Neglected Tropical Diseases

Lord Trees Excerpts

Wednesday 11th July 2018 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government what assessment they have made of progress made in combating neglected tropical diseases following publication of the Fifth Progress Report on the London Declaration on Neglected Tropical Diseases.

[Lord Trees (CB)]

My Lords, given that there is another major attraction this evening, I am very grateful to noble Lords who have put down their names to speak in this debate.

The neglected tropical diseases are a group of 20 bacterial, viral, fungal and parasitic diseases—to which snake-bite has recently been added—which affect more than a billion people a year in some of the poorest countries of the world. Recognition of their importance as a burden on health in those countries was enhanced by bringing them together under the term “neglected tropical diseases”, which we shall call NTDs, and was further strengthened by the London declaration of 2012. I shall try to limit my use of lots of names, for I fear Hansard might get apoplexy dealing with visceral leishmaniasis, schistosomiasis, onchocerciasis and the like. Suffice it to say that the colloquial names of those diseases vividly convey their consequences, such as elephantiasis, river blindness, or the appalling biblical disease of leprosy, which is still prevalent in many poor countries.

A key feature of the NTDs is high morbidity, with chronic disability, disfigurement, social stigma and long-term loss of health affecting the poorest members of society. NTDs are a result of poverty, but in a malignant circle they are a cause of poverty, because they reduce the potential of millions of people to improve their economic well-being.

While chronic disease is a feature, some NTDs cause considerable mortality. For example, snake-bite is estimated to kill about 100,000 people a year. We are also beginning to understand the important role that NTDs play in predisposing to a range of other significant health problems, such as mental ill health, HIV/AIDS, epilepsy and cancer, among others. While the impact of NTDs is huge, in many cases we have the tools available to tackle them so that, given the will and the funding, we can do a great deal about their impact now.

The London declaration of 2012 focused specifically on 10 NTDs for which there are drugs available and which could be tackled by mass drug administration, which I shall refer to as MDA. That has been facilitated by donation of key drugs by several pharmaceutical companies, and the scale and significance of this is massive. Arguably, this is the greatest philanthropic gesture by industry to benefit the global public good there has ever been. Some $2 billion to $3 billion-worth of drugs is donated annually and in 2016 more than a billion treatments were donated in 130 countries.

Another important development has been the linking of NTDs to the achievement of the sustainable development goals. MDA is a great example of universal health coverage and tackling NTDs will contribute greatly to the achievement of the SDGs, especially SDG 3 to ensure healthy lives and promote well-being for all at all ages. Conversely, the attainment of other SDGs, such as the water and sanitation objectives of SDG 6, will contribute hugely to NTD control.

The progress to date in controlling NTDs has been remarkable. Between 2011 and 2016 the coverage of MDA has nearly doubled from 37% to 63% of the target populations and concomitantly the global population at risk has fallen by nearly 500 million people. In 10 countries lymphatic filariasis has been eliminated as a public health problem, as has trachoma in five countries; onchocerciasis has been almost eliminated from the Americas; and Guinea worm has been almost completely eradicated from the globe. Major progress has been made in reducing morbidity with other NTDs, all of these in countries with logistic and economic handicaps.

The UK’s contribution has been huge and is something of which we should be proud. Funding from the UK Government has been pivotal, both for research and for disease control. I am sure that the Minister will tell us about this, so I will not steal his thunder. UK scientists, too, have been and continue to be at the forefront in tackling these diseases. Here I pay particular tribute to my former colleague Professor David Molyneux, who has been at the Liverpool School of Tropical Medicine for many years and has been a tireless campaigner on NTDs. This Parliament’s All-Party Group on Malaria and NTDs, under the committed chairmanship of Jeremy Lefroy MP, has been extremely active and influential.

