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Neglected Tropical Diseases

Volume 768: debated on Monday 1 February 2016

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the effects of Neglected Tropical Diseases in impairing social and economic development in developing countries in the light of the publication of the third progress report of the 2012 London Declaration on Neglected Tropical Diseases.

My Lords, it is a great pleasure to open this debate on neglected tropical diseases, which I will refer to as NTDs. This is the third debate we have had on this subject in as many years. I thank my noble friend Lady Hayman for her leadership in initiating the previous two debates. Certainly this House cannot be accused of neglecting these diseases. Nor should we: they are of huge global health and socioeconomic importance, as is now being recognised. Coincidentally, this Wednesday former US President Jimmy Carter will give a talk in this House convened by the Lord Speaker about one NTD, guinea worm disease, and its eradication.

NTDs are a group of infections associated with poverty in tropical and sub-tropical countries. Some, such as rabies, have a high mortality rate but most are characterised by their chronicity and high levels of disability such as gross disfigurement, blindness and inability to work. As such, sufferers are unable to be productive within their already poor communities and instead become a burden on the very limited healthcare resources of their countries. More than 1 billion people are affected in 149 countries worldwide. It is estimated that some 300,000 deaths per year are caused by NTDs.

However, until recently, in comparison with for example HIV, TB and malaria, these diseases received very modest international attention and support. The bundling and aggregation of these diseases and their branding as “neglected” was a masterstroke of public health communication. In 2012, WHO published its road map laying out targets for the control, elimination or eradication of 17 NTDs by 2020. Momentum gathered pace, with the London Declaration on NTDs in 2012 enshrining further commitments. Last year, the UN sustainable development goals to 2030 included NTDs within goal 3, aimed at “healthy lives” and “well-being for all” people.

This progress is substantially contingent upon the massive commitment by the pharmaceutical industries to donate key drugs essential for many of the control programmes. Donations worth a staggering $3.8 billion per year are a massive gesture of corporate generosity. While there is still some need for research to develop drugs for some NTDs and situations, there is available now a free toolkit of drugs for many NTDs.

Notable among these drugs is ivermectin, the mass administration of which to populations in Africa and Central and South America has massively reduced the incidence of clinical onchocerciasis—river blindness. Noble Lords may be aware that the Nobel Prize for Medicine in 2015 was awarded partly for the discovery and development of ivermectin by Campbell and Omura. Noble Lords may not be aware that this drug was in fact developed and initially marketed for veterinary use in 1981 as a wormer for cattle and other species. It was so successful commercially that the parent company, Merck, was able to commit to donate ivermectin for the control of onchocerciasis and lymphatic filariasis or elephantiasis for as long as needed. I mention this not only because of its significance in NTD control but to highlight the connectivity between human health and veterinary science—the so-called “one health” concept. That relationship is particularly close with respect to human tropical diseases.

That brings me to another NTD which exemplifies the “one health” approach—rabies. I am not an expert on rabies but, of all the lectures I had as an undergraduate veterinary student, one I particularly remember was on rabies. From nearly 50 years ago, I still remember the main message: the key to controlling human rabies is to control dog rabies. Human rabies was endemic in Britain until late in the 19th century. We eradicated it by stopping dogs biting people. Worldwide, 99% of human rabies is still contracted from dogs. Rabies is a horrible disease. It is still endemic in many countries in Asia and Africa. It is estimated that about 60,000 people die of it a year, of whom nearly 50% are children. During the nine minutes of this speech, someone somewhere will have died of rabies. Once clinical signs appear, death is inevitable; it is a very unpleasant death and you know what? It is entirely preventable. We have all the tools we need: a vaccine for humans, a vaccine for dogs and post-exposure treatment for humans.

