Malaria and Neglected Tropical Diseases

Jim Shannon Excerpts

Tuesday 9th January 2024 Westminster Hall

[Patrick Grady]

The hon. Gentleman is absolutely correct. I think that the point he makes will come through in all the contributions and evidence that we hear today.

The evidence shows that, as the hon. Gentleman suggests, it is the poorest and most vulnerable and marginalised people in remote communities, and particularly women and girls, who are affected most by these diseases. For example, noma, which was added to the WHO’s list of NTDs just a few weeks ago, in December, is a severe gangrenous disease of the mouth and face that primarily affects malnourished children between the ages of two and six years in regions of extreme poverty. Hookworm, a type of soil-transmitted helminth, affects one in three pregnant women in sub-Saharan Africa and can cause anaemia and lead to death during pregnancy. Schisto-somiasis, or bilharzia, which is slightly easier to say, is very common in Malawi, where we visited; it can lead to female genital schistosomiasis, of which there are 56 million cases worldwide, which can triple the risk of HIV and cause infertility, ectopic pregnancy, and in some cases maternal death.

The human cost of these diseases is incredibly high. On our visit to Malawi, in the Salima district we met a number of people who had lived with trachoma, a bacterial infection that can cause eyelashes to draw in, damaging eyesight and even causing blindness. People affected in that way can very easily lose their independence, and their family and friends have to dedicate time and resources to caring for them. If it is caught early, trachoma can be treated with antibiotics or surgery, and it can be prevented by good water and sanitation for health practices. The key lesson, which the hon. Member for East Londonderry (Mr Campbell) just mentioned, is that trachoma can be eliminated altogether. That gives us another acronym, SAFE: surgery to treat the blinding stage of the disease, antibiotics to clear the infection, facial cleanliness and hand hygiene to help reduce transmission, and environmental improvements to help stop the infection spreading.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman. He is right to say that.

As you do over the holiday period, I watched lots of films. One of the advertisements on the channel that I was watching said that, at a small cost—I think it is as little as £11—a surgical operation that stops eyesight loss can be offered. That is a small cost to pay for a long-term health gain.

[Patrick Grady]

The hon. Gentleman is absolutely right, and we will come on to that as the debate continues. It is exactly as I was saying: we met people who had been affected by trachoma, but interventions supported by the Queen Elizabeth Diamond Jubilee Trust’s trachoma initiative helped to restore their sight through are exactly the kinds of operations and access to medicine that he is talking about. Since 2022, trachoma has been eliminated as a public health concern in Malawi. It is the first country in southern Africa, the fourth country in the WHO Africa region and the 15th country globally to achieve that milestone.

What we witnessed was not just individual transformation —men and women whose sight had been restored and who could again live independently—but community transformation, because they could go back to actively contributing by caring for their grandchildren and helping with other tasks around the home. In turn, their families benefit from that support and can focus their time and energy back on education or employment. That is the reality of the statistics, which demonstrate both the value of taking action and the cost of continuing to neglect these diseases.

Many of the researchers and practitioners who are taking an interest in this subject have told us, as the hon. Gentleman just suggested, that investment in NTDs really is a best-buy in global health intervention. The campaign group Uniting to Combat NTDs reckons that, in some cases, investing just $1 in tackling these diseases could unlock $25 of benefits. Brighton and Sussex Medical School has calculated that the economic burden to a patient with podoconiosis, which is a form of elephantiasis, can be up to £100 per year, but that the one-off cost of a single treatment is just £52. A study by Deloitte showed that, if Nigeria met its NTD elimination targets by 2030, it could add $19 billion to the value of its economy. If we want to achieve the sustainable development goals, unlock wasted economic potential, change the nature of aid flows and release new forms of finance to help developing countries drive poverty reduction and grow their economies, investing properly and effectively in tackling NTDs is essential.