In tackling these diseases, a “one health” approach is extremely important, where as well as medical scientists, veterinary scientists can make an important input. This may be where infections are known to be zoonotic—that is, transmissible between humans and animals—or in other cases where we are discovering a role for animal hosts not hitherto known, such as in the epidemiology of schistosomiasis and of Guinea worm. Most significantly, it can be in the development of drugs where the commercial market to treat worms in animals has driven research and discovery of key drugs now being repurposed and donated for MDA programmes in humans, such as ivermectin for onchocerciasis.

That brings me to rabies, a truly horrific zoonotic NTD estimated to kill nearly 60,000 people a year, of whom more than 40% are children. That is year in and year out and compares to the 11,000 that died in the recent tragic Ebola outbreak in west Africa. Once clinical signs of rabies appear, whatever the treatment given, 99.9% of all patients die a horrible death, yet this is preventable. We have the technical tools required to consign this disease to history. Almost all cases of human rabies are caused by the bite of an infected dog, but we have a simple, safe and effective vaccine to immunise dogs. Field research in a number of regions and countries in Africa, the Americas and Asia has demonstrated the success of canine vaccination campaigns in eliminating human rabies. An international effort is now under way with the key organisations: the WHO, the OIE—the world organisation for animal health—the FAO and the Global Alliance for Rabies Control, which has very recently produced a global strategic plan to end dog-mediated rabies by 2030, the Zero by 30 campaign. Key to that campaign is a dog vaccine bank that the WHO has already set up. I ask the Minister: what specific support is DfID giving to rabies control? This is a disease on which the UK could single-handedly make a huge, cost-effective impact.

Because the dog vaccine is largely an altruistic vaccine, in that it is given to dogs in order to benefit public health, it is difficult for human health ministries in low-income countries to justify expenditure on a dog vaccine from their budgets. On the other hand, impoverished dog owners are unlikely to vaccinate their dogs to benefit the general public. The donation of dog vaccines to the WHO’s vaccine bank would cut this Gordian knot and catalyse progress. Professor Sarah Cleaveland of Glasgow University, one of the world’s leading authorities on rabies control, has estimated that only $15 million to $20 million per year would purchase enough dog vaccines for all of Africa. I suggest to the Minister that a commitment to provide dog vaccines on such a scale would be a huge boost to the Zero by 30 campaign and would leverage a colossal amount of support in delivering those vaccines by NGOs, charities and ministries of health in low-income countries, acting under the umbrella of the global strategic plan to end almost all human deaths from rabies in the world.

In conclusion, the progress made in reducing the effect of all NTDs has been a remarkable testament to the efforts of the international community. To cement the progress made to date and drive these diseases to oblivion, it is essential that we maintain our efforts. Endemic countries need to take more responsibility. While the healthcare budgets of low-income and middle-income countries may be modest, the cost of delivery of donated drugs—about 20 cents to 30 cents per person per year—would amount to only 1% to 2% of such budgets, yet donated drugs are not getting delivered. We need also to better integrate interventions between various NTDs and with other healthcare interventions to be more cost-effective.

In the affluent world, we need to maintain our commitment. There is a funding gap. The WHO has estimated that an additional $300 million to $400 million is required per year up to 2020. Currently, of world Governments, the UK and the US have been the principal donors; other affluent nations need to increase their efforts. The UK pledge to spend 0.7% of GDP on overseas aid is an admirable example. We need to recognise that, even when there are many calls on public expenditure, improving the health and welfare of those in poorer countries is not only ethically admirable but makes sound sense.

Let me elaborate. Analysis has shown that, given the scale of drug donation, NTD interventions are one of the most cost-effective measures in public health, one estimate giving a 25:1 rate of return. In addition to being highly cost-effective, support for NTD control is quite simply enlightened self-interest. I need hardly emphasise to your Lordships that the issue of economic migration is a huge challenge to the affluent northern countries. I submit that the solution lies not in fences and walls but rather in improving the health, and hence wealth, of populations ravished by endemic disease, so that people can stay at home assured of a healthy, productive and economically adequate life.

