Neglected Tropical Diseases

Lord Stone of Blackheath Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord Stone of Blackheath (Lab)]

My Lords, it is really an honour to be involved in this debate with those of your Lordships who are great experts and involved in the long-term effective work of relieving millions of people the world over, particularly children, from suffering from these diseases. We, as a nation, can be proud of the work that we are doing.

I am no expert but I know particularly about the work of the Schistosomiasis Control Initiative at Imperial College. I declare an interest as a past member of its advisory board. One reason that I was taken on is that I can pronounce schistosomiasis and the drug that controls it, praziquantel. I am not surprised that these diseases are neglected, as no one can pronounce their names. Schistosomiasis affects 200 million people, primarily in sub-Saharan Africa, and very few people know about it but we do. The latest figures from the World Health Organization suggest that over 70 million people received treatment in 2016. Our own SCI, supported by the British Government since 2010, has delivered over 40% of Schistosomiasis treatment globally—thank you, the Government.

What I do know about is quality control and systems. SCI has rigorous monitoring and evaluation processes in place to ensure that it is able to track closely the treatment numbers. This also allows for the identification of areas where the prevalence and intensity of the infection are not being reduced at the expected rate, and enables those Governments to be supported to take corrective action. Due to the complex epidemiology of schistosomiasis, in which the parasite is able to multiply many thousands of times in the snail intermediate host, continued progress will require a sustained effort, as the fifth progress report says. SCI and other organisations are committed to reaching the World Health Organization targets for schistosomiasis but also to ensuring that the disease-specific NTD interventions support the health systems of endemic countries and therefore the broad sustainable development goals. In addition, there is an issue with water and sanitation. Work on that needs to be accelerated so that we progress the targets for NTDs.

If I have any expertise, it is in linking business with good works. Arup, the global business of designers, planners and engineers, is currently involved in a number of projects related to sanitation and new and emerging water-quality issues worldwide. It has a strong global water-skilled network of staff, with specialisations covering all aspects of the water cycle. These staff work with ecologists in an interdisciplinary manner, which allows them to develop solutions based on holistic whole-systems thinking, and they feel that they may be able to view the problem and the potential solutions from a slightly different angle. What are Her Majesty’s Government considering doing to link investments made by DfID with these organisations to promote improved water and sanitation and strengthening systems?

My mentor in all this, who has already been mentioned, is Professor Alan Fenwick, the founder of SCI, who is now an adviser to the Global Schistosomiasis Alliance—GSA—which brings together donors, implementation organisations and country programme managers to assist in the development and implementation of country plans for the control and elimination of schistosomiasis country by country. He and others are concerned that the member states of the World Health Organization passed a World Health Assembly resolution in 2012 identifying schistosomiasis as a disease that could be eliminated. The resolution called on the World Health Organization to prepare guidance for member states towards the elimination of transmission, to establish procedures for the confirmation of the interruption of transmission and to support countries with post-elimination surveillance to prevent reintroduction of transmission. Six years later, there is still a lack of guidance from the World Health Organization on the treatment strategies needed to fulfil the resolution. How can Her Majesty’s Government support the World Health Organization to develop that guidance?

On a positive note, Wendy Harrison, who now leads the SCI team, reports that last year NTDs entered the Guinness book of records with the world’s largest mobilisation of donated drugs: the delivery in 2016 of more than 200 million doses, which arrived in distribution sites in six countries in one 24-hour period. One of the drugs that I mentioned that treats schistosomiasis, which has been generously donated by Merck, is praziquantel. Donations of praziquantel more than doubled from 72 million tablets in 2014 to 183 million tablets in 2016, but those donations still covered only about one-third of the 563 million tablets needed. How will Her Majesty’s Government support the market for praziquantel to reach the full number of tablets required?

Finally, to celebrate the UK’s innovation, entrepreneurialism and care in these times, and linked to our work, I was yesterday on your Lordships’ Terrace with Patricia Carter a director of Howad Ltd, which produces incognito insect repellent. She smiled at the fact that as we were talking, a bus crossed Westminster Bridge with an advert for incognito. The company has won a Queen’s Award for Enterprise in Sustainable Development for its product, which protects people from mosquitoes and other biting insects at home and overseas. We should be proud of that, as a country. Due to our work and expertise, here is an example of a small UK company protecting people against neglected tropical diseases and exporting to 22 countries. It also donates 10% of its profits to charities. On that note, I am now going to donate the four minutes that I have not used to the noble Baroness, Lady Hayman.

