Ebola

Baroness Hayman Excerpts

Thursday 8th January 2015 Lords Chamber

[Baroness Hayman (CB)]

My Lords, like other speakers I congratulate the noble Lord, Lord Fowler, on introducing this debate and his consistent commitment to health in the developing world. I am delighted to be able to take part in the debate but fear my contribution would probably be more useful in five weeks’ time, when I will have returned—I hope—from a visit to Sierra Leone to see for myself the work of some of the agencies with which I am associated. I declare my interests in those, recorded in the register.

Many lessons of the Ebola outbreak are already emerging. The speed of response is one that others referred to. The need for the international community to have a plan that is both flexible—because not every emergency is the same—and already funded is tremendously important. We all have a responsibility to look at how the international community could prepare for further outbreaks. As others said, not only will they occur but we cannot consider them to be someone else’s problem. Ebola is not an airborne disease, for which we all throughout the world must be extremely grateful, but other diseases are airborne. The interconnectedness of health in our global world is a lesson we must learn.

Another lesson that no one will quarrel with is that, however much international aid and however many volunteers—I, too, pay tribute to them—we parachute into a situation such as the one we have seen in west Africa, there can never be enough to replicate a basic health system that reaches into every village and community and is the absolute foundation not only of public health in normal times but of dealing with disease outbreaks. What we as a world do post-2015 in terms of the objectives for health and providing support for health systems will be tremendously important.

That will be shown in Sierra Leone because, as others pointed out, once Ebola is, we hope, no longer rampant—the noble Lord, Lord Giddens, rightly pointed out there is a possibility of it becoming endemic in the country—there will still be a tremendous specific health need left behind by the effects of the crisis. There will be the patients with malaria. We have seen a terrible spike in malaria deaths. There will be the women who died in childbirth because they were not able to get to attended facilities. There will be the health of the orphans left behind. There will be the vaccination programmes that have been interrupted. There will be a tremendous health need. As the noble Lord, Lord Giddens, said, it will be a test of us all that we do not walk away from that at the end of this process.

The other lesson that we can learn is that we can rightly be proud of the response of professionals in this country who have volunteered, of the British public, who have given more than £30 million to the Disasters Emergency Committee, of which I am a trustee, and the work of the agencies funded by that money, which goes far beyond medical treatment to provision of food and latrines for people who are in isolation, the care of Ebola orphans and safe burials. That is a tremendously important contribution.

We should also pay tribute to those in the affected countries in Africa. I will also be considering the work of Restless Development, the charity that my husband chairs, which has about 2,000 community volunteers in the field working on social mobilisation. The trust and behaviour change of communities that is needed is on a tremendous scale and does not come from lecturing by people from outside; it comes from the mobilisation of community leaders, religious leaders and individuals who are connected to their communities, who are trusted and who give the right messages and support people to change behaviours to protect themselves.

An understanding of the need to marry the command and control and international response with the grass-roots, culturally sensitive response of those on the ground, is something that we hope we can learn from this outbreak. I cannot finish without endorsing what the noble Lord, Lord Fowler, said about vaccines, to which the noble Baroness, Lady Kinnock, also referred. We have a market failure in vaccines and medicines for the poor. We cannot simply shrug our shoulders and say that the pharmaceutical industry as currently constructed cannot and will never produce the goods. We need to ensure, through government, philanthropy and voluntary organisations, that those goods are produced for the poor.

Tuberculosis

Baroness Hayman Excerpts

Monday 8th December 2014 Grand Committee

[Baroness Hayman (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Collins, on initiating this debate and I echo the remarks of the noble Lord, Lord Lexden, about the contribution of the noble Lord, Lord Collins, to this field and his determined work to improve healthcare for some of the world’s poorest and most marginalised people. I draw attention to my interests in global health, particularly malaria and NTDs.

