Tropical Diseases

Jeremy Lefroy Excerpts

Tuesday 27th October 2015 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

I beg to move,

That this House has considered the work of the UK in tackling malaria and neglected tropical diseases.

It is a pleasure to serve under your chairmanship, Mr Davies. I refer Members to my declarations in the Register of Members’ Financial Interests. One thing that is not there that I need to declare is that I have been invited to become a trustee of the Liverpool School of Tropical Medicine. That has not yet been ratified, so will not be in the register.

I have secured this debate at a critical time in tackling malaria and neglected tropical diseases, which affect up to 1.4 billion people across the world. Just to explain, neglected tropical diseases include leprosy, lymphatic filariasis, schistosomiasis, soil-transmitted helminths—or worms—leishmaniasis, human African trypanosomiasis and Chagas disease. All those diseases are preventable and treatable using existing treatments, yet they continue to cause death and disability in a way that would simply not be acceptable were they endemic in the United Kingdom. This debate is particularly important as the 2015 Nobel prize in physiology or medicine was awarded this month for work on malaria and neglected tropical diseases. Professor Youyou Tu was awarded the prize for the discovery of artemisinin, which I will come on to later, and Doctor William C. Campbell of Ireland and the USA and Professor Satoshi Omura of Japan were awarded the prize for their discovery of avermectin, which is effective against river blindness, lymphatic filariasis and a growing number of other parasitic diseases.

Over the past decade and a half, the UK has taken a prominent role in the fight against malaria and neglected tropical diseases, and I will set out the great progress made and the challenges that face us if we are to see their elimination. I ask the Minister to consider the future of the UK’s programmes in both areas.

Twenty years ago, we were losing the fight against malaria—I declare an interest, having had it at least four times—and there was widespread resistance to the main drugs used to cure it: chloroquine and sulfadoxine-pyrimethamine. The international will to tackle malaria seemed absent. All of that changed with the adoption of the millennium development goals. MDG 6 targeted malaria, while MDG 4 focused on child mortality. We have to remember that children are the ones who suffer most from malaria, as more children die from malaria than adults. MDG 5 was on maternal health, and pregnant women are particularly at risk of catching and suffering from malaria. The fight against malaria has resulted in a 58% decline between 2000 and 2015 in deaths from malaria globally. The World Health Organisation estimates that that means that 6.2 million deaths from malaria have been averted, primarily among children under five in sub-Saharan Africa.

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

I congratulate the hon. Gentleman on securing this debate. Does he agree that while significant progress has been made, the fact that 200 million new cases of malaria have been reported this year alone calls into question our legitimate and worthwhile attempt to try to eliminate malaria in the next 15 years?

[Jeremy Lefroy]

I entirely agree with the hon. Gentleman. Between 450,000 and 500,000 people—they are mainly children—are dying unnecessarily every year from the disease. How did the tremendous progress—I stress that huge progress has indeed been made—happen? Principally, reliable long-term funding enabled the development and implementation of various interventions, including prevention through insecticide-treated bed nets and the development of vaccines, and diagnosis through the rapid diagnostic tests that enable people, particularly children, to be diagnosed with malaria in the village, rather than having to come to a laboratory in a town when the malaria may be severe.

[Graham Stringer (Blackley and Broughton) (Lab)]

The hon. Gentleman makes a good point about the progress made and the different ways of making that progress. Does he agree that the earlier regression was partly to do with the mistaken banning of DDT in Africa and elsewhere?

[Jeremy Lefroy]

I agree with the hon. Gentleman. DDT was banned for clear, understandable reasons, but it had some severe consequences that resulted in malaria taking a grip in areas where it had almost been eliminated. Even today, when DDT is being used for indoor residual spraying, we are seeing its effectiveness when topically applied and carefully used.

There have been some tremendous advances in cures, notably in the artemisinin combination therapies, which I will come to and which are the subject, in part, of this year’s Nobel prize in physiology or medicine. There has also been the welcome development of new medicines. One of them is coming out of Dundee University, and I am sure other Members will wish to discuss that.

The UK has played a major role in providing the long-term funding. It was less than £100 million a year in 2000, but it now stands at £500 million. That is the direct result of the Chancellor’s pledge, while shadow Chancellor in 2007, to increase funding to tackle malaria to £500 million. It is not simply funding that is essential, however; we need the institutions through which the work can be done. It is pointless for several different nations to all work on their own programmes independently. Overseas development assistance is far too precious a commodity for that, so co-operation was essential from the beginning.

