Malaria and Neglected Tropical Diseases

James Sunderland Excerpts

Tuesday 9th January 2024 Westminster Hall

[Wendy Morton]

The hon. Gentleman makes an important point. We often talk about budgets in terms of countries and regions; insects and diseases such as malaria do not see the boundaries that we do, so it is always important that we do as much as we can, working with our partners, to address the long-term issues and finding the solutions, but taking a holistic approach. I do not believe it is always that simple, but we must absolutely continue to work on it. That is why I think the UK has a very good reputation when it comes to international development, particularly now that that work is integrated within the Foreign Office. However, it is important that we continue to work on this, whether on malaria or many of the other diseases that we see around the world.

[James Sunderland (Bracknell) (Con)]

As a vice-chair of the all-party group on malaria and neglected tropical diseases, I have a great interest in this issue, and having spent a lot of time in Africa over the years, mainly with the military, I understand this particular field intimately. Does my right hon. Friend agree that even though the percentage of overseas aid fell from 0.7% to 0.5%, the Foreign Office should now be focused on maintaining at a consistent level the funding relating to life and death issues? With the overall funding headroom being reduced, the funding element for life and death issues—particularly malaria and NTDs—should be consistent in order for the UK to fulfil its global responsibilities.

[Wendy Morton]

My hon. Friend makes a very important point, and having been a Minister, I know how difficult some of these challenges can be. I am sure that the Minister may well pick up on that issue during her speech. It is important that we look at our priorities and seek to achieve the most effective outcomes for our spend. It does not matter whether this is about international development or any other Department. All too often we talk about the amount of money we are putting into a project, whereas I would like to see us look more at the outcomes alongside that. As my hon. Friend the Member for Bracknell (James Sunderland) acknowledges, we are discussing really important topics this morning that are often about the difference between life and death.

I was pleased that in May 2022, the UK launched its 10-year international development strategy, with one of its four priorities being global health. The strategy states that we will

“work towards ending preventable deaths”

by

“investing both bilaterally and through initiatives such as Gavi, the Vaccine Alliance; and the Global Fund to Fight AIDS, Tuberculosis and Malaria.”

I appreciate the great work of the Global Fund. I also gently remind Ministers—I am sure they are very aware—that there have been some issues with funding in certain parts of the world. That is why it is so important that there must always be the appropriate management and oversight capacity, as well as accurate inventory records checked by external auditors, so that we have overall accountability to British taxpayers.

That said, I absolutely acknowledge the positive results that have been achieved. The Global Fund’s 2023 report states that in 2022, it treated 165 million cases of malaria, and gave preventive treatment for malaria to 14.6 million pregnant women. That is another example of the scale of the challenge we face, and how important this is.

The UK has contributed to those results as the third largest Government donor to the Global Fund, pledging £1 billion for the Global Fund’s seventh replenishment for 2023 to 2025. It is also important to recognise that the funds are spent on some other very important areas, such as HIV and TB, which I know this House and some Members here take very seriously.

It is right that we continue to invest in malaria prevention and treatment if we are to meet our target of ending preventable deaths by 2030. I recognise that the total number of malaria deaths worldwide is falling. The statistics show a fall from 896,000 deaths in 2000 to 608,000 in 2022. By my calculation, that equates to a reduction of about 13,000 deaths a year. Even if we apply that rate between today and 2030, there will still be approximately 517,000 malaria deaths in 2030, which is obviously far from us being malaria-free, so we urgently need innovations to continue to tackle malaria. Perhaps we need to scale up the newly recommended R21 malaria vaccine as part of the solution.

Good international development is not all about spending money overseas to benefit developing countries, although we need the funds to do this. It is also about protecting and developing our interests as the UK: for example, through trade and the building of new trade relationships, and making a strong contribution to the UK’s soft power and international place in the world. It is about honouring the UK’s international commitments, but it must also firmly remain about making this more effective by improving openness, transparency, value for money and delivering. Today’s debate is a very helpful reminder of that.

--- Later in debate ---

[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.