Malaria and Neglected Tropical Diseases

Catherine West Excerpts

Tuesday 9th January 2024 Westminster Hall

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a real pleasure to serve under your chairmanship, Mrs Harris. I congratulate the hon. Member for Glasgow North (Patrick Grady) on securing this debate; he has a proud record of work, both in his constituency, with the University of Glasgow, and in Malawi itself. I also refer to my entry in the Register of Members’ Financial Interests.

As hon. Members have said, we remain at a critical point in tackling malaria and neglected tropical diseases due to the pandemic; humanitarian crises as a result of conflicts, flooding and famine; rising biological threats such as insecticide and drug resistance; a decline in the effectiveness of core tools; a widening funding gap and resource constraints; and disruptions to already fragile health systems. We really must act now. Global malaria progress has stalled in recent years, with malaria incidence and mortality currently above pre-pandemic levels. In 2022, 5 million more people were infected than in 2021, and 16 million more than in 2019.

Despite malaria being preventable and treatable, nearly half the world’s population remains at risk—particularly in African countries, as the hon. Member for Bracknell (James Sunderland) said. The global burden of neglected tropical diseases also remains significant and, as with malaria, continues to be a barrier to health equity, prosperity and development, with devastating health, social and economic consequences to 1.65 billion people worldwide, including over 600 million people in Africa.

[Mr Dhesi]

As a vice-chair of the all-party parliamentary group on malaria and neglected tropical diseases, I thank my hon. Friend for her leadership as chair of our APPG. I also thank her and Martha Varney of Malaria No More for their leadership in orchestrating our recent visit to Malawi. Their insights and the dedication of partners such as the Wellcome Trust have significantly deepened my understanding of the challenges at hand. Does the shadow Minister agree that malaria is a relentless barrier to development, thwarting educational progress, disproportionately impacting women and girls, and perpetuating cycles of poverty?

[Catherine West]

Indeed, and my hon. Friend pre-empts my point about the impact on women and girls. I know that you will be particularly interested, Mrs Harris, in the relevance of tackling what seems to be the disproportionate impact on women and girls, due to various biological, social, economic and cultural factors. Limited financial resources, time constraints, diminished autonomy, and stigma and discrimination create barriers that prevent women from gaining access to timely healthcare, education and employment opportunities. Due to their responsibility for home and family care, they often miss out on crucial treatments. Through close contact with children, women are two to four times more likely to develop trachoma, which is a neglected tropical disease, and are blinded up to four times as often as men.

It was particularly exciting, in the visit mentioned by my hon. Friend the Member for Slough (Mr Dhesi) and the hon. Member for Glasgow North (Patrick Grady), to see old women, who are often neglected in developing countries, receiving crucial treatments and being enabled to feel that they were not a burden on their children. It was particularly special to learn that trachoma has been eliminated in Malawi. The World Health Organisation has signed that off, which is a really exciting development. Sometimes, these things feel very overwhelming, but when we see that trachoma has been eliminated in Malawi, it really is wonderful and encouraging.

The “Ending Preventable Deaths” strategy recognised malaria as a major cause of child deaths, and important tools such as bed nets and intermittent preventive treatment in pregnancy as examples of evidence-based health intervention and best buys. It was also welcome that the strategy recognised the critical importance of clean water, sanitation and hygiene. However, there is no way of ending these epidemics and meeting the sustainable development goals without working to empower and enable women and girls to succeed. I know that is very much at the heart of your work in Parliament, Mrs Harris.

[James Sunderland]

The shadow Minister and I, and many others here, went to Malawi, as we heard earlier, and we share many of the same views on the way forward. In fact, it is quite nice to have cross-party support on such a key issue. We have sought a Commonwealth Heads of Government meeting in Rwanda. Does the shadow Minister agree that it is important for the league tables to be published, so that African nations can take a lead and have responsibility for a particular NTD? In Malawi, we have eliminated trachoma, and I welcome that noma has now been added to the list of approved—if that is the right word—diseases that the WHO is looking at and investing in. Does the shadow Minister agree that empowering African nations and ensuring that the UK can take a lead in thought leadership and education is really important?

[Catherine West]

Indeed, and it has been estimated that 500 million more people, rising to a billion by 2080, could become exposed to chikungunya and dengue, as these diseases spread to new geographies due to warmer climates—a point made by my hon. Friend the Member for Slough. As an example, the impact of flooding in Pakistan has also been mentioned, and in 2022 there was a 900% increase in dengue and a fivefold increase in the number of malaria cases. The Minister might be quite creative and see whether there is money in the climate funds to join up the health inequalities with the climate funding that will eventually become available through the COP28 process.

