Malaria and Neglected Tropical Diseases

Tanmanjeet Singh Dhesi Excerpts

Tuesday 9th January 2024 Westminster Hall

[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.

[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.

--- Later in debate ---

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

It is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who contributes to so many debates and always brings a huge amount of commitment, passion and knowledge. I thank the hon. Member for Glasgow North (Patrick Grady) for securing time for this important debate on malaria and neglected tropical diseases, particularly ahead of the world awareness day. I have long been interested in the issue and my support continues. Malaria and neglected tropical diseases are embedded in UN sustainable development goal 3—good health and wellbeing—and under target 3.3, as I am sure hon. Members will know all too well, to end the epidemic of malaria and NTDs by 2030. The UK actively contributes to that target.

As a former FCDO global health Minister, I was pleased to launch the “Ending preventable deaths of mothers, babies and children by 2030” paper in December 2021. That paper highlights the UK’s key achievements to date in the fight against malaria and NTDs. It is worth just reminding ourselves of a few of those achievements. In 2019, UK aid helped to distribute 160 million mosquito nets, sprayed 8 million buildings with anti-malarial indoor spray, gave preventive malaria treatment to 11 million women and supported the development of seven new drugs for malaria.

But, all too sadly, as we know, malaria transmissions are concentrated throughout countries in sub-Saharan Africa, especially those close to the equator. In 2022, there were 249 million cases of malaria and 608,000 deaths, of which 95% were in Africa. I am very fortunate to have visited, and actually volunteered in, some of those sub-Saharan countries—for example through Project Umubano, with the Westminster Foundation for Democracy, and as a member of the International Development Committee—including Kenya, Rwanda, Burundi, Sierra Leone, Nigeria and Mozambique. Like most travellers, when I visited, I would take anti-malarial pills as a short-term preventive precaution. However, for people living in those countries, anti-malarial pills are either not an option or not a long-term solution.

Another preventive measure, which of course is more accessible and affordable—and often free—is the use of mosquito nets. When used properly, mosquito nets are very effective. However, an unintended consequence that we need to be aware of is that, when they are free or subsidised—which is a good thing—that can lead to some of those nets being used for alternative uses, such as for fishing.

I therefore urge that, when the Government are looking at these projects and at funding, we also insist that we accompany that with education of how to use mosquito nets properly. I think we all know that there is no point in having a mosquito net if it is not being used effectively. Otherwise, not only are we risking somebody’s life, but we are risking our investment at the expense of the British taxpayer.

I was also very fortunate to visit the Liverpool School of Tropical Medicine during my time as Minister for global health. That is, again, another organisation here in the UK that does absolutely incredible work, and I am glad to see that the UK continues to set malaria and NTDs as a priority on its agenda.

The UK’s international development White Paper, published in November 2023, highlights the following achievements: the UK’s contribution to the World Health Organisation’s malaria vaccine implementation programme, the UK’s Fleming fund for strengthening anti-microbial resistance surveillance systems in more than 20 low and middle-income countries, support for civil society advocacy groups such as Malaria No More, and both of the first two malaria vaccines in the world to be recommended by the WHO coming from British science and British expertise. Those are Mosquirix, developed by GSK, and R21, developed by the University of Oxford. I would like to give recognition to GSK and the University of Oxford’s Jenner Institute for that incredible contribution to global health.

[Mr Dhesi]

Indeed, our battle against malaria and NTDs is not just a struggle for survival but a reflection of our collective humanity. Does the right hon. Lady agree with me that it is a global fight that transcends national boundaries and demands worldwide unity, that our actions today will define the legacy we leave for future generations, and that this battle is about saving lives and upholding our moral duty to the global community?

[Wendy Morton]

The hon. Gentleman makes an important point. We often talk about budgets in terms of countries and regions; insects and diseases such as malaria do not see the boundaries that we do, so it is always important that we do as much as we can, working with our partners, to address the long-term issues and finding the solutions, but taking a holistic approach. I do not believe it is always that simple, but we must absolutely continue to work on it. That is why I think the UK has a very good reputation when it comes to international development, particularly now that that work is integrated within the Foreign Office. However, it is important that we continue to work on this, whether on malaria or many of the other diseases that we see around the world.

--- Later in debate ---

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a real pleasure to serve under your chairmanship, Mrs Harris. I congratulate the hon. Member for Glasgow North (Patrick Grady) on securing this debate; he has a proud record of work, both in his constituency, with the University of Glasgow, and in Malawi itself. I also refer to my entry in the Register of Members’ Financial Interests.

As hon. Members have said, we remain at a critical point in tackling malaria and neglected tropical diseases due to the pandemic; humanitarian crises as a result of conflicts, flooding and famine; rising biological threats such as insecticide and drug resistance; a decline in the effectiveness of core tools; a widening funding gap and resource constraints; and disruptions to already fragile health systems. We really must act now. Global malaria progress has stalled in recent years, with malaria incidence and mortality currently above pre-pandemic levels. In 2022, 5 million more people were infected than in 2021, and 16 million more than in 2019.

Despite malaria being preventable and treatable, nearly half the world’s population remains at risk—particularly in African countries, as the hon. Member for Bracknell (James Sunderland) said. The global burden of neglected tropical diseases also remains significant and, as with malaria, continues to be a barrier to health equity, prosperity and development, with devastating health, social and economic consequences to 1.65 billion people worldwide, including over 600 million people in Africa.

[Mr Dhesi]

As a vice-chair of the all-party parliamentary group on malaria and neglected tropical diseases, I thank my hon. Friend for her leadership as chair of our APPG. I also thank her and Martha Varney of Malaria No More for their leadership in orchestrating our recent visit to Malawi. Their insights and the dedication of partners such as the Wellcome Trust have significantly deepened my understanding of the challenges at hand. Does the shadow Minister agree that malaria is a relentless barrier to development, thwarting educational progress, disproportionately impacting women and girls, and perpetuating cycles of poverty?

[Catherine West]

Indeed, and my hon. Friend pre-empts my point about the impact on women and girls. I know that you will be particularly interested, Mrs Harris, in the relevance of tackling what seems to be the disproportionate impact on women and girls, due to various biological, social, economic and cultural factors. Limited financial resources, time constraints, diminished autonomy, and stigma and discrimination create barriers that prevent women from gaining access to timely healthcare, education and employment opportunities. Due to their responsibility for home and family care, they often miss out on crucial treatments. Through close contact with children, women are two to four times more likely to develop trachoma, which is a neglected tropical disease, and are blinded up to four times as often as men.

It was particularly exciting, in the visit mentioned by my hon. Friend the Member for Slough (Mr Dhesi) and the hon. Member for Glasgow North (Patrick Grady), to see old women, who are often neglected in developing countries, receiving crucial treatments and being enabled to feel that they were not a burden on their children. It was particularly special to learn that trachoma has been eliminated in Malawi. The World Health Organisation has signed that off, which is a really exciting development. Sometimes, these things feel very overwhelming, but when we see that trachoma has been eliminated in Malawi, it really is wonderful and encouraging.

The “Ending Preventable Deaths” strategy recognised malaria as a major cause of child deaths, and important tools such as bed nets and intermittent preventive treatment in pregnancy as examples of evidence-based health intervention and best buys. It was also welcome that the strategy recognised the critical importance of clean water, sanitation and hygiene. However, there is no way of ending these epidemics and meeting the sustainable development goals without working to empower and enable women and girls to succeed. I know that is very much at the heart of your work in Parliament, Mrs Harris.