The fight against malaria is one of the best demonstrations of that point. The all-party group’s visit to Malawi was not my first visit, or even my last visit to that beautiful country. I first lived and worked in Malawi nearly 20 years ago. The prevalence and impact of malaria has always been evident throughout that country’s history. Those of us who came from Scotland and other countries where malaria is not endemic were affected, because we were strongly encouraged to take prophylactic medication—at that time, Lariam—which is not without side effects. Daily, we saw kids in the school where we taught missing class because they had contracted malaria. Sometimes it would affect the teachers, too, so that whole classes missed out on their education or relied on some of the volunteers to pick up the slack, which might have been okay if it was a maths or English class, but was slightly more complicated if it was Chichewa lessons.

Malaria, like so many of these diseases, is preventable and curable, yet there were 249 million cases in 2022, which is five million more than in 2021 and 16 million more than in 2019. Malaria still kills around 608,000 people around the world each year, most of them young children. That is approximately one child a minute, or 90 completely avoidable deaths in the time set aside for today’s debate. There has been progress, but more can be made. Many of the required interventions are, in principle at least, very straightforward: for example, using bed nets is very simple and effective. The New Nets Project, developed by a number of UK institutions including the Innovative Vector Control Consortium, a Liverpool-based product development partnership, along with the London School of Hygiene and Tropical Medicine, the Liverpool School of Tropical Medicine and Imperial College London, has developed nets with dual active ingredients that combine insecticides to respond to growing resistance to insecticides among mosquitos.

In Malawi, in Mtira village in the Balaka district, we witnessed indoor residual spraying of insecticide, and in the local clinic—a small, brick, thatched building with one room—a chart was proudly displayed showing the dramatic decline in the incidence of malaria patients in the village in just the four years since the spraying began. Outside Lilongwe, in Mitundu village, we visited the clinic where some of the very first doses of the new RTS,S vaccine against malaria had been dispensed, starting in 2019. We were very privileged to meet young Evison Saimon, who is now five years old and had benefited from the vaccine.

These success stories have come about only through the incredible effort of and collaboration between a range of partners and funding bodies, including national Government ministries, UNICEF, the WHO and private or charitable organisations including GlaxoSmithKline and the Bill & Melinda Gates Foundation. What they all have in common is security of funding and a clear goal.

Around the world, however, more money is still spent on treating male pattern baldness and curing hay fever—I and a few other hon. Members in the Chamber have lived experience of both conditions—than on tackling malaria. Hay fever can be debilitating, but it is rarely life-threatening, and the main symptoms of baldness can be readily treated with a hat. That speaks to some of the serious challenges in how the pharmaceutical industry approaches these diseases and how research and development can be properly carried out.

Many of us know about researchers’ frustration with the lack of certainty around funding. The product development partnership model funded by the former Department for International Development worked to overcome shortcomings in the commercial research and development sector and was seen as a leader in funding such efforts through public ODA until the axe began to fall in 2021. Since then, the Foreign, Commonwealth and Development Office has been able to provide funding guarantees only one year at a time, which causes massive uncertainty for projects that require long-term funding. Clinical trials cannot be turned on and off like a tap; they take time and effort in the field and have to run over defined periods of time. They cannot be driven by political funding cycles.

Where trials work, there have been and continue to be breakthroughs. The drug discovery unit at the University of Dundee, which my hon. Friend the Member for Dundee West (Chris Law) will be familiar with, has worked with the PDP Medicines for Malaria Venture to develop cabamaquine, which could not only treat malaria with a single dose but potentially protect people from contracting the disease and stop its spread. The Drugs for Neglected Diseases initiative has revolutionised treatment for sleeping sickness with fexinidazole, a simple oral cure, instead of the only available previous treatment, which was toxic and cumbersome and could kill up to one in 20 patients. For those kinds of innovations to be effective, there has to be sustained, effective and targeted investment. Without it, we find an ever-changing environment where the malaria virus continues to adapt and evolve, and buzzes about just like the mosquito that carries it, frustratingly difficult for the scientists to whack it against the wall, even though they can see and hear it.

