Malaria and Neglected Tropical Diseases

Tuesday 9th January 2024 Westminster Hall

00:00

[Carolyn Harris (in the Chair)]

As this is the first sitting in this Chamber of 2024, may I take this opportunity to wish everyone a very happy and prosperous 2024?

[Patrick Grady (Glasgow North) (SNP)]

I beg to move,

That this House has considered the role of the UK in ending malaria and neglected tropical diseases.

Thank you, Mrs Harris, and a very happy new year to you too. It is a pleasure to serve under your chairmanship.

I am grateful to the Backbench Business Committee for granting time for this debate, and to the hon. Members from across the House who supported the bid, not all of whom have been able to make it here today. I think a few folk are stuck in traffic or whatever, so perhaps we will see some more faces as the debate goes on. I am very grateful to everyone who has come here to take part.

I refer to my entry in the Register of Members’ Financial Interests. Last year I and a number of colleagues visited Malawi with the all-party parliamentary group on malaria and neglected tropical diseases to learn more about the efforts to end these diseases, and to see at first hand the impact of UK investment on those efforts. I will draw on that experience in my contribution today.

We are particularly grateful to the Backbench Business Committee for granting the debate now, because at the end of this month, on Tuesday 30 January, we will mark World Neglected Tropical Diseases Day—a day designated by the World Health Organisation to raise awareness of the challenge and the opportunity that we have to eliminate many of these deadly diseases. It will be the first such awareness day of the calendar year, and the fourth time that that particular day has been marked. This year’s theme is “Unite. Act. Eliminate.” It challenges decision makers and those in positions of power—including everyone taking part in this debate—to work together to mobilise the resources necessary to eliminate malaria and other neglected tropical diseases.

Debates such as this about international development can be full of acronyms, and we will no doubt hear today references to many of them, including SDGs, sustainable development goals; spending on ODA, official development assistance; and WHO, the World Health Organisation. Acronyms can be a useful shorthand, but we have to be careful that we do not reduce what we are discussing to technical or abstract concepts. When we talk about NTDs—neglected tropical diseases—we are not talking just about a group of 21 diseases that exist in test tubes or Petri dishes in a laboratory somewhere. These diseases are having an impact on the daily lives of 1.7 billion people around the world—nearly one in five of the global population. They can cause immense suffering, disability and disfigurement, and are often fatal. In many ways, it is not just the diseases that are neglected; the people affected by them are also, by definition, being neglected.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Member on securing the debate. He rightly says that we should not be distracted by the statistics, but given the fact that one in five people on the planet is affected, it is important that we remember that many of these diseases are entirely preventable if the right action is taken as early as possible.

[Patrick Grady]

The hon. Gentleman is absolutely correct. I think that the point he makes will come through in all the contributions and evidence that we hear today.

The evidence shows that, as the hon. Gentleman suggests, it is the poorest and most vulnerable and marginalised people in remote communities, and particularly women and girls, who are affected most by these diseases. For example, noma, which was added to the WHO’s list of NTDs just a few weeks ago, in December, is a severe gangrenous disease of the mouth and face that primarily affects malnourished children between the ages of two and six years in regions of extreme poverty. Hookworm, a type of soil-transmitted helminth, affects one in three pregnant women in sub-Saharan Africa and can cause anaemia and lead to death during pregnancy. Schisto-somiasis, or bilharzia, which is slightly easier to say, is very common in Malawi, where we visited; it can lead to female genital schistosomiasis, of which there are 56 million cases worldwide, which can triple the risk of HIV and cause infertility, ectopic pregnancy, and in some cases maternal death.

The human cost of these diseases is incredibly high. On our visit to Malawi, in the Salima district we met a number of people who had lived with trachoma, a bacterial infection that can cause eyelashes to draw in, damaging eyesight and even causing blindness. People affected in that way can very easily lose their independence, and their family and friends have to dedicate time and resources to caring for them. If it is caught early, trachoma can be treated with antibiotics or surgery, and it can be prevented by good water and sanitation for health practices. The key lesson, which the hon. Member for East Londonderry (Mr Campbell) just mentioned, is that trachoma can be eliminated altogether. That gives us another acronym, SAFE: surgery to treat the blinding stage of the disease, antibiotics to clear the infection, facial cleanliness and hand hygiene to help reduce transmission, and environmental improvements to help stop the infection spreading.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman. He is right to say that.

As you do over the holiday period, I watched lots of films. One of the advertisements on the channel that I was watching said that, at a small cost—I think it is as little as £11—a surgical operation that stops eyesight loss can be offered. That is a small cost to pay for a long-term health gain.

[Patrick Grady]

The hon. Gentleman is absolutely right, and we will come on to that as the debate continues. It is exactly as I was saying: we met people who had been affected by trachoma, but interventions supported by the Queen Elizabeth Diamond Jubilee Trust’s trachoma initiative helped to restore their sight through are exactly the kinds of operations and access to medicine that he is talking about. Since 2022, trachoma has been eliminated as a public health concern in Malawi. It is the first country in southern Africa, the fourth country in the WHO Africa region and the 15th country globally to achieve that milestone.

What we witnessed was not just individual transformation —men and women whose sight had been restored and who could again live independently—but community transformation, because they could go back to actively contributing by caring for their grandchildren and helping with other tasks around the home. In turn, their families benefit from that support and can focus their time and energy back on education or employment. That is the reality of the statistics, which demonstrate both the value of taking action and the cost of continuing to neglect these diseases.

Many of the researchers and practitioners who are taking an interest in this subject have told us, as the hon. Gentleman just suggested, that investment in NTDs really is a best-buy in global health intervention. The campaign group Uniting to Combat NTDs reckons that, in some cases, investing just $1 in tackling these diseases could unlock $25 of benefits. Brighton and Sussex Medical School has calculated that the economic burden to a patient with podoconiosis, which is a form of elephantiasis, can be up to £100 per year, but that the one-off cost of a single treatment is just £52. A study by Deloitte showed that, if Nigeria met its NTD elimination targets by 2030, it could add $19 billion to the value of its economy. If we want to achieve the sustainable development goals, unlock wasted economic potential, change the nature of aid flows and release new forms of finance to help developing countries drive poverty reduction and grow their economies, investing properly and effectively in tackling NTDs is essential.

The fight against malaria is one of the best demonstrations of that point. The all-party group’s visit to Malawi was not my first visit, or even my last visit to that beautiful country. I first lived and worked in Malawi nearly 20 years ago. The prevalence and impact of malaria has always been evident throughout that country’s history. Those of us who came from Scotland and other countries where malaria is not endemic were affected, because we were strongly encouraged to take prophylactic medication—at that time, Lariam—which is not without side effects. Daily, we saw kids in the school where we taught missing class because they had contracted malaria. Sometimes it would affect the teachers, too, so that whole classes missed out on their education or relied on some of the volunteers to pick up the slack, which might have been okay if it was a maths or English class, but was slightly more complicated if it was Chichewa lessons.

Malaria, like so many of these diseases, is preventable and curable, yet there were 249 million cases in 2022, which is five million more than in 2021 and 16 million more than in 2019. Malaria still kills around 608,000 people around the world each year, most of them young children. That is approximately one child a minute, or 90 completely avoidable deaths in the time set aside for today’s debate. There has been progress, but more can be made. Many of the required interventions are, in principle at least, very straightforward: for example, using bed nets is very simple and effective. The New Nets Project, developed by a number of UK institutions including the Innovative Vector Control Consortium, a Liverpool-based product development partnership, along with the London School of Hygiene and Tropical Medicine, the Liverpool School of Tropical Medicine and Imperial College London, has developed nets with dual active ingredients that combine insecticides to respond to growing resistance to insecticides among mosquitos.