It is about those two areas and the need for more and innovatively funded research in them that I shall speak. I congratulate the All-Party Parliamentary Group on Global TB on its overall report, Dying for a Cure: Research and Development in Global Health, with its emphasis on TB and its recognition that the needs of the 1.4 billion people who suffer from neglected tropical diseases are tremendously important, as is the interaction of those disabling, disfiguring diseases with the big three killers, TB, AIDS and malaria. It has also recognised that these are diseases not only born of poverty but which create poverty. They undermine education, employment, health—all the opportunities that would allow people to claw their way out of poverty. Therefore, combating the diseases of the poor, including the big three, is an essential element of the fight against poverty and for social and economic development.

For some of those diseases, we already have treatments for which we need more resources—for example, for mass drug administration for soil-borne helminth diseases—but we still desperately need to develop better medicines, smarter diagnostics and, above all, vaccines if we are to make progress. If we look at the position with malaria, there is an urgency to do all those things and to develop new insecticides if we are not to face exactly the same problems of resistance that plague the current fight against tuberculosis.

The main point I want to make today echoes that made by the noble Lords, Lord Collins and Lord Lexden, in terms of the challenges that are born not of scientific difficulties and obstacles but of economic difficulties and obstacles in developing new products. I think it is now universally accepted that we have a market model in pharmaceuticals that will never, on its own, deliver for the poor.

Ebola is a very good example. Ebola was such a minority interest until this year that it was not even on the WHO’s list of 17 neglected tropical diseases—it was a neglected neglected tropical disease. But the reason that treatments and vaccines have not been developed for Ebola is not because it is a uniquely difficult scientific challenge but because so few people were considered at risk and those few people were considered to be poor and a long way away. As I understand it, the candidate vaccines and treatments now being rushed through are all compounds that had already been discovered but not developed because, although potentially valuable in therapeutic terms, they were not potentially valuable in commercial terms. Of course, we now have the recognition that in a global world, epidemics are a mere flight away, so the world has now pledged to spend $2.4 billion on combating Ebola but did not in the past invest the fraction of that which would have been necessary to develop a new vaccine.

Of course, progress has been made in the area of funding of research for such diseases. We should pay tribute to the UK Government and DfID for their support for the concept of product development partnerships and to the work of the philanthropic, academic and private sectors in coming together with Governments in important and fruitful partnerships such as the Drugs for Neglected Diseases initiative and PATH, and in malaria vaccine development. But the number of chemical compounds with potential being brought forward is still worryingly low. Ebola should have taught us that we cannot afford for potential drug candidates to be left on the shelf because pharma companies have no incentive to screen them against key diseases. We have to find a way to fund discoveries that are potentially life-saving, even when they are not in the current market, profit-making.

My plea to the Government today would be for them to increase their commitment, and the resources they devote, to the vital work of PDPs. As the noble Lord, Lord Lexden, said, this is an area where we have tremendous skills and expertise. I recently took up the position of chair of Cambridge University Health Partners, and seeing the huge scientific potential we have for patient benefit on that fantastic campus is a real privilege. We also have a history of, and a great ability for, knowledge transfer through our academic institutions, particularly the London School of Hygiene and Tropical Medicine, and the Liverpool School of Tropical Medicine. I was in Zimbabwe and saw midwives and obstetricians from this country delivering training packages for midwives and skilled birth attendants in Zimbabwe, which then became sustainable programmes for supporting maternal health.

I have one other plea: we should not neglect the importance of the research that can take place in the countries and the communities where diseases are themselves endemic. Building capacity in those countries, as enlightened funders are now recognising, can have really powerful results in the quality and relevance of the research undertaken. Finally, I would encourage the Government to look at mechanisms to invest in local clinician-led research agendas in developing countries.

Ebola

Baroness Hayman Excerpts

Thursday 6th November 2014 Lords Chamber

[Baroness Hayman (CB)]

My Lords, I draw attention to my interests declared in the register. In particular, I am a trustee of the Disasters Emergency Committee, which currently has an Ebola appeal to which the British public has responded to the tune of over £13 million within a week. Also, my husband chairs Restless Development, which is supported by DfID in its work in sensitisation and education in Sierra Leone.