The cheapest of these interventions and the principal means of control is to vaccinate dogs. By vaccinating 70% of the dog population, the transmission cycle is stopped. I am pleased to say that there is now a growing movement to tackle this problem, catalysed by the awareness that the elimination of nearly all human deaths from rabies is achievable. A number of campaigns at national, regional and local level in South America, Asia and Africa, conducted by health authorities, NGOs and charities, are starting to control rabies through control of rabies in dogs. I am pleased and proud that many British scientists and vets are active in this area. Late last year, WHO and the World Organisation for Animal Health, in collaboration with the FAO and the Global Alliance for Rabies Control, organised a conference in Geneva which agreed a framework of actions to achieve the WHO goal of eliminating dog-mediated human rabies by 2030. Later this month, my noble friend Lord Crisp and I will host in this House the launch of the End Rabies Now campaign from the global alliance.

For rabies and many designated NTDs, real progress is being made. I am sure we will hear further examples in today’s debate. However, in spite of the donation of many of the drugs needed, there are still significant challenges. These relate more to the delivery of existing drugs and interventions than the development of new ones. Professor David Molyneux, a leading world expert on NTDs, argues that the availability of drugs is no longer a barrier to achieving universal coverage for most NTDs. It is estimated that there is an annual funding gap of $200 million to $300 million a year to ensure effective delivery of interventions and drugs we now have and that are given free. This funding gap should partly be met by the endemic countries themselves. Although extremely poor and with limited resources, it would only require a tiny percentage of their healthcare budgets to fund delivery of the free drugs available for NTD control.

The developed world could also do more. The UK’s leadership in this area through DfID is commendable, but globally only about 0.6% of donor governmental financial aid for healthcare is provided to tackle NTDs. Our affluent neighbours in Europe and some other countries could do more. Action against NTDs will benefit the poorest of the world’s poor. A recent study showed that tackling NTDs is highly cost-effective in terms of return on investment. The third progress report of the London declaration on NTDs said:

“This makes NTD programs a pro-poor best buy”.

I commend DfID for its commitment and support for the control of NTDs, reinforced by the recent announcement of the Ross fund. Is the Ross fund additional money to that which the UK has been committing for NTD funding? Secondly, what are the Government doing to urge other affluent nations to follow our example? Collectively, we need to close the funding gap and ensure that the great progress to control NTDs achieved in the last few years will be sustained so as to permanently eliminate these infections and the terrible diseases they cause.

My Lords, I take a great interest in this subject, as I was born and brought up in east Africa. It has now been four years since the launch of the historic London Declaration on Neglected Tropical Diseases. We cannot underestimate the importance of eliminating these diseases. They affect over 1 billion people across the world. Many of them are among the very poorest and in the hardest-to-reach areas, and they lack adequate sanitation. These are neglected diseases affecting neglected people. The personal suffering affects families and communities, resulting in greater economic hardship for all. In short, these diseases cost developing economies billions of dollars every year. Eliminating them will help to eliminate poverty. More widely, it will also greatly assist in achieving many of the new sustainable development goals. It is therefore crucial that work on eliminating NTDs forms part of wider initiatives on tackling poverty. I commend our Government’s continued commitment on that front.

I am very proud that we have enshrined into law our commitment to spend 0.7% of gross national income on overseas aid every year. We are the first G7 country to meet this target and can now set an example to other countries around the world. I was very pleased last week to see the Chancellor pledge £3 billion of our international development budget towards combating malaria. I will shortly be leading a delegation of parliamentarians to Sudan, where tackling malaria will be very high on our agenda.

I am pleased that, on the whole, progress on neglected tropical diseases continues to be very positive. The most recent report states that a growing number of endemic countries are achieving their elimination goals and that more people are being reached through these programmes. This is due mainly to the increasing number of domestic programmes and greater political and funding commitments at a national level. For example, Bangladesh now funds 85% of its own NTD programmes. The Philippines provides 94% of its own funding. Honduras has been highly commended for becoming the first Latin American country fully to finance its own NTD programme.

I want to mention specifically the creation of the Addis Ababa commitment in December 2014, when 25 African countries pledged to increase their contributions to tackling NTDs. This is extremely significant, not least because many of these diseases are most prevalent on the African continent. I visited Addis Ababa in October last year as part of a wider visit to Ethiopia, and I learned about the good work that is going on with its vaccination programmes and its attempts to tackle these diseases. I am pleased that these diseases are now high on the global agenda. Despite all this welcome news, it is crucial that the international community continues to drive forward and keep up momentum.

