Malaria and Neglected Tropical Diseases

Chris Law Excerpts

Tuesday 9th January 2024 Westminster Hall

[Chris Law (Dundee West) (SNP)]

Happy new year, Mrs Harris. It is a pleasure to serve under your chairship, as ever. I thank my hon. Friend the Member for Glasgow North (Patrick Grady) for securing this debate, not least because it is timely and critical ahead of World Neglected Tropical Diseases Day. I also thank him for his continued commitment to speaking up for the most vulnerable and poorest people in the world, as well as for his constituents.

The fact that one child dies every minute from a preventable and treatable disease is not simply a tragedy, but a moral failure. As we have heard in this debate, malaria and neglected tropical diseases are preventable and curable, but a lack of political will and much-needed investment is resulting in the progress towards eliminating these diseases stalling. When minds are focused and resources are properly mobilised, successes can be achieved. Between 2000 and 2022, an estimated 2.1 billion malaria cases and 11.7 million malaria deaths were averted globally. Fifty countries have eliminated at least one neglected tropical disease, and 600 million fewer people require intervention against those diseases compared with 2010.

In 2022, however, the global tally of malaria cases reached 249 million. That is an increase of 5 million from 2021 and 60 million more cases than in 2019—well above estimates from before the covid-19 pandemic. Today, around 1.65 billion people are estimated to require treatment for at least one neglected tropical disease, resulting in devastating health, social and economic consequences. That is more than 20% of the global population.

Malaria and neglected tropical diseases have been exacerbated by climate change, conflict and humanitarian crises. Furthermore, drug and insecticide resistance, as well as invasive mosquito species, also hamper progress. However, the challenges can be overcome with the right investment. At the heart of this debate is a significant funding gap for malaria and neglected tropical diseases, as well as the shameful role of this UK Government, with their years of death sentence cuts, stepping away when they should be stepping up.

The funding gap between the amount invested in malaria control and elimination and the resources needed is dangerously large. Spending in 2022 reached $4.1 billion, which is well below the $7.8 billion required to stay on track to reduce case incidence and mortality rates by at least 90% by 2030, as highlighted in the SDGs. Similarly, neglected tropical diseases are preventable and treatable, often at a very low cost, yet they are neglected in terms of funding and research.

The UK was once a global leader in tackling those diseases, particularly in research and innovation, but that contribution has been fundamentally undermined by the reckless decision to cut ODA from 0.7% of GNI to 0.5%. For example, in June 2021, the UK Government decided to terminate the Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases programme—otherwise known as ASCEND—with no alternative funding offered to more than 20 beneficiary countries in Africa. That resulted in over 250 million treatments and over 180,000 disability-preventing surgeries being stopped. In Zambia alone, it resulted in the cancellation of 1,500 sight-saving trachoma surgeries and 1,500 disability-preventing lymphatic filariasis surgeries.

There is international acceptance of the hard facts that demonstrate that malaria and other tropical diseases are far from eradicated. In November 2022, the UK Government announced a pledge of £1 billion for the seventh replenishment fund of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and that is to be welcomed. Crucially, however, that commitment is £400 million less than in 2019, and £800 million short of the 29% increase in funding that the Global Fund called for to get progress against those three diseases back on track. Other G7 allies, such as the US and Germany, have met that call.

That money was and is needed to regain progress lost during the covid-19 pandemic and to save 20 million lives over the next three years, but that pledge by the UK Government is on trend with their theme of grandiose gestures and media splashes that may sound good, but have little meaningful impact. It is on track with the UK Government’s morally corrupt insistence on finding loopholes in their international commitments.

For example, in the recent FCDO White Paper on international development, there was noticeably no recommitment to the 0.7% spending on ODA and no reinstatement of the pre-2021 projects or commitment to beneficiaries of cut projects. The UK Government must therefore, as a matter of utmost urgency, recommit to the UN-mandated 0.7% spending of GNI on ODA, and they must go further and clarify that funds from that are available for research into tropical diseases including malaria.

