The House of Lords yesterday held a short debate on Neglected
Tropical Diseases. Extract Lord Alton of Liverpool (CB)..
researchers are undertaking critical work to improve the use and
monitoring of insecticide in India to assist visceral leishmaniasis
elimination programmes. VL is a fatal disease if untreated, as we
have heard, but effective control of the sand-fly is vital to
reduce transmission to some of the poorest people of India, Nepal,
Bangladesh and elsewhere. Full debate...Request free trial
The House of Lords yesterday held a short debate on Neglected
Tropical Diseases.
Extract
(CB)..
researchers are undertaking critical work to improve the use and
monitoring of insecticide in India to assist visceral leishmaniasis
elimination programmes. VL is a fatal disease if untreated, as we
have heard, but effective control of the sand-fly is vital to
reduce transmission to some of the poorest people of India, Nepal,
Bangladesh and elsewhere.
Full debate
Question for Short Debate asked by
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To ask Her Majesty’s Government what is their assessment of
progress made in combating neglected tropical diseases since
the London Declaration made in January 2012.
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(CB)
My Lords, tonight’s debate has been an extremely movable feast
in terms of dates, times and length of speeches. However, at
last, we are here and I am delighted to introduce a debate
which has become, over the past five years, a standing item in
the parliamentary calendar. I am extremely grateful to
colleagues here tonight for their commitment to a subject
which, before the London declaration of 2012, was very much a
minority interest even among those who focused on health in the
developing world.
Tonight I hope that we can do two things. First, that we can
look back and record achievements in combating the 18
bacterial, viral and parasitic diseases brigaded in the WHO’s
category of neglected tropical diseases affecting more than 1
billion people in 149 countries across the world, and that we
can also look forward and recognise the major challenges that
remain if we are to meet the targets set in 2012 in the WHO’s
2020 NTD road map and in the London declaration of the same
year.
I know that colleagues are well aware of the toll that these
diseases take on individuals and on human and economic
development in the countries in which they live. These diseases
result not only in half a million deaths each year; they also
cause chronic disability, stigma and long-term ill health. They
affect children’s development and pregnancy outcomes. They are
the diseases of poverty and in themselves they perpetuate that
poverty. As Margaret Chan, the director of the WHO, put it in
that organisation’s latest report:
“NTDs thrive under conditions of poverty and filth. They tend
to cluster together in places where housing is sub-standard,
drinking water is unsafe, sanitation is poor, access to
healthcare is limited or non-existent, and insect vectors are
constant household and agricultural companions”.
Unsurprisingly, we think of NTDs primarily as diseases of the
developing world, and that of course is where they take their
highest toll. But poverty is not confined to those who live in
poor countries, and cases of NTDs are found among the poor of
even the wealthiest countries. In North America, there has been
the emergence of Chagas disease in several southern states. In
Europe, between 2007 and 2015 we saw outbreaks of chikungunya
in Italy, France and Spain, of dengue in Portugal, of
leishmaniasis in Greece and of schistosomiasis in Corsica.
The causes of these cases of emergence and re-emergence are not
only poverty, but climate change and mass human migrations
linked to the hundreds and thousands of people fleeing
conflicts in Libya, Syria and Iraq. In Syria cutaneous
leishmaniasis has reached hyper-epidemic proportions due to
breakdowns in health systems and a lack of access to essential
medicine, with tens of thousands of new cases annually. There
is a real danger of introducing or reintroducing NTDs
endemic to the Middle East and north Africa to Europe and
beyond. All this highlights the global challenge of NTDs and
emphasises the need to make progress in tackling these diseases
of poverty in our interconnected world if we are to achieve the
“ensuring healthy lives for all” sustainable development
goal.
In the five years since the London declaration, we have made
considerable progress. The bringing together of Governments,
pharmaceutical companies, NGOs and researchers, scientists and
doctors, has had profound results. Increased donations of
essential medicines, targeted funding by international
development agencies, private foundations and the domestic
financing of NTD programmes by endemic countries are
drastically improving the quality of life of millions
worldwide. Almost 1 billion people were treated in 2015 alone.
Thanks to the donations of several major pharmaceutical
companies, billions of doses of drugs have been donated in the
past five years so that by last year around 50 treatments were
being delivered by mass drug administration programmes every
second of the day. UK aid and the work of British institutions,
NGOs and partnerships like the Liverpool School of Tropical
Medicine, the Schistosomiasis Control Initiative, Sightsavers
and the London Centre for Neglected Tropical Disease Research
are all playing a critical role in implementing prevention and
treatment strategies, and in generating evidence from
operational and scientific research to inform efforts to
achieve the 2020 WHO targets. Since 2013, four countries in
central America have all eliminated river blindness and the
misery that the disease brings, and last year both the Maldives
and Sri Lanka were certified free of lymphatic filariasis.
Great progress has been made and I am happy to pay tribute to
the role that the UK Government have played both in their
original support for the London declaration and through their
ongoing leadership and financial contributions.
But we have to recognise that there are significant challenges
ahead and “steady as she goes” will not deliver the targets
set, particularly for soil-transmitted helminths. Mass drug
administrations will need supporting infrastructure such as
water and sanitation projects, additional interventions,
including new medicines, and in particular, as I raised in the
debate last year, new vaccines. We were then all anxious about
Zika and focused on the need for prevention rather than cure.
One of my questions for the Minister is whether DfID is
considering broadening the R&D focus on NTDs to explore
potential vaccines, given the research evidence that suggests
several diseases such as schistosomiasis and soil-transmitted
helminths will not be eliminated by mass drug administration
alone.
In addition to vaccines, we need to continue searching for
better tools across the board. We have new mapping tools and we
understand better the burden of disease, but we will have to
continue improving diagnostics, such as the new rapid
diagnostic test, funded by DfID, for sleeping sickness. We will
need to improve our strategies on vector control and, as in
most areas of combating poverty, to do more on the education
and empowerment of women and girls, which has a demonstrable
effect on sustained access to clean water, sanitation and
hygiene. Sufficient and safe access to water in turn helps to
combat NTDs such as trachoma, schistosomiasis and
soil-transmitted helminths.