My Lords, I share the concern of the noble Lord, Lord Trees, and others, that we must keep up the momentum in combating these awful diseases if we are to meet the World Health Organization road map targets. It is still shocking that so many of the world’s poorest men, women and children suffer from avoidable infections that, where they do not kill, bring deformity, disability, blindness, and stigma. Virtually all the world’s absolute poorest, those existing on barely more than a dollar a day, have one or more of the most common NTDs, such as river blindness, roundworm or hookworm. Adults with these diseases cannot work to support their families, and children affected by them cannot attend school. Families struggle to afford food and basic services, including healthcare, and communities blighted by these diseases are forced deeper into poverty, with few prospects for the future.

Combating NTDs is one of the best paths to cutting this cycle of poverty and enabling sustainable social and economic development. Indeed the third progress report of the 2012 London declaration confirms that NTDs provide one of the strongest returns on investment in public health. It suggests that, if countries achieve the WHO’s 2020 goals for NTDs, their healthier citizens would generate some $623 billion in increased productivity between now and 2030. If these NTD goals are reached, the ongoing health benefits up to 2030 would be comparable to those achieved for HIV/AIDS, tuberculosis and malaria. Yet, compared to those “big three” diseases, the cost of reaching the WHO targets for NTDs is relatively modest.

Clearly it is vital that we do not let up in our collective attempts to combat any of these diseases, so I was pleased to read in the report that progress is being made. However, the report also makes it clear that progress is not being made fast enough to meet key milestones. To reach them, we need greater collaboration across countries, between development organisations and across government departments and sectors. One welcome recent announcement has been the £3 billion from the UK and the Gates Foundation for the Ross fund, to support R&D and work towards the eradication of malaria. This is good news, especially in light of the disturbing spread of the Zika virus. By understanding the prevention and treatment mechanisms for mosquito-borne diseases, such as the development of genetically modified sterile mosquitoes, the global community will be much better prepared to respond to, and prevent, diseases such as Zika. I mention this because I understand the Ross fund will also encompass work that targets neglected tropical diseases, where the need for more partnerships, greater collaboration, new approaches and better preparation continues. What further steps can the UK take to continue to lead the world in R&D and, in particular, to encourage more product development partnerships and support the research to deliver such products where they are most needed?

A few weeks ago we heard the welcome news that the WHO has declared Liberia free of the deadly Ebola epidemic, which claimed some 11,000 lives in that country in 2012. Of course, I am aware that neither Zika nor Ebola are neglected tropical diseases, but I was struck by comments made by Jeremy Farrar, director of the Wellcome Trust. I believe they are just as relevant to any discussion of NTDs. He outlined the lessons that need to be learned from the Ebola epidemic, stressing the need to change structures and strengthen health systems around the world. He called 2016 a pivotal year by which changes of global governance of health and preparedness need to be effected. He also said that if we do not change now we never will, but I am more optimistic. For our continuing work to combat NTDs there is hope, and there is political will. The progress report shows us that controlling NTDs can make a greater contribution to endemic countries’ health and economies than any other investment. Getting more health for less money is a target we must continue to pursue.

My Lords, I recognise the importance of tackling neglected tropical diseases, for the reasons that other noble Lords have already identified. I do not have specialist knowledge of this subject, but I had the good fortune to have on the International Development Committee Jeremy Lefroy, chairman of the all-party group, who focused on it and kept me informed of the importance of it. It is no accident that the all-party group focuses on malaria and neglected tropical diseases, because their eradication is clearly linked. That is part of the theme that I would like to take forward. There should be no conflict between the silo approach to tackling specific diseases and ensuring that other diseases that impact on the same communities are tackled as well. For example, when evidence was provided about treating and preventing HIV/AIDS, it became obvious that malaria, TB, hepatitis and other diseases are linked to immune deficiency. It quickly becomes apparent that to tackle these diseases requires strengthened health systems, which can then provide the infrastructure for diagnosis, treatment and prevention and, equally important, health education.

