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Lord Trees
To ask Her Majesty’s Government what assessment they have made of progress made in combating neglected tropical diseases following publication of the Fifth Progress Report on the London Declaration on Neglected Tropical Diseases.
Lord Trees (CB)
My Lords, given that there is another major attraction this evening, I am very grateful to noble Lords who have put down their names to speak in this debate.
The neglected tropical diseases are a group of 20 bacterial, viral, fungal and parasitic diseases—to which snake-bite has recently been added—which affect more than a billion people a year in some of the poorest countries of the world. Recognition of their importance as a burden on health in those countries was enhanced by bringing them together under the term “neglected tropical diseases”, which we shall call NTDs, and was further strengthened by the London declaration of 2012. I shall try to limit my use of lots of names, for I fear Hansard might get apoplexy dealing with visceral leishmaniasis, schistosomiasis, onchocerciasis and the like. Suffice it to say that the colloquial names of those diseases vividly convey their consequences, such as elephantiasis, river blindness, or the appalling biblical disease of leprosy, which is still prevalent in many poor countries.
A key feature of the NTDs is high morbidity, with chronic disability, disfigurement, social stigma and long-term loss of health affecting the poorest members of society. NTDs are a result of poverty, but in a malignant circle they are a cause of poverty, because they reduce the potential of millions of people to improve their economic well-being.
While chronic disease is a feature, some NTDs cause considerable mortality. For example, snake-bite is estimated to kill about 100,000 people a year. We are also beginning to understand the important role that NTDs play in predisposing to a range of other significant health problems, such as mental ill health, HIV/AIDS, epilepsy and cancer, among others. While the impact of NTDs is huge, in many cases we have the tools available to tackle them so that, given the will and the funding, we can do a great deal about their impact now.
The London declaration of 2012 focused specifically on 10 NTDs for which there are drugs available and which could be tackled by mass drug administration, which I shall refer to as MDA. That has been facilitated by donation of key drugs by several pharmaceutical companies, and the scale and significance of this is massive. Arguably, this is the greatest philanthropic gesture by industry to benefit the global public good there has ever been. Some $2 billion to $3 billion-worth of drugs is donated annually and in 2016 more than a billion treatments were donated in 130 countries.
Another important development has been the linking of NTDs to the achievement of the sustainable development goals. MDA is a great example of universal health coverage and tackling NTDs will contribute greatly to the achievement of the SDGs, especially SDG 3 to ensure healthy lives and promote well-being for all at all ages. Conversely, the attainment of other SDGs, such as the water and sanitation objectives of SDG 6, will contribute hugely to NTD control.
The progress to date in controlling NTDs has been remarkable. Between 2011 and 2016 the coverage of MDA has nearly doubled from 37% to 63% of the target populations and concomitantly the global population at risk has fallen by nearly 500 million people. In 10 countries lymphatic filariasis has been eliminated as a public health problem, as has trachoma in five countries; onchocerciasis has been almost eliminated from the Americas; and Guinea worm has been almost completely eradicated from the globe. Major progress has been made in reducing morbidity with other NTDs, all of these in countries with logistic and economic handicaps.
The UK’s contribution has been huge and is something of which we should be proud. Funding from the UK Government has been pivotal, both for research and for disease control. I am sure that the Minister will tell us about this, so I will not steal his thunder. UK scientists, too, have been and continue to be at the forefront in tackling these diseases. Here I pay particular tribute to my former colleague Professor David Molyneux, who has been at the Liverpool School of Tropical Medicine for many years and has been a tireless campaigner on NTDs. This Parliament’s All-Party Group on Malaria and NTDs, under the committed chairmanship of Jeremy Lefroy MP, has been extremely active and influential.
In tackling these diseases, a “one health” approach is extremely important, where as well as medical scientists, veterinary scientists can make an important input. This may be where infections are known to be zoonotic—that is, transmissible between humans and animals—or in other cases where we are discovering a role for animal hosts not hitherto known, such as in the epidemiology of schistosomiasis and of Guinea worm. Most significantly, it can be in the development of drugs where the commercial market to treat worms in animals has driven research and discovery of key drugs now being repurposed and donated for MDA programmes in humans, such as ivermectin for onchocerciasis.
That brings me to rabies, a truly horrific zoonotic NTD estimated to kill nearly 60,000 people a year, of whom more than 40% are children. That is year in and year out and compares to the 11,000 that died in the recent tragic Ebola outbreak in west Africa. Once clinical signs of rabies appear, whatever the treatment given, 99.9% of all patients die a horrible death, yet this is preventable. We have the technical tools required to consign this disease to history. Almost all cases of human rabies are caused by the bite of an infected dog, but we have a simple, safe and effective vaccine to immunise dogs. Field research in a number of regions and countries in Africa, the Americas and Asia has demonstrated the success of canine vaccination campaigns in eliminating human rabies. An international effort is now under way with the key organisations: the WHO, the OIE—the world organisation for animal health—the FAO and the Global Alliance for Rabies Control, which has very recently produced a global strategic plan to end dog-mediated rabies by 2030, the Zero by 30 campaign. Key to that campaign is a dog vaccine bank that the WHO has already set up. I ask the Minister: what specific support is DfID giving to rabies control? This is a disease on which the UK could single-handedly make a huge, cost-effective impact.