While most of the targets of both the WHO and the London
declaration understandably focus on interrupting transmission
and infection cycles, we have to be aware that NTDs cause
severe morbidity and lifelong disabling conditions such as
blindness and disfigurement, which in turn lead to stigma and
exclusion. So resources should also be directed towards
improving the quality of life for people suffering from the
consequences of these diseases and integrating services into
existing health systems and ongoing NTD programmes. I hope the
Minister can give us some information about the Government’s
plans for NTD spending and how the NTD portion of the Ross fund
will be managed and allocated, as this portfolio will be key to
the delivery of UK aid to NTDs.
Next month, the WHO, Uniting to Combat NTDs and the NTD
community will host a summit in Geneva to mark the fifth
anniversary of the road map and declaration, and to plan for
the future control, elimination and eradication of NTDs. I hope
the Minister will make clear the Government’s commitment to
that summit; that we will have high-level political
representation at that meeting; and that we will have a
commitment to further funding and continuing the task set five
years ago. That meeting is an opportunity for us to continue
our leadership with other donors in the philanthropic world and
other national donors, and to work with the Governments of
endemic countries to come together and once again commit to
consigning these diseases of poverty to history.
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(Con)
My Lords, all noble Lords may speak for five minutes.
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7.13 pm
-
(Lab)
My Lords, I declare an interest as a member of the advisory
board of the Schistosomiasis Control Initiative at Imperial
College. I am on the board only because I am one of the few
people who can say schistosomiasis. No wonder it is neglected.
I have asked them to rebrand it. I am also on the board because
I am a businessman and retailer. I will focus on the enormous
cost/benefit of SCI’s work and the huge return on capital
employed. It effectively controls schistosomiasis across 11
countries in Africa at a cost for each child treated of 30p a
year.
This is one of the most cost-effective public health programmes
ever. Let us look at the scale: more than 91 million treatments
have already been delivered, with funding largely from DfID.
More than 200 million treatments will be delivered by 2019,
half of them to girls and women. The worms are killed in
children by just one safe and effective treatment; anaemia and
malnutrition are reduced; the healthier children will then go
on to attend school, and in the longer term, free from serious
organ damage, they can contribute to their society for
life.
So let us look at the maths. Disability-adjusted life years, or
DALYs, due to schistosomiasis cost Africa hugely. Treated
youths will be able to work for years to come. For every
million who can work, even at just $1 a day, it is like $400
million of aid for Africa every year for ever. Other
business people see this immediately as a must. Merck and
GlaxoSmithKline donate tens of millions of praziquantel and
albendazole tablets every year. The “effective altruism”
movement has highly recommended our project. Philanthropists
such as Luke Ding are there year after year donating large sums
through Prism the Gift Fund—where I declare a trusteeship. The
Bill & Melinda Gates Foundation has supported us hugely
over the long term. Just recently, Dustin Moskovitz and Cari
Tuna, through their charity, Good Ventures, have made one of
the largest gifts ever received to Imperial College for this
cause.
In addition to controlling schistosomiasis, we could eliminate
it in most countries across Africa by 2030. Elimination would
pay back enormously in increased prosperity across Africa and
the world. To this end, and to break down the silos, SCI is
part of a global network which, together with DfID investments,
is working to strengthen local health systems. It is working
with the World Health Organization; with Oxfam’s water,
sanitation and hygiene programme—or WASH; with the Natural
History Museum in a partnership studying the larvae, worms and
snails that cause schistosomiasis; and with the noble Lord,
and the Royal College of
Veterinary Surgeons.
Schistosomiasis elimination is not only the right thing to do
but would be massively cost effective. Perhaps the Minister
would like to meet those expert practitioners at the
Schistosomiasis Control Initiative at Imperial College to
discuss the cost effectiveness of all this and a brighter
future for all.
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7.17 pm
-
(LD)
My Lords, I thank the noble Baroness, Lady Hayman, for securing
this debate and, as ever, for opening it so effectively. I
declare an interest: I am a trustee of the Malaria Consortium,
a position that I took over from the noble Baroness.
-
I shall not take up more time, but I did not declare my
interests at the beginning of my speech, which I should have
done. I therefore do so now: they are as recorded in the
register.
-
I remember the huge excitement of the London meeting in 2012,
when the UK, by that stage moving towards spending 0.7% of GNI
on aid, as so long promised, was able to increase its
commitment on neglected tropical diseases so substantially, by
an additional £195 million. I was proud to be part of DfID’s
ministerial team at the time and recall the amazing briefings
that I was given by committed experts not only from the
department but from the London School of Hygiene & Tropical
Medicine—including on how you pronounce the names of all these
various diseases.
As the noble Baroness has pointed out, NTDs affect more than
1.3 billion people worldwide and cause half a million deaths
each year. They cause chronic disability, disfigurement, stigma
and ill health. They disproportionately affect the poor and
marginalised.
It is vital for delivering the SDGs that we address the NTDs.
Of course, there is goal 3 on healthy lives, but it is much
more than that. The SDGs aim to eliminate extreme poverty while
leaving no one behind. It is the poorest and those with
disabilities who are so often left behind. Tackling these
diseases is part of the overall strategy of all the SDGs. In
doing so, we need to focus on research, and here the London
School of Hygiene & Tropical Medicine and the Liverpool
School of Tropical Medicine have been so important, and the UK
has had such strengths.
We need to make sure that treatments and preventive measures,
such as vaccines, are coming forward and that we get them where
they are needed. We need also to ensure that we have adequate
surveillance. This is, of course, vital for understanding a
country’s true burden of disease, as well as for securing and
achieving intervention, detecting the last cases and, when and
if we are in that fortunate position, making sure that there is
no resurgence. I urge the Government to use their position as a
leader in this area to encourage others to increase their own
support. The noble Baroness, Lady Hayman, mentioned the
upcoming summit in Geneva towards the end of April as a key
opportunity for this. I, too, ask whether the Secretary of
State will attend.
Like the noble Baroness, Lady Hayman, I want to ask about the
Government’s Ross fund, announced by the former Chancellor in
the autumn of 2015. It seems an absolute age ago, but it
included £200 million to tackle NTDs. As far as I know, there
have been no announcements yet relating to NTDs. Can the
Minster clarify what is happening? It has also been flagged to
those of us speaking today that leprosy remains a neglected
disease, where others are no longer so neglected. Will the
Minister comment on this?
I come now to the eradication of certain NTDs: it is fantastic
that we have reached that point. We had the wonderful visit
from President Carter last year—in 1986, Guinea worm disease
affected 3.5 million people; now, it is almost eradicated.
