Malaria and Neglected Tropical Diseases

Lord Trees Excerpts

Thursday 7th July 2022 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government, further to the Kigali Summit on Malaria and Neglected Tropical Diseases on 23 June, what assessment they have made of the effect of current reductions in Official Development Assistance on the global control of (1) malaria, and (2) neglected tropical diseases.

[Lord Trees (CB)]

My Lords, I draw attention to my interests in the register and thank those who have committed to speak today. I am very grateful. The Kigali Summit on Malaria and NTDs on 23 June, running alongside the Commonwealth Heads of Government Meeting in Rwanda, reaffirmed international commitment to control and eliminate malaria and neglected tropical diseases in the Kigali Declaration, to which I will return later.

The fact that these diseases were singled out emphasises their importance to the health of the populations in Commonwealth countries and globally. Malaria, as many will know, is a protozoal infection transmitted by mosquitoes and is of huge importance in sub-Saharan Africa and Asia, but it is controllable. I can travel and work in malaria-endemic countries safely, as I have done many times, provided I have access to certain safeguards, namely prophylactic drugs, bed nets and, if necessary, curative treatment. However, millions of people in endemic countries do not have such access, so malaria has been, and still is, one of the globe’s biggest killer diseases. International efforts have reduced mortality from nearly 1 million per year before 2000 to about 500,000 by 2015, but that welcome reduction in mortality has stalled since 2015, and I note that was before the Covid epidemic.

This is profoundly worrying because malaria and NTDs are endemic infections which, without interventions, cause morbidity and mortality year after year. It is imperative, if we are to avoid 500,000 deaths a year from malaria in future—some 80% of which are of children under the age of five—that we redouble our efforts to mend damaged health systems and to continue to deliver malaria interventions.

Turning to NTDs, they are a group of 20 health challenges affecting the most disadvantaged and impoverished communities in the world. In a vicious circle, they are a cause of poverty but also caused by poverty. Individually neglected, a brilliant initiative was to bring these disparate conditions together under the title of neglected tropical diseases, which thereby highlighted their huge collective impact. They share many features. In most cases they cause chronic, disabling and stigmatising illnesses such as leprosy; elephantiasis—otherwise called lymphatic filariasis—which causes swollen limbs and genitals; major facial and other disfigurement caused by leishmaniasis; female genital disease and predisposition to HIV as a result of schistosomiasis; and blindness through river blindness and trachoma, to name but a few. Collectively, the NTDs place a huge health burden on the societies affected, while reducing the ability of the afflicted to contribute fully to their societies. Some NTDs, such as rabies and snake bite, kill.

NTDs are a key barrier to the attainment of the sustainable development goals, not only SDG 3 on health but those on poverty eradication, hunger, education, gender equality, work and economic growth, and reducing inequalities. Yet we already have the means to prevent or control many of these horrific diseases, partly with drugs—in many cases donated free by the pharmaceutical industry or recently developed by product development partnerships—or, for rabies, by vaccination of dogs, which are the major cause, through bites, of nearly 60,000 estimated deaths per year from rabies, of which nearly half are in children. What is needed is to deliver these interventions, which may cost as little as 50 cents per treatment.

A major positive, historic initiative was the London declaration of 2012, which identified 10 NTDs for which mass drug administration provided a practical and effective intervention. Substantial progress has been made since 2012: 12 billion treatments have since been donated to prevent or treat NTDs; 600 million people now do not require interventions, which they did in 2010; 43 countries have eliminated at least one NTD; 10 countries have now eliminated lymphatic filariasis as a public health problem; five countries have eliminated trachoma; river blindness has been eliminated in nearly all the Americas; Guinea worm disease is now on the brink of eradication; and there has been a 96% reduction in sleeping sickness cases since 2000.

I reel off these figures to emphasise the great progress made quite recently in controlling diseases that have plagued the endemic populations for centuries. NTDs, however, continue to affect more than 1 billion people worldwide. We must keep the foot on the pedal to sustain these gains. The UK has been a leading supporter of NTD control and research but the recent gains, for which we can take much credit, have been imperilled by the official development assistance cuts. It is difficult to ascertain exactly how much of the £4 billion reduction in the total ODA budget announced in November 2020 fell on health sector support, but the savings are small in comparison with total UK public expenditure, which in 2020-21 was £1,000 billion pounds.

We do know that cuts for NTD control have been disproportionately huge in their effect. The UK’s flagship Ascend programme, essentially our entire operational contribution to NTD control, had its £220 million original budget slashed. These cuts were immediately applied to ongoing programmes. The result was that millions of already donated medicines have been unused, and millions of at-risk people have been left exposed to horrible preventable diseases. Moreover, support for health system strengthening and capacity-building within the NTD programmes was lost. In its two years, however, Ascend consistently scored “exceeds expectations” in evaluations.

We know that the control of NTDs is one of the most cost-effective health interventions, with an average economic benefit of at least $25 dollars for every $1 spent. The Government themselves, in their recent international development strategy, have emphasised that success for that strategy means

“unleashing the potential of people in low- and middle-income countries to improve their lives”,

and that they want women and children to have

“the freedom they need to succeed”.

Yet malaria and NTDs disproportionately affect the health, well-being and life chances of women and children, who bear the brunt of morbidity, mortality, and the stigmatising effects of these diseases. Moreover, tackling these diseases can improve and strengthen health systems, surveillance systems and healthcare delivery methods that align totally with the Government’s priorities for ODA and pandemic preparedness, as well as with the sustainable development goals.

The Kigali Declaration on NTDs seeks to galvanise further commitments to end NTDs by reducing by 90% the number of people requiring interventions for NTDs by 2030. It was backed by high-level participants, including the Minister, the noble Lord, Lord Ahmad, who, on behalf of Her Majesty’s Government, endorsed the agreement.

Returning to malaria, the UK has made major contributions to its control, mainly through the Global Fund, for which the UK was a founding member and has been the second-biggest donor. The fund can command huge economies of scale and has been A-rated by quality assessments. Most importantly, the seventh replenishment goal of $18 billion dollars—to be discussed in September—has already received a pledge from US President Biden for $6 billion dollars but is conditional on the balance of $12 billion dollars being raised from other sources. Failure to reach the target will reduce the US commitment, so potentially every $2 the UK commits will help ensure $1 from the US.

In conclusion, health underpins every attempt to improve social, educational and economic development, which we espouse to support. Without health, endemic communities are handicapped in their ability to help themselves. We need to emphasise that support for health—closely integrated in partnership with endemic communities and Governments—not only is an altruistic and humanitarian good thing to do but is in our own interest.

A huge challenge facing the affluent global North is migration—yes, much of it is driven by conflict, but also by the desire for a better life. With relatively modest investment, returning to our legal commitment to devote 0.7% of our GNI to ODA, and by prioritising health, we can improve the life chances of disadvantaged communities, and through health create wealth: stabilising those communities, promoting social and educational equality, enabling economic development and aiding detection and control of potential pandemics at source, all of which will benefit us in the UK.

Finally, I ask the Minister: how will the UK Government deliver their commitment in the Kigali Declaration to support NTD elimination programmes? Secondly, will Her Majesty’s Government support malaria control by increasing their commitment to the Global Fund at the next replenishment in line with the US Government’s increased commitment?