Because the dog vaccine is largely an altruistic vaccine, in that it is given to dogs in order to benefit public health, it is difficult for human health ministries in low-income countries to justify expenditure on a dog vaccine from their budgets. On the other hand, impoverished dog owners are unlikely to vaccinate their dogs to benefit the general public. The donation of dog vaccines to the WHO’s vaccine bank would cut this Gordian knot and catalyse progress. Professor Sarah Cleaveland of Glasgow University, one of the world’s leading authorities on rabies control, has estimated that only $15 million to $20 million per year would purchase enough dog vaccines for all of Africa. I suggest to the Minister that a commitment to provide dog vaccines on such a scale would be a huge boost to the Zero by 30 campaign and would leverage a colossal amount of support in delivering those vaccines by NGOs, charities and ministries of health in low-income countries, acting under the umbrella of the global strategic plan to end almost all human deaths from rabies in the world.
In conclusion, the progress made in reducing the effect of all NTDs has been a remarkable testament to the efforts of the international community. To cement the progress made to date and drive these diseases to oblivion, it is essential that we maintain our efforts. Endemic countries need to take more responsibility. While the healthcare budgets of low-income and middle-income countries may be modest, the cost of delivery of donated drugs—about 20 cents to 30 cents per person per year—would amount to only 1% to 2% of such budgets, yet donated drugs are not getting delivered. We need also to better integrate interventions between various NTDs and with other healthcare interventions to be more cost-effective.
In the affluent world, we need to maintain our commitment. There is a funding gap. The WHO has estimated that an additional $300 million to $400 million is required per year up to 2020. Currently, of world Governments, the UK and the US have been the principal donors; other affluent nations need to increase their efforts. The UK pledge to spend 0.7% of GDP on overseas aid is an admirable example. We need to recognise that, even when there are many calls on public expenditure, improving the health and welfare of those in poorer countries is not only ethically admirable but makes sound sense.
Let me elaborate. Analysis has shown that, given the scale of drug donation, NTD interventions are one of the most cost-effective measures in public health, one estimate giving a 25:1 rate of return. In addition to being highly cost-effective, support for NTD control is quite simply enlightened self-interest. I need hardly emphasise to your Lordships that the issue of economic migration is a huge challenge to the affluent northern countries. I submit that the solution lies not in fences and walls but rather in improving the health, and hence wealth, of populations ravished by endemic disease, so that people can stay at home assured of a healthy, productive and economically adequate life.
Baroness Stroud (Con)
My Lords, I thank the noble Lord, Lord Trees, for tabling this Question for Short Debate. The story of tackling NTDs is one of extraordinary progress and collaboration. There is plenty to celebrate in this space but, as always, still more to do.
Earlier this year I had the opportunity to visit Rwanda and see a mass drug administration take place in a school. It is not hard to imagine why children whose bodies are infected with parasitic intestinal worms find it difficult to go to school, concentrate in class and get an education. The children I visited are now free to learn and fulfil their potential. Almost 4.5 million people a year in Rwanda receive treatment for NTDs, and for every one of those children I met, there are millions more stories of lives changed. Across the world, this story of lives changed is multiplied. Some 1 billion people received treatment for at least one NTD in 2016. These people are now able to see, walk to work, access education, get jobs and have better lives.
The reach of treatment of all NTDs has grown dramatically, freeing more people from disease every year. There has been a 68% reduction in the number of cases of sleeping sickness, and several countries, such as Bangladesh, have significantly reduced the number of new cases of visceral leishmaniasis—I say this because I have just learned it. In several cases countries have managed to eliminate diseases entirely. I will not go through the entire list because the noble Lord, Lord Trees, has already done so.
This success is testament to people working together across the world in a co-ordinated response. Researchers have been developing effective cures and treatments. Pharmaceutical companies have provided the means to fight the diseases: 1.8 billion treatments were donated by pharmaceutical companies in 2016 alone. Targeted funding has been provided by international development agencies and private foundations to train medical professionals and provide help where it is needed. Domestic Governments in endemic countries have financed and enabled NTD programmes, meaning that in 2016 interventions against NTDs were able to take place in more than 130 countries.
This progress is testament to the extraordinary power of networks, and should give heart to any who doubt that large-scale change is possible. I pay tribute to the work of the END Fund, one of the sister charities of the Legatum Institute, in which I declare an interest. It has shown the power of mobilising private philanthropy and what can be achieved by building coalitions to actively identify gaps and opportunities for investment. In 2006, Alan McCormick saw an article in the Financial Times by a professor of tropical parasitology, Alan Fenwick, which explained that for just 50 cents per person, a life could be freed from disease. Alan and the Legatum group went on to found the END Fund to co-ordinate and generate the capital that would scale up their response. A decade later, in 2017, the fund invested in 23 countries to train 345,000 health workers and treat more than 97 million people. It has been chosen to manage the Reaching the Last Mile Fund, which is a 10-year, $100 million dollar fund founded by His Highness the Crown Prince of Abu Dhabi. It is excellent news that DfID has committed a further £1 million to the fund for 2019, in addition to co-investment with the Bill and Melinda Gates Foundation. This partnership has enormous potential and, I hope, will lead to greater collaboration beyond 2019.
As we celebrate these extraordinary achievements, it must not be forgotten that these diseases affect the world’s poorest and most vulnerable communities and trap them in cycles of poverty. These diseases are not rife in wealthy communities; they thrive where conditions are symptomatic of severe poverty. Margaret Chan, the former director-general of the WHO, said that,
“all of these diseases thrive under conditions of poverty and filth. They tend to cluster together in places where housing is substandard, drinking water is unsafe, sanitation is poor, access to health care is limited or non-existent, and insect vectors are constant household and agricultural companions”.