Neglected Tropical Diseases

Lord Stone of Blackheath Excerpts

Monday 3rd April 2017 Lords Chamber

[Lord Stone of Blackheath (Lab)]

My Lords, I declare an interest as a member of the advisory board of the Schistosomiasis Control Initiative at Imperial College. I am on the board only because I am one of the few people who can say schistosomiasis. No wonder it is neglected. I have asked them to rebrand it. I am also on the board because I am a businessman and retailer. I will focus on the enormous cost/benefit of SCI’s work and the huge return on capital employed. It effectively controls schistosomiasis across 11 countries in Africa at a cost for each child treated of 30p a year.

This is one of the most cost-effective public health programmes ever. Let us look at the scale: more than 91 million treatments have already been delivered, with funding largely from DfID. More than 200 million treatments will be delivered by 2019, half of them to girls and women. The worms are killed in children by just one safe and effective treatment; anaemia and malnutrition are reduced; the healthier children will then go on to attend school, and in the longer term, free from serious organ damage, they can contribute to their society for life.

So let us look at the maths. Disability-adjusted life years, or DALYs, due to schistosomiasis cost Africa hugely. Treated youths will be able to work for years to come. For every million who can work, even at just $1 a day, it is like $400 million of aid for Africa every year for ever. Other business people see this immediately as a must. Merck and GlaxoSmithKline donate tens of millions of praziquantel and albendazole tablets every year. The “effective altruism” movement has highly recommended our project. Philanthropists such as Luke Ding are there year after year donating large sums through Prism the Gift Fund—where I declare a trusteeship. The Bill & Melinda Gates Foundation has supported us hugely over the long term. Just recently, Dustin Moskovitz and Cari Tuna, through their charity, Good Ventures, have made one of the largest gifts ever received to Imperial College for this cause.

In addition to controlling schistosomiasis, we could eliminate it in most countries across Africa by 2030. Elimination would pay back enormously in increased prosperity across Africa and the world. To this end, and to break down the silos, SCI is part of a global network which, together with DfID investments, is working to strengthen local health systems. It is working with the World Health Organization; with Oxfam’s water, sanitation and hygiene programme—or WASH; with the Natural History Museum in a partnership studying the larvae, worms and snails that cause schistosomiasis; and with the noble Lord, Lord Trees, and the Royal College of Veterinary Surgeons.

Schistosomiasis elimination is not only the right thing to do but would be massively cost effective. Perhaps the Minister would like to meet those expert practitioners at the Schistosomiasis Control Initiative at Imperial College to discuss the cost effectiveness of all this and a brighter future for all.

Neglected Tropical Diseases

Lord Stone of Blackheath Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Stone of Blackheath (Lab)]

My Lords, it is a shame that we have to use the term “neglected”, but yes, ever since I joined the advisory board of the Schistosomiasis Control Initiative—SCI—I have found that whenever I mention schistosomiasis to friends and acquaintances they say, “What? What’s that?”. First, I explain the scale, that over 260 million people in the world need treatment for schistosomiasis and 120 million of these are of school age, and then, as noble Lords all know, that schistosomiasis causes malnutrition and anaemia in children and blood in their urine; if untreated, it goes on to cause liver fibrosis and bladder cancer; and female genital schistosomiasis increases the risk of HIV. I can only think that the world neglects such diseases because over 90% of these cases are in sub-Saharan Africa. However, wherever these diseases exist, their effects are appalling.

I myself come at this not as a medic, an academic or someone working in an NGO but as a businessperson seeing the numbers and the cost-effectiveness of compassion. Reaching out to treat these young children before the worms cause this extensive damage costs less than 50p per treatment per child per year. However, the recent “scorecards” show that schistosomiasis is lagging behind in coverage, and programmes targeting the intestinal worms still have a long way to go to reach the World Health Organization’s target of annual treatment with 75% coverage of children at school age. This can be rectified. We have had generous help from the Bill and Melinda Gates Foundation, philanthropists such as Luke Ding through Prism the Gift Fund, the END Fund and, of course, DfID.

