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Malaria and Neglected Tropical Diseases

Volume 823: debated on Thursday 7 July 2022

Question for Short Debate

Asked by

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

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

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

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

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

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

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

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

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

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

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

and that they want women and children to have

“the freedom they need to succeed”.

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

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

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

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

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

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

My Lords, I thank the noble Lord, Lord Trees, for obtaining this important debate on a subject that really needs to be before your Lordships’ House more frequently and deserves a much higher profile. This is a topic of some interest to me because one of my colleagues, the Bishop of Hertford—last week, he became the Bishop of Bath and Wells—is a professional epidemiologist. I hope that he will be in this House in a few years, because he has spent a lot of his time—even though he has been a bishop—in Africa working on a variety of things such as malaria and Ebola. Thanks to him, I have become increasingly aware of just how important this area is and, as we come out of Covid, how vital it is that we grow human capital in these regions.

It was said to me that rather than calling them “neglected tropical diseases” it would be more apt to call them “tropical diseases of neglected peoples”, given the global economic status of their victims. While I am conscious that malaria is specifically referenced in this debate and that NTDs include a host of serious bacterial and viral infections, I want to focus my brief comments on the parasitical infections within the NTD umbrella, as these are really diseases of poverty. Parasitical infections such as worms are in many cases caught because of the social context in which people are living—poor sanitary conditions, lack of clean water and the inability to store or consume food safely. It is therefore no surprise that deworming programmes are a huge part of the global effort to combat NTDs.

Typically, the victims are school-age children, which is why the standard way of delivering these treatments is very often through schools. This is why the millennium development goals and the specific provision to achieve universal primary education are so crucial, because, as well as giving education, these are the places where parasitical infections can be treated. However, as we experienced during the Covid lockdowns and the gradual emergence from them, children in areas of the world where NTDs are prevalent were unable to attend their schools and were locked out of the treatment that they desperately needed. This created a backlog in the delivery of these treatments. It is important to emphasise that the delivery systems and infrastructure are equally important as any medication if we are going to sort this out. To be fair to some of our pharmaceutical companies, very often that medication is donated.

It is deeply regretful, therefore, to see the very sizeable cuts in foreign aid. Parents in this country would be rightly outraged if children were being infected with parasites which could be treated for as little as 50p—I think the noble Lord, Lord Trees, said 50 cents, but I thought it was 50p. The currency does not matter; it is pennies we are talking about. This is a minor amount of money yet, in some respects, by reducing our foreign aid funding, we are allowing these diseases to occur in the developing world. The real danger, as people face starvation, shortages and famine—and these NTDs—is that we potentially face mass migrations. It really makes sense for us to think about how we can make improvements in these other parts of the world.

The point about treating NTDs, especially parasites, is that by building the delivery infrastructure, such as schools, as well as better sanitary facilities to prevent infection in the first place, we are investing in the human capital of these nations. In rich countries, human populations constitute between 70% and 80% of the nation’s wealth. In low-income countries it is around 30% to 40%. The implication is that the majority of people in these countries fail to achieve their full potential. That is a tragedy for them as people and for the well-being of their nation. Therefore, when we talk about treating NTDs, it has to be within a wider framework of boosting human capital within nations. This occurs through direct treatment, which is extraordinarily cheap per child; supporting universal primary education, especially where women are concerned, since they are more likely to be locked out of primary education; and continuing to improve public health infrastructure in these areas.

All these things will improve treatment and human capital, which in itself will lift people out of poverty and prevent infection. Therefore, when we consider cuts in aid to the tune of £150 million for the elimination and eradication of NTDs, this is only one section of the funding required to address this problem, as it fails to account for the cuts in funding to help build the human capital that is so vital to combatting these diseases in the long run.

Many charities are doing their best to address these issues. Within the Anglican Church we have the Anglican Alliance, which is a major fundraiser trying to do that. Just this morning I chaired an online meeting with people from Mozambique, because my diocese is seeking to make a serious input into the north of that country to see whether we can give it a serious boost. The problem is that, despite all our voluntary efforts, it will not be enough without government help. I believe that is what we need urgently.

