Health: Neglected Tropical Diseases

Baroness Hayman Excerpts

Thursday 6th February 2014 Grand Committee

Asked by

[Baroness Hayman]

To ask Her Majesty’s Government what progress has been made in combating neglected tropical diseases since the London Declaration in 2012; and how that issue will feature in the post-2015 Millennium Development Goals health agenda.

[Baroness Hayman (CB)]

My Lords, I am delighted to have the opportunity to introduce today’s debate on progress in combating neglected tropical diseases and I draw attention to my non-financial interests in health and development, particularly as a trustee of the Sabin Vaccine Institute and the Malaria Consortium. I am also delighted that what many would consider an abstruse and minority interest subject has attracted such a large and expert speakers list—and even an equally distinguished audience in the Moses Room—and I look forward to hearing the contributions.

I am also glad to see the noble Lord, Lord Bates, here today as the Minister replying. I welcome him to our world of worms, snails, flukes and flies, the vectors of the group of parasitic and bacterial diseases that are categorised as neglected tropical diseases—NTDs. Of course, these diseases—afflictions such as river blindness, human hookworm and elephantiasis—are not actually part of our world as people who live in rich, developed countries. They are the diseases of the world’s poorest people, predominantly the rural poor. For them, NTDs are far from abstruse or a specialised interest; they are illnesses that affect one in six of the world’s population and blight the development of half a billion of the world’s poorest children.

Although NTDs do not cause as many immediate deaths as AIDS, TB and malaria, they kill, they maim and disfigure and they stunt and disable, causing decades of pain and, often, isolation. These diseases not only have direct effects but also weaken the immune system, cause anaemia, put infected individuals at higher risk of contracting other diseases and impair the ability to resist infection. They increase the risks in pregnancy and childbirth and they can have a negative effect on the efficacy of treatments for diseases such as TB. The link in particular between genital schistosomiasis and HIV infection, particularly in young women, has not been taken seriously enough in the past. Beyond those health effects, NTDs also form a terrible barrier to education and employment. They are not only the diseases of poverty; they are the diseases that cause poverty. Combating NTDs is therefore one of the best routes to cutting the cycle of poverty itself and to the sustainable development that we all seek.

The good news is that, unlike with many diseases, we have many of the tools necessary to combat those afflictions. We know that the combination of mass drug administration and water and sanitation projects, for example, can result in dramatic benefits and reduction in the incidence of disease. With concerted effort, with research into new vaccines, new diagnostics, new insecticides and medicines, with improved mapping and monitoring, with operational research, we could make much more progress. Much of that work is in train in academic institutions, in the voluntary sector and in the countries themselves

The London declaration of 2012, whose second anniversary we mark with this debate, was hugely important, because it brought together funders, both national and philanthropic, pharmaceutical companies that donate the drugs necessary for mass drug administration programmes and endemic countries themselves in an effort to co-ordinate the fight against these diseases. Together with the ongoing support of the World Health Organisation, which has championed this work in recent years, we have seen a significant shift in the global prioritisation of neglected tropical diseases. Their inclusion in the healthy lives goal of the high-level panel on the post-2015 development agenda, published in May last year, was, I believe, a crucial step forward.

I welcome, too, the formation of NTD coalitions, such as the very successful one that we have in the UK, in countries across the world and, particularly importantly, the drawing up of integrated NTD control strategies in endemic countries. The academic and voluntary sector, both of which are so strong in the United Kingdom, have much to offer both in research and in resource. For example, the London Centre for Neglected Tropical Disease Research, which had just been launched when we debated this subject a year ago, works continuously to improve the effectiveness of control measures. We need to know how to do what we do better. Such technical support will be essential for plans such as the recently drawn-up Africa regional NTD strategy if it is to be successful.

As well as technical support, money remains an issue. Even given the relative cheapness—we know that many would argue that treating NTDs was the best bang for your buck that you could get in public health expenditure—and the cost efficiency of NTD control work, given the extensive drug donations, it has been estimated that there is still a £200 million funding gap to be bridged if we are to meet the goals of the London declaration. I am not asking Her Majesty’s Government to meet that gap themselves; they have already been generous and committed in this area. However, I ask the Minister what progress the Government are making in championing investment in NTD work with other key international donor Governments, particularly perhaps France, Germany and Australia.

As we have recently and sadly seen with polio eradication, conflict can threaten to destroy the painstaking work of decades. When countries experience violence and civil wars, health programmes and the benefits that they provide to the poor and the marginalised are threatened. Through the Malaria Consortium, I know of the situation in South Sudan. There, it is working on DfID-supported programmes and bringing long-standing expertise in malaria to bear on programmes to combat neglected tropical diseases. We have discussed in your Lordships’ House before the issue of not working in silos in this area. Members of the charity’s staff had to be evacuated during the recent violence and have only just been able to return. I pay tribute to the courage and commitment of the very many—both local and international—NGO workers throughout the world who continue to operate in extremely difficult and often dangerous circumstances. On the specifics of South Sudan, I understand that the DfID NTD programme, though not the malaria programme, is on hold because of the perceived continuing dangers. I wonder whether the Minister could give any indication today, or perhaps in writing, of when that programme might be restarted.

I return to the issue of a post-2015 millennium development goal. Combating NTDs punches above its weight in broader health and wider development terms. We need to renew and reinvigorate our commitment to research, prevention and treatment programmes. By integrating existing strategies such as mass drug administration with broader public health programmes such as those on water, sanitation and education, we not only enhance the effectiveness of those strategies but start to build from the bottom up the sort of universal health coverage and health systems needed to underpin development. Therefore, I end by congratulating the Government on the leadership that they, together with the United States, have given so far and I urge them to ensure that NTD control features in the final formulation of the sustainable post-2015 health agenda.