We know that elimination of malaria and other tropical diseases is possible, because it has already been done. Many diseases that were once endemic here in the United Kingdom and in other parts of the world have been eradicated. Individual countries and regions, as we saw in Malawi with trachoma, have been able to make progress and eliminate certain diseases as public health threats, but if we allow progress to stall, we risk undoing the good work that has already been done, and new, stronger and more difficult to treat variants of these diseases will emerge.

That is before we take into account increasing challenges such as climate change. Last year, for the first time, the World Malaria Report included a chapter on climate change. Malaria and other tropical diseases are extremely sensitive to the environment, affected by temperature, rainfall and humidity. Locally acquired malaria has been detected in Florida and Texas in recent years, while dengue fever has appeared in France and other parts of Europe. All of a sudden, commercial pharma-ceutical companies are taking more interest in many of these diseases, but a purely economic or profit-driven approach on its own will not be enough to tackle these diseases properly. For example, investing in a vaccine for dengue fever that would benefit tourists travelling to affected areas is very important, but for countries such as Bangladesh or the Philippines, an effective, immediate treatment for people who have already contracted the disease is more of a priority.

In all of this, we have to consider the role of institutions and organisations in the United Kingdom and the role of the UK Government in supporting them and global partners. There can be no hiding from the impact of the cuts to the ODA budget. Any of us who speak to partner organisations or to those who have previously received funding and put it to such good use, continue to hear of the long-term impact of short-term decisions. We all welcome the White Paper, the new tone and focus of the International Development Minister, the right hon. Member for Sutton Coldfield (Mr Mitchell), and his team, the reinvigoration of the SDGs and the determination to build a new consensus, but at the end of the day, stakeholders ask us when 0.7% will return. That is a question both for the Minister and for the official Opposition, and for all our manifestoes in this election year.

The next replenishment cycle for the Global Fund will be in 2025. At that point, we hope that the UK will be in a position to meet the requested funding, rather than the 29% reduction that it provided last year. Can the Minister make similar commitments for multilateral initiatives such as Gavi, the Vaccine Alliance, and Unitaid? The UK has signed up to a number of commitments on neglected tropical diseases, including the 2022 Kigali declaration, the G7 leaders’ communiqué and the Commonwealth Heads of Government Meeting communiqué, so what steps will the Minister be taking to drive these commitments forwards?

The SDGs are a welcome focus in the White Paper. SDG 3.3 sets a target of ending the malaria epidemic and achieving a 90% reduction in the number of people requiring interventions against NTDs by 2030, so how are the Government leveraging funding and working with partners to meet those goals? In practical terms, can the Minister commit to multi-year funding for research and development in these areas, particularly for product development partnerships? What steps are the Government taking to build and support R&D and manufacturing capacity in affected countries? On our visit to Malawi, we saw the world-class Blantyre-Blantyre facility, which was developed in partnership between the University of Glasgow, in my constituency, and the Kamuzu University of Health Sciences, and funded in part by the Scottish Government. That is real innovation, genuine partnership and the empowerment of a new generation of young local researchers, clinicians and academics, and it was inspiring to meet a number of them during our visit.

The Government must recognise the importance of cross-sectoral approaches, and ensure that there is co-ordination and collaboration between malaria and NTD programmes and existing investments in nutrition, education, WASH—water, sanitation and hygiene—disability inclusion, and maternal and child health. In all of this, we have to address the structural issues, including the climate emergency and the growing debt burden on developing countries. We have debated a number of these topics recently in Westminster Hall, and it shows the interconnectedness of so many of the challenges around achieving the SDGs.

In November’s debate on African debt, which was led by the hon. Member for Slough (Mr Dhesi), who I am delighted to see present, I said that Malawi is one of 21 African countries that are in or at high risk of debt distress. Its external debt effectively tripled between 2009 and 2021, and we can see the impact of that in the country’s inability to get moving. How different the country might be if the payments it is making on debt, or even just on debt interest, could be invested instead in primary healthcare and in eradicating not just trachoma, but malaria and all the other endemic diseases affecting its population.

