Neglected Tropical Diseases

Baroness Hayman Excerpts

Monday 3rd April 2017 Lords Chamber

Asked by

[Baroness Hayman]

To ask Her Majesty’s Government what is their assessment of progress made in combating neglected tropical diseases since the London Declaration made in January 2012.

[Baroness Hayman (CB)]

My Lords, tonight’s debate has been an extremely movable feast in terms of dates, times and length of speeches. However, at last, we are here and I am delighted to introduce a debate which has become, over the past five years, a standing item in the parliamentary calendar. I am extremely grateful to colleagues here tonight for their commitment to a subject which, before the London declaration of 2012, was very much a minority interest even among those who focused on health in the developing world.

Tonight I hope that we can do two things: first, that we can look back and record achievements in combating the 18 bacterial, viral and parasitic diseases brigaded in the WHO’s category of neglected tropical diseases affecting more than 1 billion people in 149 countries across the world, and that we can also look forward and recognise the major challenges that remain if we are to meet the targets set in 2012 in the WHO’s 2020 NTD road map and in the London declaration of the same year.

I know that colleagues are well aware of the toll that these diseases take on individuals and on human and economic development in the countries in which they live. These diseases result not only in half a million deaths each year; they also cause chronic disability, stigma and long-term ill health. They affect children’s development and pregnancy outcomes. They are the diseases of poverty and in themselves they perpetuate that poverty. As Margaret Chan, the director of the WHO, put it in that organisation’s latest report:

“NTDs thrive under conditions of poverty and filth. They tend to cluster together in places where housing is sub-standard, drinking water is unsafe, sanitation is poor, access to healthcare is limited or non-existent, and insect vectors are constant household and agricultural companions”.


Unsurprisingly, we think of NTDs primarily as diseases of the developing world, and that of course is where they take their highest toll. But poverty is not confined to those who live in poor countries, and cases of NTDs are found among the poor of even the wealthiest countries. In North America, there has been the emergence of Chagas disease in several southern states. In Europe, between 2007 and 2015 we saw outbreaks of chikungunya in Italy, France and Spain, of dengue in Portugal, of leishmaniasis in Greece and of schistosomiasis in Corsica.

The causes of these cases of emergence and re-emergence are not only poverty, but climate change and mass human migrations linked to the hundreds and thousands of people fleeing conflicts in Libya, Syria and Iraq. In Syria cutaneous leishmaniasis has reached hyper-epidemic proportions due to breakdowns in health systems and a lack of access to essential medicine, with tens of thousands of new cases annually. There is a real danger of introducing or reintroducing NTDs endemic to the Middle East and north Africa to Europe and beyond. All this highlights the global challenge of NTDs and emphasises the need to make progress in tackling these diseases of poverty in our interconnected world if we are to achieve the “ensuring healthy lives for all” sustainable development goal.

In the five years since the London declaration, we have made considerable progress. The bringing together of Governments, pharmaceutical companies, NGOs and researchers, scientists and doctors, has had profound results. Increased donations of essential medicines, targeted funding by international development agencies, private foundations and the domestic financing of NTD programmes by endemic countries are drastically improving the quality of life of millions worldwide. Almost 1 billion people were treated in 2015 alone. Thanks to the donations of several major pharmaceutical companies, billions of doses of drugs have been donated in the past five years so that by last year around 50 treatments were being delivered by mass drug administration programmes every second of the day. UK aid and the work of British institutions, NGOs and partnerships like the Liverpool School of Tropical Medicine, the Schistosomiasis Control Initiative, Sightsavers and the London Centre for Neglected Tropical Disease Research are all playing a critical role in implementing prevention and treatment strategies, and in generating evidence from operational and scientific research to inform efforts to achieve the 2020 WHO targets. Since 2013, four countries in central America have all eliminated river blindness and the misery that the disease brings, and last year both the Maldives and Sri Lanka were certified free of lymphatic filariasis. Great progress has been made and I am happy to pay tribute to the role that the UK Government have played both in their original support for the London declaration and through their ongoing leadership and financial contributions.

But we have to recognise that there are significant challenges ahead and “steady as she goes” will not deliver the targets set, particularly for soil-transmitted helminths. Mass drug administrations will need supporting infrastructure such as water and sanitation projects, additional interventions, including new medicines, and in particular, as I raised in the debate last year, new vaccines. We were then all anxious about Zika and focused on the need for prevention rather than cure. One of my questions for the Minister is whether DfID is considering broadening the R&D focus on NTDs to explore potential vaccines, given the research evidence that suggests several diseases such as schistosomiasis and soil-transmitted helminths will not be eliminated by mass drug administration alone.