Zika Virus

Lord Trees Excerpts

Tuesday 2nd February 2016 Lords Chamber

[Baroness Verma]

My Lords, as I have said, the Ross fund will be used for research and development. On the noble Lord’s point about doing research with Brazil, only last week the UK announced a £400,000 Newton fund Zika research project between Glasgow University and Fiocruz in Brazil, which is in the hotspot area of the outbreak.

[Lord Trees (CB)]

My Lords, Zika is the latest of a series of infectious diseases to have emerged in recent years in humans and animals. Some 75% of new infectious diseases emerging in humans are derived from animals. Does the Minister agree that, at this time, when our biosecurity is threatened by globalisation, we need to strengthen national surveillance capabilities for infectious diseases in humans and animals?

[Baroness Verma]

My Lords, the wider point is, as the noble Lord, Lord Patel, said, that the rate of spread of this particular virus is low. However, I agree with the noble Lord that we need to understand better why this virus and others are suddenly increasing at a greater rate than the normal pattern in the past. The UK is showing leadership by putting money behind research and development. Working with countries where outbreaks are taking place will not just benefit our own understanding but will build resilience for those countries.

Neglected Tropical Diseases

Lord Trees Excerpts

Monday 1st February 2016 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government what assessment they have made of the effects of Neglected Tropical Diseases in impairing social and economic development in developing countries in the light of the publication of the third progress report of the 2012 London Declaration on Neglected Tropical Diseases.

[Lord Trees (CB)]

My Lords, it is a great pleasure to open this debate on neglected tropical diseases, which I will refer to as NTDs. This is the third debate we have had on this subject in as many years. I thank my noble friend Lady Hayman for her leadership in initiating the previous two debates. Certainly this House cannot be accused of neglecting these diseases. Nor should we: they are of huge global health and socioeconomic importance, as is now being recognised. Coincidentally, this Wednesday former US President Jimmy Carter will give a talk in this House convened by the Lord Speaker about one NTD, guinea worm disease, and its eradication.

NTDs are a group of infections associated with poverty in tropical and sub-tropical countries. Some, such as rabies, have a high mortality rate but most are characterised by their chronicity and high levels of disability such as gross disfigurement, blindness and inability to work. As such, sufferers are unable to be productive within their already poor communities and instead become a burden on the very limited healthcare resources of their countries. More than 1 billion people are affected in 149 countries worldwide. It is estimated that some 300,000 deaths per year are caused by NTDs.

However, until recently, in comparison with for example HIV, TB and malaria, these diseases received very modest international attention and support. The bundling and aggregation of these diseases and their branding as “neglected” was a masterstroke of public health communication. In 2012, WHO published its road map laying out targets for the control, elimination or eradication of 17 NTDs by 2020. Momentum gathered pace, with the London Declaration on NTDs in 2012 enshrining further commitments. Last year, the UN sustainable development goals to 2030 included NTDs within goal 3, aimed at “healthy lives” and “well-being for all” people.

This progress is substantially contingent upon the massive commitment by the pharmaceutical industries to donate key drugs essential for many of the control programmes. Donations worth a staggering $3.8 billion per year are a massive gesture of corporate generosity. While there is still some need for research to develop drugs for some NTDs and situations, there is available now a free toolkit of drugs for many NTDs.

Notable among these drugs is ivermectin, the mass administration of which to populations in Africa and Central and South America has massively reduced the incidence of clinical onchocerciasis—river blindness. Noble Lords may be aware that the Nobel Prize for Medicine in 2015 was awarded partly for the discovery and development of ivermectin by Campbell and Omura. Noble Lords may not be aware that this drug was in fact developed and initially marketed for veterinary use in 1981 as a wormer for cattle and other species. It was so successful commercially that the parent company, Merck, was able to commit to donate ivermectin for the control of onchocerciasis and lymphatic filariasis or elephantiasis for as long as needed. I mention this not only because of its significance in NTD control but to highlight the connectivity between human health and veterinary science—the so-called “one health” concept. That relationship is particularly close with respect to human tropical diseases.

