the long-standing expertise of UK academics in the epidemiology and transmission of NTDs, such as that of Professor Alan Fenwick, whose team, working with ministries of health across sub-Saharan Africa, assisted in the delivery of 100 million treatments in Africa and, indeed, the Middle East during 2013. Other speakers have referred to the research priorities of the centre, including bilharzia and intestinal worms.
Elsewhere in the UK, our universities are well placed for multidisciplinary approaches from the bench to the field. The Drug Discovery Unit at Dundee, referred to by the noble Lord, Lord Patel, has made major breakthroughs in NTD research, with £10 million of funding from the Wellcome Trust, including more than £8 million for a partnership with GlaxoSmithKline. Its teams work across academia, industry and the charitable sector worldwide.
There is always more that needs to be done. For example, there has been very little research into Buruli ulcer, an NTD in the leprosy family which is on WHO’s road map but not included in the London declaration. The exact mode of transmission is still unknown. There is no vaccine for primary prevention, and secondary prevention is based on early detection. WHO says that 80% of cases detected early can be cured with a combination of antibiotics. But early detection and antibiotic treatment require health education at community level, training of health workers and village volunteers, strengthening of health facilities, laboratory confirmation of cases, standardised recording and reporting systems, and monitoring and evaluation of control activities.
I hope that the noble Lord the Minister will agree with me that research remains fundamental to this vital work. Two years on from the London declaration, it is important to remind ourselves that medicines alone will not eradicate the diseases of poverty.
Lord Trees (CB)
My Lords, it is my pleasure to join others in thanking the noble Baroness, Lady Hayman, for initiating this important debate. The control of NTDs is a challenge, the success of tackling which has been to some extent quite remarkable to date. To make it a total success story, it is critical that the international community maintains the momentum of the London declaration of 2012 to achieve the goals of the WHO NTD 2012 road map on implementation for the control, elimination and in some cases eradication of NTDs between 2015 and 2020.
Most of the NTDs are parasitic or bacterial diseases characterised, as has been said, by high morbidity and chronicity, which affect some 1.4 billion people in the world. These are severely debilitating and, in some cases, disfiguring diseases, which have profound social, cultural and economic effects. They contribute to poverty and poverty contributes to their causes in a potentially permanent cycle of poverty. This restrains economic development, social justice, equality and female emancipation, as females and children are particularly at risk. The targeting of these diseases is therefore an important contribution for the attainment of the millennium development goals and any such targets to be set thereafter.
Historically, these have been relatively neglected diseases, although, as a number of noble Lords have commented, not by the very strong UK scientific community working in this area. Indeed, we can take pride in the efforts of British scientists such as Professor David Molyneux at Liverpool, Professor Peter Holmes in Glasgow—he is chairman of the NTD committee of WHO—and many others. We have heard about the contributions from Dundee, Imperial and others. We can take great pride in the contribution of those British scientists to ensuring that these diseases are getting adequate research attention. Critically, the WHO and the Bill and Melinda Gates Foundation, among other NGOs, are now taking these diseases seriously.
The other major factor, which has not had a great deal of attention in this debate so far but is a major contribution to the control of these diseases, is the generous donation of drugs worth between $2 billion and $3 billion a year by a number of pharmaceutical companies. In spite of this remarkable commercial philanthropy, there is still a funding gap, as the noble Baroness, Lady Hayman, has commented, not only in ensuring adequate surveillance, monitoring and delivery of the drugs that we have, but also in research to improve therapies and to provide, in some cases, vaccines. British institutions have a major role to play in this.
Only 0.6% of overseas development assistance for health is devoted to NTDs. The British Government have set an excellent example, along with the US Government and NGOs, but I join the noble Baroness, Lady Hayman, in urging the Government to exert all the pressure that they can on other richer countries, particularly in the EU, to ensure that they contribute more to this endeavour.
If ever there was a case of enlightened self-interest, this is it. Healthier, wealthier populations can feed themselves better, relieving the pressure on global food supplies; they are more stable, relieving the pressure on migration; and, ultimately, they will be purchasers of the products and services that richer countries can provide. Tackling the NTDs gives a big bang for one’s buck. Huge benefits accrue from relatively modest investment. Not only does it make economic sense, but it satisfies our obligations to relieve poverty, create opportunity and achieve fairness and social justice for all in our world.