An effective response is therefore not just one which treats the diseases themselves but has a strategy to invest in raising the prosperity of communities and nations where these diseases are rife. More than 70% of countries and territories that report the presence of neglected tropical diseases are low-income or lower middle-income economies. We must be investing to break the cycle of poverty of which NTDs are a part. Can the Minister expand on what the Government are doing, through our Commonwealth and other relationships, to ensure that this is a priority at the highest level of government in endemic countries? The targets set in 2012 were ambitious; to meet them, more work must be done to reach the remaining 1.5 billion people affected. The role of DfID investment in eliminating neglected tropical diseases is a genuine success story and we have a proud history, as a nation, of contributing to this fight. I therefore call upon the Minister to comment on how we will commit to seeing this fight through right to the end.
Lord Stone of Blackheath (Lab)
My Lords, it is really an honour to be involved in this debate with those of your Lordships who are great experts and involved in the long-term effective work of relieving millions of people the world over, particularly children, from suffering from these diseases. We, as a nation, can be proud of the work that we are doing.
I am no expert but I know particularly about the work of the Schistosomiasis Control Initiative at Imperial College. I declare an interest as a past member of its advisory board. One reason that I was taken on is that I can pronounce schistosomiasis and the drug that controls it, praziquantel. I am not surprised that these diseases are neglected, as no one can pronounce their names. Schistosomiasis affects 200 million people, primarily in sub-Saharan Africa, and very few people know about it but we do. The latest figures from the World Health Organization suggest that over 70 million people received treatment in 2016. Our own SCI, supported by the British Government since 2010, has delivered over 40% of Schistosomiasis treatment globally—thank you, the Government.
What I do know about is quality control and systems. SCI has rigorous monitoring and evaluation processes in place to ensure that it is able to track closely the treatment numbers. This also allows for the identification of areas where the prevalence and intensity of the infection are not being reduced at the expected rate, and enables those Governments to be supported to take corrective action. Due to the complex epidemiology of schistosomiasis, in which the parasite is able to multiply many thousands of times in the snail intermediate host, continued progress will require a sustained effort, as the fifth progress report says. SCI and other organisations are committed to reaching the World Health Organization targets for schistosomiasis but also to ensuring that the disease-specific NTD interventions support the health systems of endemic countries and therefore the broad sustainable development goals. In addition, there is an issue with water and sanitation. Work on that needs to be accelerated so that we progress the targets for NTDs.
If I have any expertise, it is in linking business with good works. Arup, the global business of designers, planners and engineers, is currently involved in a number of projects related to sanitation and new and emerging water-quality issues worldwide. It has a strong global water-skilled network of staff, with specialisations covering all aspects of the water cycle. These staff work with ecologists in an interdisciplinary manner, which allows them to develop solutions based on holistic whole-systems thinking, and they feel that they may be able to view the problem and the potential solutions from a slightly different angle. What are Her Majesty’s Government considering doing to link investments made by DfID with these organisations to promote improved water and sanitation and strengthening systems?
My mentor in all this, who has already been mentioned, is Professor Alan Fenwick, the founder of SCI, who is now an adviser to the Global Schistosomiasis Alliance—GSA—which brings together donors, implementation organisations and country programme managers to assist in the development and implementation of country plans for the control and elimination of schistosomiasis country by country. He and others are concerned that the member states of the World Health Organization passed a World Health Assembly resolution in 2012 identifying schistosomiasis as a disease that could be eliminated. The resolution called on the World Health Organization to prepare guidance for member states towards the elimination of transmission, to establish procedures for the confirmation of the interruption of transmission and to support countries with post-elimination surveillance to prevent reintroduction of transmission. Six years later, there is still a lack of guidance from the World Health Organization on the treatment strategies needed to fulfil the resolution. How can Her Majesty’s Government support the World Health Organization to develop that guidance?
On a positive note, Wendy Harrison, who now leads the SCI team, reports that last year NTDs entered the Guinness book of records with the world’s largest mobilisation of donated drugs: the delivery in 2016 of more than 200 million doses, which arrived in distribution sites in six countries in one 24-hour period. One of the drugs that I mentioned that treats schistosomiasis, which has been generously donated by Merck, is praziquantel. Donations of praziquantel more than doubled from 72 million tablets in 2014 to 183 million tablets in 2016, but those donations still covered only about one-third of the 563 million tablets needed. How will Her Majesty’s Government support the market for praziquantel to reach the full number of tablets required?
Finally, to celebrate the UK’s innovation, entrepreneurialism and care in these times, and linked to our work, I was yesterday on your Lordships’ Terrace with Patricia Carter a director of Howad Ltd, which produces incognito insect repellent. She smiled at the fact that as we were talking, a bus crossed Westminster Bridge with an advert for incognito. The company has won a Queen’s Award for Enterprise in Sustainable Development for its product, which protects people from mosquitoes and other biting insects at home and overseas. We should be proud of that, as a country. Due to our work and expertise, here is an example of a small UK company protecting people against neglected tropical diseases and exporting to 22 countries. It also donates 10% of its profits to charities. On that note, I am now going to donate the four minutes that I have not used to the noble Baroness, Lady Hayman.