In Malawi, in Mtira village in the Balaka district, we witnessed indoor residual spraying of insecticide, and in the local clinic—a small, brick, thatched building with one room—a chart was proudly displayed showing the dramatic decline in the incidence of malaria patients in the village in just the four years since the spraying began. Outside Lilongwe, in Mitundu village, we visited the clinic where some of the very first doses of the new RTS,S vaccine against malaria had been dispensed, starting in 2019. We were very privileged to meet young Evison Saimon, who is now five years old and had benefited from the vaccine.

These success stories have come about only through the incredible effort of and collaboration between a range of partners and funding bodies, including national Government ministries, UNICEF, the WHO and private or charitable organisations including GlaxoSmithKline and the Bill & Melinda Gates Foundation. What they all have in common is security of funding and a clear goal.

Around the world, however, more money is still spent on treating male pattern baldness and curing hay fever—I and a few other hon. Members in the Chamber have lived experience of both conditions—than on tackling malaria. Hay fever can be debilitating, but it is rarely life-threatening, and the main symptoms of baldness can be readily treated with a hat. That speaks to some of the serious challenges in how the pharmaceutical industry approaches these diseases and how research and development can be properly carried out.

Many of us know about researchers’ frustration with the lack of certainty around funding. The product development partnership model funded by the former Department for International Development worked to overcome shortcomings in the commercial research and development sector and was seen as a leader in funding such efforts through public ODA until the axe began to fall in 2021. Since then, the Foreign, Commonwealth and Development Office has been able to provide funding guarantees only one year at a time, which causes massive uncertainty for projects that require long-term funding. Clinical trials cannot be turned on and off like a tap; they take time and effort in the field and have to run over defined periods of time. They cannot be driven by political funding cycles.

Where trials work, there have been and continue to be breakthroughs. The drug discovery unit at the University of Dundee, which my hon. Friend the Member for Dundee West (Chris Law) will be familiar with, has worked with the PDP Medicines for Malaria Venture to develop cabamaquine, which could not only treat malaria with a single dose but potentially protect people from contracting the disease and stop its spread. The Drugs for Neglected Diseases initiative has revolutionised treatment for sleeping sickness with fexinidazole, a simple oral cure, instead of the only available previous treatment, which was toxic and cumbersome and could kill up to one in 20 patients. For those kinds of innovations to be effective, there has to be sustained, effective and targeted investment. Without it, we find an ever-changing environment where the malaria virus continues to adapt and evolve, and buzzes about just like the mosquito that carries it, frustratingly difficult for the scientists to whack it against the wall, even though they can see and hear it.

We know that elimination of malaria and other tropical diseases is possible, because it has already been done. Many diseases that were once endemic here in the United Kingdom and in other parts of the world have been eradicated. Individual countries and regions, as we saw in Malawi with trachoma, have been able to make progress and eliminate certain diseases as public health threats, but if we allow progress to stall, we risk undoing the good work that has already been done, and new, stronger and more difficult to treat variants of these diseases will emerge.

That is before we take into account increasing challenges such as climate change. Last year, for the first time, the World Malaria Report included a chapter on climate change. Malaria and other tropical diseases are extremely sensitive to the environment, affected by temperature, rainfall and humidity. Locally acquired malaria has been detected in Florida and Texas in recent years, while dengue fever has appeared in France and other parts of Europe. All of a sudden, commercial pharma-ceutical companies are taking more interest in many of these diseases, but a purely economic or profit-driven approach on its own will not be enough to tackle these diseases properly. For example, investing in a vaccine for dengue fever that would benefit tourists travelling to affected areas is very important, but for countries such as Bangladesh or the Philippines, an effective, immediate treatment for people who have already contracted the disease is more of a priority.

In all of this, we have to consider the role of institutions and organisations in the United Kingdom and the role of the UK Government in supporting them and global partners. There can be no hiding from the impact of the cuts to the ODA budget. Any of us who speak to partner organisations or to those who have previously received funding and put it to such good use, continue to hear of the long-term impact of short-term decisions. We all welcome the White Paper, the new tone and focus of the International Development Minister, the right hon. Member for Sutton Coldfield (Mr Mitchell), and his team, the reinvigoration of the SDGs and the determination to build a new consensus, but at the end of the day, stakeholders ask us when 0.7% will return. That is a question both for the Minister and for the official Opposition, and for all our manifestoes in this election year.

The next replenishment cycle for the Global Fund will be in 2025. At that point, we hope that the UK will be in a position to meet the requested funding, rather than the 29% reduction that it provided last year. Can the Minister make similar commitments for multilateral initiatives such as Gavi, the Vaccine Alliance, and Unitaid? The UK has signed up to a number of commitments on neglected tropical diseases, including the 2022 Kigali declaration, the G7 leaders’ communiqué and the Commonwealth Heads of Government Meeting communiqué, so what steps will the Minister be taking to drive these commitments forwards?

The SDGs are a welcome focus in the White Paper. SDG 3.3 sets a target of ending the malaria epidemic and achieving a 90% reduction in the number of people requiring interventions against NTDs by 2030, so how are the Government leveraging funding and working with partners to meet those goals? In practical terms, can the Minister commit to multi-year funding for research and development in these areas, particularly for product development partnerships? What steps are the Government taking to build and support R&D and manufacturing capacity in affected countries? On our visit to Malawi, we saw the world-class Blantyre-Blantyre facility, which was developed in partnership between the University of Glasgow, in my constituency, and the Kamuzu University of Health Sciences, and funded in part by the Scottish Government. That is real innovation, genuine partnership and the empowerment of a new generation of young local researchers, clinicians and academics, and it was inspiring to meet a number of them during our visit.

The Government must recognise the importance of cross-sectoral approaches, and ensure that there is co-ordination and collaboration between malaria and NTD programmes and existing investments in nutrition, education, WASH—water, sanitation and hygiene—disability inclusion, and maternal and child health. In all of this, we have to address the structural issues, including the climate emergency and the growing debt burden on developing countries. We have debated a number of these topics recently in Westminster Hall, and it shows the interconnectedness of so many of the challenges around achieving the SDGs.

In November’s debate on African debt, which was led by the hon. Member for Slough (Mr Dhesi), who I am delighted to see present, I said that Malawi is one of 21 African countries that are in or at high risk of debt distress. Its external debt effectively tripled between 2009 and 2021, and we can see the impact of that in the country’s inability to get moving. How different the country might be if the payments it is making on debt, or even just on debt interest, could be invested instead in primary healthcare and in eradicating not just trachoma, but malaria and all the other endemic diseases affecting its population.

All of these challenges are created or, at the very least, exacerbated by the actions and decisions of people, which means that the challenges can be overcome by the actions and decisions of people—whether that it is each of us as individuals practising basic hand and face hygiene to help prevent the spread of disease, or Government Ministers making decisions about millions of pounds of aid spending. Malaria and many other tropical diseases have been neglected for far too long, which means that the people most affected by these diseases have also been neglected for far too long, but all the evidence shows that we can cure, prevent and, ultimately, end the scourge of these diseases. For relatively little cost, we can achieve a massive return on investment, both in long-term savings on the costs of chronic treatment and in the actualisation of the economic and social potential of people who are no longer confined to a sick bed or, worse, to an early death, but who are working for the betterment of their families and communities.

Many, if not most of us, present for the debate will have witnessed malaria and tropical diseases at first hand on delegations or through our own personal experiences, so I look forward to hearing the contributions from other Members and how the Minister responds. I hope that when we get to World NTD Day at the end of the month, the Government will be able to draw on the experiences of Members and their contributions to today’s debate, and endorse this year’s theme that we should all unite, act and, ultimately, eliminate malaria and all neglected tropical diseases.

