Health: Neglected Tropical Diseases

Lord Rea Excerpts

Wednesday 30th January 2013 Lords Chamber

[Lord Rea]

My Lords, I thank the noble Baroness, Lady Hayman, for bringing this important subject before the House. I was stimulated to take part because half a lifetime ago I worked with children in Lagos, Nigeria, for two and a half years and met with some of these diseases. They can have a debilitating effect by causing anaemia, malnutrition, impairment of immunity or renal failure. Most of them have a secondary host, or vector, which spreads the infection. These include a number of insects and other organisms which have been referred to and described by other speakers. I think noble Lords would agree that nobody living in the Western world would tolerate being exposed to any of these pests. However, people living in poor housing with no clean water or sanitation cannot guard against them. In this context, I would echo the noble Baroness, Lady Hayman, in asking the Minister how far vector control for NTDs other than malaria is being addressed by any of the programmes supported by DfID.

People suffering from these tropical diseases are also subject to the full panoply of other universal infections, such as pneumonia and diarrhoea, which are more likely to be severe because of lowered immunity, caused by one or other NTDs, and associated malnutrition. While welcoming the international initiatives that have been praised by everybody, I have a slight caveat, as did the noble Earl, Lord Sandwich. Anthropologists Tim Allen of LSE and Melissa Parker of Brunel point out in the Lancet that, welcome though treatment of NTDs is, the mass administration of drugs gives rise to a danger that these vertical programmes can undermine already fragile and overstretched healthcare systems. However, I think that with care, co-ordination and collaboration this can be avoided. In fact, if properly managed, these programmes can actually strengthen primary care.

Populations receiving mass medication often do not understand why tablets are being given to everyone, including those with no symptoms, and may not understand or accept scientific explanations of the causes of NTDs. The two anthropologists I mentioned write:

“The availability of tablets is not enough ... dealing with NTDs in a sustainable way will involve a range of factors including behavioural change. Imagining that mass drug administration ‘will make poverty history’ is unrealistic”.

I think that the leaders of the current interest in conquering NTDs are fully aware of this, and I certainly feel that this was given evidence by the excellent research papers that were given at the School of Hygiene and Tropical Medicine this afternoon. As someone who has worked at the grass roots, the observations of the two anthropologists need to be taken into account; they have the ring of truth.

I would like the noble Baroness to reassure me if she can that the generous funding going to mass treatment of NTDs is not diverting DfID researchers away from the longer-term, but ultimately much more sustainable, objective of relieving poverty and improving health by strengthening health systems, improving nutrition, ending illiteracy and providing clean water and sanitation. Mass administration of drugs can set the ball rolling, but only through these wider means can NTDs be sustainably controlled and eventually eliminated.