Baroness Hayman (CB)
I am a very charitable cause. My Lords, I am delighted to take part in this debate, and I draw the House’s attention to my interests as set out in the register. I congratulate the noble Lord, Lord Trees, on obtaining this debate and on introducing it so effectively and comprehensively. It has become something of an annual parliamentary event. If we look back to last year’s debate, we can see the value of having an annual debate. I start off by congratulating and thanking not only the noble Lord, Lord Trees, but the Minister, the noble Lord, Lord Bates. Last year, those of us who spoke in this debate—many of us are in the Chamber today—gave him not a hard time but an element of harangue because we were coming up to some crucial funding decisions. He took on board everything that we said. He went back to the department—and maybe there was an element of harangue in his conversations with colleagues—and he certainly came up with the goods. I think we ought to record, if not our effectiveness, his effectiveness in ensuring that the DfID commitment to NTDs continued.
As we have heard, that commitment is showing results. When we look at the fifth annual assessment following the London declaration and the published work of Professor Hotez, Professor Molyneux and Professor Fenwick—to whom the noble Lord, Lord Stone, referred—we can see that, particularly in sub-Saharan Africa, and particularly through the mass drug-administration programmes, we are making a real inroad into the diseases that we have described every year in terms of their debilitating effects on individuals and communities and their educational and employment status. We have often said that these are diseases of neglected people, not just neglected diseases.
We also have to recognise that while we have seen successes—I think we can say with some confidence from the academic research that the integrated MDA programmes are highly successful, and of course they are immensely cost effective because of the donations, as has been referred to—there are also areas where success has stalled. Sometimes that is because of conflict and political destabilisation. Last year we discussed the areas of Syria and Iraq, which have seen a rise in NTDs, but also in Venezuela destabilisation has resulted in the rise of Chagas disease, malaria infections and indeed schistosomiasis.
The noble Baroness, Lady Stroud, said correctly that we do not see these diseases in wealthy communities but we see them in wealthy countries. A growing number of NTDs now occur among the poorest living in G20 nations. For example, today 90% of people living with leishmaniasis and Chagas disease, particularly the latter, live in the four leading economies in the western hemisphere—the US, Argentina, Brazil and Mexico—and 99% of those sufferers are denied access to diagnosis and treatment. They are the diseases of the poor but they are not only diseases of the poor living in poor countries. It is very important that we realise that. There are 12 million Americans living with NTDs, particularly in the south.
So we need to look at conflict zones and at the poor in G20 nations. That means we have to continue with the drive for innovation, creativity and new treatments, particularly antihelminthic drugs, and I will bang the drum for vaccines once again. I particularly know about the Texas Children’s Hospital Center for Vaccine Development, which is developing a whole new generation of NTD antipoverty vaccines for Chagas, leishmaniasis, schistosomiasis and hookworm, among others. Many of these vaccines are being developed jointly with manufacturers in disease-endemic countries, and obviously one can see the benefits of that. They are key technologies to ensure the elimination of NTDs.
Talking of vaccines, if I may digress a little, we have to be aware of the dangers of the anti-vax movement. Look at the progress of measles: last year we had 20,000 cases in Europe, and it looks as if we will have more this year. The pernicious effects of the anti-vax movement are already being felt among their own children and children among Europe. What we do not want to see is new vaccines coming in for these diseases being subject to the same sort of scaremongering. That is why it is very important that we take on the anti-vax movement very strongly, otherwise we will quickly erode the gains that we got through MDG 4 and Gavi.
I want to raise a point that I know is of issue particularly to those concerned with leprosy. For very obvious reasons, DfID has had a focus on five diseases and on mass drug administration programmes. In terms of bangs for your buck, one can see exactly why that has happened, but the London declaration went much further than those five diseases. I know that the work of DfID goes much wider than that—for example in the aid match that it has given for leprosy.
It is important that we recognise that many people suffer from not one NTD but several. We must not neglect opportunities to treat the whole person and all their diseases because we are too much in a single disease silo—which of course goes against the whole ethos of universal health coverage, which NTD treatments could be a pathway into.
Can the Minister reassure me that the department will look widely in asking for bids and expressions of interest for NTD work and consider bids that are not necessarily from the five priority areas but particularly involve co-ordination with one of those diseases and a separate disease? It would be nice to know a little more about the Ross fund and what elements of that are going into vaccine and treatment development.
I end by thanking the Minister once again so much for what he did last year.
Baroness Warwick of Undercliffe (Lab)
My Lords, I am grateful to the noble Lord, Lord Trees, for once again giving us an opportunity to consider what progress has been made in the unceasing challenge to combat neglected tropical diseases. He is steadfast in his commitment to bringing this issue to the attention of the House.
We have now had the fifth report on the progress of the London Declaration on NTDs, and I share other noble Lords’ satisfaction with the tremendous strides that have been taken in the five years since the World Health Organization set out its road map and prompted the London declaration. As the report highlights, the story of tackling NTDs is one of great progress alongside continuing challenge.
The progress is well documented. In 2016, more than 1 billion people received treatment for at least one NTD. Since 2012, pharmaceutical companies have collectively donated more than 10 billion tablets. With the support of many logistical partners, ministries of health and local NGOs, treatments are getting to some of the remotest communities across the world.