All of these challenges are created or, at the very least, exacerbated by the actions and decisions of people, which means that the challenges can be overcome by the actions and decisions of people—whether that it is each of us as individuals practising basic hand and face hygiene to help prevent the spread of disease, or Government Ministers making decisions about millions of pounds of aid spending. Malaria and many other tropical diseases have been neglected for far too long, which means that the people most affected by these diseases have also been neglected for far too long, but all the evidence shows that we can cure, prevent and, ultimately, end the scourge of these diseases. For relatively little cost, we can achieve a massive return on investment, both in long-term savings on the costs of chronic treatment and in the actualisation of the economic and social potential of people who are no longer confined to a sick bed or, worse, to an early death, but who are working for the betterment of their families and communities.

Many, if not most of us, present for the debate will have witnessed malaria and tropical diseases at first hand on delegations or through our own personal experiences, so I look forward to hearing the contributions from other Members and how the Minister responds. I hope that when we get to World NTD Day at the end of the month, the Government will be able to draw on the experiences of Members and their contributions to today’s debate, and endorse this year’s theme that we should all unite, act and, ultimately, eliminate malaria and all neglected tropical diseases.

[Jim Shannon (Strangford) (DUP)]

It is an absolute pleasure to follow the hon. Member for Glasgow North (Patrick Grady), whom I commend. He and I are often side by side in debates on issues that are of interest to us—whether freedom of religious belief or health—and I know this subject is close to his heart. When he asked whether I would participate in the debate, I said, “Of course; it is Westminster Hall, after all.”—[Laughter.] No, I said I would do it because it is the right thing to do and because the subject matter he has chosen is also close to my heart. Due to his personal experiences, he brings vast knowledge to the subject matter that I do not have. He also brings compassion for those who are less well off. That is what I always admire about the hon. Gentleman, and he has done that exceptionally well today.

I am pleased to see the shadow Ministers in their place and I look forward to their contributions, because they both have a deep interest in the subject matter. It is always a pleasure to see the Minister in her place. She often speaks as we speak, with the difference that the Minister has the opportunity to put in place the answers we need, which is what we always ask for. It is also a pleasure to serve under your chairship, Mrs Harris. You are looking extremely well this morning. Your choice of glasses excels each time I see you. Well done and thank you very much.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

I thank the hon. Gentleman for giving way, and congratulate the hon. Member for Glasgow North (Patrick Grady) on securing this important debate on malaria and neglected tropical diseases. Does the hon. Gentleman agree that climate change—the worsening climate crisis—has had an alarming impact on malaria and neglected diseases?

Locally acquired cases of malaria have now been found in the US, and a recent UK Health Security Agency report concluded that dengue fever could be transmitted in London by 2060. Does he agree that addressing the climate crisis is imperative in our fight against these diseases, and that this global challenge requires a unified global response?

[Jim Shannon]

I thank the hon. Gentleman for that intervention, and I completely agree with his point. I said beforehand to my colleague, my hon. Friend the Member for East Londonderry (Mr Campbell), that in the past year there have been reports, in southern England anyway, of mosquitoes that we had never had before. The threat level cannot be ignored in this country. He is right to underline the need to address climate change. To be fair, the Government have a commitment on that. It is important to work together collectively politically across the United Kingdom, Europe and the world, to try to address these issues. He rightly says that we cannot ignore them.

Global aid funding cuts not only have affected developing countries, which need our help, but lead to a knock-on effect for British citizens travelling globally. Looking at the title of the debate—malaria and neglected tropical diseases—we must acknowledge travel is easier to achieve now, and with that comes the potential threat. For example, since foreign development aid was cut, there has been an increase in malaria cases globally. I have no empirical evidence that the two are linked, but I believe that is noteworthy and should be acknowledged.

Africa accounts for the majority of global cases of malaria. According to the World Malaria Report 2023, there were 249 million malaria cases in 85 malaria-endemic countries. The hon. Member for Glasgow North also referred to that. It is so important that we grasp the magnitude of this problem.