Along with this, SCI, which is centred at Imperial College, provides the drugs, microscopes, training materials, vehicles and other transport and ensures that the programmes are managed efficiently. As has been said, the pharmaceutical companies Merck, GlaxoSmithKline and Johnson & Johnson have generously offered to donate all the drugs that are needed to treat 100 million children with praziquantel every year against schistosomiasis and 600 million with deworming pills.

Where, then, is the problem? As was said, it is in delivery that there needs to be help. To treat children in schools, working with local governments, SCI has built a network in 11 countries. This network is set up, but in many of these countries many of the children are simply not at school. Delivery to these outlying children is vital.

The world can afford to help. The economics of the case are that, each and every year, 50 million years’ work is lost through people’s disability resulting from NTDs. Were these people well and able to contribute fully to their society, even at just $1 a day, as my noble friend Lady Warwick said, in each of these countries, this would mean an extra $18 billion a year for the African economy.

I urge the Minister to follow up this excellent debate with a meeting of DfID with the expert people working on this at Imperial College, the Liverpool School of Tropical Medicine and Sightsavers, so we could see how we might allocate more money to those who are already implementing treatment to millions of children so that they may treble their coverage in the next five years to have a chance, as was said, of eliminating these diseases in many more countries.

Dealing with these NTDs in this way could change the world immensely for the better. It would give these young girls and boys a better future, help their countries begin to thrive and thence would add $18 billion a year to the wealth of their continent and, therefore, to the world’s economy. I thank noble Lords.

Ethical and Sustainable Fashion

Lord Stone of Blackheath Excerpts

Tuesday 19th March 2013 Lords Chamber

[Lord Stone of Blackheath]

My Lords, perhaps because of our society’s destructive obsession with speed and short-termism, fashion is often neither ethical nor sustainable. In many fields we fail to consider the long-term effects of what we do: in politics, it is the next term’s votes; in the media, it is weekly ratings; in business, it is tomorrow’s share prices; and in fashion, consumers want today’s new look. At Marks & Spencer, I was taught by the late Lord Seiff about good human relations in industry. We were not only concerned with the long-term satisfaction of our customers and of our shareholders who were often with us for life, we were also frugal with our use of resources. We used minimal packaging; we did not have fancy window displays; we used low-energy lighting; and even our relationship with our suppliers was that of a long-term partnership. We mainly bought our goods in the UK, but even when we moved some production abroad, we ensured that there was fair pay and good conditions in the factories that made our clothing. Home production is an issue to which I will return.

The consumer, too, has a role in this. How does he or she decide what to buy? A brilliant mind in this field, as was mentioned, is the designer, artist and academic, Professor Helen Storey at the Centre for Sustainable Fashion at the London College of Fashion. She is involved in a project that seeks to explore and understand more deeply the relationship between us and our desire to acquire. At the heart of the question posed by this debate lies our understanding of human actions in relation to material consumption habits. Here in the western world we are consuming and wasting at a rate that threatens our own health and that of the planet. The fashion industry exemplifies the complexity and extreme nature of human society’s obsessive cycle of creation and destruction, but it is also a great place to find solutions. Fashion sits at a point that crosses economics, aesthetics, psychology, creativity and our individual notions of who we are. This research will produce some really interesting results.

At this point I must declare an interest. I have three wonderful children. I tried to stop each of them following me into the shmatter business. Daniel and Jessica work respectively in charities and healing, but I failed with my youngest child, Susie Stone, who has a couture fashion business. She says that sustainable fashion requires us to buy less but wear it more and to spend more on good, bespoke, UK-made clothing, which in the long term will cost you less, suit you more and make you feel better about yourself.

On a grander, wider scale, the noble Lord, Lord Alliance, is working on a project to bring textiles back to Britain. He and his team have involved Manchester University, local businesses and regional and central government. This should be supported by regional investment and government grants. Tens of thousands of jobs could be created, so the investment would be cost effective. Within it, ethics and sustainability should be built into contracts to make them synonymous with “Made in Britain”.