President Carter said that he hoped to outlast the last Guinea
worm. I am delighted that the former President is still with us
and I want to ask about those last Guinea worms. Have we almost
reached that point and do we have any information on other NTDs
which are on their way out?
Finally and most importantly, what assessment has DfID made of
the effect of Brexit in this area? We know that scientists
working in the United Kingdom come from many different parts of
the world, but especially from the EU. What are we doing to
encourage them to stay? How can we make sure that they know
that the UK’s leadership in this area, as in many others,
depends so much on them and that we are very grateful to them?
I look forward to the Minister’s responses in this vital area,
which is so important for the health of the poorest around the
world, and where the United Kingdom has such a proud
record.
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7.23 pm
-
(Con)
My Lords, I congratulate my noble friend Lady Hayman on what
she said at the commencement of this special debate. I endorse
everything she said 100%. We have had many battles in the past
but on this issue we agree completely. I have many interests in
this field but I want to focus mainly, as a long-term supporter
and as a patron of WaterAid, on the critical role of water and
sanitation in helping to defeat NTDs.
First, I pay tribute to Barbara Frost, the chief executive of
WaterAid, who is to retire in the coming months after more than
10 notable years as its head. Much of what has come into the
WASH programme and into other considerations, could not have
occurred but for her leadership and her team’s work and we
should put on record our thanks to her. She has been totally
relentless in what she has done to get increased action to
supply clean water and basic sanitation, not just through our
own department’s programme, which has been notable, but also in
other countries’ programmes which were not as well led as the
water and sanitation programmes led by DfID in this
country.
One question I want to ask my noble friend is whether the Ross
fund can be extended to some of the further work that needs to
be done to get better water engineering, which is essential to
the supply of clean water. It seems to me that we know what
needs to be done, but the resources are very often at the end
of the pipe, rather than at the beginning of the process. I
believe that we should be paying more attention to this.
There is one further area of work that I hope DfID will
undertake. We are doing very well indeed, with the help of the
London School of Hygiene & Tropical Medicine, where I was
proud to be the chairman for eight years, and the Liverpool
School of Tropical Medicine, where I was on the council. But we
are not doing enough on basic health training for doctors in
countries where the NTDs are still thriving. We need to focus,
with the royal colleges, on better training in-country for the
doctors of the countries that suffer the NTDs. We are doing
insufficient work in that field. Much as we try, it is
certainly not reaching many of the doctors who are practising,
when it is accepted knowledge in this country and many other
developed countries.
I do not wish to repeat what the noble Baroness, Lady
Northover, or anyone else in the debate said, but I believe
that we should have not just an annual repeat of our efforts
but more frequent debates on these vital subjects. Healthy
societies in the developing world help the education of the
young in the developing world. They cannot have those healthy
societies if they continue to have the amount of illness caused
by NTDs and, indeed, dirty water. I hope my noble friend will
be able to give us some hope of more activity.
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7.26 pm
-
The
Lord
My Lords, I, too, thank the noble Baroness, Lady Hayman, for
introducing the debate. It is good to pause and reflect on the
extraordinary progress that has been made, as well as the
salutary thought of just how much more needs to be done. I am
not a medic and do not want to engage in the medical aspect of
this, but I want to make one, very brief point: the need to
adopt clear protocols and joined-up approaches if we are going
to be really effective in combating neglected tropical
diseases.
I will illustrate this with the Ebola crisis in Sierra Leone,
which broke out in 2014. At that point, medical teams were
deployed from various parts of the world in the most
extraordinary way. They adopted various measures for
containment and treatment that were not always understood
or appreciated by many local people. Indeed, it was very
frightening, and the first-hand accounts of these teams by
local people showed that it was quite shocking for many of
them. In some areas there was actually hostility to what
appeared to be draconian measures—made for the very best
medical reasons—some of which were confronting local customs or
traditions that the local population held dear.
Of course, community leaders have a role in education and
communication, yet it took quite a long time to realise the
role that faith leaders could play in mobilising and educating
local people. Faith communities were to be found in virtually
every community. They had regular meetings. They had resources,
networks and communication. In Sierra Leone, respected
Christian and Muslim leaders were eventually recognised as
allies in challenging some of the myths and misinformation that
were around. It was as important as the medical interventions
that people had to want to collaborate. It was about local
empowerment as well as medicine. That provided an important
avenue by which to get life-saving advice about protection and
prevention out to the community. Then there was the question of
preventing and confronting the stigmatisation of the survivors,
which was a profound problem.
This sort of engagement is an excellent example of what, at
their best, worldwide religious networks such as the Anglican
communion can do so effectively. Of course we are involved in
raising money for water projects. A number of my churches
proudly have signs up saying they have adopted toilets in other
countries, and so on. These are the sorts of things that are
happening because of the links right across the world. This is
where we can act as a bridge between local people and outside
agencies, often in hard-to-reach areas.
This is especially important for countries or areas which are
in conflict or at war. At such times, NGOs can find it very
difficult to deploy anybody and if war breaks out they have to
withdraw their staff, rightly, to protect them—there is not
much choice if you employ people from elsewhere. But unlike the
NGOs, the churches will be there before, during and after the
conflict or disaster and their clergy tend to be local
community leaders, rather than outsiders. Very often it is
local parishes or the diocese which run the schools, clinics
and hospitals.
My simple plea to DfID, NGOs and all parties involved in this
area is to bear in mind the vital need to get everybody round
the table at the earliest stage to think about the cultural
traditions and local faith issues if we are really to mobilise
all people in delivering good health advice, some of which is
preventative. This is so that we do not just look at the
medical challenges but work with all the networks on the ground
to address the social and religious contexts of those
communities which are suffering so from these terrible
diseases.
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7.31 pm
-
(Lab)
My Lords, the noble Baroness, Lady Hayman, deserves our thanks
for asking this Question and for her persistence with NTDs. She
makes sure that these debilitating diseases are not neglected,
at least in your Lordships’ House. Because these diseases
are now mostly treatable, the accent up to now has been on
medication, with less emphasis on prevention. But the
underlying causal factors will allow the diseases to return,
requiring repeated medication if they are not addressed. An
example of this is onchocerciasis, or river blindness, where it
is extremely difficult to eliminate the insect vector—a tiny
blackfly. Repeated courses to treat river blindness are often
necessary.