I finish by reiterating that foreign aid is an undeniable moral good, especially when we consider our good fortune in not being plagued by these diseases. That is not to say that we do not currently have problems at home, but it is about being mindful of our privilege and material well-being. The Covid pandemic has set back efforts to tackle NTDs, which makes it more important than ever to see what we can do to help these countries, which will also benefit us as being the right thing to do.

My Lords, I declare my interests as set out in the register and apologise for not doing so when I intervened in a Question earlier. I hope the House will forgive me.

I have been involved in these issues for a long time. I remember the excitement around the London Declaration on NTDs. I very much welcome the speech that the noble Lord, Lord Trees, made, which I thought set out comprehensively the implications of these diseases for some of the poorest people in the world—some of the most neglected people in the world, as the right reverend Prelate said.

The London declaration aimed to enable more than a billion people suffering from NTDs to lead healthier and more productive lives. The link between good health and development is very well understood. We have made a great deal of progress, but we are at a very dangerous point for NTDs and malaria. There is a double challenge. There is the challenge of the post-Covid environment. Covid had a tremendous effect in the poorest countries in the world in diverting resources away from the absolutely basic services given for malaria and NTDs, and we have seen the consequent rises in death, as far as malaria is concerned, and in disability and disfigurement that come from NTDs.

However, as well as the effects of Covid, we have had the effects mentioned by both speakers already of the reduction in ODA, which have been devastating as far as NTDs are concerned. The flagship Ascend programme was cut off completely and in a totally irresponsible way, which ended up with donated medications being thrown away on a horrific scale. If we are to end programmes, there is a way to end them which is sensible and minimises disruption and damage, and we did not do that with the Ascend programme. There are other examples across the board. The RISE leprosy programme in Bangladesh just went, in exactly the same way.

Not to be completely negative, I say that I hope that the Kigali Declaration can bring us back to some focus on NTDs. The Minister, who I know has always been very concerned about these issues and committed to tackling them, endorsed the Kigali Declaration during the summit last month and committed to supporting NTD elimination programmes, recognising that tackling NTDs also helps to reduce poverty, address inequality, strengthen health systems, increase human capital, and build resilient communities. However, I would be very grateful if, when he winds up, he can give us a little of the detail on how the UK intends to act on its CHOGM and Kigali Declaration commitments, and what technical and financial resources it will deploy in support of countries to achieve the WHO 2030 NTD road map, and to partner and collaborate with endemic countries to support action to achieve disease-specific goals while building resilient health systems.

Turning to malaria, I think that the most important message that we can give to the Minister today is on the need for this country’s strong support of the Global Fund. The US has shown the way. We have always been the joint leader on donations to the Global Fund. I hope that this continues. Any reduction in that funding would have long-term consequences. Not only would it imbed and continue the reduction in the progress that we have made in reducing deaths from malaria, it could also have very different consequences. There was a fascinating meeting yesterday with the Medicines for Malaria Venture. One consequence of reducing funding to the Global Fund would be on endemic countries’ access to quality medicines. The shortfalls in the funding of quality medicines might oblige countries to source lower-quality medicines, which are not as effective, and which could have potentially devastating effects. I hope that the Government will look at that potential negative consequence and at the potential positive consequence in supporting the local manufacturing of malaria and NTD medicines, particularly malaria drug production. There are some examples of local manufacturing, but they need support and investment to meet international regulatory standards and WHO prequalification.

I hope that if the Minister cannot reply today he will write to me on whether the Government are considering the positive role they can play in knowledge transfer and supporting capacity-building in-country so that endemic countries can move towards self-sufficiency in the production of these medicines. The UK has been a long-standing leader in the fight against malaria, supporting ground-breaking R&D and the large-scale deployment of tools to tackle the disease. That has been done particularly through generous contributions to the Global Fund.

I shall make one last point. When we were discussing Nigeria the other day, the Minister reassured the House about the priority that the Government give to programmes for women and girls. I hope he will recognise today that those programmes are not just about violence against women and girls. Those who suffer from these diseases most acutely are women and girls. Support for the Global Fund means support for 60% of a programme specifically directed to women and girls. Deaths occur in children under five and pregnant women. NTD infections contribute to maternal mortality and morbidity, poor foetal development, maternal anaemia, maternal mortality, pregnancy complications, infant mortality and low birth weight. They also heavily impact on education and employment opportunities for women and girls. These are important areas, and I hope the Minister will be able to respond positively.