09:49

[Jim Shannon (Strangford) (DUP)]

It is an absolute pleasure to follow the hon. Member for Glasgow North (Patrick Grady), whom I commend. He and I are often side by side in debates on issues that are of interest to us—whether freedom of religious belief or health—and I know this subject is close to his heart. When he asked whether I would participate in the debate, I said, “Of course; it is Westminster Hall, after all.”—[Laughter.] No, I said I would do it because it is the right thing to do and because the subject matter he has chosen is also close to my heart. Due to his personal experiences, he brings vast knowledge to the subject matter that I do not have. He also brings compassion for those who are less well off. That is what I always admire about the hon. Gentleman, and he has done that exceptionally well today.

I am pleased to see the shadow Ministers in their place and I look forward to their contributions, because they both have a deep interest in the subject matter. It is always a pleasure to see the Minister in her place. She often speaks as we speak, with the difference that the Minister has the opportunity to put in place the answers we need, which is what we always ask for. It is also a pleasure to serve under your chairship, Mrs Harris. You are looking extremely well this morning. Your choice of glasses excels each time I see you. Well done and thank you very much.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

I thank the hon. Gentleman for giving way, and congratulate the hon. Member for Glasgow North (Patrick Grady) on securing this important debate on malaria and neglected tropical diseases. Does the hon. Gentleman agree that climate change—the worsening climate crisis—has had an alarming impact on malaria and neglected diseases?

Locally acquired cases of malaria have now been found in the US, and a recent UK Health Security Agency report concluded that dengue fever could be transmitted in London by 2060. Does he agree that addressing the climate crisis is imperative in our fight against these diseases, and that this global challenge requires a unified global response?

[Jim Shannon]

I thank the hon. Gentleman for that intervention, and I completely agree with his point. I said beforehand to my colleague, my hon. Friend the Member for East Londonderry (Mr Campbell), that in the past year there have been reports, in southern England anyway, of mosquitoes that we had never had before. The threat level cannot be ignored in this country. He is right to underline the need to address climate change. To be fair, the Government have a commitment on that. It is important to work together collectively politically across the United Kingdom, Europe and the world, to try to address these issues. He rightly says that we cannot ignore them.

Global aid funding cuts not only have affected developing countries, which need our help, but lead to a knock-on effect for British citizens travelling globally. Looking at the title of the debate—malaria and neglected tropical diseases—we must acknowledge travel is easier to achieve now, and with that comes the potential threat. For example, since foreign development aid was cut, there has been an increase in malaria cases globally. I have no empirical evidence that the two are linked, but I believe that is noteworthy and should be acknowledged.

Africa accounts for the majority of global cases of malaria. According to the World Malaria Report 2023, there were 249 million malaria cases in 85 malaria-endemic countries. The hon. Member for Glasgow North also referred to that. It is so important that we grasp the magnitude of this problem.

[Mr Gregory Campbell]

Does my hon. Friend agree that the frustrating part of this issue of neglected tropical diseases is that a straightforward partial solution would be the greater availability of clean drinking water, particularly in sub-Saharan Africa? That would not solve all the problems, but many of them.

[Jim Shannon]

My hon. Friend is absolutely right. In the past, there have been debates on water aid in this Chamber. If the hon. Member for Putney (Fleur Anderson) were participating in the debate, she would have brought her knowledge from her involvement with Christian Aid and other charitable organisations. Their advertisements on TV always mention clean water, so we have a massive role to play there too.

On 14 December 2023, the UK Health Security Agency published provisional UK case numbers for 2022-23 up to October that suggested that there were 250 more cases in the first nine months of 2023 than in the whole of 2022, and that the case total in 2023 was higher than the average between 2010 and 2019 of 1,612. That upward trend is discouraging. That is despite preliminary data from the Office for National Statistics suggesting that UK resident visits abroad remain lower than pre-covid-19 pandemic levels. Travel destination data for this year is not yet available. I am not sure whether the Minister is able to provide that, but it would be good to get some figures. If we cannot get them today, will she pass them on to those who have participated in the debate?

In previous years, the majority of cases where the travel history was known were acquired in Africa—particularly western Africa—by travellers visiting friends and relatives. In my constituency—I know this is true for my hon. Friend the Member for East Londonderry and others, including the hon. Member for Glasgow North—I have a large number of church groups and non-governmental organisations that work across Africa. Nearly every church has a missionary connection with Africa, so people travel there maybe once a year—certainly, every couple of years.

The rise in the number of cases, despite travel intensity lessening, is a worrying trend that must be addressed, alongside the reinstatement of our foreign aid. The hon. Member for Glasgow North referred to the 0.7% target, and I support that 100%, as others do. I know the Minister is keen to respond positively. I am ever mindful that she is not in charge of the money, but I want to underline the issue. We need investment in malaria research, and we must make cheap and reliable medication available.

The last time I went to an area with high malaria levels—Nigeria—my wife was able to order malaria tablets online from the local Boots pharmacy. I am not promoting Boots; I just went there and collected the tablets. It is great to have that facility available. I only knew that the medication was necessary when one of my staff members looked up the area and told me. Information about the spread of malaria in certain countries is not readily available. Perhaps flight tickets should come with a warning. They could say, “Your bag must weigh under 23 kg and you really should get your malaria tablets.” There are some things we could do from a practical point of view. There is no 100% effective vaccine for malaria, but there is medication that massively reduces its severity. The official advice is that a combination of preventive measures provides significant protection against malaria.

This is not solely an issue for travellers; we have a moral obligation to tackle malaria. I believe that is the motivation of the hon. Gentleman; it is certainly my motivation for being here. The restrictions on travel and aid due to the covid pandemic demonstrate halting those steps had a detrimental effect. In 2020 and 2021, there was significant disruption to malaria services, such as the distribution of bed nets, which the hon. Gentleman referred to. That caused a spike not just in malaria incidence but mortality rates.

In 2022, $4.1 billion was invested globally to fight malaria—far short of the World Health Organisation’s $7.8 billion target. Before I look globally to ask other nations to step up to the mark, I look to my own Minister and Government and ask what else we can do right here, right now to assure others across the world that we will not simply increase funding but ensure that none of the funding is wasted and that it goes directly towards meeting the need.

[Mr Dhesi]

The hon. Gentleman is making an excellent speech. Does he agree that preventing and treating malaria and NTDs is within our grasp? They can be beaten, but progress is stalling. Does he agree with me that the UK aid funding gap from Government, the climate crisis, conflict and humanitarian crises all pose a serious threat to sustaining those lifesaving efforts?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. It gave me time to get a good gulp of water. He is right again in underlining the issue and our role as this United Kingdom of Great Britain and Northern Ireland and what we can do together. The use of non-governmental organisation partnerships that are charitable and faith-based will always be my motivation for being here. That is where I come from.

I think of the clinics in Malawi, which the hon. Member for Glasgow North referred to, as well as in Zimbabwe and Swaziland. I think of those three and of those in Uganda, Kenya and Nigeria that I know the churches back home are involved with. The Elim church and missions are active in my constituency. In particular, the clinics in the first three countries are supported through the Elim Relief Association, which has taken steps to deliver anti-malaria tools at a low cost with a big dividend at the end, purchasing nets in bulk and handing them out through the charitable hospital and clinics. That is replicated worldwide.

We have questions to ask about how much funding is wasted on unnecessary red tape. When we see images of a child wasting away with no proper care, suffering from a disease that could have been managed, it underlines how we must do better. I believe we can.