I have seen at first hand, on successive visits to Ethiopia, the valuable impact of community health workers, who are recruited from their local communities and trained to offer informed advice on a range of public health matters, basic treatments and referrals. This can make a huge contribution to tackling, preventing and treating diseases. The British Government have been a major backer of the fight against high-profile diseases and, in particular, the quest to eradicate malaria. The announcement last week of the partnership with the Gates Foundation is of course welcome. The Liverpool School of Tropical Medicine, with which I am sure the noble Lord, Lord Trees, is very familiar, is a world leader in its field and can make a contribution to the challenge.

I ask the Minister to give us a little more information on how the £200 million identified within the Ross fund for NTDs will be spent, and how the spending on NTDs, malaria and other major diseases can be interlinked in ways that will give a synergy in tackling them.

I was aware of the fact that, prior to the Ebola outbreak—I take the point that Ebola is not one of these diseases, but this is instructive—the UK Government were planning to reduce spending on health systems in Sierra Leone and Liberia, but in the event ended up spending five times as much as they had been planning to in order to tackle the outbreak. Although they were late in tackling it, there was a very good example of cross-government co-operation when they finally addressed it.

What must be hoped for after such an event is that the health systems of affected countries have been strengthened so that there is a legacy and they have the ability, in future, to tackle these things much more effectively. We cannot just zoom in and zoom out; there has to be a continuing capacity to deliver. The Global Fund and other targeted funds have been criticised, not for failing to deliver their objectives but for not always leaving that legacy behind. I suggest that the Government consider, in their engagement with the Global Fund and their own substantial initiative, that the Global Fund should also address NDTs. It is logical to do so at the same time. These diseases cause death and disability to hundreds of millions, and people who are sick or disabled inevitably compromise development. They cannot work and their children suffer, missing out on education and having to work to help the family income, as well as being at risk themselves.

In my maiden speech in this House, I broadly welcomed the Government’s development strategy but warned of the dangers of short-term changes in priorities. We have just heard that the demands of the Syrian refugee crisis have put pressure on DfID’s development budget. It is therefore important that we get maximum synergy and that the Government co-ordinate everything they do on all these diseases, because in that way we can eradicate them much more quickly.

My Lords, I am going to concentrate mainly on strategies to develop treatment for neglected tropical diseases. I am a doctor by background, as everyone knows. I was born in Tanzania and I visit there often in relation to charity. Last year, I was bitten extensively by the flies that carry sleeping sickness and every time I doze off I wonder if I caught it, so I am concerned about finding treatments.

Effective control against NTDs can be achieved if several public health approaches are combined, guided by local epidemiology and the availability of appropriate detection, prevention and control measures. Due to the nature of many of the parasites that cause NTDs, it has proved very difficult or impossible to develop vaccines that are suitable for mass administration. Other approaches are therefore required, and we are familiar with them, including: vector control, such as spraying to kill insects; strategies to reduce contact with insect vectors, such as bed nets; improved hygiene, housing and new drugs; and, more recently, as the House of Lords Science and Technology Committee report suggests, the genetic modification of insects, and today’s news about gene editing, which can also apply to insects.

To reduce the burden of NTDs using drugs, we must address three main urgent issues. First, many current drugs to treat NTDs are extremely toxic and difficult to administer. Secondly, many drugs now simply do not work because parasites have become resistant, for a variety of reasons. Thirdly, disease diagnosis remains challenging. Additionally, the development of new treatments for NTDs is hampered by a historic lack of systemic drug discovery, due to the lack of a commercially viable market for drugs and insufficient understanding of parasite biology, resulting in a lack of validated drug targets—that is, good approaches to develop drugs.

Three years ago my university, the University of Dundee, made a commitment that by 2020 it would try to find cures for some of these diseases. To tackle those issues, the university has combined renowned scientists with expertise in NTDs with professional drug discovery within its drug discovery unit, mainly recruited from pharmaceutical industry and led by Professor Paul Wyatt. I declare an interest: not only have I been an associate of the university since I went there as a medical student, but I am now chancellor of the university. With support from organisations like the Wellcome Trust and the Gates Foundation, Dundee has been making good progress across the areas. A new and exciting antimalarial compound has recently been developed, with the potential not only to cure but to prevent and block the transmission of malaria with a single dose, and it is now going to clinical trials.