My Lords, this is a short debate on a hugely important topic. The three speakers who preceded me have outstanding experience and knowledge on this issue and I commend them on their remarks. I particularly commend the noble Lord, Lord Trees, on securing this debate, so relevant after the Kigali announcements and incredibly prescient since the Government will be making decisions about the Global Fund replenishment that has been made. The timing could not be better, and I hope and expect that the noble Lord, Lord Ahmad, will respond positively—but I look forward to hearing the extent of that positive nature.

The right reverend Prelate is right that this topic is not solely a health topic but is primarily a life chances topic. The eradication of these diseases has a low financial value but a high value in enabling and liberating girls and young women in particular, as the noble Baroness, Lady Hayman, indicated. She stressed that 11.5 million pregnant young women, the focus of the Global Fund, will be impacted by this, which draws into sharp focus why we believe so passionately that the UK should repeat its full complement to the Global Fund replenishment, as it did last time. I will return to that in a moment.

Just two weeks ago when the Minister—along with the Prince of Wales, who was representing Her Majesty—was in attendance at CHOGM on behalf of the UK Government, I was fortunate to join the all-party group on malaria, of which the noble Lord, Lord Trees, is chair, which visited a health centre on the outskirts of Kigali. I met pregnant women who are directly benefiting from this work on greater education and awareness of how to receive medication and use nets and to communicate to the wider community about their effective use and the positive impact that makes.

We also visited a community health centre, where we met one of the networks, made up primarily of women, which provide vaccination services after the identification of potential malaria. These people are volunteers in their community. They are paired up, a man and a woman, in each community. I saw at first hand the materials they use from USAID, the equipment they have been provided with via the Global Fund from the UK contribution, and their impact on the wider community. I am sure that the Minister is aware of this but, if the UK does not replenish, we will see to the same extent we have seen before an immediate reversal in some of the progress we have heard about. It will not be a gradual decline, in the same way as we have seen a gradual improvement; it will be an immediate reversal, which is why the UK needs to replenish in full.

I welcome the Kigali Declaration on reducing NTDs by 90%. In the Commonwealth, there was a restatement of the ambitions with regard to malaria. However, we have been informed through our briefings that the 2018 Commonwealth declaration on the reduction of malaria, with the UK as chair-in-office, is now off track. I would be grateful if the Minister could give an update on where we are in the Commonwealth after the commitment on malaria made at the 2018 CHOGM. I remind the House that the commitment was to halve malaria across the Commonwealth by 2023. I would be grateful to know where we are on that.

The noble Baroness, Lady Hayman, is absolutely right that we are at a dangerous tipping point. The good intentions of the summit and the Kigali Declaration were very positive. They included commitments totalling more than $4 billion from Governments, international organisations and philanthropists; commitments of more than $2.2 billion in partner countries’ domestic resources; and 18 billion tablets being donated by nine pharmaceutical companies. However, they will go only so far in maintaining this level of progress if the Global Fund replenishment, which supports the distribution of many donated medicines, does not happen, as this will reduce the capacity of partner countries to deliver them to their people. From the point of view of value for money, levering in support from other partner countries and the private sector for full replenishment should be seen as one of the best things we can do.

The tragedy of the cuts we have seen in UK ODA has been twofold. The first is something that is often under-debated: research and development. In many respects, the UK has led in the fight against malaria and NTDs because of UK research and what the UK has brought about through science and innovation, working with our universities, health partnerships and partner countries in particular. All that has come through UK leadership. Therefore, the cut in UK R&D as a result of the funding cuts will cause long-term damage.

Following the announcement of the ODA spend for 2021-22, UK Research and Innovation announced a £120 million research gap. Think about the partnerships with Imperial College, the Liverpool School of Tropical Medicine, the London School of Hygiene & Tropical Medicine, the University of York and the University of Lancaster—these are world-leading partnerships that have been starved of the kind of capacity that is necessary for the next generation.

I am not an expert on these areas. I defer to the noble Lord, Lord Trees, all the time. In fact, I have in front of me the names of the conditions that he so easily pronounced, and I look down at my notes with foreboding because I cannot even pronounce them. However, getting to the next level of improvement will require even greater levels of innovation because by definition these people are harder to reach.