The noble Lord, Lord Trees, enumerated many of the key successes, and I shall not repeat them, but I mention Pfizer, which just last month agreed to extend to 2025 the donation of Zithromax, its antibiotic, to the International Trachoma Initiative, to help eliminate that horrible disease. Trachoma is the world’s leading infectious cause of blindness. Pfizer’s recommitment is a critical component of the global strategy to eliminate trachoma. It will certainly help accelerate progress brought about by drug donations, which in the past decade have resulted in in a roughly 50% decrease in the number of people at risk compared to 2011. In May, Nepal became the sixth country to declare the elimination of trachoma. Ghana is close to being validated by the World Health Organization, and when this happens, it will be the first country in sub-Saharan Africa to achieve this milestone.
Like the noble Lord, Lord Trees, I want to mention rabies. It is one of the oldest and most terrifying of diseases. Although it can be prevented, it kills an estimated 59,000 people a year. About 40% of the victims are children younger than 15 living in Asia and Africa. It is almost universally fatal yet, unlike many other NTDs, there is a vaccine. However, implementation, research and political challenges still mean that it has been neglected for a very long time. Until recently, the global response to rabies was fragmented and unco-ordinated. Now, the WHO, the FAO, the World Organisation for Animal Health and the Global Alliance for Rabies Control are joining forces to support countries as they seek to accelerate their actions towards the elimination of dog-related rabies by 2030. So there is at last some global momentum working towards breaking the cycle of neglect, but much remains to be done to achieve the goals the global community has set.
The challenges overall remain enormous. NTDs kill 170,000 people every year, but the biggest impact is on the millions they disable and disfigure. Currently, NTDs affect some 1.5 billion people in the world. These are the poorest of the poor, who live in the hardest to reach, most marginalised communities. We know also that women and girls bear the highest burden of infection.
The London declaration’s 2020 timeframe for eliminating 10 NTDs is not far off, and there is a more urgent tone to the latest progress report to make sure no one is left behind. We know that drugs alone cannot achieve the London declaration goals. There needs to be an increased domestic financial and political commitment to tackling NTDs, as well as new resources, new partners and new approaches. Among these new approaches, I was fascinated to learn of the role technology is playing in some critical areas. I am thinking of the work of German biochemist Christian Schröter, who as head of pharma business integration at Merck, has been involved with a WHO donation programme to treat children in Africa against schistosomiasis. He has worked with supply chain experts from around the world to develop a method for tracking medical donations from the warehouse to NTD treatment points in the most inaccessible places, using a simple cell phone. In his recent TED talk he describes the process as being similar to the way you track a package you order on Amazon: text messaging allows you to see in real time when the drugs leave the warehouse and when they reach the school or medical centre. We can see how many tablets have been administered, and where, and how many are still on the inventory.
The system was piloted in Mozambique last year and has huge promise. Schröter describes how it could mean excess shipments being rerouted after treatment campaigns have been completed; an end to drugs being stuck in warehouses reaching their expiry dates and having to be destroyed; and an end to paper-based reporting, which can take months to receive and process. Noble Lords will see from my description that his enthusiasm has certainly communicated itself to me.
I was also captivated by the ingenuity and practicality of Zipline, a start-up company which uses drones as a delivery system to transport blood and plasma to remote clinics in east Africa. This fleet of electric autonomous aircraft are helping to ensure that local people can have access to basic healthcare, no matter how hard it is to reach them. Equally inspiring is the software being devised in Malawi to ensure that health records can be kept electronically, even in areas of sub-Saharan Africa with power outages, low technology penetration, slow internet and understaffed hospitals.
I have enumerated these because it seems to me that such new ideas are vital if we are to beat these diseases. Alongside the basic science, multidisciplinary and long-term medical research and development, we need to be funding our engineers and smart technology experts to take forward new and exciting approaches to mapping NTDs. Can the Minister tell us whether DfID is looking at the use of such smart technologies?
The World Health Assembly recently set out an ambitious target to eliminate at least one NTD in 30 additional countries between 2019 and 2023. It is clear that if we are to continue to make progress against these awful diseases and future threats to global health, existing scientific partnerships must be expanded and new ones created. Yet our future involvement in European research programmes remains uncertain. Can the Minister reassure us that the UK’s research expertise and commitment to the London declaration goals will be supported as we look beyond 2020?
This is probably a bit unfair, but I asked exactly the same question last year in relation to our continuing collaboration with member countries of the European and Developing Countries Clinical Trials Partnership. I was not reassured by the Minister’s answer. Programmes such as EDCTP have proved very effective, yet I got rather a bland response last year, and I still feel very uneasy that our participation in such programmes would be a casualty of Brexit. So I ask the Minister, a little more bluntly: can he tell the House categorically that the impetus for this European funding will be continued?
Baroness Sheehan (LD)
My Lords, I too add my congratulations to the noble Lord, Lord Trees, on bringing this debate to your Lordships’ House, and thank him for his very thorough introduction to the huge global health burden that NTDs pose for developing countries. I will keep my remarks short, as it is not every day that the England football team has an opportunity to secure a place in the World Cup final.
The success of the London declaration in bringing together the partners necessary to deliver a holistic attack on 10 NTDs is documented quite thoroughly in its fifth progress report. Let us be clear—and other noble Lords have emphasised this point. Without collaboration among stakeholders, including Governments, donors, civil society—particularly the private sector—and academia, this record of achievement would have remained a pipe dream. What a catalogue of progress it documents.
Let me pick out a couple of highlights. Lymphatic filariasis—I am not sure whether I said that correctly—is no longer a public health concern in 10 countries, and Guinea worm disease is poised for eradication, with only four cases reported by WHO from 1 January to the end of May this year. When the eradication programme began in 1986, there were 3.5 million cases worldwide. That is a real testimony of what determined leadership from an individual such as President Carter can achieve.
