Drug-Resistant Infections

Baroness Hayman Excerpts

Thursday 15th September 2016 Lords Chamber

[Baroness Hayman (CB)]

My Lords, like others, I congratulate the noble Lord, Lord Lansley, both on securing this debate and on his very cogent introduction today.

My contribution will concentrate on the global health aspects of the report, particularly in relation to malaria and artemisinin resistance. I draw attention to my interests in this area, as set out in the register. Much of what I will say draws on the recent report of the All-Party Group on Malaria and Neglected Tropical Diseases, and the Malaria Consortium, entitled, Racing Against Time: Protecting the Gains Achieved in Malaria Control Against Drug Resistance. It was dedicated to the memory of Dr Sylvia Meek of the Malaria Consortium—its co-author—who died tragically young very soon after completing the report. Sylvia dedicated her life to the fight against malaria with both passion and intellectual rigour. I pay tribute today to the enormous contribution she made, and the example of service she gave in international health.

Malaria control is one of the great global health success stories of this century. Deaths have declined by 60% across the world since 2000, which equates to 6.2 million fewer deaths than would have occurred. The incidence of new cases is down by 37%. The UK has played a major part in this achievement: at government level, through NGOs like Malaria Consortium, and through the enormous scientific contribution of our centres of excellence, particularly the Liverpool School of Tropical Medicine and the London School of Hygiene and Tropical Medicine. Progress has been achieved through collaborative action and the development of new tools—treatments, diagnostics, vector control, prevention strategies—and their effective deployment in endemic countries. The research continues, not least on the development of an effective vaccine against malaria.

But all this progress and all the investments we have made are threatened—and the history of malaria teaches us that progress has been threatened and lost in decades past—by the declining effectiveness of vector control because of the growth in resistance to insecticides and, in particular, to artemisinin combination therapies, which are the most effective treatment we now have for malaria. Resistance to ACTs is already a significant threat to health in south-east Asia and it will be a global threat if it spreads. Drug resistance has been detected in five countries in the Greater Mekong Subregion: Cambodia, Myanmar, Thailand, Vietnam and the Lao People’s Democratic Republic. If it spreads to other parts of south Asia, and worst of all to Africa, a global public health crisis will occur.

Drug-resistant malaria parasites have not yet been detected in Africa, but, following the pattern of the spread of previous resistant strains—as I said, we have been here before—drug-resistant malaria is a distinct and worrying possibility. At the moment, despite ongoing work to develop replacement drugs and a vaccine, no new treatment for malaria is in the pipeline if ACTs were to become ineffective. If resistance were to reach Africa, where the malaria burden is greatest, the impact could be devastating, leading not only to a massive increase in deaths but to massive costs—both medical costs and productivity losses.

I welcome the publication of this report and the opportunities it gives us to tackle the threat and existence of antimicrobial resistance. There are certain areas to which I wish to draw attention. One is recommendation 4, on improving global surveillance of drug resistance. The noble Lord, Lord Lansley, rightly drew attention to this, and I would like to endorse what he said. Strong disease surveillance systems are critical to monitoring and responding to the spread of disease resistance, as well as to the management and elimination of diseases such as pneumonia and malaria. Effective surveillance systems allow resources to be directed to the most affected populations, enabling us to identify gaps in programme coverage, detect outbreaks and assess the impact of interventions. The Ebola crisis provided a stark warning of the need to strengthen surveillance, particularly at community level, as I saw for myself when I visited Sierra Leone 18 months ago at the height of the epidemic. However, countries like Sierra Leone need support to substantially strengthen disease surveillance so that it becomes a core intervention and part of their public health systems. I encourage the Government to prioritise surveillance and would be grateful if the Minister, either in summing up today or separately in writing, told me what plans there are to help countries strengthen their surveillance.

The other recommendation to which I would like to draw attention is promoting new, rapid diagnostics as one of the ways of cutting the unnecessary use of antibiotics. Universal access to accurate diagnosis prior to treatment is a critical element of decreasing the irrational use of drugs, which is one of the causes of their reducing efficacy. The increase in availability of malaria rapid diagnostic tests over recent years has improved the rational use of artemisinin combination therapies. In 2014, for the first time, more RDTs were distributed through the public sector globally than ACT treatments. The availability of RDTs was also crucial in extending the accurate diagnosis and treatment of malaria at community level through trained volunteer community health workers, allowing for the differential diagnosis and treatment of febrile illness and reducing the common blanket prescribing of antibiotics for almost every sick child.

In Uganda, I had the privilege of seeing community health workers, some of whom were barely literate, doing an amazing job of differential diagnosis and effective treatment in the middle of the night with a two year-old with a high temperature. It is extraordinary what can be achieved. Developing new, accurate and easy-to-use diagnostic tools for other diseases, such as neglected tropical diseases like dengue and Zika, would support efforts to eliminate them and deserves priority.

Finally, the announcement of the Ross Fund is much to be welcomed, particularly the £350 million that has been committed to fight antimicrobial resistance. We hope that surveillance will be at the centre of the Ross Fund’s strategy. I would be grateful if the Minister provided an update, either today or in a letter, on the progress of the fund, along with details of how and when funding is likely to be allocated.

The UK Government, through DfID programmes and support for the Global Fund—HIV and TB being other areas, like malaria, threatened by antimicrobial resistance—have made a huge contribution to the fight against those three diseases, particularly in leadership on malaria. I hope the Minister will commit not only to the robust and speedy implementation of the recommendations in this report, but also to continuing the British Government’s commitment to their leadership role in the fight against malaria.