Neglected Tropical Diseases

Lord Trees Excerpts

Monday 1st February 2016 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government what assessment they have made of the effects of Neglected Tropical Diseases in impairing social and economic development in developing countries in the light of the publication of the third progress report of the 2012 London Declaration on Neglected Tropical Diseases.

[Lord Trees (CB)]

My Lords, it is a great pleasure to open this debate on neglected tropical diseases, which I will refer to as NTDs. This is the third debate we have had on this subject in as many years. I thank my noble friend Lady Hayman for her leadership in initiating the previous two debates. Certainly this House cannot be accused of neglecting these diseases. Nor should we: they are of huge global health and socioeconomic importance, as is now being recognised. Coincidentally, this Wednesday former US President Jimmy Carter will give a talk in this House convened by the Lord Speaker about one NTD, guinea worm disease, and its eradication.

NTDs are a group of infections associated with poverty in tropical and sub-tropical countries. Some, such as rabies, have a high mortality rate but most are characterised by their chronicity and high levels of disability such as gross disfigurement, blindness and inability to work. As such, sufferers are unable to be productive within their already poor communities and instead become a burden on the very limited healthcare resources of their countries. More than 1 billion people are affected in 149 countries worldwide. It is estimated that some 300,000 deaths per year are caused by NTDs.

However, until recently, in comparison with for example HIV, TB and malaria, these diseases received very modest international attention and support. The bundling and aggregation of these diseases and their branding as “neglected” was a masterstroke of public health communication. In 2012, WHO published its road map laying out targets for the control, elimination or eradication of 17 NTDs by 2020. Momentum gathered pace, with the London Declaration on NTDs in 2012 enshrining further commitments. Last year, the UN sustainable development goals to 2030 included NTDs within goal 3, aimed at “healthy lives” and “well-being for all” people.

This progress is substantially contingent upon the massive commitment by the pharmaceutical industries to donate key drugs essential for many of the control programmes. Donations worth a staggering $3.8 billion per year are a massive gesture of corporate generosity. While there is still some need for research to develop drugs for some NTDs and situations, there is available now a free toolkit of drugs for many NTDs.

Notable among these drugs is ivermectin, the mass administration of which to populations in Africa and Central and South America has massively reduced the incidence of clinical onchocerciasis—river blindness. Noble Lords may be aware that the Nobel Prize for Medicine in 2015 was awarded partly for the discovery and development of ivermectin by Campbell and Omura. Noble Lords may not be aware that this drug was in fact developed and initially marketed for veterinary use in 1981 as a wormer for cattle and other species. It was so successful commercially that the parent company, Merck, was able to commit to donate ivermectin for the control of onchocerciasis and lymphatic filariasis or elephantiasis for as long as needed. I mention this not only because of its significance in NTD control but to highlight the connectivity between human health and veterinary science—the so-called “one health” concept. That relationship is particularly close with respect to human tropical diseases.

That brings me to another NTD which exemplifies the “one health” approach—rabies. I am not an expert on rabies but, of all the lectures I had as an undergraduate veterinary student, one I particularly remember was on rabies. From nearly 50 years ago, I still remember the main message: the key to controlling human rabies is to control dog rabies. Human rabies was endemic in Britain until late in the 19th century. We eradicated it by stopping dogs biting people. Worldwide, 99% of human rabies is still contracted from dogs. Rabies is a horrible disease. It is still endemic in many countries in Asia and Africa. It is estimated that about 60,000 people die of it a year, of whom nearly 50% are children. During the nine minutes of this speech, someone somewhere will have died of rabies. Once clinical signs appear, death is inevitable; it is a very unpleasant death and you know what? It is entirely preventable. We have all the tools we need: a vaccine for humans, a vaccine for dogs and post-exposure treatment for humans.

The cheapest of these interventions and the principal means of control is to vaccinate dogs. By vaccinating 70% of the dog population, the transmission cycle is stopped. I am pleased to say that there is now a growing movement to tackle this problem, catalysed by the awareness that the elimination of nearly all human deaths from rabies is achievable. A number of campaigns at national, regional and local level in South America, Asia and Africa, conducted by health authorities, NGOs and charities, are starting to control rabies through control of rabies in dogs. I am pleased and proud that many British scientists and vets are active in this area. Late last year, WHO and the World Organisation for Animal Health, in collaboration with the FAO and the Global Alliance for Rabies Control, organised a conference in Geneva which agreed a framework of actions to achieve the WHO goal of eliminating dog-mediated human rabies by 2030. Later this month, my noble friend Lord Crisp and I will host in this House the launch of the End Rabies Now campaign from the global alliance.

For rabies and many designated NTDs, real progress is being made. I am sure we will hear further examples in today’s debate. However, in spite of the donation of many of the drugs needed, there are still significant challenges. These relate more to the delivery of existing drugs and interventions than the development of new ones. Professor David Molyneux, a leading world expert on NTDs, argues that the availability of drugs is no longer a barrier to achieving universal coverage for most NTDs. It is estimated that there is an annual funding gap of $200 million to $300 million a year to ensure effective delivery of interventions and drugs we now have and that are given free. This funding gap should partly be met by the endemic countries themselves. Although extremely poor and with limited resources, it would only require a tiny percentage of their healthcare budgets to fund delivery of the free drugs available for NTD control.

The developed world could also do more. The UK’s leadership in this area through DfID is commendable, but globally only about 0.6% of donor governmental financial aid for healthcare is provided to tackle NTDs. Our affluent neighbours in Europe and some other countries could do more. Action against NTDs will benefit the poorest of the world’s poor. A recent study showed that tackling NTDs is highly cost-effective in terms of return on investment. The third progress report of the London declaration on NTDs said:

“This makes NTD programs a pro-poor best buy”.

I commend DfID for its commitment and support for the control of NTDs, reinforced by the recent announcement of the Ross fund. Is the Ross fund additional money to that which the UK has been committing for NTD funding? Secondly, what are the Government doing to urge other affluent nations to follow our example? Collectively, we need to close the funding gap and ensure that the great progress to control NTDs achieved in the last few years will be sustained so as to permanently eliminate these infections and the terrible diseases they cause.