My first question is: will the Minister tell us what tangible action the UK Government intend to take to make up the shortfall left by the ODA cuts? Do their Government colleagues feel any remorse for the beneficiaries of projects that have had their funding stripped due to the 2021 policy?

Over the past decade, the UK has led the way in research into global infectious diseases, and the thriving scientific research and innovation sector must continue to be world leading and supported through long-term, sustainable UK funding and investment. The lack of commercial drivers for anti-malarials and neglected tropical diseases requires not-for-profit solutions to help to develop new medicines through public sector and charitable sources.

I am very proud to say that the Drug Discovery Unit at the University of Dundee in my constituency is a world-leading drug discovery centre, focused on developing new treatments for neglected infectious diseases. I have had the opportunity to visit the unit on a number of occasions, and I give my personal thanks and gratitude to all those who use their skills and expertise to make such valued contributions.

The Drug Discovery Unit has collaborated with the Medicines for Malaria Venture on the discovery of a potential anti-malarial compound called cabamiquine—a single-dose cure that has also been shown to be effective in preventing malaria in trials and is currently undergoing phase 2 clinical trials with patients in Africa. That type of research does not fit nicely into typical funding body structures based around a specific scientific hypothesis and employing one person for three years. Rather, it requires large multidisciplinary groups and is focused not around a narrow research question, but a broader challenge. Are the Government looking at recommitting to longer-term multi-year funding?

Furthermore, the Drug Discovery Unit recognises the increasing need and desire to involve scientists from low and middle-income countries in partnership in this work, and it has been working to establish collaborations with scientists with particular focuses on Ghana and Brazil as part of the Wellcome Centre for Anti-Infectives Research. Do the UK Government intend to support partner programmes from countries that are most impacted by malaria and other tropical diseases?

Of course, to continue its world-leading progress on virus research, it is fundamental that Scotland and the rest of the UK continue to be able to attract the best talent from the European Union. The “make it up as you go along” approach to Brexit, which was not voted for in Scotland, has had one disastrous consequence after another for Scotland and the rest of the UK.

In that context, the inability to work effectively and efficiently with partners in the EU has hindered the UK’s full potential in addressing malaria and tropical diseases. Despite the UK now rejoining Horizon, which I welcome, the years of missed opportunity, broken partnership and lack of EU funding have significantly set the UK back in the context of tropical disease research. Crucially, can the Minister explain how the UK Government intend to be a global leader or to continue to punch above their weight in global medical research without the collaboration or resources of one of the deepest pots of funding, and by limiting the information-sharing capacity and collaboration with our European counterparts?

The fight against malaria and neglected tropical diseases is global, requiring collaboration and for each of us to take all the necessary steps to help combat them. The existential global challenge of climate change should further focus minds on malaria and NTDs. We know that many of these diseases are driven by the environment. Changing temperatures, precipitation levels and increasing extreme weather events have the potential to change the distribution, prevalence and virulence of these diseases. For example, flooding in Pakistan in 2022 resulted in more than 2 million additional cases of malaria and a 900% increase in dengue fever.

One of the most meaningful ways in which the UK Government can be proactive in combating malaria and other tropical diseases is to acknowledge the nexus between climate change and the transmission of these diseases. Again, can the Minister outline how the UK Government intend to work with global partners to tackle malaria and NTDs as part of their work on reacting to climate change?

Finally, these diseases are referred to as “neglected” because they have been largely wiped out in more developed parts of the world, but they persist in its poorest, most marginalised or isolated communities. I cannot help but feel that we would be doing more if they existed here. Of course we would—we just have to look at the experience of covid-19 to see that, and the subsequent inequitable distribution of vaccines from high and middle-income countries to low-income countries as another example of the moral failure to protect the most vulnerable in our world.

The UK Government must restore their credibility and urgently scale up their contribution to the eradication of these diseases. Given the vast numbers of people affected across the world, there is no excuse for neglecting them. As I said, more than 20% of the global population is affected. The elimination of malaria and neglected tropical diseases is possible, and it will be a small step to a more equal world when it is achieved.