[Wendy Morton (Aldridge-Brownhills) (Con)]

To allow the hon. Gentleman to have a quick drink, I will make the following point. He is making a passionate speech on the importance of supporting the tremendous work to tackle malaria and neglected tropical disease. We often talk about this from an Africa or an international perspective. Does he agree with me that it is important we recognise that our work through the UK aid budget and international development also has an impact on UK citizens and the UK’s reputation in many ways? It is important we do not lose sight of that.

[Jim Shannon]

The right hon. Lady is absolutely right. That is a good reminder that what we do here is appreciated across the world. There is feedback and a positivity that comes through that.

I support many organisations, as do others, whether they be church groups or charitable groups. One such organisation that I want to mention is the Christian Blind Mission, which I have supported for about 20 years. I had never met any representatives in person until I got to Nigeria and visited them and saw what and how much they do. One of our former Members, Jo Cox, was involved with that organisation. I did not know that until that day and it was interesting to catch up. We may donate to charity but may not always know all the good an organisation does.

Time has prevented me from going into other tropical diseases, but the trends are the same and so is the solution: joined-up thinking, working in partnership with the bodies that exist on the ground and a budget that can and does deliver compassionate aid. This debate is important. I believe we have an obligation to speak up for those who need help and be the ears and voice of those across the world. I thank the Government for what they do but urge them to do more.

10:03

[Wendy Morton (Aldridge-Brownhills) (Con)]

It is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who contributes to so many debates and always brings a huge amount of commitment, passion and knowledge. I thank the hon. Member for Glasgow North (Patrick Grady) for securing time for this important debate on malaria and neglected tropical diseases, particularly ahead of the world awareness day. I have long been interested in the issue and my support continues. Malaria and neglected tropical diseases are embedded in UN sustainable development goal 3—good health and wellbeing—and under target 3.3, as I am sure hon. Members will know all too well, to end the epidemic of malaria and NTDs by 2030. The UK actively contributes to that target.

As a former FCDO global health Minister, I was pleased to launch the “Ending preventable deaths of mothers, babies and children by 2030” paper in December 2021. That paper highlights the UK’s key achievements to date in the fight against malaria and NTDs. It is worth just reminding ourselves of a few of those achievements. In 2019, UK aid helped to distribute 160 million mosquito nets, sprayed 8 million buildings with anti-malarial indoor spray, gave preventive malaria treatment to 11 million women and supported the development of seven new drugs for malaria.

But, all too sadly, as we know, malaria transmissions are concentrated throughout countries in sub-Saharan Africa, especially those close to the equator. In 2022, there were 249 million cases of malaria and 608,000 deaths, of which 95% were in Africa. I am very fortunate to have visited, and actually volunteered in, some of those sub-Saharan countries—for example through Project Umubano, with the Westminster Foundation for Democracy, and as a member of the International Development Committee—including Kenya, Rwanda, Burundi, Sierra Leone, Nigeria and Mozambique. Like most travellers, when I visited, I would take anti-malarial pills as a short-term preventive precaution. However, for people living in those countries, anti-malarial pills are either not an option or not a long-term solution.

Another preventive measure, which of course is more accessible and affordable—and often free—is the use of mosquito nets. When used properly, mosquito nets are very effective. However, an unintended consequence that we need to be aware of is that, when they are free or subsidised—which is a good thing—that can lead to some of those nets being used for alternative uses, such as for fishing.

I therefore urge that, when the Government are looking at these projects and at funding, we also insist that we accompany that with education of how to use mosquito nets properly. I think we all know that there is no point in having a mosquito net if it is not being used effectively. Otherwise, not only are we risking somebody’s life, but we are risking our investment at the expense of the British taxpayer.

I was also very fortunate to visit the Liverpool School of Tropical Medicine during my time as Minister for global health. That is, again, another organisation here in the UK that does absolutely incredible work, and I am glad to see that the UK continues to set malaria and NTDs as a priority on its agenda.

The UK’s international development White Paper, published in November 2023, highlights the following achievements: the UK’s contribution to the World Health Organisation’s malaria vaccine implementation programme, the UK’s Fleming fund for strengthening anti-microbial resistance surveillance systems in more than 20 low and middle-income countries, support for civil society advocacy groups such as Malaria No More, and both of the first two malaria vaccines in the world to be recommended by the WHO coming from British science and British expertise. Those are Mosquirix, developed by GSK, and R21, developed by the University of Oxford. I would like to give recognition to GSK and the University of Oxford’s Jenner Institute for that incredible contribution to global health.

[Mr Dhesi]

Indeed, our battle against malaria and NTDs is not just a struggle for survival but a reflection of our collective humanity. Does the right hon. Lady agree with me that it is a global fight that transcends national boundaries and demands worldwide unity, that our actions today will define the legacy we leave for future generations, and that this battle is about saving lives and upholding our moral duty to the global community?

[Wendy Morton]

The hon. Gentleman makes an important point. We often talk about budgets in terms of countries and regions; insects and diseases such as malaria do not see the boundaries that we do, so it is always important that we do as much as we can, working with our partners, to address the long-term issues and finding the solutions, but taking a holistic approach. I do not believe it is always that simple, but we must absolutely continue to work on it. That is why I think the UK has a very good reputation when it comes to international development, particularly now that that work is integrated within the Foreign Office. However, it is important that we continue to work on this, whether on malaria or many of the other diseases that we see around the world.

[James Sunderland (Bracknell) (Con)]

As a vice-chair of the all-party group on malaria and neglected tropical diseases, I have a great interest in this issue, and having spent a lot of time in Africa over the years, mainly with the military, I understand this particular field intimately. Does my right hon. Friend agree that even though the percentage of overseas aid fell from 0.7% to 0.5%, the Foreign Office should now be focused on maintaining at a consistent level the funding relating to life and death issues? With the overall funding headroom being reduced, the funding element for life and death issues—particularly malaria and NTDs—should be consistent in order for the UK to fulfil its global responsibilities.

[Wendy Morton]

My hon. Friend makes a very important point, and having been a Minister, I know how difficult some of these challenges can be. I am sure that the Minister may well pick up on that issue during her speech. It is important that we look at our priorities and seek to achieve the most effective outcomes for our spend. It does not matter whether this is about international development or any other Department. All too often we talk about the amount of money we are putting into a project, whereas I would like to see us look more at the outcomes alongside that. As my hon. Friend the Member for Bracknell (James Sunderland) acknowledges, we are discussing really important topics this morning that are often about the difference between life and death.

I was pleased that in May 2022, the UK launched its 10-year international development strategy, with one of its four priorities being global health. The strategy states that we will

“work towards ending preventable deaths”

by

“investing both bilaterally and through initiatives such as Gavi, the Vaccine Alliance; and the Global Fund to Fight AIDS, Tuberculosis and Malaria.”

I appreciate the great work of the Global Fund. I also gently remind Ministers—I am sure they are very aware—that there have been some issues with funding in certain parts of the world. That is why it is so important that there must always be the appropriate management and oversight capacity, as well as accurate inventory records checked by external auditors, so that we have overall accountability to British taxpayers.

That said, I absolutely acknowledge the positive results that have been achieved. The Global Fund’s 2023 report states that in 2022, it treated 165 million cases of malaria, and gave preventive treatment for malaria to 14.6 million pregnant women. That is another example of the scale of the challenge we face, and how important this is.

The UK has contributed to those results as the third largest Government donor to the Global Fund, pledging £1 billion for the Global Fund’s seventh replenishment for 2023 to 2025. It is also important to recognise that the funds are spent on some other very important areas, such as HIV and TB, which I know this House and some Members here take very seriously.

