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?