These are some examples, but the main thing is that, with support from the Gates Foundation, the university has made available a set of 70,000 compounds to initiate new drug discovery programmes for multiple NTDs. The new team is using cutting-edge technologies to determine the mechanisms by which drugs kill parasites. I hope that such strategies will lead to finding cures for many of the NTDs. To quote Richard Horton, editor-in-chief of the Lancet, in praising Dundee University’s effort:

“Something very special is taking place in Dundee … a drug discovery unit for parasitology … has torn down disciplinary walls to put chemists next to biologists, industry scientists beside academics. The result is a portfolio of promising new medicines for malaria”.

I hope that the Ross Fund will be used to fund clinical trials when the time comes, because there will be no other way of doing so.

My Lords, I welcome this debate and the continuing attention that it gives to neglected tropical diseases, at a time when they are becoming more prominent and well known. After all, as my noble friend said, it was only a few years ago that some UK academics coined the phrase, in a masterstroke of marketing. It is very good to see that NTDs are now mentioned in the sustainable development goals, great foundations and indeed great NGOs are tackling them—here I declare an interest as a recently retired chairman of Sightsavers—and there are great efforts in that regard by the UK Government.

This is an area, like much in development, where the UK is a world leader. As an example, DfID funded the mapping of blinding trachoma globally, with Sightsavers as its lead co-ordinating agent. I am delighted to say, although I claim no personal credit, that Sightsavers delivered the mapping on time and on budget. Arguably, this is the largest ever public health mapping exercise, and is now bearing results as we can target the right areas globally to tackle the disease.

My noble friend Lord Trees draws attention to neglected tropical diseases in impairing social and economic development. This is two way—they do not occur in prosperous countries. He mentioned rabies, but trachoma was a major problem in 19th-century Europe. There are strong links between prosperity and these diseases, which are, as has already been mentioned, the diseases of neglected people, who are certainly excluded from prosperity. They impact most heavily on women because they are generally the care givers, and on their children, because they are most likely to come into contact with dirty water. My noble friend also makes a strong point that some things are associated with neglected tropical diseases as a class, not just with individual ones: poverty, dirty water, low levels of education, high birth rates, and much more.

My noble friend Lord Trees references the third report on progress since the 2012 London Declaration on Neglected Tropical Diseases. It points out that there has been pretty good progress: NTDs provide one of the strongest returns on public health investment, and points to the extraordinary levels of partnership here, between the public, private and voluntary sectors, and globally, nationally and locally. It is a terrific example for elsewhere.

However, here is the rub: it is now all about implementation: chasing down—as I suspect President Carter may say to us—the last guinea worm. As the report says,

“Coverage is increasing, but the pace is too slow to meet key milestones”.

We all know what will happen if the pace is slackened or people slow down. It happened with polio a few years ago, when it was eliminated in a number of countries but came back because people did not chase it down to the last moment. The paradox is that catching those last few microbes or worms is very expensive, and it is very important that we keep up the political will here in this country and elsewhere. The biggest risk for many of these diseases is that we do not finish the job properly; that is still an issue, for example, for polio. Like others, therefore, I urge the Government to keep up and even increase their current commitments.

Finally, I have two questions, which relate to the point made by my noble friend Lord Trees about the social and economic impacts, and which largely follow what the noble Baroness, Lady Warwick, and the noble Lord, Lord Bruce, have already said, on integration. We know that successful and sustainable elimination of these diseases will depend on many other developments, including provision of clean water, economic development and the education of adults and children. I therefore ask how the Government, through their wider development programmes, are integrating their support for eliminating NTDs with these wider programmes. I also note that this depends on surveillance and the provision of even basic health systems. How, therefore, are the Government both supporting the development of health systems in the poorest countries in the world and ensuring that these will be able to address NTDs?