That brings me to another NTD which exemplifies the “one health” approach—rabies. I am not an expert on rabies but, of all the lectures I had as an undergraduate veterinary student, one I particularly remember was on rabies. From nearly 50 years ago, I still remember the main message: the key to controlling human rabies is to control dog rabies. Human rabies was endemic in Britain until late in the 19th century. We eradicated it by stopping dogs biting people. Worldwide, 99% of human rabies is still contracted from dogs. Rabies is a horrible disease. It is still endemic in many countries in Asia and Africa. It is estimated that about 60,000 people die of it a year, of whom nearly 50% are children. During the nine minutes of this speech, someone somewhere will have died of rabies. Once clinical signs appear, death is inevitable; it is a very unpleasant death and you know what? It is entirely preventable. We have all the tools we need: a vaccine for humans, a vaccine for dogs and post-exposure treatment for humans.

The cheapest of these interventions and the principal means of control is to vaccinate dogs. By vaccinating 70% of the dog population, the transmission cycle is stopped. I am pleased to say that there is now a growing movement to tackle this problem, catalysed by the awareness that the elimination of nearly all human deaths from rabies is achievable. A number of campaigns at national, regional and local level in South America, Asia and Africa, conducted by health authorities, NGOs and charities, are starting to control rabies through control of rabies in dogs. I am pleased and proud that many British scientists and vets are active in this area. Late last year, WHO and the World Organisation for Animal Health, in collaboration with the FAO and the Global Alliance for Rabies Control, organised a conference in Geneva which agreed a framework of actions to achieve the WHO goal of eliminating dog-mediated human rabies by 2030. Later this month, my noble friend Lord Crisp and I will host in this House the launch of the End Rabies Now campaign from the global alliance.

For rabies and many designated NTDs, real progress is being made. I am sure we will hear further examples in today’s debate. However, in spite of the donation of many of the drugs needed, there are still significant challenges. These relate more to the delivery of existing drugs and interventions than the development of new ones. Professor David Molyneux, a leading world expert on NTDs, argues that the availability of drugs is no longer a barrier to achieving universal coverage for most NTDs. It is estimated that there is an annual funding gap of $200 million to $300 million a year to ensure effective delivery of interventions and drugs we now have and that are given free. This funding gap should partly be met by the endemic countries themselves. Although extremely poor and with limited resources, it would only require a tiny percentage of their healthcare budgets to fund delivery of the free drugs available for NTD control.

The developed world could also do more. The UK’s leadership in this area through DfID is commendable, but globally only about 0.6% of donor governmental financial aid for healthcare is provided to tackle NTDs. Our affluent neighbours in Europe and some other countries could do more. Action against NTDs will benefit the poorest of the world’s poor. A recent study showed that tackling NTDs is highly cost-effective in terms of return on investment. The third progress report of the London declaration on NTDs said:

“This makes NTD programs a pro-poor best buy”.

I commend DfID for its commitment and support for the control of NTDs, reinforced by the recent announcement of the Ross fund. Is the Ross fund additional money to that which the UK has been committing for NTD funding? Secondly, what are the Government doing to urge other affluent nations to follow our example? Collectively, we need to close the funding gap and ensure that the great progress to control NTDs achieved in the last few years will be sustained so as to permanently eliminate these infections and the terrible diseases they cause.

Agriculture and Food Industry

Lord Trees Excerpts

Thursday 24th July 2014 Lords Chamber

[Lord Trees (CB)]

My Lords, it is a great pleasure to contribute to this debate on agriculture and the food industry, which I am grateful to the noble Lord, Lord Plumb, for initiating. It is on agriculture that I wish to focus.