A friend who has a new factory in the UK tells me that some awful UK factories bring in people at night to work the machines. They are paid by the illegal “cabbage” system. They have no right-to-work documentation to prove they are legitimate workers. We need this stopped so that ethical trading companies with audited compliance are not put at a disadvantage. As well as criticising other countries, we need to enforce ethical trading here in the UK.

Finally, I am afraid we have uneducated consumers in this field. They do not know what is involved in making clothes well from start to finish in terms of skills nor what the costs of a retailer are in terms of staffing, distribution and running stores. The public have never been exposed to this understanding. Many companies in the retail industry tick the boxes in terms of ethical and sustainable initiatives but do not have them high on their agenda because their one-year operating plans are dominated by recession survival and the complexities of multichannel retailing. As we found this week with controlling the press and media, we cannot wait for retailers and manufacturers to put in place voluntary, sustainable and ethical reporting practices. We need to create laws and ensure compliance with them.

After the unchecked industrialism of the 20th century and in order to advance sustainable and ethical fashion, there is a need for reinvestment in the textile industry in this country, for transparency and information from brands so that people can make informed longer-term purchasing choices and for legislation and compliance monitoring from Her Majesty’s Government.

Health: Neglected Tropical Diseases

Lord Stone of Blackheath Excerpts

Wednesday 30th January 2013 Lords Chamber

[Lord Stone of Blackheath]

My Lords, my involvement in this area has come about from chairing DIPEx, an online health charity. We publish videos and audio interviews conducted over 10 years of qualitative research into people’s personal experiences of illness by a brilliant team of academics at Green Templeton College, Oxford. Our website, healthtalkonline, was featured last week in the Times as number two in the top 50 websites that “you cannot live without”. We are good at publicity. Sir Tom Hughes-Hallett, the chair of the Institute of Global Health Innovation at Imperial College, has been a great supporter of DIPEx International, and he thought that perhaps our methodology of videoing patients’ experiences might help NTD workers to record and report their effectiveness because they do not get enough exposure; they are neglected. We are looking at that with the institute.

When I met Professor Alan Fenwick, the expert at the Schistosomiasis Control Initiative at Imperial College, he amazed me. The initiative has used its DfID funding to such great effect that it facilitated some 4 million treatments against schistosomiasis in its first year, which was 2011. By 2012 it had reached eight countries and provided 15 million treatments. Similarly, the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine has increased its number of treatments against lymphatic filariasis from 35 million in 2011 to 52 million in 2012. Both are confident that they will further expand their coverage in 2013 and get to Ethiopia, the Democratic Republic of Congo and Cote d’Ivoire.

It is excellent that DfID funding is reaching the poorest of the poor with cost-effective treatments of NTDs, but the world should view addressing these diseases not only within the health context, of course, but also in the important economic context. The Hudson Institute says that about 50 million DALYs—disability adjusted life years—are lost in developing countries to the NTDs alone. The treatment of NTDs is immensely cost-effective on a massive scale. The teams involved in these projects want the correct measurements, graphic representation and feedback loops in place to prove the effectiveness of allocating further huge resources to this work because it pays over the long term. The sources of funding are entitled to know that the route whereby their cash is getting to good causes is providing value for money. If they know that, they can target their funding better and co-operate across the piece, and thence give more. Yesterday evening, Lindsey Wu of Policy Cures described the integration of the malaria vaccine technology road map being co-ordinated by the World Health Organisation. It seeks to involve players at all stages of malaria control and elimination and considers how that can back into early stage vaccine work. This type of holistic approach at all stages goes beyond the lab to deliver the most impact on the ground.

There are, of course, powerful drivers for “commercial” funders to conduct R&D on drugs and thus develop vaccines and diagnostics, but not enough resources are allocated to the less commercial end, which is that of vector control. Millions of people could be prevented from getting these diseases in the first place. Furthermore, more attention is needed on the less exciting areas of operational research, implementation and logistics, as well as an integrated approach to multiple NTDs.

This whole project is amazingly heartening and I urge the Minister to look at the need for well informed, powerfully and graphically presented feedback loops, which could inspire greater integration of funding and bring the successful treatments of these neglected diseases to the attention of the larger world community; thereby supporting these great people working in this field and enabling millions of wonderful individuals in these countries not only to live but to live better lives.