Tackling the causes, as at least two if not three previous
speakers have said, requires the introduction of clean water,
sanitation, improved hygiene and vector control where possible.
As my noble friend Lord Stone said, this is encapsulated in the
acronym WASH, which is now very much part of the NTD programmes
of the WHO, DfID and other agencies. Of course, WASH plays a
big part in the control of other diseases and the elimination
of extreme poverty. We should remember that the provision of
clean water and sanitation was and still is a basic part of all
public health, dating from the time of our great-grandfathers
in the 19th and early 20th centuries. Much earlier, water-borne
sanitation was used by the ancient Romans, but with the decline
and fall sanitation was also lost. Can the noble Lord,
, give us a report on
international progress with WASH programmes across the board
and DfID’s part in them?
I also repeat the request of the noble Baroness, Lady Hayman,
for information about the development of new vaccines for NTDs.
In particular, I wonder whether we are having success in
developing new point-of-care rapid diagnostic tests. These can
greatly increase the cost-effectiveness of treatment programmes
because it is possible to identify people who are not carrying
the disease.
As a further point, the Leprosy Mission is concerned that not
enough is being done to control and eradicate that stigmatising
neglected disease. There are still pockets around the world
where it is not eliminated. Can the Minister say whether DfID’s
role in this will continue—it already plays a certain part—and,
I hope, be stepped up?
Finally, I follow other speakers in hoping the Minister can
assure us that the UK’s contribution to the international
collaboration on NTDs will continue to be adequately funded,
Brexit or not, and help to achieve the UN’s sustainable
development goals.
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7.35 pm
-
(LD)
My Lords, I thank the noble Baroness, Lady Hayman, not just for
today’s debate but for the succession of world-leading
scientists who she and bring into Parliament week
after week so that some of us can begin to understand the
complex science about which we are speaking tonight. Having
listened to those scientists for over a year, I now understand
that we are talking about three main types of disease when we
talk about neglected tropical diseases. Those caused by worms
and flukes are largely treated by very simple population
management methods. Those which are vector-borne are much more
complicated and need treatment in hospital; malaria is the
classic example. The third group is made up of the very highly
contagious epidemics which hit a population with a much more
profound effect than they would do here when that
population is, as noble Lords have said, living in poverty and
without access to basic medicine.
The approaches to all three of these disease groups are quite
distinct, and the hazards that they pose are quite different.
They are also all happening, worryingly, against the background
of multidrug resistance, for example for TB and malaria, which
is probably the equivalent of climate change in medicine and
something that we should be very focused on and frightened of.
But a very important point is that the same institutions and
scientists that work on drug resistance mechanisms are the same
scientists who work on the mechanism behind NTDs. So the
science is interconnected, and I want to talk about maintaining
that science base.
Other noble Lords have spoken about the heritage that we have
from our colonial past in the schools of tropical medicine in
London and Liverpool, and it is time that we repaid what we
took from the world, by ensuring that those institutions
continue to work to provide the basic science to support
pharmaceutical companies to take forward new compounds into
development and clinical trials and on towards new medicines.
In that, international funding from Governments, including for
example from DfID, is really important. It does two different
things: humanitarian aid, which is very important, but also
funding for long-term scientific and medical development. That
is the stuff which the public do not really see and which is
therefore much more vulnerable to cuts. I hope the Minister
might be able to assure the House that DfID will continue to
play its leading role in humanitarian funding but will also not
take its foot off the pedal in terms of funding the scientific
research.
Other noble Lords have spoken about the fact that it is always
the marginalised people in these countries who suffer the most,
but I want to raise one other issue with the Minister. The
disengagement from global health by the USA under the Trump
Administration will have a huge impact on in-country
programmes, particularly in Africa, where many institutions
such as hospitals and universities are very dependent on
American support for funding both their staff and the equipment
and buildings. In Ethiopia, for example, the whole of the
medical school expansion programme is funded from the USA via
the World Bank. It remains to be seen whether organisations
such as the Bill & Melinda Gates Foundation, the Carter
Center and the Clinton Foundation can step up and fill that
gap. US government institutions such as the CDC and American
universities such as Johns Hopkins, we think, may also be
forced to stand back.
It is really important when we are trying to deal with
outbreaks of these diseases around the world that there is a
standing body of people in countries who have the scientific
expertise to bring about a response. Will DfID perhaps switch
its funding, in light of the American’s withdrawal of funding
from certain sexual and reproductive health programmes, to
ensure that funding for those programmes continues? Will the
Government also press the Trump Administration, who have less
objection to work on NTDs, to place some of the money that they
have withdrawn from the other programmes into programmes
supporting the science and treatment of neglected tropical
diseases?
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7.39 pm
-
(CB)
My Lords, it is a great pleasure to support my noble friend
Lady Hayman and salute her dogged persistence in raising the
issue of rare and neglected tropical diseases. In doing so, I
should mention that I am a vice-president of the Liverpool
School of Tropical Medicine and have been associated with the
school in one way or another for the best part of 40 years. I
particularly pay tribute to Professor Janet Hemingway, whose
brilliant leadership has ensured that the school has maintained
its world-class status, and the remarkable Professor David
Molyneux, who ranks as one of the foremost global authorities
on neglected tropical diseases.
The Liverpool school has been involved with NTDs since its
creation in 1898, and has been responsible for many of the
ground-breaking discoveries in the field. A school staff member
was among the small group who coined the term “NTDs” with the
World Health Organization in 2004-05. I should like to use my
brief contribution to this evening’s debate to shine a light on
the school’s amazing work and to encourage the noble Lord,
, to consider what extra
assistance might be given.
Let me give the House just some examples of the ground-breaking
work in which the Liverpool school has been involved in the
past decade. With DfID support, the lymphatic filariasis
programme continues to make a real impact on poor people in 12
countries, having assisted ministries of health to deliver 200
million drug doses since 2009. As a result, in Malawi, for
instance, transmission of filariasis has stopped. The Liverpool
school and the London Centre for Neglected Tropical Diseases
have expanded their commitment to those who remain disabled
through the disease, recognising the tandem aims of stopping
transmission and, as my noble friend Lady Hayman said, reducing
chronic disablement. The school has been identifying patients,
training surgeons to alleviate this stigmatising male genital
disease, and demonstrating the benefits of surgery to those who
are disabled.