Can I ask the Minister about DfID’s approach to leprosy? The Leprosy Mission’s briefing informs me that DfID currently does not include leprosy as a priority NTD. Can the Minister elaborate on why that is the case, particularly in light of the fact that multi-drug therapy is available free of charge through the WHO and is a very effective cure for all types of leprosy?
The fifth progress report on the London declaration makes it clear that it is the poorest of the poor in developing countries who continue to be disproportionately affected by NTDs. The noble Baroness, Lady Hayman, is quite correct when she says that poor people in developed countries are also facing attack from NTDs. It is clear that those living in closest proximity to dirty water and soil are worst affected. Clearly, prevention is the first line of defence in ridding the world of these diseases of the poor, and WASH initiatives are key to prevention. I hope the Minister agrees with me that, if we are to sustain the progress made to date, basic principles of clean water, sanitation and hygiene, in collaboration with in-country organisations, must underpin all DfID NTD partnership programmes.
On data, in the Parliamentary Office of Science and Technology report of May 2017 entitled Global Health Inequalities, we are told that, although more people have access to essential health services now than at any time in history, profound health inequalities persist—that is, differences in health status between different population groups such as age or socio-economic status. To overcome health inequalities and meet the 13 targets of SDG 3, which is to ensure healthy lives and provide well-being to all at all ages, it is essential that we have access to good-quality data. Yet it seems that good data, although gathered at distribution points, are nevertheless not captured further up the report chain. For example, the November 2016 report from Uniting to Combat Neglected Tropical Diseases, Neglected Tropical Diseases: Women and Girls in Focus, makes the point that current WHO reporting forms include sex-disaggregated data, collected at the point of distribution. However, these are not reported up when the data are aggregated, which is a lost opportunity for action. It is important to understand where these data are lost, so that the integrity of information can be restored. Maybe we can bypass human error through smart technologies, as outlined by the noble Baroness, Lady Warwick of Undercliffe—that would be a way to move forward on this. Nevertheless, will the Minister undertake to follow up with WHO on this point, and will he undertake to write to me if and when he receives a response?
In its briefing for this debate, the British Society for Immunology quite rightly draws our attention to the importance of immunological research in developing new drugs, vaccines and diagnostics for NTDs. However, it goes on to say that, since the London declaration was signed, research progress has been slow. The importance of vaccines and new drugs in the face of rising antimicrobial resistance is self-evident. Let me focus on the importance of rapid point-of-care diagnostics, which need little skill to operate. This is as an area where huge opportunities exist, and with good payback. At present, seven of the 10 NTDs in the London declaration lack essential rapid point-of-care diagnostic tools. Yet government agencies have demonstrated that, with the correct support, they are able to very quickly develop medical products for other diseases, such as the rapid antigen diagnostic test for Ebola. Will the Minister make inquiries as to why this success, in collaboration with industry and clinicians, cannot be replicated for the NTDs listed in the London declaration? I believe that this is a clear case of where there is a will, there is a way. The British Society for Immunology certainly thinks so.
My final question to the Minister is about the Ross fund, about which we still know very little. In preparing for this debate, I reread last year’s debate and was surprised to find that there had been five speakers—namely my noble friend Lady Northover, the noble Baronesses, Lady Hayman and Lady Chalker, the noble Lord, Lord Collins of Highbury, and myself—who asked for more details on the role of the Ross fund in delivering UK aid to NTDs. It may be churlish of me to say, but I note that the Minister did not address these questions in his response last time. I hope that he will take the opportunity today to do so, or, if time does not permit, will he undertake to write to me and others who are interested with a response?
Lord Collins of Highbury (Lab)
My Lords, I, too, thank the noble Lord, Lord Trees, for initiating today’s debate. Like the noble Baroness, Lady Hayman, I am pleased that he has kept up the tradition of maintaining this debate on a regular basis since the 2012 summit, which set out the way forward towards achieving a world free of NTDs. I was just thinking, as noble Lords were talking about pronunciations, that I have successfully managed throughout five years of debates not to use one Latin word—so I will continue with that and avoid slipping up with any mispronunciations.
As we have heard, neglected tropical diseases are the most common infections among the world’s poorest communities. Like the noble Baroness, Lady Hayman, I use the term “communities” because it is not about rich countries and poor countries: it is about poor people, and poor people have suffered the most from these diseases. It is a vital issue, and one reason why I have been so pleased about this annual event is that it is a way of keeping the public and the Government aware of the impact of these diseases and ensuring that they continue with the battle against them.
While their effects are not always fatal, their effects on individuals and families can be devastating, and the brunt is often felt by women and children, which acts as a serious impediment to economic development. I remember that, before one of the debates we had, the noble Baroness, Lady Hayman, introduced me to John Kufuor, the former president of Ghana, who said:
“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”.
That sums up what tonight is all about.
We have heard that treating NTDs is extremely cost effective, and heard about the tremendous impact that public-private partnerships and the commitment of pharmaceutical companies to donate nearly all of the drugs necessary for counteracting the seven most common NTDs have had. Like the noble Baroness, Lady Hayman, I recognise the huge progress that has been made, which was highlighted in the fifth progress report. I also pay tribute to the Minister for his continued activity in this regard, pushing the Government. I know that I have done this in the past, and I am sure that it has not necessarily helped his career, but I will continue to do so.