Agriculture, as has been said by several noble Lords, contributes hugely to the economy—£9 billion to the UK economy in gross value added—making it one of the biggest manufacturing sectors in our land. Its value, of course, extends much beyond that. It underpins much of the food sector, about which we heard from the noble Lord, Lord Bilimoria, which is worth far more—about £88 billion in gross value added to the economy in 2012. More than that, agriculture is the custodian for most of our land. Some 71% of the land area of the UK is classed as agricultural. Finally, as has been mentioned by the noble Baroness, Lady Scott, and the noble Earl, Lord Selborne, agriculture provides a substantial part of our food. Some 76% of the food that we could grow in Britain we are growing and providing for the nation. In that respect, it underpins our security, health, and productivity.

I want to concentrate particularly on livestock production and in that respect I draw attention to my register of interests and my chairmanship of an animal health research institute. Nearly 40% of the total UK land area is classed as permanent grassland, much of it upland and in less favoured areas. This is ideal for raising ruminants, which turn indigestible cellulose in grass into nutritious products that are in high demand nationally and internationally.

The gross output value for livestock production is estimated at £14.2 billion in the UK in 2013. That makes it a very substantial level of productivity in comparison with other EU member states, as the noble Lord, Lord Bilimoria, outlined. However, we still have a substantial overall negative balance of payments position for livestock products. This presents a challenge but, coupled with the likely increase in the value of livestock as the result of a rapidly expanding global population which demands more meat and dairy products, it also presents a great opportunity.

Production of food in the UK is under threat from competing claims for land use within the finite boundaries of our land. There are competing claims for energy production, forestry, transport infrastructure, conservation and so on. In future, land for agriculture and livestock production will reduce.

None the less, our livestock industry has been very resilient in recent years. Productivity has been more or less maintained and in some cases considerably increased, although the number of animals and holdings has decreased in many cases. For example, in the dairy industry between 1997 and 2005 the size of the dairy herd shrank by 20% but milk production fell by only 2%. This has been achieved partly by fewer but bigger units with concomitant efficiency gains. However, there can be downsides to that. I have not the time to go into them but the pollution and so on will be apparent to your Lordships.

In terms of increasing efficiency of livestock production, what does not have downsides is improving the health of our herds and flocks. In a given period, disease morbidity impairs productivity but inputs, pollution and greenhouse gas emissions remain more or less the same. Mortality from disease of course stops production from an animal. One loses totally its productive capacity without reducing the inputs and emissions up to the point of death. Improving health can reverse all these negative impacts.

Investment in disease control and the application of science is essential. Recent initiatives such as the Government’s agritech strategy are very welcome, but overall investment in agricultural research in 2010 was just 5% of the gross value added of the industry. I suggest that that is below the norm for comparable high-tech industries. This investment does not all have to come from the Government of course: industry should contribute. However, given the national importance of food production, the Government have an important part to play.

It is essential in supporting research investment that we give attention to endemic disease research—those diseases indigenous to the UK which affect livestock every minute of every hour of every day, 365 days a year. They are diseases such as mastitis, lameness, reproductive and parasitic diseases and, of course, TB. It is important that we emphasise research on those endemic diseases as well as protect against incursions of so-called transboundary diseases like foot and mouth. It is also important that we gear incentives to reward health and not disease, and that biosecurity, health planning and disease surveillance—the concepts of protect and prevent—are given appropriate emphasis rather than purely reactive measures. Research into and application of disease prevention measures are the equivalent of insurance. It is tempting to cut back on this, especially when times are hard but, to use a domestic analogy, it is a false economy to cancel one’s household insurance if the house then burns down.

The reforms of the common agricultural policy, which is set to distribute £15 billion in England alone between 2014 and 2020, give an opportunity to reposition a proportion of funding to support and facilitate farmers to embrace health planning and disease prevention. Maintaining or even improving productivity from fewer animals reduces pollution and reduces inputs in imported feedstuffs and greenhouse gas emissions but increases food security and improves animal welfare. It makes sense to improve animal health and thereby strengthen a sustainable agricultural economy so that it can continue to make such a valuable contribution to the nation’s well-being.