I remember how important the first artemisinin-based cures for malaria were when they came out in the mid- 1990s. At last, there was a cure that was very effective and had limited side effects, unlike chloroquine, which was increasingly ineffective, and Lariam, which was effective, but which, as I found out to my cost, had potentially severe side-effects. At between $10 and $15 a dose, the drug was unaffordable to almost all those who needed it. It needed to be more like $1 a dose at the most.

The Medicines for Malaria Venture was established in 1999 as a product development partnership, with considerable UK support from the Labour Government right from the beginning. Its aim was to take up promising new projects from pharmaceutical companies and help them to fruition, so that effective drugs would be available at a price affordable to the poorest and to developing countries’ health systems. The founders of MMV recognised that developing medicines for malaria was not commercially attractive to companies, as those who most needed the drugs were least able to pay prices that covered the costs of development. There is a big lesson there for our work on tackling antimicrobial resistance. Indeed, I believe that Professor Dame Sally Davies, the chief medical officer, refers to the example of MMV when talking in her book, “The Drugs Don’t Work”, about what we need to do to tackle antimicrobial resistance.

By bringing together Governments including Switzerland, the UK and the US, private foundations such as the Gates Foundation and the Wellcome Trust, pharmaceutical companies, critically including small companies and not just the majors, and researchers, MMV was able to do in co-operation what had not been possible in isolation. Two drugs that have come from that work are: Coartem Dispersible, which is for children and has had more than 250 million doses produced and distributed; and the artesunate injection, which is very effective against severe malaria—possibly more effective than quinine—and has had 35 million doses produced.

A second, larger example of co-operation was the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was also established in the time of the Labour Government in 2002 to concentrate efforts to fight those diseases. The UK, along with the US, France and the Bill & Melinda Gates Foundation, was a prominent supporter of the fund right from its creation. Indeed, the first executive director was a Briton, Dr—now Sir—Richard Feachem. The fund has been responsible for supporting programmes in malaria-endemic countries, including programmes on the mass distribution of insecticide-treated bed nets and the introduction of rapid diagnostic tests.

A third example is the Malaria Vaccine Initiative of PATH, which supports the development of promising malaria vaccines. The most advanced is GlaxoSmithKline’s vaccine, which was developed in Belgium and is called RTS,S. It recently received approval from the European Medicines Agency and will, I hope, become available in the not too distant future.

The progress made in the past 15 years has in large part been down to political will through the millennium development goals and the work of the United Nations and the Governments of the United Kingdom, the United States and other countries increasing long-term funding, with the UK taking a lead alongside the US and the Bill & Melinda Gates Foundation.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

I congratulate my hon. Friend on securing this debate. Does he agree that the tenacity of malaria means that much more money will have to be spent to beat it? The Gates Foundation estimated that it could cost between $90 billion and $120 billion up to 2020 to deal with it. Does he agree that we must not take our foot off the pedal?

--- Later in debate ---

[Jeremy Lefroy]

My hon. Friend is exactly right, and we have seen the consequences of taking our foot off the pedal in the past. In Zanzibar, malaria was almost eliminated in the 1950s, but it came back with a vengeance. There was another programme in the 1980s, and the foot was taken off the pedal and it came back with a vengeance. The same has happened in Sudan and many other places, so we must deal with that. I think the figures she quoted are accurate, but if we manage to tackle malaria and get to virtual elimination, it will add more than $4 trillion dollars to world GDP, so it is a hugely important investment to make.

Improving health systems is another reason why we have seen progress in many developing countries, with increasing local funding, although some countries really need to step up to their pledges—for instance, the Abuja declaration of committing 15% of budgets to health, which only a few sub-Saharan countries do at the moment, along with unprecedented co-operation, which I have described. We will need all these and more as we face the challenge of the next 15 years, which is to meet the WHO’s global technical strategy for malaria 2016 to 2030.

On top of that, we face two forms of serious resistance: by the malaria parasite to artemisinin-based combination therapies in the Mekong region in south-east Asia, from where resistance to both chloroquine and sulfadoxine-pyrimethamine started and spread to sub-Saharan Africa, which is why it is vital to get on top of this; and by mosquitoes to the insecticides on bed nets, which are becoming resistant to pyrethroids. We also see serious outbreaks where bed net distribution has failed and health systems are weak. I believe my hon. Friend the Member for Mid Derbyshire (Pauline Latham) is going to describe one such instance later in this debate.