[Mr Gregory Campbell]

Does my hon. Friend agree that the frustrating part of this issue of neglected tropical diseases is that a straightforward partial solution would be the greater availability of clean drinking water, particularly in sub-Saharan Africa? That would not solve all the problems, but many of them.

[Jim Shannon]

My hon. Friend is absolutely right. In the past, there have been debates on water aid in this Chamber. If the hon. Member for Putney (Fleur Anderson) were participating in the debate, she would have brought her knowledge from her involvement with Christian Aid and other charitable organisations. Their advertisements on TV always mention clean water, so we have a massive role to play there too.

On 14 December 2023, the UK Health Security Agency published provisional UK case numbers for 2022-23 up to October that suggested that there were 250 more cases in the first nine months of 2023 than in the whole of 2022, and that the case total in 2023 was higher than the average between 2010 and 2019 of 1,612. That upward trend is discouraging. That is despite preliminary data from the Office for National Statistics suggesting that UK resident visits abroad remain lower than pre-covid-19 pandemic levels. Travel destination data for this year is not yet available. I am not sure whether the Minister is able to provide that, but it would be good to get some figures. If we cannot get them today, will she pass them on to those who have participated in the debate?

In previous years, the majority of cases where the travel history was known were acquired in Africa—particularly western Africa—by travellers visiting friends and relatives. In my constituency—I know this is true for my hon. Friend the Member for East Londonderry and others, including the hon. Member for Glasgow North—I have a large number of church groups and non-governmental organisations that work across Africa. Nearly every church has a missionary connection with Africa, so people travel there maybe once a year—certainly, every couple of years.

The rise in the number of cases, despite travel intensity lessening, is a worrying trend that must be addressed, alongside the reinstatement of our foreign aid. The hon. Member for Glasgow North referred to the 0.7% target, and I support that 100%, as others do. I know the Minister is keen to respond positively. I am ever mindful that she is not in charge of the money, but I want to underline the issue. We need investment in malaria research, and we must make cheap and reliable medication available.

The last time I went to an area with high malaria levels—Nigeria—my wife was able to order malaria tablets online from the local Boots pharmacy. I am not promoting Boots; I just went there and collected the tablets. It is great to have that facility available. I only knew that the medication was necessary when one of my staff members looked up the area and told me. Information about the spread of malaria in certain countries is not readily available. Perhaps flight tickets should come with a warning. They could say, “Your bag must weigh under 23 kg and you really should get your malaria tablets.” There are some things we could do from a practical point of view. There is no 100% effective vaccine for malaria, but there is medication that massively reduces its severity. The official advice is that a combination of preventive measures provides significant protection against malaria.

This is not solely an issue for travellers; we have a moral obligation to tackle malaria. I believe that is the motivation of the hon. Gentleman; it is certainly my motivation for being here. The restrictions on travel and aid due to the covid pandemic demonstrate halting those steps had a detrimental effect. In 2020 and 2021, there was significant disruption to malaria services, such as the distribution of bed nets, which the hon. Gentleman referred to. That caused a spike not just in malaria incidence but mortality rates.

In 2022, $4.1 billion was invested globally to fight malaria—far short of the World Health Organisation’s $7.8 billion target. Before I look globally to ask other nations to step up to the mark, I look to my own Minister and Government and ask what else we can do right here, right now to assure others across the world that we will not simply increase funding but ensure that none of the funding is wasted and that it goes directly towards meeting the need.

[Mr Dhesi]

The hon. Gentleman is making an excellent speech. Does he agree that preventing and treating malaria and NTDs is within our grasp? They can be beaten, but progress is stalling. Does he agree with me that the UK aid funding gap from Government, the climate crisis, conflict and humanitarian crises all pose a serious threat to sustaining those lifesaving efforts?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. It gave me time to get a good gulp of water. He is right again in underlining the issue and our role as this United Kingdom of Great Britain and Northern Ireland and what we can do together. The use of non-governmental organisation partnerships that are charitable and faith-based will always be my motivation for being here. That is where I come from.