I have two points. The first, which comes from the 11 DEC agencies working in the field, is about the breadth of the needs in these countries. Of course treatment and quarantine centres are essential, but if we are to stop the spread by stopping transmission we need to facilitate safe burial, education, water and sanitation kits and food for people who are in quarantine and who will otherwise leave it to get their own food. The range of humanitarian needs is enormous and will continue to be so, because of those orphaned children, because of those children who have not been educated since April and have no prospect of schooling, because of the women who are dying in childbirth and who will be leaving more orphans, because of the people with malaria who are not getting treatment and because of the vaccination programmes that are not taking place. So the scale and range of needs is going to be really long term.

The second point is one to which the noble Baroness, Lady Kinnock, referred. The reason why we do not have a vaccine for Ebola is not because it is a uniquely complex vaccine to develop. The reason why we do not have a vaccine for Ebola is the same as the reason why we do not have treatments and vaccines for other neglected tropical diseases: they are diseases of the poor, and we have a complete market failure in meeting them. We need to put more resources into developing vaccines and treatments, not only because of the humanitarian imperative but because we live in a global world and it is actually our best protection, as well as a humanitarian imperative, to use our expertise and resources to treat these diseases.

Health: Ebola

Baroness Hayman Excerpts

Wednesday 15th October 2014 Lords Chamber

[Baroness Northover]

I am very happy to reassure my noble friend that the Home Secretary is looking at this at the moment. Tier 2 skilled workers can indeed return to their home country for short periods to provide support and can take their annual leave to volunteer. However, the Home Secretary is looking at this.

[Baroness Hayman (CB)]

My Lords, alongside the need for developing vaccines and cures for the diseases of the poor that the noble Baroness, Lady Kinnock, described, is there not also a tremendous need to develop public health and basic health systems in the developing world in the future? On the Ebola crisis, does the Minister agree that, alongside our assistance on medical treatment services, it is very important that we also help on the prevention side by stopping transmission, getting good public information and sensitising communities? In that respect, will she endorse the work of the British NGO Restless Development—I declare a family interest—which has already sent 200 young Sierra Leonean volunteers to work in their own communities?

[Baroness Northover]

The noble Baroness is quite right about the importance of public health in strengthening health systems and changing various cultural practices. I again pay tribute to those who are working there at the moment.

South Sudan

Baroness Hayman Excerpts

Tuesday 8th July 2014 Lords Chamber

[Baroness Northover]

I too pay tribute to those who are working in these extremely difficult circumstances. The right reverend Prelate will know that the United Kingdom is a leading donor. We are meeting about 7.5% of the total appeal at the moment and working to support all the agencies that are managing to get in. We do not underestimate the difficulties.

[Baroness Hayman (CB)]

My Lords, I declare an interest as a trustee of the Disasters Emergency Committee. Does the noble Baroness agree that it is essential to flag up and respond to these complex and developing crises, which can be just as devastating if not as instantly newsworthy as the sudden catastrophic natural disaster?

[Baroness Northover]

The noble Baroness is absolutely right. Of course it is the fact that this is a very fragile state which leads to the problems that we are indentifying here. It is one of the reasons too why it is important to act early and to plan ahead, which the United Kingdom is seeking to do.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Hayman Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Hayman (CB)]

My Lords, it is a real pleasure for me to be able to congratulate the noble Lord, Lord Verjee, on what I think all noble Lords would agree was an outstanding maiden speech. It was passionate, very personal and very modest. The noble Lord’s story is an extraordinary one of academic, entrepreneurial and philanthropic success. His business achievements are manifold, but anyone who has ever fought an election campaign will always owe him a particular debt of gratitude as the founder of Domino’s Pizza in the UK.

In his speech, the noble Lord referred to what aid money can achieve when well spent. The noble Lord, Lord Verjee, is not only a generous but an intelligent philanthropist. He works, through the Rumi Foundation, in a variety of fields, but I pay particular tribute to the work that he has described today in encouraging, through the leadership programme, people from underrepresented groups to participate in political life. We hear and see a great deal about the perpetuation of privilege in public life in this country and it is enormously important that stories about those who overcome obstacles and the triumph of talent are also told as examples to others. I first heard about the noble Lord, Lord Verjee, from my son, who works in the philanthropic field. He said, “You should meet Rumi, Mum, he’s one of the really good guys”. I think that the House will share that opinion as time goes by.