My Lords, it is a shame that we have to use the term “neglected”, but yes, ever since I joined the advisory board of the Schistosomiasis Control Initiative—SCI—I have found that whenever I mention schistosomiasis to friends and acquaintances they say, “What? What’s that?”. First, I explain the scale, that over 260 million people in the world need treatment for schistosomiasis and 120 million of these are of school age, and then, as noble Lords all know, that schistosomiasis causes malnutrition and anaemia in children and blood in their urine; if untreated, it goes on to cause liver fibrosis and bladder cancer; and female genital schistosomiasis increases the risk of HIV. I can only think that the world neglects such diseases because over 90% of these cases are in sub-Saharan Africa. However, wherever these diseases exist, their effects are appalling.

I myself come at this not as a medic, an academic or someone working in an NGO but as a businessperson seeing the numbers and the cost-effectiveness of compassion. Reaching out to treat these young children before the worms cause this extensive damage costs less than 50p per treatment per child per year. However, the recent “scorecards” show that schistosomiasis is lagging behind in coverage, and programmes targeting the intestinal worms still have a long way to go to reach the World Health Organization’s target of annual treatment with 75% coverage of children at school age. This can be rectified. We have had generous help from the Bill and Melinda Gates Foundation, philanthropists such as Luke Ding through Prism the Gift Fund, the END Fund and, of course, DfID.

Along with this, SCI, which is centred at Imperial College, provides the drugs, microscopes, training materials, vehicles and other transport and ensures that the programmes are managed efficiently. As has been said, the pharmaceutical companies Merck, GlaxoSmithKline and Johnson & Johnson have generously offered to donate all the drugs that are needed to treat 100 million children with praziquantel every year against schistosomiasis and 600 million with deworming pills.

Where, then, is the problem? As was said, it is in delivery that there needs to be help. To treat children in schools, working with local governments, SCI has built a network in 11 countries. This network is set up, but in many of these countries many of the children are simply not at school. Delivery to these outlying children is vital.

The world can afford to help. The economics of the case are that, each and every year, 50 million years’ work is lost through people’s disability resulting from NTDs. Were these people well and able to contribute fully to their society, even at just $1 a day, as my noble friend Lady Warwick said, in each of these countries, this would mean an extra $18 billion a year for the African economy.

I urge the Minister to follow up this excellent debate with a meeting of DfID with the expert people working on this at Imperial College, the Liverpool School of Tropical Medicine and Sightsavers, so we could see how we might allocate more money to those who are already implementing treatment to millions of children so that they may treble their coverage in the next five years to have a chance, as was said, of eliminating these diseases in many more countries.

Dealing with these NTDs in this way could change the world immensely for the better. It would give these young girls and boys a better future, help their countries begin to thrive and thence would add $18 billion a year to the wealth of their continent and, therefore, to the world’s economy. I thank noble Lords.

My Lords, I am delighted to follow other noble Lords in today’s debate, and I draw attention to my interests as declared in the register. I am delighted, too, not to be introducing the debate tonight but speaking last from the Back Benches, because so many other speakers have dealt with the basics around NTDs. That includes the devastating effects that they have, not only on individuals in terms of debilitation or disfigurement and people often being excluded from their own society because of the effects of the diseases, but also the later effects on child development, educational attainment and pregnancy outcome, and of the interrelation of NTDs with other diseases such as HIV or malaria. All these things together are not only the results of the poverty in these communities but in themselves engender that poverty again. So NTDs are both the result of and the cause of poverty. We have done a great deal to recognise that and much progress has, as has already been stated, been made through the WHO road map, the London declaration, the announcement of the Ross fund and the inclusion of NTDs in the sustainable development goals. But there is much still to be done.

The funding gap, even for the provisions that we know about, has been pointed out tonight, but it goes wider than that because, as other noble Lords have pointed out, we need to tackle this problem not in individual silos. The public health measures that will defeat these diseases are to do with water and sanitation, public health education and the provision of basic services; without those, we will not get very far, and those are expensive items.