With the cuts to NTDs, with the matter—which we have debated and had Questions about over the period—of the disgrace of the incineration of medicines that could have been provided, and with the distribution of vaccines whose lives were just short of their effective use, we could potentially see 24 million people with lymphatic filariasis, 21 million people with river blindness, 21 million people with schistosomiasis and 4 million children with intestinal worms. That is the scale of the human impact.

Given the life chances that this measure is going to remove for those nearly 100 million people, I hope the Government will think again, lever in UK support and deliver the replenishment to the Global Fund in full.

My Lords, I thank the noble Lord, Lord Trees, for initiating this short debate on a vital subject. I too want to start on a positive note, because the Kigali summit displayed something unique and important that we should stress: it included Governments, coinciding with CHOGM, but also civil society and the private sector.

We heard clear government commitments to support the fight against malaria and NTDs, which included domestic resources, co-financing and support for innovation, from all the countries committed to that declaration. Like the noble Baroness, Lady Hayman, I would like to know what that commitment means in terms of action by this Government, so I hope the Minister can translate those words into specific actions.

We also had clear commitments from the private sector, which we should welcome, including the donation of drugs, as the right reverend Prelate referred to. Again, that is action that we should encourage and support; it is not all about government action. We also had support from trust funds and philanthropists such as Bill and Melinda Gates, who also make important contributions.

Just as important are civil society organisations and NGOs, which have made a significant commitment in the fight against malaria and NTDs. It is those sorts of commitments and programmes that we should also hear about from the Minister regarding how our Government’s commitments can translate into support for those civil society organisations.

However, as we have heard in this debate, such collective action will not deliver without the support of overseas development assistance—from all countries but, more importantly, from this country. As we have heard, progress in combating malaria has stalled in recent years despite the gains of the past two decades. In 2019 there were 229 million cases of malaria and 409,000 deaths, and it continues to take a heavy toll on pregnant women and children, particularly in Africa. The noble Baroness, Lady Hayman, is right: if this Government are going to make women and girls a priority, they need to focus on these policies. It is not just about conflict prevention.

As all noble Lords mentioned, the cuts in the UK’s ODA budget, to which I shall return, have had serious impacts. I will not repeat what the noble Baroness, Lady Hayman said but I was going to refer to the issue in more explicit detail. It was not just a question of the amount of those cuts but the speed at which they occurred. We have had repeated debates on the unnecessary harm caused by the speed of those cuts. They were not planned. I am not advocating cuts but damage was caused by immediately stopping programmes. I cannot imagine the consequences.

It is important to acknowledge the role of this country because we have been in the lead. The London declaration was an important initiative, supported by philanthropists and others. I must thank the noble Baroness, Lady Hayman, who, when I first came into this House, initiated a series of debates on the declaration. We had a sort of annual anniversary debate to monitor the progress of the commitments made.

As we have heard, however, one of the impacts of Covid has been a coming together on all NTDs to look at how collective action and cross-sectoral collaboration can help rebuild programmes—particularly on WASH and NTDs. The NTD road map, which has been referred to, set vital global targets. I want to say a few words about the importance of cross-sectoral collaboration. Through co-ordinated investment, we can have an impact across the range of NTDs as well as in terms of priorities for women and girls.

I declare an interest as co-chair of the APPG on Nutrition for Growth. Nutrition is a vital foundation activity for safeguarding women and girls and ending some of the worst diseases. Nutrition relies primarily on education and primary healthcare. Universal healthcare is a priority that this Government have led the way on but where the ODA cuts have impacted hugely. They are not programmes that one can set up one year and then take away; they need long-term investment. A lot of the activities that we have been talking about are precisely that—five, 10 or 15-year programmes. We are talking about sustainability and employing nurses and community nursing activity to go out and build sustainable development. That is vital and I hope that the noble Lord can reassure us on how we will support the road map highlighted by NTDs.

We have focused heavily not just on the physical means to deliver progress against these diseases but on the need to stress the importance of research and innovation. That is true of Malaria and many NTDs. We need to hear from the Minister about how we will continue to support that innovation through the Kigali Declaration. The Global Fund is a vital instrument for change and for pushing back these diseases. The US Government have led the way. I have asked the Minister questions on this and the noble Lord, Lord Trees referred to it. That leadership by the US needs UK support. If we do not support it, the overall amount given to the Global Fund will reduce, which is why it is vital that we continue with that commitment.