It is right that we continue to invest in malaria prevention and treatment if we are to meet our target of ending preventable deaths by 2030. I recognise that the total number of malaria deaths worldwide is falling. The statistics show a fall from 896,000 deaths in 2000 to 608,000 in 2022. By my calculation, that equates to a reduction of about 13,000 deaths a year. Even if we apply that rate between today and 2030, there will still be approximately 517,000 malaria deaths in 2030, which is obviously far from us being malaria-free, so we urgently need innovations to continue to tackle malaria. Perhaps we need to scale up the newly recommended R21 malaria vaccine as part of the solution.

Good international development is not all about spending money overseas to benefit developing countries, although we need the funds to do this. It is also about protecting and developing our interests as the UK: for example, through trade and the building of new trade relationships, and making a strong contribution to the UK’s soft power and international place in the world. It is about honouring the UK’s international commitments, but it must also firmly remain about making this more effective by improving openness, transparency, value for money and delivering. Today’s debate is a very helpful reminder of that.

10:14

[Chris Law (Dundee West) (SNP)]

Happy new year, Mrs Harris. It is a pleasure to serve under your chairship, as ever. I thank my hon. Friend the Member for Glasgow North (Patrick Grady) for securing this debate, not least because it is timely and critical ahead of World Neglected Tropical Diseases Day. I also thank him for his continued commitment to speaking up for the most vulnerable and poorest people in the world, as well as for his constituents.

The fact that one child dies every minute from a preventable and treatable disease is not simply a tragedy, but a moral failure. As we have heard in this debate, malaria and neglected tropical diseases are preventable and curable, but a lack of political will and much-needed investment is resulting in the progress towards eliminating these diseases stalling. When minds are focused and resources are properly mobilised, successes can be achieved. Between 2000 and 2022, an estimated 2.1 billion malaria cases and 11.7 million malaria deaths were averted globally. Fifty countries have eliminated at least one neglected tropical disease, and 600 million fewer people require intervention against those diseases compared with 2010.

In 2022, however, the global tally of malaria cases reached 249 million. That is an increase of 5 million from 2021 and 60 million more cases than in 2019—well above estimates from before the covid-19 pandemic. Today, around 1.65 billion people are estimated to require treatment for at least one neglected tropical disease, resulting in devastating health, social and economic consequences. That is more than 20% of the global population.

Malaria and neglected tropical diseases have been exacerbated by climate change, conflict and humanitarian crises. Furthermore, drug and insecticide resistance, as well as invasive mosquito species, also hamper progress. However, the challenges can be overcome with the right investment. At the heart of this debate is a significant funding gap for malaria and neglected tropical diseases, as well as the shameful role of this UK Government, with their years of death sentence cuts, stepping away when they should be stepping up.

The funding gap between the amount invested in malaria control and elimination and the resources needed is dangerously large. Spending in 2022 reached $4.1 billion, which is well below the $7.8 billion required to stay on track to reduce case incidence and mortality rates by at least 90% by 2030, as highlighted in the SDGs. Similarly, neglected tropical diseases are preventable and treatable, often at a very low cost, yet they are neglected in terms of funding and research.

The UK was once a global leader in tackling those diseases, particularly in research and innovation, but that contribution has been fundamentally undermined by the reckless decision to cut ODA from 0.7% of GNI to 0.5%. For example, in June 2021, the UK Government decided to terminate the Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases programme—otherwise known as ASCEND—with no alternative funding offered to more than 20 beneficiary countries in Africa. That resulted in over 250 million treatments and over 180,000 disability-preventing surgeries being stopped. In Zambia alone, it resulted in the cancellation of 1,500 sight-saving trachoma surgeries and 1,500 disability-preventing lymphatic filariasis surgeries.

There is international acceptance of the hard facts that demonstrate that malaria and other tropical diseases are far from eradicated. In November 2022, the UK Government announced a pledge of £1 billion for the seventh replenishment fund of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and that is to be welcomed. Crucially, however, that commitment is £400 million less than in 2019, and £800 million short of the 29% increase in funding that the Global Fund called for to get progress against those three diseases back on track. Other G7 allies, such as the US and Germany, have met that call.

That money was and is needed to regain progress lost during the covid-19 pandemic and to save 20 million lives over the next three years, but that pledge by the UK Government is on trend with their theme of grandiose gestures and media splashes that may sound good, but have little meaningful impact. It is on track with the UK Government’s morally corrupt insistence on finding loopholes in their international commitments.

For example, in the recent FCDO White Paper on international development, there was noticeably no recommitment to the 0.7% spending on ODA and no reinstatement of the pre-2021 projects or commitment to beneficiaries of cut projects. The UK Government must therefore, as a matter of utmost urgency, recommit to the UN-mandated 0.7% spending of GNI on ODA, and they must go further and clarify that funds from that are available for research into tropical diseases including malaria.

My first question is: will the Minister tell us what tangible action the UK Government intend to take to make up the shortfall left by the ODA cuts? Do their Government colleagues feel any remorse for the beneficiaries of projects that have had their funding stripped due to the 2021 policy?

Over the past decade, the UK has led the way in research into global infectious diseases, and the thriving scientific research and innovation sector must continue to be world leading and supported through long-term, sustainable UK funding and investment. The lack of commercial drivers for anti-malarials and neglected tropical diseases requires not-for-profit solutions to help to develop new medicines through public sector and charitable sources.

I am very proud to say that the Drug Discovery Unit at the University of Dundee in my constituency is a world-leading drug discovery centre, focused on developing new treatments for neglected infectious diseases. I have had the opportunity to visit the unit on a number of occasions, and I give my personal thanks and gratitude to all those who use their skills and expertise to make such valued contributions.

The Drug Discovery Unit has collaborated with the Medicines for Malaria Venture on the discovery of a potential anti-malarial compound called cabamiquine—a single-dose cure that has also been shown to be effective in preventing malaria in trials and is currently undergoing phase 2 clinical trials with patients in Africa. That type of research does not fit nicely into typical funding body structures based around a specific scientific hypothesis and employing one person for three years. Rather, it requires large multidisciplinary groups and is focused not around a narrow research question, but a broader challenge. Are the Government looking at recommitting to longer-term multi-year funding?

Furthermore, the Drug Discovery Unit recognises the increasing need and desire to involve scientists from low and middle-income countries in partnership in this work, and it has been working to establish collaborations with scientists with particular focuses on Ghana and Brazil as part of the Wellcome Centre for Anti-Infectives Research. Do the UK Government intend to support partner programmes from countries that are most impacted by malaria and other tropical diseases?

Of course, to continue its world-leading progress on virus research, it is fundamental that Scotland and the rest of the UK continue to be able to attract the best talent from the European Union. The “make it up as you go along” approach to Brexit, which was not voted for in Scotland, has had one disastrous consequence after another for Scotland and the rest of the UK.

In that context, the inability to work effectively and efficiently with partners in the EU has hindered the UK’s full potential in addressing malaria and tropical diseases. Despite the UK now rejoining Horizon, which I welcome, the years of missed opportunity, broken partnership and lack of EU funding have significantly set the UK back in the context of tropical disease research. Crucially, can the Minister explain how the UK Government intend to be a global leader or to continue to punch above their weight in global medical research without the collaboration or resources of one of the deepest pots of funding, and by limiting the information-sharing capacity and collaboration with our European counterparts?

The fight against malaria and neglected tropical diseases is global, requiring collaboration and for each of us to take all the necessary steps to help combat them. The existential global challenge of climate change should further focus minds on malaria and NTDs. We know that many of these diseases are driven by the environment. Changing temperatures, precipitation levels and increasing extreme weather events have the potential to change the distribution, prevalence and virulence of these diseases. For example, flooding in Pakistan in 2022 resulted in more than 2 million additional cases of malaria and a 900% increase in dengue fever.

