Malaria and Neglected Tropical Diseases

Patrick Grady Excerpts

Tuesday 9th January 2024 Westminster Hall

[Carolyn Harris (in the Chair)]

As this is the first sitting in this Chamber of 2024, may I take this opportunity to wish everyone a very happy and prosperous 2024?

[Patrick Grady (Glasgow North) (SNP)]

I beg to move,

That this House has considered the role of the UK in ending malaria and neglected tropical diseases.

Thank you, Mrs Harris, and a very happy new year to you too. It is a pleasure to serve under your chairmanship.

I am grateful to the Backbench Business Committee for granting time for this debate, and to the hon. Members from across the House who supported the bid, not all of whom have been able to make it here today. I think a few folk are stuck in traffic or whatever, so perhaps we will see some more faces as the debate goes on. I am very grateful to everyone who has come here to take part.

I refer to my entry in the Register of Members’ Financial Interests. Last year I and a number of colleagues visited Malawi with the all-party parliamentary group on malaria and neglected tropical diseases to learn more about the efforts to end these diseases, and to see at first hand the impact of UK investment on those efforts. I will draw on that experience in my contribution today.

We are particularly grateful to the Backbench Business Committee for granting the debate now, because at the end of this month, on Tuesday 30 January, we will mark World Neglected Tropical Diseases Day—a day designated by the World Health Organisation to raise awareness of the challenge and the opportunity that we have to eliminate many of these deadly diseases. It will be the first such awareness day of the calendar year, and the fourth time that that particular day has been marked. This year’s theme is “Unite. Act. Eliminate.” It challenges decision makers and those in positions of power—including everyone taking part in this debate—to work together to mobilise the resources necessary to eliminate malaria and other neglected tropical diseases.

Debates such as this about international development can be full of acronyms, and we will no doubt hear today references to many of them, including SDGs, sustainable development goals; spending on ODA, official development assistance; and WHO, the World Health Organisation. Acronyms can be a useful shorthand, but we have to be careful that we do not reduce what we are discussing to technical or abstract concepts. When we talk about NTDs—neglected tropical diseases—we are not talking just about a group of 21 diseases that exist in test tubes or Petri dishes in a laboratory somewhere. These diseases are having an impact on the daily lives of 1.7 billion people around the world—nearly one in five of the global population. They can cause immense suffering, disability and disfigurement, and are often fatal. In many ways, it is not just the diseases that are neglected; the people affected by them are also, by definition, being neglected.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Member on securing the debate. He rightly says that we should not be distracted by the statistics, but given the fact that one in five people on the planet is affected, it is important that we remember that many of these diseases are entirely preventable if the right action is taken as early as possible.

[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.

--- Later in debate ---

[Patrick Grady]

I am grateful to all Members who have taken part today. The hon. Member for East Londonderry (Mr Campbell) spoke about the return on investment. The hon. Member for Strangford (Jim Shannon) made the point that this issue is very important to our church communities and to many of our constituents. The right hon. Member for Aldridge-Brownhills (Wendy Morton) brought to bear much of her personal experience, as did the hon. Member for Bracknell (James Sunderland)—I will call him my hon. Friend, because I think we are all hon. Friends today. I thank the hon. Members for Slough (Mr Dhesi) and for Hornsey and Wood Green (Catherine West)—this is a bit of a reunion for those who went on the APPG’s visit—and my hon. Friend the Member for Dundee West (Chris Law), who provided a suitably robust challenge to the Minister. I also thank the Minister for her summation and her reflection on all the points that were made during the debate.

It is quite frustrating that there is a category of diseases known as “neglected” and that work has to be focused on them. One of the key principles of the sustainable development goals is that we leave no one behind. Nobody should be neglected, and none of the factors that keep people in poverty, including these diseases, should be neglected. That is a challenge for all of us as we come to write our election manifestos for the coming year.

I hope that today’s debate has, at the very least, raised some awareness, meaning that these diseases will be slightly less neglected and that we can continue to unite and act and can, ultimately, eliminate malaria and other neglected tropical diseases so that they become eradicated tropical diseases.

Question put and agreed to.

Resolved,

That this House has considered the role of the UK in ending malaria and neglected tropical diseases.