Bovine Tuberculosis

Lord Trees Excerpts

Wednesday 25th June 2014 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government whether they intend to modify their strategy to control bovine tuberculosis in the United Kingdom in the light of the independent expert panel report on the pilot badger culls.

[Baroness Northover (LD)]

My Lords, in April we launched our TB strategy, setting out our plans to achieve officially TB-free status by 2038 through both new and existing tools. We have always been clear that lessons would be learnt from the badger control pilots. Having considered the report of the independent expert panel, we have accepted its conclusions and are currently working to implement its recommendations in advance of the second year of culling in Gloucestershire and Somerset.

[Lord Trees (CB)]

I am grateful to the Minister for that Answer. In the light of the fact that vaccination is likely to be a significant, although not the only, tool in the future long-term and sustainable control of this terrible disease, can the Minister give this House an assurance that the three important goals of research into and development of an oral vaccine for badgers, the registration and deployment of a cattle vaccine and the research into and development of appropriate cattle diagnostic tests will not be hindered by a lack of resources?

[Baroness Northover]

I can give the noble Lord that assurance. I hope that he was pleased to see the strategy announced at the beginning of April, which makes it very clear that culling is only a small part of an overall approach to this disease. He has outlined some very important areas, and Defra has pledged significant support to take that research forward. I hope that the noble Lord will also be pleased with the announcement of support for vaccination on the edge between the areas with a high incidence of bovine TB and those that currently have a lower incidence.

Animal Welfare: Methods of Slaughter

Lord Trees Excerpts

Thursday 16th January 2014 Grand Committee

Asked by

[Lord Trees]

To ask Her Majesty’s Government what assessment they have made of the ethical, legal and religious factors that influence the way in which some animals are slaughtered in the United Kingdom.

[Lord Trees (CB)]

My Lords, in my 45 years as a veterinary surgeon I have witnessed the abattoir slaughter of many animals with and without stunning, but when I first witnessed slaughter without stunning it was profoundly disturbing. The animal staggered from its killing crate, blood gushing from the neck wound, and it did not collapse into unconsciousness for some considerable time. It is that experience and others since that have caused me to bring this debate.

It might be useful initially to cover the legal framework surrounding the slaughter of animals—and I am going to concentrate on cattle and sheep. The legal framework is straightforward. In abattoirs, the death of animals is due to exsanguination following severance of the major blood vessels in the neck. It is illegal in the UK and throughout the EU to do that without first rendering animals insensible by stunning—except that that requirement for pre-stunning is exempted for those of Muslim and Jewish faiths to produce either respectively halal meat or kosher meat by shechita. I intend to talk about stunning and non-stunning in the rest of my speech.

Noble Lords have heard my reactions. Let me quote the reactions of a female, Jewish vet, who recently sent me an e-mail. She said:

“Without a doubt, during my almost twenty years as a vet, I have never witnessed anything as horrific as Shechita slaughter. That horror lives fresh in my mind today and having been raised and now living in a Kosher home I do not and never have eaten a piece of Kosher meat since the day I witnessed this barbaric practice. Indeed I have seen much suffering and many severe injuries in the animals I have treated over the years, but nothing comes close to the unnecessary and brutal suffering that these animals experience at the very end of their lives”.

Note that that is from a qualified, official veterinary surgeon who has done a lot of meat hygiene work and has witnessed the slaughter of many animals involving both stunning and non-stunning.

Let me emphasise that I recognise that both the great faiths in question have serious concerns for animal welfare. I also make it quite clear that I defend and respect the freedom of expression of all groups, religious or non-religious, within reasonable limits acceptable to our society. Nevertheless, it is my contention that unnecessary suffering is being caused to a very substantial number of animals by slaughter without stunning. I want to address this under three headings: inconsistency, injury and insult.