The UK is heavily involved in work to counter both those threats, through the Department for International Development’s work and the global fund supported by DFID in Myanmar, working alongside the Government there, and through the work of the Innovative Vector Control Consortium, based in the Liverpool school, in searching for and testing new insecticides for bed nets. The UK has therefore been at the forefront in so many different ways, whether through funding or research—from the London school, the Liverpool school, Dundee, York, Imperial, Keele and other universities, or from business, NGOs, or, above all, people. There are so many I would like to mention, but I will not because of time constraints, but the UK has fantastic scientists in this field at all levels.

Given the effectiveness of UK support for tackling malaria over the last 15 years, will the Minister undertake to do his utmost to maintain that for the future? I am asking the UK not to increase the level of funding, but to maintain current levels. Reaching £500 million a year is a great achievement and others need to come forward to support the UK in this, not least the countries in which malaria is endemic.

The WHO’s roll back malaria framework states that malaria interventions are very good value for money:

“Immunisation is the only public health intervention that has been shown to be more effective than malaria interventions. Beyond the financial return, investments in fighting malaria will have enormous positive effects on agriculture, education and women’s empowerment. They will also contribute significantly to reductions in poverty and the alleviation of inequality.”

Almost exactly the same can be said about the work on neglected tropical diseases. They affect 1.4 billion people—possibly an underestimate—bringing disability and sometimes death. They have a devastating economic impact, yet treating them is cheap and entirely possible. Co-operation plays a vital role, and host Governments have a vital role to play. Many of these diseases can be treated in parallel through local health systems. It makes sense to work together rather than in silos. We saw that when we visited the NTD control programme in Mkuranga district in Tanzania—I went with two other hon. Members in the all-party group on malaria and neglected tropical diseases—where they were tackling lymphatic filariasis, schistosomiasis, soil-transmitted helminth and trachoma all together. Universities also have a vital role to play. In the case of Mkuranga, an important partner was the schistosomiasis control initiative, based in the UK’s Imperial College London. Other universities are very important partners.

In the private sector, we have seen extraordinarily generous donations of drugs. I will list them because it is important that hon. Members understand the scale. Merck and Co. will donate Mectizan—ivermectin—for onchocerciasis and lymphatic filariasis in Africa for as long as it is needed, with no limit. GSK has already donated nearly 2 billion tablets of albendazole for lymphatic filariasis and will continue until elimination, and has also donated 1 billion per annum to de-worm school-aged children. Johnson & Johnson has donated 200 million tablets of mebendazole a year. Pfizer donated 70 million doses of azithromycin for trachoma in 2012 alone. Novartis has donated drugs for leprosy. Eisai, the Japanese company, has donated 2 billion tablets of Diethylcarbamazine for lymphatic filariasis, and E. Merck has donated 20 million doses of praziquantel a year, going up to 250 million tablets a year from 2016 for schistosomiasis. These are huge figures that will substantially reduce the costs of treatment in countries where those diseases are endemic.

There are also product development partnerships. As well as the Medicines for Malaria Venture and the Malaria Vaccine Initiative, we have the Drugs for Neglected Diseases initiative, which focuses on developing new treatments for the most neglected patients suffering from diseases such as human Africa trypanosomiasis, Chagas disease and lymphatic filariasis, as well as paediatric HIV. Again, the UK has taken a leading role. On top of the £50 million committed by the previous Labour Government, a further £195 million was pledged by the coalition. The UK is also the second largest funder of the Drugs for Neglected Diseases initiative, with £64 million donated, second to Gates, who has given $126 million. The one other donor with more than €20 million of donations is Médecins sans Frontières, which has donated €66 million.

The UK has also played a leading role by hosting the London conference—a big conference that set the path for the next few years; we need to find out where we have got to with that—and the declaration on neglected tropical diseases, an important declaration that I want to quote from:

“Inspired by the World Health Organization’s 2020 Roadmap on NTDs, we believe there is a tremendous opportunity to control or eliminate at least 10 of these devastating diseases by the end of the decade”—

that is just over four years away.

“But no one company, organization or government can do it alone. With the right commitment, coordination and collaboration, the public and private sectors will work together to enable the more than a billion people suffering from NTDs to lead healthier and more productive lives—helping the world's poorest build self-sufficiency.”