Secondly, LSTM researchers are at the forefront of new and
exciting approaches to mapping neglected tropical diseases
using remote sensing technologies, mobile smartphone
technologies for detecting NTD cases, patient identification
and mapping diseases. I should be grateful if the Minister
could tell us what study DfID has made of the use of such
technologies.
Thirdly, with support from the Bill and Melinda Gates
Foundation, the school has developed the use of the antibiotic
doxycycline and, with industrial partners, has developed a new
drug ready for clinical trials to treat river blindness and
elephantiasis.
Fourthly, the school’s staff are at the forefront of research
on insecticide resistance—a major and increasing problem in the
fight against malaria, but now also against Zika. This work has
major policy impacts in all insect-transmitted diseases. The
LSTM is a key policy adviser to the World Health Organization
and is working on Zika projects to assist control. Perhaps the
Minister could say a word about that too.
Fifthly, the school leads the way in snake-bite research.
Snake-bite is a massively underestimated problem globally. I
was amazed to be told that at least 100,000 deaths per year are
attributable to a condition that often leads to amputation.
Africa is in dire need of anti-venoms, as the major
manufacturer has ceased production. The LTSM is seeking to
develop new products which are multivalent, do not need to be
in cold storage and are therefore affordable to those in urgent
need. Perhaps the Minister will also comment on that.
Sixthly, researchers are undertaking critical work to improve
the use and monitoring of insecticide in India to assist
visceral leishmaniasis elimination programmes. VL is a fatal
disease if untreated, as we have heard, but effective control
of the sand-fly is vital to reduce transmission to some of the
poorest people of India, Nepal, Bangladesh and elsewhere.
Seventhly, LSTM researchers are involved in reducing the burden
of sleeping sickness in several countries, with cases now at
the lowest reported level ever—fewer than 3,000 per year.
Perhaps the Minister can tell us how and when we expect to see
this reach zero.
To conclude, around 1 billion neglected tropical diseases are
treated each year via donated quality drugs to the poorest
people most in need at lowest per capita cost of any health
intervention. This is often called, “the best buy in public
health”, addressing equity, human rights, disability
alleviation, and based on effective partnerships and alliances
from community to global level. It is crucial work and my noble
friend is right to press the Government to build on the
progress made since the 2012 London declaration.
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7.45 pm
-
The
Lord
My Lords, I am grateful to the noble Baroness, Lady Hayman, for
raising this short debate. I rise to highlight the issue of
leprosy, and I am also grateful to the noble Baroness, Lady
Northover, for mentioning that briefly in her contribution.
I also express surprise that the Government seem to be less
committed to supporting research into leprosy or the
eradication of this terrible scourge than they might be. I
suspect that many people think of leprosy purely as a disease
of Bible times, but, according to the World Health
Organization’s 2016 figures, more than 200,000 people are
diagnosed with leprosy every year—10% of them children. There
is an effective cure, but many people go untreated, and around
3 million people live with leprosy-related disability.
Leprosy is endemic in 14 countries today, in South Asia,
Africa, the Pacific and South America. The complications when
it is untreated include severe disfigurement and blindness. But
discrimination against leprosy sufferers—some of it by statute
in places where leprosy is grounds for divorce, confinement or
confiscation of property—makes it a major social problem and a
factor in mental illness. Leprosy was listed in the London
declaration of 2012 and targeted for eradication by 2020. The
Government have made some limited investment in the social
aspects of the disease, but none that I can find in the
scientific research necessary for eradication. I urge the
Minister to include leprosy in the funding priorities for the
NTD programme.
There are, of course, other bodies committed to working in this
area—I support and commend the work of the Leprosy Mission, for
example—but, without government funding, the targets for 2020
are most unlikely to be met.
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7.47 pm
-
(Lab)
My Lords, I congratulate the noble Baroness, Lady Hayman, on
getting this debate before us after a number of tries. I have a
particular interest in this debate as, in East Africa in 1958,
I contracted a nasty form of malaria, which left me for about
10 days totally unaware of what was happening and with the
officer cadet on duty having to observe my state of health
every 15 minutes.
Neglected tropical diseases comprise a diverse group of 17
communicable diseases which prevail in certain conditions in
149 countries and affect more than 1.3 billion people, most of
whom are living in poverty, without sanitation and in contact
with infected animals and livestock, as has already been
mentioned by other noble Lords. Evidence recently published
indicates that there is a heavy geographical overlap between
malaria and the neglected tropical disease known as lymphatic
filariasis, or LF. Both diseases are transmitted by the same
mosquito species in sub-Saharan Africa. LF, also known as
elephantiasis, is treatable and curable, but unfortunately the
treatment does not reverse the effects of the parasitic
infection, which damages the lymph nodes and causes the
swelling of limbs. This can often result in lifelong
disability, which again has already been mentioned.
To date, synergy between malaria and LF control programmes has
been mostly in the form of accidental side-effects of malaria
control. There are worries about insecticide resistance,
showing the need for an efficient, sustainable and well
thought-out approach to controlling multiple diseases. The
benefits from attacking two diseases with the same
interventions should be exploited to a greater extent in
elimination programmes. Like others, I would be interested to
learn what measures DfID will take to ensure integration
between malaria and NTD control programmes that use similar
interventions. This needs clarification.
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7.50 pm
-
(CB)
My Lords, I thank my noble friend Lady Hayman for all she does
on this subject. One aim of the declaration is to enhance
collaboration and co-ordination on neglected tropical diseases
at national and international levels, through public and
private multilateral organisations, in order to work more
efficiently and effectively together. If so many countries were
not ravaged by wars, which produces so many refugees and
poverty, there might not be so many health problems.
In 2015 alone, pharmaceutical companies donated an estimated
2.4 billion tablets—enough for 1.5 billion treatments—to
prevent and treat NTDs. There is now a global problem with the
growing resistance to antibiotics, especially in poor
countries, which need more education. I had a very good friend,
a Holy Rosary nun, who was a health visitor; she worked in
Ethiopia and the Cameroons and told me that it is no good
bringing babies into this world if they are to die from
disease from contaminated water. She became an expert in
sinking wells and providing sanitation.