[Noble Lords]

Hear, hear.

[Baroness Hayman]

When speaking about the Global Fund, I must declare my non-financial interests. I am a trustee of the Sabin Vaccine Institute, a vice-chair of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases and a trustee of the Malaria Consortium. I pay tribute to what the fund has achieved in the battle against malaria, to which the noble Lord, Lord Verjee, referred. Hearing the statistic that since 2001 the number of child deaths from malaria has been halved reminds you what aid money well spent can achieve. The Global Fund has been enormously important in that. The Malaria Consortium is the leading UK implementer of Global Fund money. In Uganda, with the fund’s support, we are working with the Ministry of Health to distribute more than 20 million long-lasting insecticidal nets to achieve universal net coverage in that country.

As many have said in debates about the Global Fund, it is essential that we replenish the fund if we are successfully to continue and build on what has already been done. The fund is hugely important, not only in its own work but—as was made clear to me at a meeting of the all-party group last night—in the effect it has on the upstream work to face the new challenges and create the new vaccines, medicines, insecticides and diagnostics. While those are being developed, there must be the encouragement of knowing that there will be an implementation machine to take them to the patients. It is tremendously important that the fund is replenished.

Replenishment will also allow the Global Fund to build and extend its work. I very much welcome the new funding model, which seeks to align investments in combating HIV, TB and malaria with national health strategies, while strengthening health systems and serving as a platform promoting the health of a person rather than combating only specific diseases. I feel this particularly strongly when I look at the issues of maternal and child health and of neglected tropical diseases.

For the world’s poorest people, these things do not fit into nicely delineated silos and different funding streams; these are the health issues of the poor. To be effective, we need to combine the programmes to ensure that the synergies are achieved and the best value for money is obtained. I think of it most particularly with regard to schistosomiasis. Schistosomiasis increases by twofold or threefold the likelihood that an adolescent girl exposed to HIV will contract HIV. The treatment for schistosomiasis is very cheap but, as a neglected tropical disease, it does not fall within the bounds of the Global Fund. My question to the Minister is: what are the Government willing to do to encourage the Global Fund to take a broader approach to health in the future?

Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Hayman Excerpts

Tuesday 3rd December 2013 Lords Chamber

[Baroness Northover]

As the noble Lord knows, the two things go closely together. I will have to look carefully at what his question implied. Of course, both the global fund and DfID are well aware of that interrelationship. Where you have patients suffering from TB, especially when it is multidrug resistant TB, you often have HIV going alongside, so the two are being tackled together. I will need to look at the noble Lord’s question to see whether there is something in it that I did not understand.

[Baroness Hayman (CB)]

My Lords, I echo the remarks of the noble Lord, Lord Fowler, about the enormous benefits that the global fund has brought to international health and its commitment to transparency and to dealing with these issues when they arise. I declare my interest in malaria and neglected tropical diseases. Will Her Majesty’s Government encourage the global fund to look at partnership working and integrating programmes, particularly on maternal and child health and neglected tropical diseases, as part of the post-2015 commitment to strengthening health systems and doing that from the bottom up rather than the top down?

[Baroness Northover]

The noble Baroness is absolutely right. The global fund has had an effect across all those areas and I pay tribute to her work on neglected tropical diseases. DfID has been strongly supportive of that. There are a number of areas where obviously the work of the global fund is complementary. If you look at its aim to raise $15 billion, at the moment $37 billion across this whole area is coming from the developing countries, supporting the kind of work that the noble Baroness is talking about.

Global Partnership for Aid Effectiveness

Baroness Hayman Excerpts

Tuesday 16th July 2013 Lords Chamber

[Baroness Northover]

I can give the noble Lord that assurance. He will note that it is a crucial part of the arrangements in the new deal for fragile states, and it also underlies and is an extremely important part of our principles regarding where we are willing to give budget support.

[Baroness Hayman]

My Lords, although I fully support the development of technical indicators for aid effectiveness, will the Minister confirm that there is manifold evidence that the most effective form of aid is that which concentrates on the social, economic and educational development of women?