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving me a chance to speak in this debate. Obviously the issue is very important. The number of Members present is an indication of that. I have not yet heard—although I am sure he is coming to it—about the vast contributions that faith groups, churches and missionaries make throughout the world to eliminate poverty and help people to work their farms and so on. Almost every church in my constituency of Strangford has a project to give help directly to an area in Africa, the middle east and the far east. Does he recognise the good work that those churches and faith groups do?

[Jeremy Lefroy]

I do indeed. I am most grateful to the hon. Gentleman for that intervention. I recognise the huge amount of work done by faith groups and missions around the world. They often run remote hospitals, which even the state health system cannot afford to maintain. I have seen the work that they do. Indeed, my wife ran a public health education programme for 11 years in Tanzania and saw at first hand the work that was done when she worked for the Lutheran Church there.

I will not go through the London declaration in detail, because I want other hon. Members to speak, but I will quote the final words:

“We believe that, working together, we can meet our goals by 2020 and chart a new course toward health and sustainability among the world’s poorest communities to a stronger, healthier future.”

Real progress has been made in the past few years. To take one example of many highlighted by the Overseas Development Institute last year, Sierra Leone made great strides in preventing four of the five diseases that make up 90% of the world’s NTD burden: onchocerciasis, lymphatic filariasis, soil-transmitted helminth and schistosomiasis. In particular, on schistosomiasis, which can lead to death through liver disease and bladder cancer, 562,000 people in Sierra Leone received preventative treatment in 2009. By 2012, that figure had reached 1.4 million, which was 99% of those needing treatment. We have heard of the tragic trials of Sierra Leone in the past year and a half, but it is important that we also recognise the huge amount of work that Sierra Leoneans have done to treat many of these other diseases.

[Bob Stewart (Beckenham) (Con)]

When my hon. Friend refers to elimination, does he mean the elimination of a disease in human beings or the elimination of the scourge of these diseases from the face of the earth? Have I got that wrong, or is it a combination of the two?

[Jeremy Lefroy]

My hon. Friend is absolutely right to raise that distinction. The recent leader article on malaria in The Economist discussed eradication, which is what I believe we have to go for. There are slightly different meanings to elimination and eradication, but whatever it is, we have to aim for what we have seen with smallpox and are approaching with polio, with no one getting these diseases anymore.

[Bob Stewart]

I am sorry, but my question was really about the distinction between getting rid of a disease from the face of the earth, so that it is never there again and human beings cannot catch it, and dealing with a disease in a human being.

[Jeremy Lefroy]

Ultimately it is about making sure that human beings cannot catch a disease. Whether we can get rid of a disease from the face of the earth is another matter, because they have a tendency to come back. We have to ensure that we have the tools in place so that if a disease does return when we think it is eliminated, we can deal with it.

I have three questions for the Minister. What progress has been made in investing the additional £195 million committed by the coalition Government to work on neglected tropical diseases? Given the tremendous cost-effectiveness of interventions—we are talking about tackling diseases that affect 1.4 billion people by committing over four years the cost of running an average district general hospital in the UK for just one year—will the Minister look carefully at increasing the UK’s support for NTD work, especially drug discovery and support for programmes that strengthen health systems as they deliver prevention, diagnosis and cure? Finally, will he update us on the progress made on implementing the London declaration? We hosted the conference, so it is important that we take the lead in ensuring that the declaration comes to fruition.

Over the past 15 years great progress has been made on malaria and NTDs. The UK has been a vital part of that work, not just via funding from DFID, but through our scientists, universities, NGOs and voluntary organisations such as the Rotary Foundation, which has done tremendous work on malaria on top of its work on polio, and most certainly through our private pharmaceutical sector, whether in its commitment to research and development in unfashionable areas or in its direct donations of billions of doses of essential drugs. Nevertheless, the job is only half done for malaria, and even less so for NTDs. If the UK remains committed over the coming 15 years, I remain hopeful that we can make substantial progress. I ask the Minister to make that commitment. It is not about specific sums of money, but about an overall approach that recognises how much difference this work makes to billions of people and what an effective use of UK taxpayers’ money it is.

Let me conclude by quoting the leader article in The Economist from 10 October:

“Throughout history, humans and disease have waged a deadly and never-ending war. Today the casualties are chiefly the world’s poorest people. But victory against some of the worst killers is at last within grasp. Seize it.”

[Several hon. Members rose—]