As the fifth progress report rightly highlights—noble Lords mentioned this—the programmes that have been introduced have been an important gateway to universal health coverage, reaching as they do some of the world’s most isolated and poorest communities. They do so by training health workers and empowering health facilities with scant resources to reach more people effectively. As the noble Baroness, Lady Hayman, said, they can fuel innovation, which is crucial to ensuring universal health coverage, and can ensure that everyone has access to high-quality essential healthcare without suffering financial hardship—which of course is what the SDGs are all about.
DfID has promised to help countries build “resilient, responsive health systems”. Will the Minister say how his department is using the lessons learned from the NTD programmes to deliver on that DfID promise? Labour is committed to establishing a new centre for universal health coverage to give technical and policy assistance to support low-income countries to strengthen and expand their own free, universal public health systems. As we have heard tonight, despite the striking progress since the 2012 summit—it has been striking—the long-term elimination goals cannot be reached without addressing the primary risk factors for NTDs, such as access to clean water and basic sanitation, vector control, and, as I mentioned, stronger health systems, particularly in endemic areas.
As we have also heard, many of the issues and concerns raised in our last debate on the subject still hold. As my noble friend Lady Warwick said, one of those concerns is Brexit and the impact it may have on our research institutions. I hope that the Minister will be able to respond to questions in a direct way.
The other threat that we referred to in the last debate is the impact that President Trump’s changes, particularly to USAID, might have. The United States, through its private foundations and as a Government, has played a critical role in the NTD campaign. As we have heard, Governments and private philanthropists have been providing generous funding, with $812 million pledged at the 2017 summit.
The progress report calls on existing donor countries such as the UK to invest more to support NTD programmes and to support the leverage that can occur from those donations, multiplying the impact, particularly with donated drugs, of every dollar committed. I know that the Minister may have difficulty in answering this, but can he tell us what steps the Government are taking to ensure that the US stays the course until these diseases are eliminated and to encourage new donors to join this global effort? For example, will the Prime Minster raise this issue with President Trump when she meets him this week? US aid is a critical factor in these programmes. The report also calls on us to encourage new donors to join the global effort. Will the Minister tell us whether the Government have made representations to others who have not yet committed to encourage the programmes?
My noble friend Lady Warwick highlighted trachoma —I have managed to pronounce one term—which is a bacterial infection that can lead to permanent loss of sight. It is one of the world’s main infectious causes of blindness. As we have heard, five countries have been validated by the WHO as having eliminated trachoma. The Minister was present at the CHOGM where I was extremely pleased to hear the announcement that the UK would step up its programme to combat the disease that affects 52 million people across 21 Commonwealth countries. That support is extremely welcome and will be added to by additional donors, including the Queen Elizabeth Diamond Jubilee Trust, which is working towards elimination in 12 Commonwealth countries.
Later this month, the UK will host the first Global Disability Summit with its Charter for Change, which aims to ensure rights, freedoms, dignity and inclusion for all persons with disabilities. One way of delivering real change would be to ensure that lessons from initiatives such as the UK-funded trachoma programme are shared so that all people with disabilities are empowered and no one is left behind.
The Minister of State, Department for International Development (Lord Bates) (Con)
My Lords, I join other noble Lords in paying tribute to the noble Lord, Lord Trees, for securing this debate on NTDs. The noble Lord, Lord Collins, mentioned that he is a veteran of five such debates. I think that I have probably managed three, the last one, last year, introduced by the noble Baroness, Lady Hayman. I also particularly pay tribute to the noble Lord, Lord Trees, for his work as the chair of the advisory group for DfID on zoonosis. I also take the opportunity to commend the work of the APPG on Malaria and Neglected Tropical Diseases, and I am delighted that part of our proceedings have been observed by Jeremy Lefroy, who has done so much to raise the profile of this area and to continue interest in it. I also thank the noble Lord, Lord Kakkar, for his support, including at the global health forum.
It has been a fascinating debate, with a lot of new areas being raised. The noble Lord, Lord Trees, began by reminding us that NTDs are a result of poverty, as well as a cause of poverty. He placed this debate in the context of the sustainable development goals—particularly three, although others are impacted too.
My noble friend Lady Stroud spoke about the impact she had witnessed at first hand in Rwanda. She referred to the work that had been done and the impact it had on children’s education, reminding us of the connectedness of these diseases with other development needs.
The noble Lord, Lord Stone, again reminded us of the incredible work of Imperial College in the schistosomiasis group and the work of Professor Alan Fenwick, which is well regarded in this area.
The noble Baroness, Lady Hayman, is an example of persistence and perseverance in this area, which is not only necessary to tackle neglected tropical diseases but to advance the issue up the agenda of government. She pressed us on that.
The noble Baroness, Lady Warwick, reminded us that women and girls often bear the greatest burden of these diseases. She then went on to highlight a series of technical innovations—such as the example she gave in Mozambique—and called for new ideas.
The noble Baroness, Lady Sheehan, pointed out that none of the progress which has been made would have been possible without collaboration. She said that it would have remained a pipe dream. She also pointed to the important role that data and diagnostics can play in achieving this.
The noble Lord, Lord Collins, reminded us that investing in health systems and the health of populations is one of the most effective ways of correspondingly lifting people out of poverty. Again, he placed that in the context of further work that will be carried out on 24 July at the global disability summit. I am delighted that he is participating in it.