[Baroness Northover]

The noble Baroness is absolutely right, which is why we have put women and girls very much at the centre of what DfID does. Education is part of that. As for the stages of development of various countries, I note that the countries that are most developed have the highest levels of educational enrolment and adult literacy.

Women: Developing Countries

Baroness Hayman Excerpts

Thursday 27th June 2013 Lords Chamber

[Baroness Hayman]

My Lords, in joining the congratulation of the noble Lord, Lord Loomba, not only on this debate but his tireless commitment to the plight in particular of widows across the world, I congratulate him too on provoking a debate that has had some extraordinarily good speeches in the mould of his own. I had not intended to say anything about women in this country, but the noble Baronesses, Lady Jenkin and Lady Hamwee, have provoked me to do so. There is also, not least, my noble friend Lord Crisp, whose question has been concerning me during the debate.

One of the few advantages of getting into one’s anecdotage is that you have a perspective over decades. I share the concern about 22% of parliamentarians in this country being women, but I experienced being one of 4%—that is 27 out of 635—and I know the progress that can been made. At that time I also experienced having to come into the House of Commons two days after leaving hospital after the birth of my first child. Maternity leave was not considered relevant. It is an enormous joy when I now see the Prime Minister and the Deputy Prime Minister taking paternity leave. Things have improved since the days when there were seven of us women among 200 studying law at Cambridge. It no longer means that you have to be one of one rather than one of 10 who had access to that university education. I never had daughters and now I have a granddaughter, so I have been worrying away at my noble friend Lord Crisp’s question. I am optimistic as well as joyful when I hold my granddaughter.

The only thing I worry about is something we have discussed in this House before, which is the level of pornography and sexualisation and the diminution of women, in ways which are different from how women were diminished in my experience, by a wave of easily accessible material that is bad for boys, bad for girls and bad for society overall. That is an issue to which we need to turn our attention.

I want to talk today, quite differently, about women in the developing world and to echo some of the things that have already been said about the crucial role—the Kofi Annan line—of women in development overall. It is important to recognise that what we consider as women’s rights—access to education, freedom from violence and forced and early marriage, the right to participate in political and civic life, economic empowerment and the provision of health services for women in the developing world—are not just matters of individual women’s rights. Those rights are also the key to development in the families, communities and countries in which those women live. If those women are not empowered, if they are not allowed to thrive, the countries in which they live will not develop and flourish either. Like others, I was enormously heartened by the work that has been done by the Secretary of State and by the Prime Minister in his role as co-chair of the high level panel on ensuring that a stand-alone goal on gender equality will be taken into account in the post-millennium development goals framework.

Today, I want to address particularly one of the goals in the MDGs up to 2015 that will not be reached, which is reduction in maternal mortality. Before I do so, I should declare my non-financial interests as a trustee of the Sabin Vaccine Institute and the Malaria Consortium and as chair of the advisory group for the Maternal and Newborn Health Unit at the Liverpool School of Tropical Medicine, which has already been mentioned.

The noble Lord, Lord Loomba, quoted the chilling statistic that a girl in South Africa is more likely to be raped than to learn to read. I want to quote an equally chilling statistic: a girl born today in South Sudan—a country to which reference has already been made—is statistically more likely to die in childbirth than to complete her primary school education. I read “education” as meaning secondary school education, but it is her primary school education. That is a terrible statistic, and we have heard about the hundreds of thousands of women who die in childbirth, the widowers who are created by that, the children who are left motherless and the tremendous disease that follows from the morbidity that comes from inadequate care in childbirth.

The most awful thing is that the majority of those deaths are preventable. Some of them are preventable by changes in major structural issues which have already been referred to. We know the effects of early marriage, and we know the effects of excluding girls from education and basic healthcare. In development, I normally speak about neglected tropical diseases. Those diseases in themselves create a high risk of death and morbidity in pregnancy and childbirth. The anaemia that comes with malaria means that women are more prone to die. Access to fundamental healthcare is tremendously important as is, as has been said over and again today, access to family planning and the ability to choose when and whether to have children.