One of the most meaningful ways in which the UK Government can be proactive in combating malaria and other tropical diseases is to acknowledge the nexus between climate change and the transmission of these diseases. Again, can the Minister outline how the UK Government intend to work with global partners to tackle malaria and NTDs as part of their work on reacting to climate change?

Finally, these diseases are referred to as “neglected” because they have been largely wiped out in more developed parts of the world, but they persist in its poorest, most marginalised or isolated communities. I cannot help but feel that we would be doing more if they existed here. Of course we would—we just have to look at the experience of covid-19 to see that, and the subsequent inequitable distribution of vaccines from high and middle-income countries to low-income countries as another example of the moral failure to protect the most vulnerable in our world.

The UK Government must restore their credibility and urgently scale up their contribution to the eradication of these diseases. Given the vast numbers of people affected across the world, there is no excuse for neglecting them. As I said, more than 20% of the global population is affected. The elimination of malaria and neglected tropical diseases is possible, and it will be a small step to a more equal world when it is achieved.

10:24

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a real pleasure to serve under your chairmanship, Mrs Harris. I congratulate the hon. Member for Glasgow North (Patrick Grady) on securing this debate; he has a proud record of work, both in his constituency, with the University of Glasgow, and in Malawi itself. I also refer to my entry in the Register of Members’ Financial Interests.

As hon. Members have said, we remain at a critical point in tackling malaria and neglected tropical diseases due to the pandemic; humanitarian crises as a result of conflicts, flooding and famine; rising biological threats such as insecticide and drug resistance; a decline in the effectiveness of core tools; a widening funding gap and resource constraints; and disruptions to already fragile health systems. We really must act now. Global malaria progress has stalled in recent years, with malaria incidence and mortality currently above pre-pandemic levels. In 2022, 5 million more people were infected than in 2021, and 16 million more than in 2019.

Despite malaria being preventable and treatable, nearly half the world’s population remains at risk—particularly in African countries, as the hon. Member for Bracknell (James Sunderland) said. The global burden of neglected tropical diseases also remains significant and, as with malaria, continues to be a barrier to health equity, prosperity and development, with devastating health, social and economic consequences to 1.65 billion people worldwide, including over 600 million people in Africa.

[Mr Dhesi]

As a vice-chair of the all-party parliamentary group on malaria and neglected tropical diseases, I thank my hon. Friend for her leadership as chair of our APPG. I also thank her and Martha Varney of Malaria No More for their leadership in orchestrating our recent visit to Malawi. Their insights and the dedication of partners such as the Wellcome Trust have significantly deepened my understanding of the challenges at hand. Does the shadow Minister agree that malaria is a relentless barrier to development, thwarting educational progress, disproportionately impacting women and girls, and perpetuating cycles of poverty?

[Catherine West]

Indeed, and my hon. Friend pre-empts my point about the impact on women and girls. I know that you will be particularly interested, Mrs Harris, in the relevance of tackling what seems to be the disproportionate impact on women and girls, due to various biological, social, economic and cultural factors. Limited financial resources, time constraints, diminished autonomy, and stigma and discrimination create barriers that prevent women from gaining access to timely healthcare, education and employment opportunities. Due to their responsibility for home and family care, they often miss out on crucial treatments. Through close contact with children, women are two to four times more likely to develop trachoma, which is a neglected tropical disease, and are blinded up to four times as often as men.

It was particularly exciting, in the visit mentioned by my hon. Friend the Member for Slough (Mr Dhesi) and the hon. Member for Glasgow North (Patrick Grady), to see old women, who are often neglected in developing countries, receiving crucial treatments and being enabled to feel that they were not a burden on their children. It was particularly special to learn that trachoma has been eliminated in Malawi. The World Health Organisation has signed that off, which is a really exciting development. Sometimes, these things feel very overwhelming, but when we see that trachoma has been eliminated in Malawi, it really is wonderful and encouraging.

The “Ending Preventable Deaths” strategy recognised malaria as a major cause of child deaths, and important tools such as bed nets and intermittent preventive treatment in pregnancy as examples of evidence-based health intervention and best buys. It was also welcome that the strategy recognised the critical importance of clean water, sanitation and hygiene. However, there is no way of ending these epidemics and meeting the sustainable development goals without working to empower and enable women and girls to succeed. I know that is very much at the heart of your work in Parliament, Mrs Harris.

[James Sunderland]

The shadow Minister and I, and many others here, went to Malawi, as we heard earlier, and we share many of the same views on the way forward. In fact, it is quite nice to have cross-party support on such a key issue. We have sought a Commonwealth Heads of Government meeting in Rwanda. Does the shadow Minister agree that it is important for the league tables to be published, so that African nations can take a lead and have responsibility for a particular NTD? In Malawi, we have eliminated trachoma, and I welcome that noma has now been added to the list of approved—if that is the right word—diseases that the WHO is looking at and investing in. Does the shadow Minister agree that empowering African nations and ensuring that the UK can take a lead in thought leadership and education is really important?

[Catherine West]

Indeed, and it has been estimated that 500 million more people, rising to a billion by 2080, could become exposed to chikungunya and dengue, as these diseases spread to new geographies due to warmer climates—a point made by my hon. Friend the Member for Slough. As an example, the impact of flooding in Pakistan has also been mentioned, and in 2022 there was a 900% increase in dengue and a fivefold increase in the number of malaria cases. The Minister might be quite creative and see whether there is money in the climate funds to join up the health inequalities with the climate funding that will eventually become available through the COP28 process.

While countries in the global south will of course carry a disproportionate burden, tropical diseases are now becoming a growing concern in non-endemic countries. Will the Minister update the House on Government efforts to mitigate the impact of climate change on malaria and NTDs, and what steps they are taking to support lower-income countries to address climate-sensitive infectious diseases? Conflict and humanitarian crises are considerable threats to progress. Many countries have seen increases in malaria cases and deaths, and a few experienced malaria epidemics. Ethiopia saw an increase of 1.3 million cases between 2021 and 2022, and political instability in Myanmar led to a surge in cases, from 78,000 in 2019 to 584,000 in 2022, with a knock-on effect in neighbouring Thailand.

Last June, mycetoma services in Sudan were suspended due to a lack of safety, resulting in patients not receiving vital medication. We know that in refugee camps—as I am sure the Minister also knows from visiting refugee or internally-displaced persons camps—there is a particularly high risk of scabies due to overcrowding. Can the Minister reassure us that the UK is working to support countries affected by conflict and other humanitarian crises to ensure the safe delivery of medical supplies, which are the basics?

Despite the difficulties in surmounting the challenges we face, the elimination of these diseases is possible. Both malaria and neglected tropical diseases can be beaten, as we have seen. Azerbaijan, Belize and Tajikistan have been declared malaria-free by the World Health Organisation recently, and 50 countries, including 21 in Africa, have eliminated at least one neglected tropical disease, marking the halfway point toward the target of 100 countries set for 2030. As a result, 600 million fewer people globally require interventions against neglected tropical diseases than in 2010. Bangladesh, supported by the UK and other partners, is the first country in the world to be validated for the elimination of visceral leishmaniasis, which is the very complicated form of the disease that is fatal in over 95% of cases and has devastating impacts, particularly on women.

The Labour party is proud of the UK’s contribution to date in this global effort, and of the legacy of Department for International Development, one of our proudest achievements of the last Labour Government. As part of that commitment, the last Labour Government helped to found the Global Fund in 2002. It is an incredible fund, and we saw the important work it does when visiting Blantyre. The results are staggering, with the malaria incidence rate decreasing from 164 positive cases four years ago to 36 at the time of our visit last autumn.