While countries in the global south will of course carry a disproportionate burden, tropical diseases are now becoming a growing concern in non-endemic countries. Will the Minister update the House on Government efforts to mitigate the impact of climate change on malaria and NTDs, and what steps they are taking to support lower-income countries to address climate-sensitive infectious diseases? Conflict and humanitarian crises are considerable threats to progress. Many countries have seen increases in malaria cases and deaths, and a few experienced malaria epidemics. Ethiopia saw an increase of 1.3 million cases between 2021 and 2022, and political instability in Myanmar led to a surge in cases, from 78,000 in 2019 to 584,000 in 2022, with a knock-on effect in neighbouring Thailand.

Last June, mycetoma services in Sudan were suspended due to a lack of safety, resulting in patients not receiving vital medication. We know that in refugee camps—as I am sure the Minister also knows from visiting refugee or internally-displaced persons camps—there is a particularly high risk of scabies due to overcrowding. Can the Minister reassure us that the UK is working to support countries affected by conflict and other humanitarian crises to ensure the safe delivery of medical supplies, which are the basics?

Despite the difficulties in surmounting the challenges we face, the elimination of these diseases is possible. Both malaria and neglected tropical diseases can be beaten, as we have seen. Azerbaijan, Belize and Tajikistan have been declared malaria-free by the World Health Organisation recently, and 50 countries, including 21 in Africa, have eliminated at least one neglected tropical disease, marking the halfway point toward the target of 100 countries set for 2030. As a result, 600 million fewer people globally require interventions against neglected tropical diseases than in 2010. Bangladesh, supported by the UK and other partners, is the first country in the world to be validated for the elimination of visceral leishmaniasis, which is the very complicated form of the disease that is fatal in over 95% of cases and has devastating impacts, particularly on women.

The Labour party is proud of the UK’s contribution to date in this global effort, and of the legacy of Department for International Development, one of our proudest achievements of the last Labour Government. As part of that commitment, the last Labour Government helped to found the Global Fund in 2002. It is an incredible fund, and we saw the important work it does when visiting Blantyre. The results are staggering, with the malaria incidence rate decreasing from 164 positive cases four years ago to 36 at the time of our visit last autumn.

I know that you want me to wind up, Mrs Harris, but I have one final anecdote. I met Mirriam, an inspiring midwife and primary healthcare provider working in rural Zambia, when she visited the UK Parliament. She said that she encounters disease every day at her health centre, and spoke to me about her harrowing experience of caring for and losing pregnant women and young children with malaria. However, over the past few years the availability of high-quality, inexpensive, rapid diagnostic tests, insecticide-treated bed nets and preventive treatment for pregnant women, all provided by the Global Fund, are transforming how Mirriam and her midwife colleagues diagnose and manage cases of malaria. She also mentioned the important work being done on tuberculosis and HIV.

Many of the tools and medicines we need to beat malaria were also developed here in the UK, and a number of Members have outlined the important connection with our excellence in research—for example, at the University of Dundee, which the hon. Member for Dundee West (Chris Law) mentioned in his speech, and other important UK research institutions. It is important that we listen to what they say about what we need to keep that research going and maintain this country’s leadership in research and development.

We have already talked about the Vaccine Alliance, Unitaid and the Global Fund, so I will not go into the detail. However, we have one specialism that I need to mention: the crucial research into snakebite. Many who may be watching parliamentlive.tv will not be aware that snakebite kills so many people in Africa, or aware of the important work being done at the Liverpool School of Tropical Medicine—I declare an interest as an unpaid trustee there. That work is very special and niche, but it is crucial to keep it going.

I will conclude on the important work that we need to do this month, given that World Neglected Tropical Disease Day is on 30 January. Can the Minister assure me that the UK is doing all it can to support the development of new medicines for neglected tropical diseases and look at re-committing to multi-year funding for product development partnership models? What is her view on manufacturing in Africa? If we look at the map, we see that expensive medicines are produced here in Europe or America and then sent to Africa and so on, so it would be wonderful to see more manufacturing, perhaps through the Serum Institute of India, for example, which did so much important work during covid. What is her thinking about collaborations there that we could lead and push different parties towards? Finally, as 30 January 2024 approaches—World Neglected Tropical Disease Day—the World Health Organisation argues that, for malaria, “business as usual” will simply not be enough. I hope that the Minister agrees that we now need to act, because there is no more time for us to lose.

[The Minister of State, Foreign, Commonwealth and Development Office (Anne-Marie Trevelyan)]

I apologise for the cough—I am apparently enjoying a three-month winter cough, so apologies to all for that. I thank the hon. Member for Glasgow North (Patrick Grady) for securing this important debate and thank the all-party parliamentary group on malaria and neglected tropical diseases for its really thoughtful contributions today and, more importantly, for its long-standing advocacy in this whole arena. I thank all hon. Members for their contributions.