It is encouraging to hear that South Sudan is soon to be
certified free of guinea worm disease, which thrives in poor
areas where there is little sanitation and people bathe in and
drink stagnant water. I have visited a leprosy colony on one of
the islands, and two babies died in half an hour from malaria
when I visited a ward in Mombasa where a friend worked. These
people working with NTDs are the unsung heroes. There is much
to do, and they need concerted support from Governments and
anyone involved.
A neglected disease that is a global danger is tuberculosis,
which has not had new drugs for a long time. In 2013-15, there
were an estimated 480,000 new cases of multi-drug resistant TB
in the world. There are substantial differences in the
frequency of MDR-TB among countries. In some cases, more severe
drug resistance can develop; extensively drug-resistant TB is a
more serious form of MDR-TB, caused by bacteria that do not
respond to the most effective second line anti-TB drugs, often
leaving patients without any further treatment options.
Worldwide, only 52% of MDR-TB patients and 28% of XDR-TB
patients are successfully treated. Infections that are
resistant are much more expensive and take much longer to
treat. It is vital that global leadership be provided on
matters critical to TB. Ending the TB epidemic by 2030 is among
the health targets of the newly adopted sustainable development
goals but, unless there is less poverty in the world, that will
be difficult to achieve. Also, resistance to a form of HIV
treatment, antiretroviral therapy, is increasing around the
world. The co-infection of HIV and TB, which are resistant to
treatment, is very serious. So many people have been working on
vaccines. Like my noble friend , I ask the Minister what
hope there is of vaccines for TB, HIV and other diseases.
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7.55 pm
-
(Lab)
My Lords, I am grateful to the noble Baroness, Lady Hayman, for
her tenacity in keeping this issue high on the agenda and for
giving the House this opportunity to consider the progress
being made in combating neglected tropical diseases. It is
certainly worth celebrating. In January, the WHO published an
impressive catalogue of progress made in the prevention,
control and elimination of NTDs such as guinea worm disease,
sleeping sickness, river blindness and trachoma. The
collaboration between the WHO and the global NTD community has
clearly had a tremendous impact, but the task remains enormous
and we have only four years to meet the WHO’s road map targets.
Although we are reaching more people than ever, we need to
accelerate to stay on track. Last year’s progress report on the
London declaration points out that the road map’s drug donation
programme alone is not enough. The coverage and reach of
programmes must increase for all these diseases.
I have two questions for the Minister. First, the UK Coalition
against Neglected Tropical Diseases said that there must be
national government leadership to integrate programmes with
other health, water, sanitation and education
initiatives. DfID has promised to help countries build
“resilient, responsive health systems”. What priority are the
Government giving to supporting health systems in the countries
dealing with NTDs? What practical steps are we taking in the UK
to ensure that donated treatments, surgical interventions and
hygiene promotions are delivered to where they are so
desperately needed?
My second point is about research. Even as some NTDs are
eliminated, others will take their place. Mycetoma joined the
list of poverty-related diseases last year. It is just one of
the many tropical, poverty-related diseases affecting the same
populations and sharing many features with NTDs. Advancing
research and development is essential in tackling the next bend
in the road map. Priorities must be debated, but the need for
more research and funding remains constant. Globally, in recent
years, 60% of clinical research on poverty-related diseases,
including NTDs, has been conducted in collaboration with
European member countries of the European and Developing
Countries Clinical Trials Partnership. Historically, the UK and
France have been part of these collaborations, due to our
former colonial ties. Several other European countries are now
increasing their research interests in PRDs and collaborating
both with each other and sub-Saharan African countries.
Programmes such as EDCPT, promoting cross-national research,
make this possible.
To make progress against these hideous diseases and future
threats to global health, existing and new scientific
partnerships must be able to flourish. It is so important that
the UK collaborates with our European counterparts. Among the
many uncertainties that lie ahead for UK involvement in
European research programmes, has this area been highlighted in
the Prime Minister’s agenda for Brexit discussions? Can the
Minister reassure us that the UK’s research expertise and
commitment to the London declaration goals will continue to
play their part as we reach 2020?
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7.58 pm
-
(LD)
My Lords, I add my thanks to those of other noble Lords to the
noble Baroness, Lady Hayman, for finally securing this debate.
It comes at an opportune moment for me as just last week I
visited the headquarters of global health institutions working
in the fight against malaria, HIV/AIDS and TB. While none of
those are, technically, neglected tropical diseases, there are
nevertheless many lessons that we can learn from the global
fight against these big three killer diseases. I will pick out
just three from among the many challenges.
The first is communicating key messages to effective
communities, a point made by the right reverend Prelate the
. The other two
points were picked up by other noble Lords. The second issue
concerns the in-country training of medical practitioners to
administer drugs effectively. The noble Baronesses, Lady
Chalker and Lady Barker, spoke forcefully on that. Thirdly, we
need to recognise that prevention and long-term sustainable
control are key to success in tackling NTDs. My noble friend
Lady Northover made the point that no resurgence is a key goal
if we are to be successful.
I focus on TB as an example. That disease was the scourge of
Victorian times in the UK. However, with improved public
health, less overcrowding and better nutrition we were able to
control it effectively—crucially, without the use of drugs,
although, of course, antibiotics helped with the final push.
That is the key message I want to get across.
Prevention has to be the first line of defence. Effective
prevention needs an integrated holistic approach, starting with
disease surveillance to identify hotspots, to enable an
effective targeted response. In hotspots, to be effective, the
mass administration of drugs must be followed by WASH
initiatives—again, the noble Baroness, Lady Chalker, spoke
about this—that is, water, sanitation and hygiene initiatives,
coupled with vector control and education about local factors
that perpetuate the disease. Overarching all this is the need
to tackle gender and child inequalities, ensuring that women
and children are not left behind, because all too often they
are left untreated. They are inadvertently most active in
infecting others—women through their role as primary carers and
children as they play together.
Why have these diseases been neglected and why are they called
neglected tropical diseases? The reason lies in the fact that
in general they tend not to be direct killers but instead leave
people with disfiguring disabilities, which impact on their
schooling, work and economic independence. In 2010, the Global
Burden of Disease Study, the precursor to the 2012 London
declaration, confirmed that collectively they rank as the most
common affliction of the world’s poor, blighting the lives and
livelihoods of more than a billion people. If developing
countries are to pull themselves out of poverty, these diseases
must be eradicated. Eradication, however, will need increased
focus on research and development. The Ebola outbreaks in 2014
and the 2015-16 Zika epidemics in the western hemisphere
highlighted an almost empty pipeline of new NTD products. I
would be very interested to hear the Minister’s response to the
Ross fund’s work with respect to NTDs.