Lord Crisp (CB)
My Lords, I, too, congratulate my noble friend Lady Hayman on her eloquent speech and for keeping this issue so well highlighted. There has been good progress but there is much more to do. I also congratulate the Government on taking such a strong lead on this. In doing so, I of course encourage them to continue to do so in the future.
I declare an interest as chair of trustees of Sightsavers, which deals with two of the major blinding diseases. Trachoma was endemic in London 400 years ago—so it can be eliminated—and I am delighted that DfID has supported Sightsavers to lead a collaboration of partners who are mapping trachoma worldwide. This will enable us to understand exactly what the level of trachoma is in every community and how we can go about eliminating it. It is a very important programme. DfID has also been supporting us in tackling trachoma in Nigeria in particular, with another project with the Government there. I am also delighted that the Diamond Jubilee Trust has chosen trachoma to be its major target for the funding that has been raised, with the intention of eliminating trachoma from five countries in the Commonwealth.
The other great disease we deal with is onchocerciasis, or river blindness. This reminds me of the wonderful co-operation there is in the world of neglected tropical diseases. It is public-private, as we have heard, and, in the case of onchocerciasis, Merck committed itself 25 years ago to give the drug ivermectin free for as long as it takes to eliminate the disease around the world. There is co-operation between countries and co-operation between academic departments and services, which several noble Lords have highlighted. It is worth remembering that there are people who have been quietly working away for 25 to 30 years on those diseases before they had a high public profile, and it is great to see them now getting some recognition for that tremendous work over those many years.
The other group worth mentioning is the communities themselves in Africa. The African Programme for Onchocerciasis Control, which is one of our partners at Sightsavers, has 100,000 community distributors of drugs, one in each village, who, once a year, deliver the drugs to everyone in the village in an attempt to eliminate the disease. That is an excellent example of community self-help, but it also allows them to distribute drugs for other diseases. A point of co-operation in this field is the way that we in Sightsavers, while focusing on blindness, also distribute drugs through that network for lymphatic filariasis and other things.
Your Lordships will gather that I am proud of what Sightsavers does, but I am also proud as a British citizen of what the UK is doing. That seems to me to be real solidarity between some of the richest people in the world and some of the poorest. Of course, there is more to do. As my noble friend Lord Alton said, the reason why it is so urgent is that, largely, we know what to do. We need money and the priority to do it.
Let me finish on three final points. The first, as other noble Lords have said, is that this programme of dealing with neglected tropical diseases needs to integrate with the wider development push, so that it is not just dealing with those diseases but linking it in with water cleanliness and everything else.
The second point, which has not been raised, is that although this is a fight to eliminate those diseases, many people are disabled by them. On the wider issue of disability, there are about 1 billion people disabled in the world, and 80% live in developing countries. They have not been systematically included in international aid programmes, and we ask DfID to develop a strategic approach to disability-inclusive development to sit alongside the valuable work on preventing disability. I ask the Minister to respond on that point; I would very happy to receive a letter. I hope that he can, because that is very important and would be another example of the UK’s leading the way internationally on development by having disability-inclusive development in all its aspects.
My final point is to add my voice to those continuing to press for inclusion of neglected tropical diseases in the MDG successor framework.
Lord Collins of Highbury (Lab)
My Lords, I must admit that the discipline of three minutes had enabled me to eliminate all the Latin names for neglected tropical diseases and, in the extra minute I have, I do not intend to put them back.
I too thank the noble Baroness, Lady Hayman, for initiating today's debate. Although neglected tropical diseases are the most common infections among the world’s poorest communities, they still receive little public attention. I am also pleased that the noble Baroness has made this debate a regular event since the 2012 global health summit, which set out a way forward to achieve a world free of NTDs.
As we have heard in the debate, NTDs disproportionately affect the world's poorest people and are a serious impediment to economic development in developing nations. Thanks to the noble Baroness, I recently met the special envoys for the Global Network for Neglected Tropical Diseases. I too, like the noble Lord, Lord Alton, would like to quote the former President of Ghana, John Kufuor, who I met. I will repeat the quote in full:
“There is no silver bullet remedy to helping a country break the cycle of poverty, but investing in the health of its population offers one of the best options for unlocking economic potential. With full support both from national governments and from the global community, we can … put an end to NTDs on the African continent”—
and beyond.