Members will be aware that my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) is the Minister in FCDO with responsibility for global health. He is unfortunately unable to be here, hence my presence. I am happy to respond; this is an area of both policy and personal interest anyway. When I was the Secretary of State for International Development before the merger, we spent a lot of time on this policy area, so I am pleased to be able to respond on behalf of the Government. If I miss any questions, for which I apologise, I will ensure that my right hon. Friend picks up on them.

On the point made by the shadow Minister, the hon. Member for Hornsey and Wood Green (Catherine West), a number of colleagues touched on the wider question of the UK’s focus on climate change, the impacts more broadly, and how the UK can assist, and is assisting, on the wider question of resilience and adaptation to the changing nature of communities, landscapes and healthcare. All the work that we do has health impacts at its heart. Women and girls are at the centre of every single piece of programming work that the FCDO does, but I will ask my right hon. Friend the Member for Sutton Coldfield to set out a few examples in his reply to help colleagues to see the broader picture, beyond the issue we are discussing today.

As colleagues have pointed out, we are at a critical point for the sustainable development goals. With COP’s focus on the impact of climate change on global health, and with World Neglected Tropical Disease Day at the end of the month, this is a really important opportunity to consider the UK’s role in helping to end those diseases. We know that the covid pandemic has taken a toll in so many ways on the pathway to the 2030 SDGs, and I can safely say that, across the world, we are all focused on trying to get back on track and thinking about how we can do that, using all the tools at our disposal.

As many colleagues have set out, the burden that malaria and NTDs place on so many countries is not geographical; it is about families and people. It is perhaps concentrated in some countries, not only by virtue of their geography and their landscapes, but because of the state of their health systems. As colleagues have said, malaria is still killing a child every minute of every day, and NTDs are causing devastating health, social and economic consequences for more than 1 billion people. We know that they fall most heavily on the poorest and the most marginalised.

In November, my right hon. Friend the Member for Sutton Coldfield set out the Government’s White Paper on development, which has at its heart the principles underpinning the UK’s ongoing contribution towards ending extreme poverty and combating climate change. A key focus of getting the world back on track to meet the 2030 SDGs includes targets to end the epidemic of malaria and NTDs. The White Paper reaffirms our commitment to ending the preventable deaths of mothers, newborns and children under five, which we cannot achieve without a particular focus on malaria. As I have mentioned, however, the White Paper also underlines the importance of helping countries to build health systems by working with them in mutually respectful partnerships and harnessing innovation and new technologies to help them to solve some of these problems.

On malaria, we are at a critical juncture in our fight against the disease. As a number of colleagues have set out, this year’s World Malaria Report showed once again that progress has stalled. We are facing a perfect storm of challenges, including rising drug and insecticide resistance, the climate impacts we have talked about, the spread of urban mosquitoes, conflict and humanitarian crises, rising prices and funding shortfalls. This is, of course, a complex mix to try to get ahead of, but the UK continues to provide global leadership. We will continue to make the limited resources that we have go further and to think about how we can adapt our approaches to fit local contexts more closely, because it is not the same everywhere. How can we help countries to focus in a more targeted way on tackling their most difficult health problems?

The UK has long been a leader in the fight against malaria. As my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) mentioned, we have been the third largest contributor to the Global Fund over its lifetime, investing over £4.5 billion. It has three specific focuses—to eradicate malaria, TB and AIDS—which has enabled it to channel global energies into tackling those diseases. We provided £1 billion towards the seventh replenishment of the fund, and the mission to eradicate those diseases remains absolutely at the heart of the UK Government. The latest investment will help to fund 86 million mosquito nets and 450,000 seasonal malaria chemoprevention treatments, and provide treatment and care for 18 million people. Our funding continues to help drive scientific advancement—for example, the next generation of malaria bed nets, which were developed with funding from the UK and which the Global Fund is now rolling out. We have also long funded the Medicines for Malaria Venture, whose anti-malarial drugs are estimated to have averted nearly 14 million deaths since 2009.

There is further cause for optimism from new vaccines. As colleagues have mentioned, in October the WHO recommended the second ever malaria vaccine, R21. In November, just before Christmas, the first consignment of the RTS,S vaccine was delivered to Cameroon to begin roll-out across Africa. Both vaccines were developed through British scientific expertise, including the long-term commitments that we have seen from GSK, whose RTS,S vaccine has now been given to over 1.5 million children in Ghana, Kenya and Malawi. A further nine countries will receive the vaccine over the next two years, and the UK will continue to support roll-out through our £1.65 billion funding for Gavi and by further funding clinical trials.