I think of the clinics in Malawi, which the hon. Member for Glasgow North referred to, as well as in Zimbabwe and Swaziland. I think of those three and of those in Uganda, Kenya and Nigeria that I know the churches back home are involved with. The Elim church and missions are active in my constituency. In particular, the clinics in the first three countries are supported through the Elim Relief Association, which has taken steps to deliver anti-malaria tools at a low cost with a big dividend at the end, purchasing nets in bulk and handing them out through the charitable hospital and clinics. That is replicated worldwide.

We have questions to ask about how much funding is wasted on unnecessary red tape. When we see images of a child wasting away with no proper care, suffering from a disease that could have been managed, it underlines how we must do better. I believe we can.

[Wendy Morton (Aldridge-Brownhills) (Con)]

To allow the hon. Gentleman to have a quick drink, I will make the following point. He is making a passionate speech on the importance of supporting the tremendous work to tackle malaria and neglected tropical disease. We often talk about this from an Africa or an international perspective. Does he agree with me that it is important we recognise that our work through the UK aid budget and international development also has an impact on UK citizens and the UK’s reputation in many ways? It is important we do not lose sight of that.

[Jim Shannon]

The right hon. Lady is absolutely right. That is a good reminder that what we do here is appreciated across the world. There is feedback and a positivity that comes through that.

I support many organisations, as do others, whether they be church groups or charitable groups. One such organisation that I want to mention is the Christian Blind Mission, which I have supported for about 20 years. I had never met any representatives in person until I got to Nigeria and visited them and saw what and how much they do. One of our former Members, Jo Cox, was involved with that organisation. I did not know that until that day and it was interesting to catch up. We may donate to charity but may not always know all the good an organisation does.

Time has prevented me from going into other tropical diseases, but the trends are the same and so is the solution: joined-up thinking, working in partnership with the bodies that exist on the ground and a budget that can and does deliver compassionate aid. This debate is important. I believe we have an obligation to speak up for those who need help and be the ears and voice of those across the world. I thank the Government for what they do but urge them to do more.

--- Later in debate ---

[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.

[Jim Shannon]

I and others mentioned the important role that church and charity groups play and the significant voluntary contribution they make. How can the Minister’s Department work alongside them to encourage them and align partnerships so that things can go better?

[Anne-Marie Trevelyan]

The hon. Gentleman raises a really important point. When I visited Malawi a few years ago, I was struck by the fact that almost every Scottish church and school has a relationship with that country. The history goes back to the Scottish explorers of the 19th century, and that fascinating relationship feeds into church and other community groups across Scotland working together to support religious hospitals in Malawi. That really interesting model has been built up over more than 100 years, and those connections continue to grow. I have visited schools in my patch where children want to be involved in these issues and understand them more closely. Strong relationships can be built, and there are some very good organisations—I will come back to the hon. Gentleman because I cannot remember their names—that try to develop links with schools, in particular, to help them understand each other better. We know, as Churches across the world do ecumenically, that that is the best way to share knowledge and develop better understanding.

[Jim Shannon]

The Minister is right to acknowledge the good work that has been done in Malawi. There are 94 churches in my constituency, and I know of only one that is not doing some work in Africa. In particular, the Elim church and the Church Mission Society do work in Malawi, Zimbabwe and Swaziland. I would like to encourage those things, and I am keen to hear how we can do that.

[Anne-Marie Trevelyan]

I will take that away and we can perhaps pick it up more fully.

As colleagues set out, this has been an important and positive debate. The UK plays a long-standing and leading role in the fight against malaria and neglected tropical diseases, both as a leading donor and with our world-leading scientific and research capability, which has focused on this issue for decades. Although, as a global community, we have made incredible progress in the last 20 years, we know that too many countries still face major challenges, not the least of which is the impact of climate change. As colleagues have pointed out, in many countries the most challenging health problems are across boundaries—diseases do not see a line in the sand. As we set out in the development White Paper, we will continue to lead the fight against poverty and climate change, including, very importantly, on global health.

If I have failed to answer any questions, I hope that the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield, will pick up on them. We will continue to seek health solutions, alongside building health systems to help make these diseases history.