Treating NTDs is extremely cost-effective, as my noble friend Lord Stone and the noble Lord, Lord Trees, highlighted, through successful public-private partnerships. Pharmaceutical companies donate nearly all the drugs necessary for counteracting the seven most common NTDs. Fifty US cents per person per year can treat and protect against NTDs, as the noble Baroness, Lady Hayman, said, and in turn avert malnutrition, improve education outcomes, improve maternal and child health, reduce new cases of HIV, and set the stage for sustainable economic development.
Despite the momentum since the 2012 summit, and as we have heard, long-term elimination goals cannot be reached without addressing primary risk factors for NTDs, such as the noble Lord, Lord Crisp, highlighted, having access to clean water and basic sanitation, vector control and stronger health systems in endemic areas. These issues will need to be addressed beyond the WHO 2020 goals and as part of the post-2015 development framework. Will the Minister update us on the Government’s overall strategy to help control or eliminate the seven major neglected tropical diseases? As the noble Baroness, Lady Hayman, said, it is welcome that the high-level panel included NTDs in the healthy living section, but can the Minister tell us what steps the Government will take to ensure that other countries will support us to include specific targets and indicators for NTDs in the final post-2015 framework?
Lord Bates (Con)
My Lords, I am pleased to have the opportunity to respond to this debate, which has been fascinating, and led so movingly and passionately by the noble Baroness, Lady Hayman, who comes to this area with great expertise as a trustee in the Sabin Vaccine Institute and the Global Network for Neglected Tropical Diseases. Putting this on the map annually is a way of ensuring that it keeps the heels of Her Majesty’s Government and others to the fire. It ensures that progress continues to be made.
The noble Baroness welcomed me to her world, which is a fascinating one. She outlined some of the creatures that inhabited it. I was going to make a quick aside about being no stranger to this world because it sounded rather familiar as a member of the Government Whips Office, but it would be inappropriate to do so. I am pleased to answer the question because every year neglected tropical diseases adversely affect the lives of more than a billion people, causing disability, disfigurement, stigma and an estimated half a million deaths, mainly in the poorest countries. By helping countries to tackle them we alleviate unnecessary suffering and help to reduce poverty. That point was made by many noble Lords, including the noble Lords, Lord Collins and Lord Alton, who quoted the former President of Ghana, John Kufuor, in talking about the silver bullet and the bang for the buck, which I think the noble Lord, Lord Crisp, mentioned, in terms of public health and its effect on alleviating poverty.
The noble Lord, Lord Collins, asked me to update your Lordships on progress made since the London declaration. Since that meeting the UK has launched a trachoma programme that completes the mapping of the disease. The noble Lord, Lord Crisp, referred to that in his association with Sightsavers. It is an incredible programme that will be immensely beneficial as part of the general research effort. We are delighted to be part of it. New programmes will be developed to tackle NTDs in an integrated fashion in Nigeria and South Sudan. I will come back to the point about South Sudan, which the noble Baroness, Lady Hayman, referred to, later in my remarks. We have helped World Health Organisation to strengthen its NTD capacity, and approved a programme to help deal with kala azar in south Asia and east Africa, which I am sure that my noble friend Lord Sheikh will be pleased to note given the personal experiences that he brought to the debate.
We have maintained UK support for the Carter Center’s Guinea worm eradication programme, and I am grateful to my noble friend Lord Chidgey for raising that example. As someone who was clearly coming to this from a non-expert position, to be frank, it was heartening to hear that a disease that in 1986 had 3.5 million people suffering with Guinea worm in 20 countries could be reduced to 154 in four countries, through concerted effort and focus and investment in research. Within a lifetime, that is a remarkable case study. He was also absolutely right to remind us that we cannot be complacent, because of the example of TB, which he highlighted.
The noble Lord, Lord Stone, spoke about support on river blindness and bilharzia. We have extended our support for that, including the elephantiasis programme. We have invested in more research on how best to deliver the NTD programme in a cost-effective and sustainable way. The point about research, raised effectively by the noble Baroness, Lady Warwick, was important. I will come back to that if I can, because research is at the heart of this. It was heartening to have so many contributions, including those from the noble Lords, Lord Patel, Lord Alton and Lord Crisp, referring to the excellence in research. Those were the words of the noble Baroness, Lady Warwick: the UK is a hub of research excellence. The noble Lord, Lord Stone, spoke about exciting initiatives with Imperial College combining with the London School of Hygiene and Tropical Medicine to provide further research in that area. I would be delighted to arrange a meeting with the appropriate Ministers and officials in the Department for International Development to see how we can support that work going forward.