I hope, therefore, that the Minister will reassure us. I know he will say that the decision on the amount has not been made yet. We do not know who is responsible for that—things could change in days, hours or minutes. But this is such an important subject, so I hope he will take back the message that we need to support the United States to ensure that the Global Fund replenishment can continue to deliver on the targets that we agreed in 2015, with the SDGs. I hope the Minister will respond positively.

My Lords, I thank all noble Lords for their, once again, detailed and expert insights in this short but very informed debate. In particular, I thank the noble Lord, Lord Trees, for tabling it and for his long-standing commitment to combating malaria and neglected tropical diseases. I pay tribute to the noble Baroness, Lady Hayman, for her continued focus; her expertise and insight were valuable to me, as they were to the noble Lord, Lord Collins. He and I joined your Lordships’ House at more or less the same time.

As the noble Lord, Lord Trees, reminded us, this debate comes hot on the heels of the successful Kigali Summit on Malaria and Neglected Tropical Diseases, alongside the Commonwealth Heads of Government Meeting. I was pleased to see members of the APPG, including the noble Lord, Lord Purvis, in Kigali and to exchange views with them directly. As he mentioned, the Commonwealth is undoubtedly disproportionately affected by these diseases, and the political will demonstrated at the summit and in the leaders’ communiqué will be key to ending these epidemics.

I agree with the noble Lord, Lord Collins, about the importance of civil society and its role. A few other events were keeping people occupied, but over the last 48 hours I was focused on the delivery of the freedom of religion or belief conference at the QEII, which has just concluded. Civil society representatives were intrinsic and central to the ministerial conference, rather than a separate part of it, and the same needs to apply in every respect of our work.

As noble Lords noted, Commonwealth leaders reaffirmed their commitment to halving cases of malaria in the Commonwealth, and countries affected by malaria made $2.2 billion of commitments to tackle the disease. As noble Lords acknowledged, I was proud to sign on behalf of the UK the Kigali Declaration on NTDs, which will continue the global momentum generated by the UK-led London declaration 10 years ago. The Kigali Declaration commits countries to supporting the delivery of the World Health Organization’s road map on NTDs, a pivotal instrument in our fight to end this epidemic by 2030. I was glad to see the commitments made by Governments, pharmaceutical companies—which the noble Lord, Lord Collins, alluded to—donors and others.

The noble Lord, Lord Purvis, asked about the Commonwealth being off track on the commitment to halve malaria by 2023. There is no hiding from this; it is off track. A large part of this is a result of the impact of Covid; many Commonwealth countries that were on track were impacted. The noble Lord is aware of the challenges of Covid and vaccine distribution, particularly for the most vulnerable. Countries currently on track include Bangladesh, Belize, Malaysia and South Africa. Off-track countries include Nigeria, Mozambique, Uganda and Tanzania, for example. Although overall we are off track as a Commonwealth of 56, the commitment to end the malaria epidemic by 2030 was restated. When I see the focus, uniformity and universality of the commitments, I believe that, rather than pushing targets back, we will see what progress can be made when the Commonwealth meets again. I would be keen to talk to all noble Lords to see what more can be done to meet this commitment.

There is no doubt about the challenges that these epidemics pose: diseases such as Covid-19 place a terrible burden, and the issue of NTDs and malaria add to that. They were there before Covid, are still very much present and affect the poorest, especially women and children.

I assure the noble Baroness, Lady Hayman, that when I alluded to the issue of women and girls, it was not just in the context of issues of sexual violence. I totally agree with the noble Baroness that it is about how we invest, which is why the Government remain committed, for example, to the important issue of girls’ education around the world. In 2020, more than 11 million pregnant women in African countries were exposed to malaria, contributing to more than 800,000 cases of low birth weight, and eight in 10 of those who died of malaria were children aged under five.

Even before Covid, the issue of being off track, which I have just alluded to, was a key challenge for everyone. The pandemic has set us back, but we have rallied to avert the worst-case scenarios, including the World Health Organization recommending the world's first malaria vaccine, as well as advances on other vaccine candidates. The Gambia was declared trachoma free last year, and Rwanda and Uganda heralded the elimination of specific strains of sleeping sickness this year.