I know that you want me to wind up, Mrs Harris, but I have one final anecdote. I met Mirriam, an inspiring midwife and primary healthcare provider working in rural Zambia, when she visited the UK Parliament. She said that she encounters disease every day at her health centre, and spoke to me about her harrowing experience of caring for and losing pregnant women and young children with malaria. However, over the past few years the availability of high-quality, inexpensive, rapid diagnostic tests, insecticide-treated bed nets and preventive treatment for pregnant women, all provided by the Global Fund, are transforming how Mirriam and her midwife colleagues diagnose and manage cases of malaria. She also mentioned the important work being done on tuberculosis and HIV.

Many of the tools and medicines we need to beat malaria were also developed here in the UK, and a number of Members have outlined the important connection with our excellence in research—for example, at the University of Dundee, which the hon. Member for Dundee West (Chris Law) mentioned in his speech, and other important UK research institutions. It is important that we listen to what they say about what we need to keep that research going and maintain this country’s leadership in research and development.

We have already talked about the Vaccine Alliance, Unitaid and the Global Fund, so I will not go into the detail. However, we have one specialism that I need to mention: the crucial research into snakebite. Many who may be watching parliamentlive.tv will not be aware that snakebite kills so many people in Africa, or aware of the important work being done at the Liverpool School of Tropical Medicine—I declare an interest as an unpaid trustee there. That work is very special and niche, but it is crucial to keep it going.

I will conclude on the important work that we need to do this month, given that World Neglected Tropical Disease Day is on 30 January. Can the Minister assure me that the UK is doing all it can to support the development of new medicines for neglected tropical diseases and look at re-committing to multi-year funding for product development partnership models? What is her view on manufacturing in Africa? If we look at the map, we see that expensive medicines are produced here in Europe or America and then sent to Africa and so on, so it would be wonderful to see more manufacturing, perhaps through the Serum Institute of India, for example, which did so much important work during covid. What is her thinking about collaborations there that we could lead and push different parties towards? Finally, as 30 January 2024 approaches—World Neglected Tropical Disease Day—the World Health Organisation argues that, for malaria, “business as usual” will simply not be enough. I hope that the Minister agrees that we now need to act, because there is no more time for us to lose.

10:37

[The Minister of State, Foreign, Commonwealth and Development Office (Anne-Marie Trevelyan)]

I apologise for the cough—I am apparently enjoying a three-month winter cough, so apologies to all for that. I thank the hon. Member for Glasgow North (Patrick Grady) for securing this important debate and thank the all-party parliamentary group on malaria and neglected tropical diseases for its really thoughtful contributions today and, more importantly, for its long-standing advocacy in this whole arena. I thank all hon. Members for their contributions.

Members will be aware that my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) is the Minister in FCDO with responsibility for global health. He is unfortunately unable to be here, hence my presence. I am happy to respond; this is an area of both policy and personal interest anyway. When I was the Secretary of State for International Development before the merger, we spent a lot of time on this policy area, so I am pleased to be able to respond on behalf of the Government. If I miss any questions, for which I apologise, I will ensure that my right hon. Friend picks up on them.

On the point made by the shadow Minister, the hon. Member for Hornsey and Wood Green (Catherine West), a number of colleagues touched on the wider question of the UK’s focus on climate change, the impacts more broadly, and how the UK can assist, and is assisting, on the wider question of resilience and adaptation to the changing nature of communities, landscapes and healthcare. All the work that we do has health impacts at its heart. Women and girls are at the centre of every single piece of programming work that the FCDO does, but I will ask my right hon. Friend the Member for Sutton Coldfield to set out a few examples in his reply to help colleagues to see the broader picture, beyond the issue we are discussing today.

As colleagues have pointed out, we are at a critical point for the sustainable development goals. With COP’s focus on the impact of climate change on global health, and with World Neglected Tropical Disease Day at the end of the month, this is a really important opportunity to consider the UK’s role in helping to end those diseases. We know that the covid pandemic has taken a toll in so many ways on the pathway to the 2030 SDGs, and I can safely say that, across the world, we are all focused on trying to get back on track and thinking about how we can do that, using all the tools at our disposal.

As many colleagues have set out, the burden that malaria and NTDs place on so many countries is not geographical; it is about families and people. It is perhaps concentrated in some countries, not only by virtue of their geography and their landscapes, but because of the state of their health systems. As colleagues have said, malaria is still killing a child every minute of every day, and NTDs are causing devastating health, social and economic consequences for more than 1 billion people. We know that they fall most heavily on the poorest and the most marginalised.

In November, my right hon. Friend the Member for Sutton Coldfield set out the Government’s White Paper on development, which has at its heart the principles underpinning the UK’s ongoing contribution towards ending extreme poverty and combating climate change. A key focus of getting the world back on track to meet the 2030 SDGs includes targets to end the epidemic of malaria and NTDs. The White Paper reaffirms our commitment to ending the preventable deaths of mothers, newborns and children under five, which we cannot achieve without a particular focus on malaria. As I have mentioned, however, the White Paper also underlines the importance of helping countries to build health systems by working with them in mutually respectful partnerships and harnessing innovation and new technologies to help them to solve some of these problems.

On malaria, we are at a critical juncture in our fight against the disease. As a number of colleagues have set out, this year’s World Malaria Report showed once again that progress has stalled. We are facing a perfect storm of challenges, including rising drug and insecticide resistance, the climate impacts we have talked about, the spread of urban mosquitoes, conflict and humanitarian crises, rising prices and funding shortfalls. This is, of course, a complex mix to try to get ahead of, but the UK continues to provide global leadership. We will continue to make the limited resources that we have go further and to think about how we can adapt our approaches to fit local contexts more closely, because it is not the same everywhere. How can we help countries to focus in a more targeted way on tackling their most difficult health problems?

The UK has long been a leader in the fight against malaria. As my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) mentioned, we have been the third largest contributor to the Global Fund over its lifetime, investing over £4.5 billion. It has three specific focuses—to eradicate malaria, TB and AIDS—which has enabled it to channel global energies into tackling those diseases. We provided £1 billion towards the seventh replenishment of the fund, and the mission to eradicate those diseases remains absolutely at the heart of the UK Government. The latest investment will help to fund 86 million mosquito nets and 450,000 seasonal malaria chemoprevention treatments, and provide treatment and care for 18 million people. Our funding continues to help drive scientific advancement—for example, the next generation of malaria bed nets, which were developed with funding from the UK and which the Global Fund is now rolling out. We have also long funded the Medicines for Malaria Venture, whose anti-malarial drugs are estimated to have averted nearly 14 million deaths since 2009.

There is further cause for optimism from new vaccines. As colleagues have mentioned, in October the WHO recommended the second ever malaria vaccine, R21. In November, just before Christmas, the first consignment of the RTS,S vaccine was delivered to Cameroon to begin roll-out across Africa. Both vaccines were developed through British scientific expertise, including the long-term commitments that we have seen from GSK, whose RTS,S vaccine has now been given to over 1.5 million children in Ghana, Kenya and Malawi. A further nine countries will receive the vaccine over the next two years, and the UK will continue to support roll-out through our £1.65 billion funding for Gavi and by further funding clinical trials.

Colleagues might not be aware that the UK led the replenishment of Gavi back in 2020, at the height of the covid pandemic, when its funding had never been more urgently needed. Gavi is the organisation that delivers vaccines to many hard-to-reach corners of the globe. It is an incredibly important organisation that is respected and welcomed in pretty much every country in the world. We were proud to bring $8 billion-worth of global commitments to Gavi, despite the challenges that everyone faced during the ongoing covid epidemic. The UK’s commitment was the largest of all those made to that replenishment.