In addition to vaccines, we need to continue searching for better tools across the board. We have new mapping tools and we understand better the burden of disease, but we will have to continue improving diagnostics, such as the new rapid diagnostic test, funded by DfID, for sleeping sickness. We will need to improve our strategies on vector control and, as in most areas of combating poverty, to do more on the education and empowerment of women and girls, which has a demonstrable effect on sustained access to clean water, sanitation and hygiene. Sufficient and safe access to water in turn helps to combat NTDs such as trachoma, schistosomiasis and soil-transmitted helminths.

While most of the targets of both the WHO and the London declaration understandably focus on interrupting transmission and infection cycles, we have to be aware that NTDs cause severe morbidity and lifelong disabling conditions such as blindness and disfigurement, which in turn lead to stigma and exclusion. So resources should also be directed towards improving the quality of life for people suffering from the consequences of these diseases and integrating services into existing health systems and ongoing NTD programmes. I hope the Minister can give us some information about the Government’s plans for NTD spending and how the NTD portion of the Ross fund will be managed and allocated, as this portfolio will be key to the delivery of UK aid to NTDs.

Next month, the WHO, Uniting to Combat NTDs and the NTD community will host a summit in Geneva to mark the fifth anniversary of the road map and declaration, and to plan for the future control, elimination and eradication of NTDs. I hope the Minister will make clear the Government’s commitment to that summit; that we will have high-level political representation at that meeting; and that we will have a commitment to further funding and continuing the task set five years ago. That meeting is an opportunity for us to continue our leadership with other donors in the philanthropic world and other national donors, and to work with the Governments of endemic countries to come together and once again commit to consigning these diseases of poverty to history.

[Baroness Buscombe (Con)]

My Lords, all noble Lords may speak for five minutes.

--- Later in debate ---

[Baroness Northover (LD)]

My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate and, as ever, for opening it so effectively. I declare an interest: I am a trustee of the Malaria Consortium, a position that I took over from the noble Baroness.

[Baroness Hayman]

I shall not take up more time, but I did not declare my interests at the beginning of my speech, which I should have done. I therefore do so now: they are as recorded in the register.

[Baroness Northover]

I remember the huge excitement of the London meeting in 2012, when the UK, by that stage moving towards spending 0.7% of GNI on aid, as so long promised, was able to increase its commitment on neglected tropical diseases so substantially, by an additional £195 million. I was proud to be part of DfID’s ministerial team at the time and recall the amazing briefings that I was given by committed experts not only from the department but from the London School of Hygiene & Tropical Medicine—including on how you pronounce the names of all these various diseases.

As the noble Baroness has pointed out, NTDs affect more than 1.3 billion people worldwide and cause half a million deaths each year. They cause chronic disability, disfigurement, stigma and ill health. They disproportionately affect the poor and marginalised.

It is vital for delivering the SDGs that we address the NTDs. Of course, there is goal 3 on healthy lives, but it is much more than that. The SDGs aim to eliminate extreme poverty while leaving no one behind. It is the poorest and those with disabilities who are so often left behind. Tackling these diseases is part of the overall strategy of all the SDGs. In doing so, we need to focus on research, and here the London School of Hygiene & Tropical Medicine and the Liverpool School of Tropical Medicine have been so important, and the UK has had such strengths.

We need to make sure that treatments and preventive measures, such as vaccines, are coming forward and that we get them where they are needed. We need also to ensure that we have adequate surveillance. This is, of course, vital for understanding a country’s true burden of disease, as well as for securing and achieving intervention, detecting the last cases and, when and if we are in that fortunate position, making sure that there is no resurgence. I urge the Government to use their position as a leader in this area to encourage others to increase their own support. The noble Baroness, Lady Hayman, mentioned the upcoming summit in Geneva towards the end of April as a key opportunity for this. I, too, ask whether the Secretary of State will attend.

Like the noble Baroness, Lady Hayman, I want to ask about the Government’s Ross fund, announced by the former Chancellor in the autumn of 2015. It seems an absolute age ago, but it included £200 million to tackle NTDs. As far as I know, there have been no announcements yet relating to NTDs. Can the Minster clarify what is happening? It has also been flagged to those of us speaking today that leprosy remains a neglected disease, where others are no longer so neglected. Will the Minister comment on this?

I come now to the eradication of certain NTDs: it is fantastic that we have reached that point. We had the wonderful visit from President Carter last year—in 1986, Guinea worm disease affected 3.5 million people; now, it is almost eradicated. President Carter said that he hoped to outlast the last Guinea worm. I am delighted that the former President is still with us and I want to ask about those last Guinea worms. Have we almost reached that point and do we have any information on other NTDs which are on their way out?

Finally and most importantly, what assessment has DfID made of the effect of Brexit in this area? We know that scientists working in the United Kingdom come from many different parts of the world, but especially from the EU. What are we doing to encourage them to stay? How can we make sure that they know that the UK’s leadership in this area, as in many others, depends so much on them and that we are very grateful to them? I look forward to the Minister’s responses in this vital area, which is so important for the health of the poorest around the world, and where the United Kingdom has such a proud record.