In terms of inconsistency, we rightly pride ourselves here in Britain on our animal welfare regulations and our humaneness. Recently, it has been made an offence to dock a puppy dog’s tail. That is something that involved a snip with a pair of scissors which, on a week-old pup, evoked at most a slight yelp. We have made that illegal—and I am happy with that law—yet we allow adult animals to have their throats cut without rendering them unconscious first. Is that a consistent approach to humaneness?

I turn to biological tissue injury. The Farm Animal Welfare Council, in its report of 2003, considered the whole issue of slaughter without stunning in great detail. Considering the injury to the neck involved in throat-cutting, the council noted that this involved the incision of skin, muscle, trachea, oesophagus, both jugular veins, both carotid arteries, major nerve trunks and several other nerves. It concluded that,

“such a massive injury would result in very significant pain and distress in the period before insensibility supervenes”.

The FAWC report went on to refer to evidence of the time taken to lose brain responsiveness in different species following the neck cut. It noted that in sheep it was five to 10 seconds; in adult cattle, with excellent technique, it was a minimum of 22 to 40 seconds; and in calves it was 10 to 120 seconds. Twenty seconds is a long time if you are suffering pain. The FAWC report—and remember that this is the Government’s independent advisory committee—recommended in its 2003 report that,

“the Government should repeal the current exemption”

from pre-stunning.

I turn to insult. By this I mean tissue damage and particularly the induction of pain—I mean a biological insult. Determining the perception of pain can be very difficult, I acknowledge, but some recent research has been done on calves in New Zealand which I would argue provides strong evidence that pain is perceived by a neck cut and that stunning abrogates that. In this work, electrophysiological measurements were taken of brain signals, for which there was supportive evidence of their being associated with pain. A neck cut without pre-stunning caused pain signals lasting for up to two minutes. Such signals did not occur when stunning was used before the neck cut. Finally, if the neck cut was made and then animals were stunned, the pain signals occurring after the cut were immediately abolished. Every attempt was made in this work to mimic slaughter without stunning but true shechita could not be performed because, ironically, the animals had to be gently anaesthetised to conform to experimental animal laws and thus could not pass for human consumption, as shechita demands. So I would argue that it is likely that severe pain is caused by slaughter without stunning, albeit for a relatively short period, but perhaps for as much as two minutes in cattle.

How many animals are involved in slaughter without stunning? The latest available survey by the Food Standards Agency, in 2011, indicates that approximately 70,000 cattle are slaughtered in the UK each year without stunning, mainly by shechita, and that about 1.5 million sheep are despatched without stunning, mainly for halal consumption. I should point out that the majority of sheep that are killed for halal purposes in the UK are pre-stunned, but that still leaves the significant minority of 1.5 million that I have referred to. Thus I contend that, given the nature of the biological insult and the numbers involved, slaughter without stunning is a major, if not the major animal welfare issue in the United Kingdom today. A further important fact is that much of the meat from non-stunned slaughter goes into the food chain for mainstream consumers. I suggest that consumers can justifiably expect to be informed if the normal legally required form of humane slaughter has not been used.

All the independent welfare bodies advocate stunning before slaughter—FAWC, the British Veterinary Association, the Federation of Veterinarians of Europe, the RSPCA and the Humane Slaughter Association—and furthermore, the food-quality assurance schemes such as red tractor and the Soil Association do not permit non-stun slaughter. In Europe, Sweden, Norway, Switzerland and Iceland have disallowed non-stun slaughter, and New Zealand does not permit the non-stun abattoir slaughter of mammals. Significantly, New Zealand exports large amounts of sheep meat that has been reversibly stunned and certified as halal to Muslim communities in Asia and the Middle East.

The EU is currently conducting a study on providing consumers with the relevant information on the stunning of animals by labelling of meat products. In the UK, the beef and lamb trade organisation EBLEX is working on the issue of clear labelling with halal producers. Will the Government support measures to label meat appropriately to enable consumers to make informed choices?