The 2012 London declaration will come to an end in 2020. Given
that NTDs are an indicator for a number of SDGs, in particular
SDGs 1, 3, 6, 10 and 11—I might say what they are later if I
have time—what commitment or strategy is planned for post-2020?
Could international diplomatic pressure be brought to bear to
expand commitment to the London declaration? Lastly, could the
Minister and his colleagues in government give some thought to
placing NTDs on the G20 agenda given that most NTDs and other
poverty-related diseases are also found among the poor in
developed countries?
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8.04 pm
-
(Lab)
My Lords, the first time that I participated in a debate on
this subject was on 30 January 2013. Like today, that first
anniversary debate of the London declaration was initiated by
the noble Baroness, Lady Hayman. I, too, thank her for once
again ensuring that this vitally important subject is brought
to public attention.
NTDs remain the most common infections among the world’s
poorest communities and affect, as we have heard, close to one
in six of the global population. As the WHO NTD head put
it,
“the combination of the NTD Roadmap and the London Declaration
has been a game-changer”.
However, he reminded us:
“The next four years will be crucial in achieving the 2020
targets as we continue to work to integrate interventions into
the broader health system and development agenda so that no one
is left behind”.
As the Minister pointed out, while NTDs are not always fatal,
their effect on individuals and communities can be devastating.
The brunt is often felt by women and children, which acts as a
serious impediment to economic development in many countries.
On that point, what progress has the department made in
measuring the impact of its NTD funding on women and girls, who
disproportionality suffer from NTDs and the stigma attached to
them?
As the noble Baroness, Lady Masham, pointed out, nor must we
forget that individuals with NTDs are at higher risk of
contracting, or not recovering from, HIV/AIDS, malaria and TB,
because they weaken the immune system. On that point, I welcome
the UK replenishment of the Global Fund, but can the Minister
tell us what assessment has been made of the value of
strengthening AIDS, TB and malaria investments, with the
collaboration of national NTD programmes?
Reference has been made in the debate to the recognition given
in the SDGs. Goal 3—healthy lives—has given the fight against
NTDs new momentum, which is a positive thing. The noble
Baroness, Lady Northover, referred to the £1 billion Ross fund
and the Gates Foundation, from which £200 million has been
specifically allocated to NTDs. Like the noble Baroness, I
would like to understand what progress has been made since that
announcement in distributing work such as funding new research
areas, vaccines and drugs.
One of the things every noble Lord mentioned is that the EU is
one of the top global funders of NTD research, and the UK has
an exceptionally strong track record in leading joint European
research initiatives. Will the Minister say what assessment
DfID has made of the impact of losing access to this vital
source of research income following Brexit?
To meet the 2020 targets, 75% coverage would have had to be
reached by the end of 2015. Although data for 2015 are not yet
fully available, the target is unlikely to have been met. What
does the Minister identify as the key barriers to progress and
finding solutions?
At the beginning of the debate the noble Baroness mentioned the
forthcoming WHO NTD summit. I declare an interest here; I am a
member of the APPG on NTDs, and I signed a letter specifically
to the Secretary of State asking her to attend the summit, not
only to demonstrate the UK’s role in the fight against NTDs but
to use the opportunity to encourage others to meet our level of
commitment.
-
8.08 pm
-
The
Minister of State, Department for International Development
(Lord Bates) (Con)
My Lords, this has been an excellent debate, with 14
contributions. At the last minute, those were allowed to
increase from two to five minutes; I am reliably informed by
the Whips that my contribution cannot increase in the same
proportion, and therefore I am limited to 12 minutes.
There are a number of important issues to cover, but if I can,
I will go through this at some pace.
Like the noble Lord, Lord Collins, I can trace the antecedents
of raising these issues back a number of years—not quite back
to 2013, but to 6 February 2014, when I responded from the
Front Bench to the debate in the name of the noble Baroness,
Lady Hayman, on this issue. The noble Lord, Rea, is right to
say that the noble Baroness, Lady Hayman, deserves a great
tribute for ensuring that neglected tropical diseases are not
neglected in your Lordships’ House. We thank her for that and
commend the work of the very active APPG on Malaria and NTDs,
of which she is vice-chair.
NTDs affect 1.6 billion of the world’s poorest people, as the
noble Baronesses, Lady Hayman and Lady Northover, reminded us,
and they result in disability and have a tremendous impact on
people. They cause a great economic burden for people, as the
noble Baroness, Lady Sheehan, reminded us, as well as creating
stigma and hardship, which were also mentioned.
Reference was made by the noble Baronesses, Lady Hayman and
Lady Warwick, and the right reverend Prelate the to the progress
that has been made. The number of people at risk from NTDs fell
from 2 billion in 2010 to 1.6 billion in 2015. In the 1950s,
before programmes started, one in four people over the age of
40 went blind from river blindness in some of the highest
endemic areas. Blindness caused in this way has now been
virtually eradicated.
The noble Baroness, Lady Northover, who served as a Minister in
the department during the coalition Government, reminded us of
the visit to the House of Lords by President Carter, who spoke
in the Robing Room—an event that I, too, attended. He spoke
about guinea worm eradication. Only three countries reported a
total of 25 cases of guinea worm disease in 2016—down from 3
million cases a year when the programme started in 1986. This
is well on the way towards the target that has been set and
shows what can be achieved in this area.
A number of noble Lords referred to the high-profile London
declaration event in 2012, when the UK committed an additional
£195 million to tackle these diseases. The UK, along with the
US, is a world leader on NTDs. We are meeting our commitments.
The UK supports high-performing programmes tackling a range of
NTDs, and these programmes are delivering results. DfID
programmes delivered more than 136 million treatments for NTDs
in 2016. We have supported over 60,000 surgeries to prevent
blindness due to trachoma, and over half a million people have
been screened for kala-azar, a disease that is invariably fatal
if not treated.
Much of our support for the implementation of NTD programmes is
through our world-class British institutions. The noble Lords,
Lord Stone and Lord Alton, referred to many of these,
particularly the Liverpool School of Tropical Medicine, and I
pay tribute to the expertise that is to be found there. I am
delighted to accept the invitation from the noble Lord, Lord
Stone, to meet the SCI group at Imperial and would be very
interested to find out more about its work.