On the issue of specific deliverables raised by the noble Lords, Lord Trees and Lord Collins, and the noble Baroness, Lady Hayman, I agree that we need to be specific in what we can do. One of the important elements, to put a bit of detail on this, is that the UK will invest quite specifically in research and innovation in new drugs and diagnostics, through world-leading product development partnerships. These will include specific research on NTDs and other diseases of poverty.

Several noble Lords raised the issue of drugs being thrown away by programmes, and I will look into this in more detail. From a general perspective, while there were no reported cases of donated drugs being destroyed or thrown away, figures are being used in media reports, so I will follow this up. If noble Lords know of any specific countries or issues that can be traced back to particular programmes, it would be helpful to have that information.

Picking up several of the points raised by the right reverend Prelate, we remain very much committed to global health, and our recently published international development strategy focuses on this. Saving lives, particularly those of mothers, newborns and under-fives, while making essential health services available to all, is a top priority for the UK. We have detailed our commitments and plans in our new IDS, as well as in position papers last year on health systems strengthening and ending preventable deaths.

Strong, resilient and inclusive health systems are of course crucial here and we will continue to invest in programmes to strengthen these, to help ensure that tools for preventing and treating malaria and NTDs are readily available to all who need them. I agree again with the noble Baroness that, by investing early in R&D and prevention, we can save money but, most importantly, we can save lives.

The focus on stronger health systems is the bedrock of our efforts to improve global health, and in this respect I agree with the noble Lord, Lord Trees, that it really is the basis for continued wellbeing. It is a strategic decision to focus on the sustainable systems and essential services required to address all causes of ill-health—a point made by the noble Lord, Lord Collins.

In some cases, this focus has also meant reducing our investments in directly delivering services, but here we have worked with national programmes and partners to prioritise and complete programme activities where possible, and to co-ordinate the handover of activities to others. We continue to invest in key multilaterals and research, alongside helping to build strong health systems overall.

All noble Lords referred to the Global Fund. This year also marks the seventh replenishment of the Global Fund, which remains an essential partner in the fight against HIV, TB and malaria, as well as in strengthening health systems and supporting pandemic preparedness. As all noble Lords acknowledged, the UK is a co-founder and long-standing contributor to the Global Fund, having provided more than £4 billion in funding to date, and we are reviewing the investment case for the seventh replenishment in line with our new strategy and global health position papers. I reassure noble Lords that we will make a significant financial and leadership contribution to the Global Fund.

The noble Lord, Lord Collins, talked about needing to make sure we get the commitment. What more should I say? I am still here. In all seriousness, this is important to me; it is something I have focused on. There is nothing on which I disagree with noble Lords in relation to the importance of this fund and its contribution. We are focused on making sure that our leadership is sustained. The noble Lord spoke about supporting others, including the United States. If we can continue to focus on this, we can look ultimately again at saving lives.

Along with other institutions, we have funded Gavi and UNITAID. The Global Fund has also played a critical role in piloting the malaria vaccine. We will continue to support the Global Fund and Gavi to maximise the vaccine’s impact by helping countries plan their rollouts, alongside other proven malaria interventions. That is an important point about logistics on the ground.

On R&D, the UK continues to invest. I can assure the noble Baroness, Lady Hayman, and the noble Lord, Lord Collins, of our recognition of the importance of technology transfer. We will continue to put our scientific expertise to work for global health and development challenges in this respect, focused on NTDs. Our investments have led to the world’s first child-friendly antimalarial drug, which is estimated to have saved over a million lives. We have also funded trials, with the result published in the Lancet, of a novel type of bed net that kills mosquitoes resistant to traditional insecticides. This net reduced the prevalence of malaria by 43% in the first year of use.

The point on ODA is well made. I have always been candid and clear: when you cut funding on ODA, which we have done, that will have an impact, but ensuring prevention is a key focus. The Government’s commitment to 0.7% remains.

I am grateful to all noble Lords who have contributed. Our long-standing commitment endures. As the noble Lord, Lord Trees, said, health ultimately creates wealth. Our objective should be ensuring that countries improve not only their health services but their livelihoods. The collective will demonstrated in Kigali should be the impetus to do so much more.