Of course, time goes quickly, and Gavi’s replenishment for next year is coming round again; I know that the UK will continue to provide leadership on that. Gavi is one of the many parts of the machine that enables us to deliver. It does such important work to ensure that, whichever brilliant new technologies brilliant scientists come up with, they get to the places they need to be. That is so important. Indeed, through covid Gavi demonstrated—sadly, more urgently than ever—how effective it can be.

Colleagues have set out the impact of neglected tropical diseases across the globe. We have seen incredible progress, which has been due in part to the UK’s contribution. It is encouraging that 50 countries have eliminated at least one NTD, in line with the WHO’s ambitious target for 100 countries by 2030. Last year saw Iraq, Benin and Mali eliminate trachoma, Ghana eliminate a key strain of sleeping sickness, and Bangladesh and Laos eliminate lymphatic filariasis. In October, Bangladesh became the first country in the world to eliminate visceral leishmaniasis, which would not have happened without long-standing UK support.

Here, again, we face major challenges: climate change threatens to unravel so much of the progress that we have seen, and global funding falls short of what is needed to achieve our overall ambitions. The hon. Member for Slough (Mr Dhesi) highlighted the rise of dengue, which causes real concern and impacts too many places. The UK was pleased to sign the Kigali declaration on neglected tropical diseases at the 2022 CHOGM meeting, and towards that goal we committed to continued investment in research and development. Each signatory makes a unique contribution towards ending NTDs; it is very open and was designed to encourage countries, however small or large, to push on with tackling the challenges.

We are delivering on our commitment with our ongoing funding to the Drugs for Neglected Diseases initiative, or DNDi—I apologise for all the acronyms; there are lots of them—in which we have invested over £80 million so far. Through our and others’ support, DNDi has developed 13 treatments for six deadly diseases, and those are already saving millions of lives. They include a first oral-only treatment for both chronic and acute sleeping sickness, which recently received regulatory approval; a treatment for mycetoma, an infectious flesh-and-bone disease that leads to amputations; new short-course treatments for deadly visceral leishmaniasis, which I mentioned earlier, that can replace treatments with severe side effects and growing drug resistance, which is a continuing challenge in this space; and the first paediatric treatment for Chagas disease, a complex tropical parasitic disease that can result in heart failure.

Some of the DNDi’s incredible work takes place in the UK, where it has over 40 partners across industry and academia. To name but a few, we have the incredible leadership of global companies such as AstraZeneca UK and GSK, which are well known and based across the world, through to some of the smaller developing companies such as BenevolentAI, DeepMind and AMG Consultants. Those smaller companies are using other modern technologies—not pharmaceutical technologies but wider technologies—to think about how we can solve these challenges. It is worth remembering that many UK industry partners threw their technical expertise into the scientific ring when covid-19 hit the world, for instance through the COVID Moonshot work. Continuing to focus on the incredible investments made by our world-leading life sciences, tech and pharma companies is part of the whole solution.

[Catherine West]

The Minister is being very generous in giving way. What assessment has she made of the possibility of promoting more African leadership in manufacturing? Developing really good partnerships may require investment at the beginning, but it could be a very effective way to work. How do we strengthen in-country leadership in Africa while avoiding a top-down approach?

[Anne-Marie Trevelyan]

I said earlier that the Government are focusing not only on how we spend our development budget but on how we invest in and give space to the private sector to use its research and development investment as effectively as possible in areas where there can be global solutions. The shadow Minister raises a really important point, and I spent a lot of time at the World Trade Organisation in 2022 discussing how patents and investment in expensive production facilities can be done more globally. The issue was not resolved at the WTO, but it is at the heart of the conversation, which is, as has been said, about trade. We must understand how to empower the countries that will potentially get the most immediate benefit from production domestically, which will then be able to export to their neighbours, and ensure that investment flows work securely for the pharmaceutical companies that are investing billions of pounds to solve these challenges. We must ensure that production is secure and that the vaccines and other medications reach those they need to. A lot of discussion is going on globally around those issues, and some of our largest pharmaceutical companies are already doing these things around the world. Particularly in South Africa, there has been a real shift in investments, and that country can be a hub from which to export to neighbouring countries. That ongoing area of global policy development sits within the world trade discussions, and it is really important to keep pushing it.

[Jim Shannon]

I and others mentioned the important role that church and charity groups play and the significant voluntary contribution they make. How can the Minister’s Department work alongside them to encourage them and align partnerships so that things can go better?

[Anne-Marie Trevelyan]

The hon. Gentleman raises a really important point. When I visited Malawi a few years ago, I was struck by the fact that almost every Scottish church and school has a relationship with that country. The history goes back to the Scottish explorers of the 19th century, and that fascinating relationship feeds into church and other community groups across Scotland working together to support religious hospitals in Malawi. That really interesting model has been built up over more than 100 years, and those connections continue to grow. I have visited schools in my patch where children want to be involved in these issues and understand them more closely. Strong relationships can be built, and there are some very good organisations—I will come back to the hon. Gentleman because I cannot remember their names—that try to develop links with schools, in particular, to help them understand each other better. We know, as Churches across the world do ecumenically, that that is the best way to share knowledge and develop better understanding.

[Jim Shannon]

The Minister is right to acknowledge the good work that has been done in Malawi. There are 94 churches in my constituency, and I know of only one that is not doing some work in Africa. In particular, the Elim church and the Church Mission Society do work in Malawi, Zimbabwe and Swaziland. I would like to encourage those things, and I am keen to hear how we can do that.

[Anne-Marie Trevelyan]

I will take that away and we can perhaps pick it up more fully.

As colleagues set out, this has been an important and positive debate. The UK plays a long-standing and leading role in the fight against malaria and neglected tropical diseases, both as a leading donor and with our world-leading scientific and research capability, which has focused on this issue for decades. Although, as a global community, we have made incredible progress in the last 20 years, we know that too many countries still face major challenges, not the least of which is the impact of climate change. As colleagues have pointed out, in many countries the most challenging health problems are across boundaries—diseases do not see a line in the sand. As we set out in the development White Paper, we will continue to lead the fight against poverty and climate change, including, very importantly, on global health.

If I have failed to answer any questions, I hope that the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield, will pick up on them. We will continue to seek health solutions, alongside building health systems to help make these diseases history.

10:55

[Patrick Grady]

I am grateful to all Members who have taken part today. The hon. Member for East Londonderry (Mr Campbell) spoke about the return on investment. The hon. Member for Strangford (Jim Shannon) made the point that this issue is very important to our church communities and to many of our constituents. The right hon. Member for Aldridge-Brownhills (Wendy Morton) brought to bear much of her personal experience, as did the hon. Member for Bracknell (James Sunderland)—I will call him my hon. Friend, because I think we are all hon. Friends today. I thank the hon. Members for Slough (Mr Dhesi) and for Hornsey and Wood Green (Catherine West)—this is a bit of a reunion for those who went on the APPG’s visit—and my hon. Friend the Member for Dundee West (Chris Law), who provided a suitably robust challenge to the Minister. I also thank the Minister for her summation and her reflection on all the points that were made during the debate.

It is quite frustrating that there is a category of diseases known as “neglected” and that work has to be focused on them. One of the key principles of the sustainable development goals is that we leave no one behind. Nobody should be neglected, and none of the factors that keep people in poverty, including these diseases, should be neglected. That is a challenge for all of us as we come to write our election manifestos for the coming year.

I hope that today’s debate has, at the very least, raised some awareness, meaning that these diseases will be slightly less neglected and that we can continue to unite and act and can, ultimately, eliminate malaria and other neglected tropical diseases so that they become eradicated tropical diseases.

Question put and agreed to.

Resolved,

That this House has considered the role of the UK in ending malaria and neglected tropical diseases.