I make it clear that I am not asking in this debate for non-stun slaughter to be banned. I am not a believer in bans; I would rather that society collectively arrived at decisions about what is acceptable and what is not. However, I sincerely ask the Muslim and Jewish communities and their leaders to reflect and consider whether ancient practices, for which there were good reasons many hundreds of years ago, are necessary today. There are non-lethal, non-invasive methods of stunning, and even if there is disagreement on the extent or duration of pain perception, is it not time to adopt stunning to preclude the possibility of unnecessary suffering—as some Muslim food authorities have allowed?

Health: Neglected Tropical Diseases

Lord Trees Excerpts

Wednesday 30th January 2013 Lords Chamber

[Lord Trees]

My Lords, the debate today is to mark the first anniversary of the London declaration on neglected tropical diseases. I want to celebrate that important initiative and the considerable progress that has been, and is being, made to control and eradicate these diseases. However, I also want to emphasise that we cannot yet be complacent. The job is not finished and there is much to do, even though the way forward is largely clear.

The NTDs are now getting the attention they deserve because they afflict huge numbers of people in the poorest countries of the world—the so-called “bottom billion”. These diseases are inextricably bound with poverty. It contributes to these diseases and these diseases, in turn, contribute to poverty. Their control is an essential step in the achievement of several key millennium development goals. These diseases, which include many with bizarre, exotic and frightening names such as Kala-Azar, Chagas disease, sleeping sickness, elephantiasis and river blindness, are for the most part chronic and persisting infections, which may eventually kill but which in many cases simply—but seriously—disable, disfigure and stigmatise. The effects are pervasive and extensive in the societies in which they occur.

Another of their characteristics is that many can be treated, controlled and even eradicated with tools that we already have. These are the low-hanging fruit of tropical diseases. The costs of making progress are relatively low and the benefits are huge, as has been said by several speakers. It is very much to the credit of the WHO, the Gates Foundation, various NGOs, scientists and healthcare workers throughout the world, and of course, the London declaration, that these diseases are now being tackled in a concerted and coherent way. The contribution of the UK to this global effort is huge. DfID has played a very substantial part, as have many scientists, medics, vets and healthcare workers based in our universities and in our two schools devoted to tropical medicine and public health in Liverpool and London.

Another hugely important factor has been the donation of drugs by major pharmaceutical companies to this programme. Drugs to the value of $2 billion to $3 billion a year are being donated by big pharma; this is an altruistic gesture that is not always fully appreciated. As a vet, it gives me satisfaction that a lot of these drugs were initially developed for the control of worms in animals. A staggering 700 million tablets are administered each year to school children in developing countries to control enteric worms, and that is just one example. All of these efforts have resulted in a substantial reduction in the incidence of infection and disease, and put the goals of controlling and eradicating many—if not most—of the 17 targeted NTDs by 2020 within reach.

However, there is still a need for an estimated $2 billion to sustain this effort to achieve these goals. That is a lot of money. Currently only 0.6% of overseas development assistance for health globally is being allocated to NTDs. Some $2 billion spread over 7 years among the wealthiest nations of the globe, given the huge return, is surely not only a desirable, but also a necessary investment. Fit and healthy people can work to feed themselves, their families and, their populations and they can contribute to the economic and social progress of their countries which in turn reduces conflict and migration.

There is still a need to develop new products and technologies to continue supporting the development of healthcare systems, health services in endemic countries and particularly systems for delivery of drugs to the point of need. We need to ensure clean water supplies and good sanitation. Notwithstanding that, we now have many of the tools we need. It is the appliance of science, the delivery of what we have, that is the major challenge. Given that there are freely available drugs for many of the NTDs, it is a responsibility we all share to apply these tools to achieve the global benefits. If we fail to do that—to satisfactorily deal with the low-hanging fruit—what hope have we to tackle more complex or technical health problems facing the world?