There are specific issues, measures and interventions that we know can be made in antenatal and obstetric care. I want to highlight the work of Professor Van den Broek, who has already been referred to by the noble Lord, Lord Jones. I think that the Making It Happen programme that DfID has supported through the Liverpool school is a wonderful example of doing what the World Bank described as,

“closing the deadly gap between what we know and what we do”.

The programme concentrates on looking at the five complications that are well understood and can be readily treated in obstetric care and that account for some 80% of maternal deaths: haemorrhage, sepsis, eclampsia, complications of obstructed labour and abortion. They have devised a programme that is cheap to deliver and sustainable as it involves training trainers within the countries concerned. They are currently working in 11 countries across sub-Saharan Africa and Asia and are achieving tremendous results. Those results are important not only in preventing deaths but also in preventing those terrible conditions, such as prolapse and fistula, that lead to women being not only disabled but also often excluded from their communities.

I think that we know what can be done. We have access to well researched and proven interventions. DfID has been tremendously helpful in supporting that in the past. I hope that the Minister will be able to give some indication that it will continue to be so in the future.

Health: Neglected Tropical Diseases

Baroness Hayman Excerpts

Wednesday 30th January 2013 Lords Chamber

Asked By

[Baroness Hayman]

To ask Her Majesty’s Government what progress has been made in combating neglected tropical diseases since the London declaration on NTDs of January 2012.

[Baroness Hayman]

My Lords, much has been achieved since the signing of the London declaration on neglected tropical diseases a year ago today. Substantial progress has been made in raising awareness of the issues—in that respect I welcome the number of noble Lords who have put down their names to speak in tonight’s debate—and in the fight to control and eventually eliminate the scourge of this group of debilitating and disabling conditions.

They are diseases caused by viruses and bacteria transmitted through snails and worms, flies and mosquitoes. They are found predominantly among poor, rural and semi-urban populations in Africa, Asia and Latin America, with almost half their health burden in sub-Saharan Africa. NTDs cause disfigurement and disability, anaemia, stunting and blindness to hundreds of millions of people worldwide. It has been estimated that among the 1.4 billion people who constitute the poorest in the world today, there is not a man, woman or child who has not, is not or will not be affected by at least one of these diseases. They are not just neglected diseases in terms of research or money: they are the diseases of neglected people.

The London declaration set out an ambitious plan to work towards the control and elimination of NTDs, building on the programme set out by the World Health Organisation. The substantial progress that has been made in the past year has been clearly set out in a series of recent reports from, among others, the WHO and the Bill and Melinda Gates Foundation. Only yesterday, the executive board of the WHO passed an important, comprehensive and authoritative resolution committing the authority to grow the programmes already in place and integrate them further into the health and development agenda.

I do not intend tonight to do the Minister’s work for her by answering in detail my own question as to the progress made over the past year, but I want to emphasise the advantages that have come from the partnership approach of the London declaration: the bringing together of the pharmaceutical companies that have contributed, free of charge, more than 1 billion treatments; the endemic countries, 40 of which have developed multiyear integrated NTD plans; the donors who have committed funds to support delivery of those programmes and increase the resources available for mapping and research; and the academic institutions that are undertaking that research such as the London Centre for NTDs launched today—an important UK initiative—which will concentrate on identifying and supporting best practice and answering the practical operational questions that we need so much to understand.

The commitment to rigorous monitoring and evaluation through the scorecard for the London declaration will track delivery, highlight milestones and targets and help identify priority action areas. This joint working, accountability and transparency is one of the reasons why aid directed to NTDs is so obviously smart aid. It is aid where resources deployed are cost-effective—we come back again and again to the 50 pence per person per year for de-worming programmes—and aid that leverages resources and commitments from endemic countries, private and philanthropic sectors as well as from voluntary organisations and donor Governments.

DfID and the British Government deserve great credit for being, together with US aid, a leader in this field and I pay tribute to the previous Minister at DfID, Stephen O’Brien MP, who provided committed and knowledgeable leadership, without which we would never have got this far. I hope when she comes to wind up that the Minister will have something to say about the Government’s efforts to encourage other countries, particularly in Europe, to allocate resources in this area.

