Neglected Tropical Diseases

Baroness Warwick of Undercliffe Excerpts

Wednesday 11th July 2018 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I am grateful to the noble Lord, Lord Trees, for once again giving us an opportunity to consider what progress has been made in the unceasing challenge to combat neglected tropical diseases. He is steadfast in his commitment to bringing this issue to the attention of the House.

We have now had the fifth report on the progress of the London Declaration on NTDs, and I share other noble Lords’ satisfaction with the tremendous strides that have been taken in the five years since the World Health Organization set out its road map and prompted the London declaration. As the report highlights, the story of tackling NTDs is one of great progress alongside continuing challenge.

The progress is well documented. In 2016, more than 1 billion people received treatment for at least one NTD. Since 2012, pharmaceutical companies have collectively donated more than 10 billion tablets. With the support of many logistical partners, ministries of health and local NGOs, treatments are getting to some of the remotest communities across the world.

The noble Lord, Lord Trees, enumerated many of the key successes, and I shall not repeat them, but I mention Pfizer, which just last month agreed to extend to 2025 the donation of Zithromax, its antibiotic, to the International Trachoma Initiative, to help eliminate that horrible disease. Trachoma is the world’s leading infectious cause of blindness. Pfizer’s recommitment is a critical component of the global strategy to eliminate trachoma. It will certainly help accelerate progress brought about by drug donations, which in the past decade have resulted in in a roughly 50% decrease in the number of people at risk compared to 2011. In May, Nepal became the sixth country to declare the elimination of trachoma. Ghana is close to being validated by the World Health Organization, and when this happens, it will be the first country in sub-Saharan Africa to achieve this milestone.

Like the noble Lord, Lord Trees, I want to mention rabies. It is one of the oldest and most terrifying of diseases. Although it can be prevented, it kills an estimated 59,000 people a year. About 40% of the victims are children younger than 15 living in Asia and Africa. It is almost universally fatal yet, unlike many other NTDs, there is a vaccine. However, implementation, research and political challenges still mean that it has been neglected for a very long time. Until recently, the global response to rabies was fragmented and unco-ordinated. Now, the WHO, the FAO, the World Organisation for Animal Health and the Global Alliance for Rabies Control are joining forces to support countries as they seek to accelerate their actions towards the elimination of dog-related rabies by 2030. So there is at last some global momentum working towards breaking the cycle of neglect, but much remains to be done to achieve the goals the global community has set.

The challenges overall remain enormous. NTDs kill 170,000 people every year, but the biggest impact is on the millions they disable and disfigure. Currently, NTDs affect some 1.5 billion people in the world. These are the poorest of the poor, who live in the hardest to reach, most marginalised communities. We know also that women and girls bear the highest burden of infection.

The London declaration’s 2020 timeframe for eliminating 10 NTDs is not far off, and there is a more urgent tone to the latest progress report to make sure no one is left behind. We know that drugs alone cannot achieve the London declaration goals. There needs to be an increased domestic financial and political commitment to tackling NTDs, as well as new resources, new partners and new approaches. Among these new approaches, I was fascinated to learn of the role technology is playing in some critical areas. I am thinking of the work of German biochemist Christian Schröter, who as head of pharma business integration at Merck, has been involved with a WHO donation programme to treat children in Africa against schistosomiasis. He has worked with supply chain experts from around the world to develop a method for tracking medical donations from the warehouse to NTD treatment points in the most inaccessible places, using a simple cell phone. In his recent TED talk he describes the process as being similar to the way you track a package you order on Amazon: text messaging allows you to see in real time when the drugs leave the warehouse and when they reach the school or medical centre. We can see how many tablets have been administered, and where, and how many are still on the inventory.

The system was piloted in Mozambique last year and has huge promise. Schröter describes how it could mean excess shipments being rerouted after treatment campaigns have been completed; an end to drugs being stuck in warehouses reaching their expiry dates and having to be destroyed; and an end to paper-based reporting, which can take months to receive and process. Noble Lords will see from my description that his enthusiasm has certainly communicated itself to me.

I was also captivated by the ingenuity and practicality of Zipline, a start-up company which uses drones as a delivery system to transport blood and plasma to remote clinics in east Africa. This fleet of electric autonomous aircraft are helping to ensure that local people can have access to basic healthcare, no matter how hard it is to reach them. Equally inspiring is the software being devised in Malawi to ensure that health records can be kept electronically, even in areas of sub-Saharan Africa with power outages, low technology penetration, slow internet and understaffed hospitals.

I have enumerated these because it seems to me that such new ideas are vital if we are to beat these diseases. Alongside the basic science, multidisciplinary and long-term medical research and development, we need to be funding our engineers and smart technology experts to take forward new and exciting approaches to mapping NTDs. Can the Minister tell us whether DfID is looking at the use of such smart technologies?

The World Health Assembly recently set out an ambitious target to eliminate at least one NTD in 30 additional countries between 2019 and 2023. It is clear that if we are to continue to make progress against these awful diseases and future threats to global health, existing scientific partnerships must be expanded and new ones created. Yet our future involvement in European research programmes remains uncertain. Can the Minister reassure us that the UK’s research expertise and commitment to the London declaration goals will be supported as we look beyond 2020?

This is probably a bit unfair, but I asked exactly the same question last year in relation to our continuing collaboration with member countries of the European and Developing Countries Clinical Trials Partnership. I was not reassured by the Minister’s answer. Programmes such as EDCTP have proved very effective, yet I got rather a bland response last year, and I still feel very uneasy that our participation in such programmes would be a casualty of Brexit. So I ask the Minister, a little more bluntly: can he tell the House categorically that the impetus for this European funding will be continued?