Colleagues might not be aware that the UK led the replenishment of Gavi back in 2020, at the height of the covid pandemic, when its funding had never been more urgently needed. Gavi is the organisation that delivers vaccines to many hard-to-reach corners of the globe. It is an incredibly important organisation that is respected and welcomed in pretty much every country in the world. We were proud to bring $8 billion-worth of global commitments to Gavi, despite the challenges that everyone faced during the ongoing covid epidemic. The UK’s commitment was the largest of all those made to that replenishment.

Of course, time goes quickly, and Gavi’s replenishment for next year is coming round again; I know that the UK will continue to provide leadership on that. Gavi is one of the many parts of the machine that enables us to deliver. It does such important work to ensure that, whichever brilliant new technologies brilliant scientists come up with, they get to the places they need to be. That is so important. Indeed, through covid Gavi demonstrated—sadly, more urgently than ever—how effective it can be.

Colleagues have set out the impact of neglected tropical diseases across the globe. We have seen incredible progress, which has been due in part to the UK’s contribution. It is encouraging that 50 countries have eliminated at least one NTD, in line with the WHO’s ambitious target for 100 countries by 2030. Last year saw Iraq, Benin and Mali eliminate trachoma, Ghana eliminate a key strain of sleeping sickness, and Bangladesh and Laos eliminate lymphatic filariasis. In October, Bangladesh became the first country in the world to eliminate visceral leishmaniasis, which would not have happened without long-standing UK support.

Here, again, we face major challenges: climate change threatens to unravel so much of the progress that we have seen, and global funding falls short of what is needed to achieve our overall ambitions. The hon. Member for Slough (Mr Dhesi) highlighted the rise of dengue, which causes real concern and impacts too many places. The UK was pleased to sign the Kigali declaration on neglected tropical diseases at the 2022 CHOGM meeting, and towards that goal we committed to continued investment in research and development. Each signatory makes a unique contribution towards ending NTDs; it is very open and was designed to encourage countries, however small or large, to push on with tackling the challenges.

We are delivering on our commitment with our ongoing funding to the Drugs for Neglected Diseases initiative, or DNDi—I apologise for all the acronyms; there are lots of them—in which we have invested over £80 million so far. Through our and others’ support, DNDi has developed 13 treatments for six deadly diseases, and those are already saving millions of lives. They include a first oral-only treatment for both chronic and acute sleeping sickness, which recently received regulatory approval; a treatment for mycetoma, an infectious flesh-and-bone disease that leads to amputations; new short-course treatments for deadly visceral leishmaniasis, which I mentioned earlier, that can replace treatments with severe side effects and growing drug resistance, which is a continuing challenge in this space; and the first paediatric treatment for Chagas disease, a complex tropical parasitic disease that can result in heart failure.

Some of the DNDi’s incredible work takes place in the UK, where it has over 40 partners across industry and academia. To name but a few, we have the incredible leadership of global companies such as AstraZeneca UK and GSK, which are well known and based across the world, through to some of the smaller developing companies such as BenevolentAI, DeepMind and AMG Consultants. Those smaller companies are using other modern technologies—not pharmaceutical technologies but wider technologies—to think about how we can solve these challenges. It is worth remembering that many UK industry partners threw their technical expertise into the scientific ring when covid-19 hit the world, for instance through the COVID Moonshot work. Continuing to focus on the incredible investments made by our world-leading life sciences, tech and pharma companies is part of the whole solution.

[Catherine West]

The Minister is being very generous in giving way. What assessment has she made of the possibility of promoting more African leadership in manufacturing? Developing really good partnerships may require investment at the beginning, but it could be a very effective way to work. How do we strengthen in-country leadership in Africa while avoiding a top-down approach?

[Anne-Marie Trevelyan]

I said earlier that the Government are focusing not only on how we spend our development budget but on how we invest in and give space to the private sector to use its research and development investment as effectively as possible in areas where there can be global solutions. The shadow Minister raises a really important point, and I spent a lot of time at the World Trade Organisation in 2022 discussing how patents and investment in expensive production facilities can be done more globally. The issue was not resolved at the WTO, but it is at the heart of the conversation, which is, as has been said, about trade. We must understand how to empower the countries that will potentially get the most immediate benefit from production domestically, which will then be able to export to their neighbours, and ensure that investment flows work securely for the pharmaceutical companies that are investing billions of pounds to solve these challenges. We must ensure that production is secure and that the vaccines and other medications reach those they need to. A lot of discussion is going on globally around those issues, and some of our largest pharmaceutical companies are already doing these things around the world. Particularly in South Africa, there has been a real shift in investments, and that country can be a hub from which to export to neighbouring countries. That ongoing area of global policy development sits within the world trade discussions, and it is really important to keep pushing it.