Let me update the House on progress over the past year and then seek to address some of the questions that have been raised. Neglected tropical diseases impact on the most disadvantaged, especially those living in remote areas or areas affected by conflict. They prevent children attending school, as my noble friend Lady Stroud reminded us. Tackling NTDs enables us to ensure that everyone has the opportunity to reach their full potential, a value protected through UK aid and declared, as the noble Lord, Lord Collins, reminded us, through the SDGs, with no one being left behind.
NTDs can result in families falling into poverty as a result of having to sell assets or borrow money to pay for healthcare. Combating these diseases is a development best buy, with the average treatment for a range of commonly occurring NTDs costing between 20 and 50 cents, as the noble Lord, Lord Trees, reminded us.
As the fifth progress report shows, progress is being made. It demonstrates that the number of people needing treatment for an NTD has fallen from almost 2 billion in 2011 to 1.5 billion in 2016, reducing the numbers of people at risk from these diseases. One billion people received treatment for an NTD in 2016. This progress is continuing. Since the report’s publication, the World Health Organization has verified Ghana’s and Nepal’s elimination of blinding trachoma, a fact mentioned by the noble Baroness, Lady Warwick. Guinea worm disease has fallen from 3 million human cases a year in 1986 to just 30 cases in 2017. However, there is more to do.
These are, of course, huge achievements, but hundreds of millions of people remain without the treatment they need. We know the last mile is often the hardest. The World Health Organization has just announced that a case of Guinea worm disease has been found in Angola, a country previously thought to be free from the disease. This is disappointing to us all but I know that globally we will rise to this challenge on the path to its eradication.
The UK invests in high-performing programmes tackling a range of NTDs. These programmes are delivering results. DfID programmes delivered more than 145 million treatments for NTDs in 2017 and carried out 50,000 surgeries to prevent blindness from trachoma. Asia is making progress towards achieving the elimination of visceral leishmaniasis as a public health problem. We are prioritising the tackling of five high-burden NTDs that we can have the greatest impact on. With our increased investment, we welcome bids that include additional activities to tackle other NTDs included in the London declaration, which identified 10. We have said that we want to focus on five, but I have been persuaded by some of the representations made by noble Lords, particularly on leprosy. I want to see what more can be done there. I received representations from the Leprosy Mission, which I am looking to meet, and Lepra, to see how we can involve leprosy more. Once that meeting is scheduled, I will invite other noble Lords to attend it.
The noble Lord, Lord Trees, focused on rabies. It is a devastating disease. DfID focuses on tackling some of the priority NTDs selected following careful analysis of the disease burden, the value for money and the likely impact of our investment. We welcome the inclusion of other diseases included in the London declaration. We also support the World Health Organization’s NTD efforts, which address an even wider range of NTDs and work to improve health systems in all countries, including those affected by rabies. That is something I will take away.
I am conscious, as officials are now, that noble Lords will be reading the record in a year’s time. I want to do slightly better than I did last year in respect of the questions from the noble Baronesses, Lady Warwick and Lady Sheehan, on the Ross fund. In that context—rather than reading the short response I have from the Box—one of the interesting things about what the noble Baronesses raised on the Ross fund is that we work very closely with the Department of Health and Social Care and we need to co-ordinate a better response there. DExEU has an impact on the relationship with the EU, as does the Department of Health and Social Care. Perhaps the noble Baronesses will allow me to write a more substantive response, which other noble Lords will be copied into.
The noble Baroness, Lady Warwick, also asked what we are doing about technologies. DfID is using smart technologies. An example is trachoma mapping; another is the use of an app to guide medical staff on the dose of drugs and treatments. I know that we are also looking at the use of drone technology, which the noble Baroness also mentioned.
The noble Lord, Lord Stone, asked what we are doing to link water and sanitation work. The UK is committed to supporting people to gain access to water sanitation and hygiene. Since 2015, DfID has provided 27.2 million people with access to clean water or sanitation as part of our commitment to reach an additional 60 million people with water or sanitation between 2016 and 2020.
In passing, I will make a short reference to the Ross fund. We fund research into the development of new drugs and diagnostics for NTDs, as well as operational research. Some £100 million of the Ross fund portfolio, managed by DfID and the Department of Health and Social Care, is allocated to this work, investing in our world-leading research in this area. I also pay tribute the work of Professor Molyneux at the Liverpool School of Tropical Medicine.
Our work on NTDs is one way in which the UK is showing leadership on the global health goal, which will help others. There is a unique public/private partnership. I again pay tribute to the END fund, mentioned by my noble friend Lady Stroud, and the visionary work of Alan McCormick in seeking to advance that particular area. Most of the medicines are donated by pharmaceutical companies. As the noble Lords, Lord Collins and Lord Stone, mentioned, NTDs entered the Guinness book of records in 2017 with the most drugs donated in a 24-hour period. The noble Lord, Lord Trees, was absolutely right to remind us that this must be one of the greatest philanthropic acts in history.
In April 2017, the noble Lord and I attended the NTD summit to mark the fifth anniversary of the London declaration. To mark that conference, we announced an increase in investment to protect more than 200 million people from the pain and disfigurement of NTDs over the next five years. A total of over $800 million was pledged at that conference. The noble Baroness, Lady Hayman, was generous in recognising any small contribution which I may have made to that; I would rather pay tribute to the power of a compelling argument.
There is much more to do in this area, but I assure noble Lords that the UK is meeting our commitments. We must continue to widen the donor base and increase the domestic resources committed to health. We have made considerable progress, but more will need to be done if we are to banish to history the suffering from these dreadful diseases, which we are all committed to do.