There are also product development partnerships, including the Foundation for Innovative New Diagnostics and the Drugs for Neglected Diseases initiative—FIND and DNDi—which we are supporting. We also support operational research through a number of channels, including our existing commitments to the World Health Organisation’s tropical disease research programme and wider health-related research programme consortia.
Underpinning the results lies a collaborative network. We continue to work closely with donor colleagues, particularly the US Agency for International Development, the World Bank, the World Health Organisation and, of course, the Bill & Melinda Gates Foundation, to improve the way in which we tackle these diseases. National Governments are key partners too, particularly in the delivery of mass drug administration through schools and communities. An important point was made on that by, I think, the noble Lord, Lord Crisp, about this being about not just national Governments—that because these are diseases of the rural poor we should have people down at a village level engaged in tackling them.
Several of your Lordships mentioned the need for better integration between different NTD initiatives, as well as closer working with other disease programmes and with sectors such as water and sanitation, which are all part of the same issue. The noble Baroness, Lady Hayman, mentioned that, and the noble Lords, Lord Alton and Lord Crisp, and of course the noble Lord, Lord Collins, all referred to the vital way at which we should get better at integrating how we tackle these diseases—not just with medicines, but with water, sanitation and research. These challenges would be much tougher without the major contribution that the pharmaceutical industry makes through sustained and highly effective drug donation programmes. Combining their donations and our support to improve delivery is at the heart of the public and private sector. Several noble Lords referred specifically to the work of Merck in that capacity, and the great generosity that it has shown.
The noble Baroness, Lady Hayman, asked for an update on the closure of AstraZeneca, and the noble Lord, Lord Chidgey, also referred to that. It has announced that it is closing a major factory in India that was producing NTD medicines. Her Majesty’s Government believe that the pharmaceutical industry has an important contribution to make in enhancing access for the poor to essential medicines. The AstraZeneca decision appears to be part of a wider restructuring programme. Other pharmaceutical companies remain active in this precise area, including Merck, Johnson & Johnson and GlaxoSmithKline, and they donate free drugs to certain neglected diseases. The French drug maker Sanofi is also working on a vaccine for dengue fever. That is part of the update there.
The noble Lord, Lord Crisp, asked me to consider what DfID could be doing for those living with disabilities. More than 1 billion people, 15% of the global population, live with disability. Many of the programmes tackling NTDs prevent disability, so as well as prevention DfID is also pressing for disability to be included in the post-2015 framework under the principle, outlined in the high-level panel report, of “no one left behind”. That is a very important principle that I hope offers some reassurance to the noble Lord, who rightly raises those concerns.
In 2012 we substantially increased our commitment in terms of donations. Several noble Lords referred to the amount of funding that goes into this area and the funding gap that is still there. We acknowledge that, but it is worth putting on record that if you look back to 2008 you see that the average budget going into NTDs from the UK Government for research, medicines and so on was about £1 million. As a result of the London declaration conference that went up to £10 million per annum, and now it stands on average at about £40 million per annum.
The noble Lords, Lord Patel and Lord Alton, spoke about how it was important to encourage other countries to step up to the plate and make their contributions in this area. Her Majesty’s Government are continuing to do that. It is also the place of international organisations to do that much more effectively, such as the World Health Organisation.
I turn to the millennium development goals. This of course brings us right back, as the noble Baroness, Lady Hayman commented, not to repeating the same Motion before your Lordships’ House as last year but, this year, emphasising the importance of the millennium development goals. The high-level panel, which was co-chaired by my right honourable friend the Prime Minister, included in its recommendations that NTDs should not just be listed as “other diseases” under MDG 6, as they are in the present MDGs, but actually ought to be specified and listed—at least seven of them, and perhaps 10. That was the recommendation that it made, which her Majesty’s Government absolutely support. That programme is now under review. There are some 30 groups that the UN Secretary-General has established to take forward the recommendations by the high-level panel, and they will be put before the General Assembly when it meets in September. The period of time between now and September to re-emphasise the importance of having those diseases specified is therefore very important.
This has been a very important debate in raising this issue in a timely and effective way. Again, I pay tribute to the noble Baroness, Lady Hayman, for mentioning it. The words of the Secretary-General of the United Nations, Ban Ki-moon, when he said that:
“Poverty reduction and the elimination of NTDs go hand-in-hand”,
was quite precise and to the point. That is why Her Majesty’s Government are supporting that, not only with our efforts behind the millennium development goals but with the money that we are putting into research and medicines.