Many noble Lords, including the noble Baronesses, Lady Warwick
and Lady Barker, referred to the importance of research. This
is at the heart of what we do. DfID is committed to
spending approximately 3% of its annual budget on research, and
of course that also impacts on the NTD process. We also support
research into new drugs, diagnostics and better vector control,
as well as operational research into the best ways to implement
programmes. I very much recognise the point made on vectors by
the noble Baroness, Lady Barker, as I do the very important
point about prevention made by the noble Baroness, Lady
Sheehan. The UK Government have a strong track record of
supporting successful product development research through
public-private product development partnerships, such as the
Drugs for Neglected Diseases initiative and the Foundation for
Innovative New Diagnostics.
Tackling NTDs is highly cost effective, as the noble Lord, Lord
Stone, reminded us. The average cost of treating one person for
a range of commonly occurring NTDs is about 50 US cents. The
noble Lord, Lord Alton, described it as a “best buy”, which it
very much is. NTDs are an excellent example of a unique
public-private partnership: most of the medicines are donated
by pharmaceutical companies, which have pledged drugs valued at
$17 billion between 2014 and 2020—a point made by the noble
Baroness, Lady Masham. Without this very generous support there
would be far less progress and considerably higher costs.
A number of noble Lords referred to the London declaration. I
am pleased to report that there will be a very high level of
representation at the event taking place on 19 April. I do not
in any way want to undermine the importance of NTDs, but when
we discussed this as a ministerial team, we realised that so
many important meetings are taking place this very month: this
week on Syria, and in a couple of weeks’ time on Yemen and the
wider humanitarian crisis in Africa. However, I will certainly
convey to the department and the Secretary of State the
importance that your Lordships attach to this initiative and
the gathering that will occur on 19 April.
The noble Baroness, Lady Barker, referred to the
interconnectivity of scientific research with the attempts we
are making. That is a point I recall being made by David
Nabarro, who is a very strong candidate to be the next
director-general of the World Health Organization.
The noble Lord, , the noble Baroness, Lady
Sheehan, and my noble friend Lady Chalker raised the importance
of WASH. This very much links to what the noble Baroness, Lady
Sheehan, said about prevention. WASH is the best form of
prevention that we know for NTDs. There is strong
cross-sectoral working on this, in particular on increasing
access to water and sanitation. My noble friend asked what
commitment we have made in this area. We have a very strong
manifesto commitment to increase clean water access to 60
million people during the lifetime of this Parliament, which is
sustainable development goal 6. That is a major programme which
we are working on.
My noble friend also raised the importance of engineers. I am
delighted that through the Commonwealth Scholarship Commission
we are giving access to many students from sub-Saharan Africa
to come and study at our world-class universities and take that
expertise back with them.
The noble Viscount, , raised the importance of
co-infections. He particularly focused on malaria. The noble
Baroness, Lady Masham, referred to TB, and the noble Lord, Lord
Collins, referred to collaboration on HIV-TB. We fully
understand and stress that these are all very important
areas.
A key element is the availability of good quality data and the
disaggregation of those data in connection with the SDGs. We
want to ensure that programmes collect and analyse data on how
we are making progress against targets and disaggregate those
data to ensure that we are reaching girls, women and other
vulnerable groups—an issue that the noble Lord, Lord Collins,
asked us to work on.
The right reverend Prelate the raised the
strong partnerships that we have with faith groups. Through our
faith partnerships we work very closely with those groups in a
number of parts of the world. He talked about Sierra Leone and,
in the past week, I have been looking at what the Anglican
community is doing in the terrible situation in South Sudan,
where the conflict is making the treatment of neglected
tropical diseases and the effects of famine incredibly
difficult. That is a real manmade tragedy.
We are making efforts to work with other donors, in particular
USAID. I take the important points that were made about the
USA, with which we are working very closely. The draft budget
was prepared by the President and will be turned into a formal
budget to be announced in May. It then, of course, has to work
its way through Congress. We are looking very closely at his
nominee for USAID. The United States, through its private
foundations and as a Government, has played a critical role in
this and I very much hope we will be able to work with it in
the future in delivering this absolute best-buy for development
investment.
Our efforts to map the NTDs has helped to determine the
geographical distribution of diseases, a point made by the
noble Lord, Lord Alton, so that we can target resources where
they are most needed. We are now expanding access to treatment.
As countries are now able to stop mass drug administration for
some diseases, it will be critical to carry out the
surveillance necessary to ascertain progress and to ensure that
low infection levels are sustained. However, we must not forget
that while some countries are reaching that stage, others are
only just starting in their efforts to tackle NTDs.
On this point I echo the urging of the noble Baroness, Lady
Hayman, in introducing the debate, that there is no question of
us regarding this as “steady as she goes” or, in the phrase of
the noble Baroness, Lady Barker, taking our foot off the pedal.
This is absolutely essential to the sustainable development
goals. It is a treatment programme that works and we want it to
continue.
The noble Lord, , the right reverend Prelate
the , and the
noble Baronesses, Lady Northover and Lady Masham, asked what
progress was being made on leprosy. According to the World
Health Organization, there were over 210,000 new cases of
leprosy reported in 2015. We need to increase progress. In
2016, the World Health Organization launched a global leprosy
strategy for 2016-20 and UK aid match is supporting work
to improve the lives of people affected by leprosy and other
NTDs in Mozambique and other countries.
At the conclusion of my remarks I come back to that very
important summit. While the UK across a number of levels—from
our great research base to the work that many people have been
doing through medical science in this area—is advancing the
cause and has made great progress, it is vitally important that
we use the occasion and the platform of the World Health
Organization joint summit on NTDs on 19 April to ensure that
other donors come forward and meet their responsibilities
towards eradicating these diseases and meeting the sustainable
development goals in these areas.
As to the consequential nature of the SDGs, I have been ticking
them off and I think we have covered all 17 of the goals, from
partnerships, to conflict in number 16, to eradicating poverty
in number 1, to education in number 4, to general quality in
number 5. It is a real point of endorsement as to how the SDGs
are rightly a lens through which we judge our progress on
this.
I again thank all noble Lords who have contributed to the
debate. I shall reflect further on it and feed the messages
back to my colleagues at the department as we move forward.
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