In the few minutes that I have left, I want to talk about the reasons for making NTD control a global health priority and I remind the House of my non-financial interests in the area, particularly as a trustee of the Sabin Vaccine Institute, and to look forward to some of the areas that we need to develop for success in the future.

The value-for-money argument for making NTDs a priority goes alongside the humanitarian argument. Unlike many other diseases, we have cheap and effective tools for alleviating the misery of the disease, disablement and discrimination that these conditions cause. What we need is political will as well as resource. I hope that this debate tonight will contribute in some small way towards that political will.

These are age-old afflictions. Twenty years ago, I chaired the Whittington Hospital in Archway in London. The first health facility on that site was a leper hospital in the 12th century. It was opened and positioned there because it was just beyond the boundaries of the city of London, from which people with leprosy were barred. Much more recently on Ellis Island, emigrants from Europe to the USA were examined by immigration officers for trachoma and sent home if they were found to be infected. This experience of exclusion and discrimination still exists for many in the developing world today.

However, as a global health priority, NTDs have a much shorter history. It is less than a decade since Peter Hotez of Sabin, David Molyneux of the Liverpool School of Tropical Medicine and Alan Fenwick of Imperial College first used the term in biomedical journals and they have been tireless advocates for this cause, alongside Dr Lorenzo Savioli at the World Health Organisation. Despite their widespread prevalence, these diseases have been neglected in multiple ways and for multiple reasons. They have attracted tiny proportions of budgets for treatment from donor Governments or for research from private or academic institutions. Médecins sans Frontières presented evidence last month that only 1.4% of clinical studies undertaken in the past year focused on neglected diseases, although they cause around 11% of the global disease burden.

This is partly because of the demographic that they afflict and its lack of purchasing and political power, but also because in public health terms these diseases have been seen as causing morbidity rather than mortality. So the focus in the millennium development goals and elsewhere has been on the big three killers in the developing world—AIDS, TB and malaria. However, there is growing evidence of the important and significant interaction between NTDs and these three diseases.

As well as the obvious overlap in geography and the demographics of co-infection, the data suggest a strong association of exaggerated symptoms, rapid progression of disease and a higher risk of fatality in all three diseases where there is the presence of NTDs. To take just one example, studies in Tanzania and Zimbabwe demonstrate that women with female genital schistosomiasis have a 3% to 4% higher chance of being infected with HIV than those who are free of the disease. If we are to achieve the millennium development goal on AIDS, TB and malaria, we also need to tackle neglected diseases. I hope that the Minister may also say something about encouraging global fund programmes to integrate NTD control, as they have, for the first time, in Togo.

However, progress in achieving other millennium development goals is also impeded by the epidemic of NTDs and its effects on maternal mortality, school attendance and livelihoods. Controlling NTDs is an important component not only of the global health agenda, but of the more general development agenda.

If we are to achieve the ambitious targets set out in the London declaration, we will have to meet many varied challenges, not the least of which is providing the basic building blocks of public health, clean water, sanitation, hygiene and education. These are essential to underpinning NTD initiatives. We need to develop greater capacity to deliver and distribute the drugs that are available, and we need to know more about the best treatment regimes and about synergies with other health programmes, such as the distribution of bed nets and vaccination campaigns. I think that the London centre will be hugely helpful in this respect. We need to mobilise research and development on vector control, which is often a neglected area itself. Evidence from the WHO Global Burden of Disease 2010 study shows that diseases such as leishmaniasis, schistosomiasis and hookworm are unlikely to be eliminated solely through mass drug administration programmes. We urgently need research into the development of new control tools, including drugs, diagnostics and vaccines. We need a good pipeline of innovative products if we are not to be talking, in 20 or 30 years’ time, of re-emerging diseases.

Margaret Chan, the director of the World Health Organisation, has issued a clarion call by saying on the publication of its latest report:

“Overcoming Neglected Tropical Diseases makes sense for economies and development … Many millions of people are being freed from the misery and disability that have kept populations mired in poverty ... We are moving ahead towards achieving universal health coverage with essential health interventions for Neglected Tropical Diseases, the ultimate expression of fairness”.

As we look to the global health agenda post 2015, what better rallying cry could we have?