In the minute or so that I have left, I want to concentrate on the issue of vaccines. We know that we need to improve the toolbox that we have already. We know that we need better diagnostics, better medicines and better insecticides, and that is something that may become much more important in terms of Zika. But also, we need vaccines. There is some evidence that although for many diseases mass drug administration is extremely effective, for other diseases it is not so effective. Therefore, we need to not take our eye off the ball of vaccine development. We saw this in relation to Ebola, a different sort of disease that has already been mentioned tonight. Zika, I think, is a neglected tropical disease, but it is so neglected that it is not even included with dengue and chikungunya as one of those insect-borne diseases of the poor. It is not one of the 17 top priorities for the WHO. However, that is changing. It changed tonight by the declaration of an emergency. We need vaccines as well as all the other measures, and we know that product development partnerships are very important in getting round the failure of the market often to provide. So my question to the Minister is: what consideration is given within the Ross fund to extending its remit so that it would also cover vaccine development?

My Lords, as the noble Baroness, Lady Hayman, said, in the last two hours the WHO has declared the Zika outbreak in Latin America a global public health emergency. A silver lining may be that, as a neglected tropical disease, Zika may now receive the attention that it perhaps should have done already.

As my noble friend Lord Bruce of Bennachie made clear, public health is now a global issue and we have, in the last 20 years or so, because of the HIV/AIDS crisis and others, developed ways in which we can globally address those issues. The Global Fund brought together the private sector, Governments and the research community, and has made a major impact not only in the development of new treatments but in the new ways to get those treatments to people as quickly as possible. The Global Fund is due for replenishment this year. Will the Minister say whether the UK will remain committed to its level of contributions to that fund and encourage other international donors to do the same? As my noble friend said, the co-incidence of these diseases on the world population makes it important for that reason.

Many noble Lords referred to the announcement in the spending review of £1 billion for the Ross fund. Will the Minister indicate whether that will be additional to the funding previously made available for neglected tropical diseases and HIV? Can she tell us about the structure of that fund and whether the research findings that it funds will be made publicly available? How will access to any medical tools produced as a result of that fund be ensured?

As many noble Lords have indicated this evening, our current model of R&D for medicines is failing. If we continue to rely on a solely market-led R&D, the discovery of new medicines and, crucially, the access to those medicines by neglected populations will be hampered severely. Will the UK Government consider commissioning an economic paper to analyse the economic impact of our current market-oriented R&D model and a future model for R&D development in which the cost of research into drugs is decoupled from potential profits to companies? Much of the basic research on which the drug companies base their work is already publicly funded by Governments through academic institutions and so on. It is time that we moved to do that.

Will the UK Government, strong leader and advocate as they have been on public global public health issues, initiate a dialogue with the pharmaceutical industry and civil society to see whether it would be possible to reach agreement over a new R&D treaty in the run-up to the World Health Assembly? Noble Lords will know about mechanisms such as product development partnerships. They have proven to be instrumental in making sure that the poorest people on earth get access to the best medicine in the world, much of which is produced by our academic institutions.

My Lords, I, too, thank the noble Lord, Lord Trees, for initiating this important debate on neglected tropical diseases. Although the most common infections among the world’s poorest communities, they receive little public attention. As we have heard from many noble Lords, while not always fatal, their effect on individuals and communities can be devastating, the brunt of which is often felt by women and children, and act as a serious impediment to economic development in many countries.

The third progress report on the London declaration highlighted the dramatic health and economic benefits from investing in combating NTDs. The positive returns of relatively inexpensive programmes are significant, with an economic rate of return of 15% to 30%. As the noble Lord, Lord Trees, highlighted, NTDs are now recognised in the SDGs through Goal 3, which relates to healthy lives, and are explicitly included in Target 3.3. This is a major step forward for the profile of NTDs and a global commitment towards ending these diseases. Continuing this momentum through to national implementation strategies and national action plans will be critical to achieving the WHO NTD road map targets.

Global coverage is increasing, with around 43% of at-risk populations being reached by at least one drug, compared with around 35% in 2008. As the noble Baroness, Lady Barker, said, individuals with NTDs are at higher risk of contracting or not recovering from HIV/AIDS, malaria and TB because they weaken the immune system. Will the Minister take forward for Global Fund board discussion an assessment of the value of strengthening HIV/AIDS, TB and malaria investments through collaboration with national NTD programmes?

The risks to achieving the WHO targets remain not least the wars and conflicts that we have seen, and vector control. There are risks to promoting mass drug administration as highlighted by the noble Baroness, Lady Hayman, which include undermining already fragile healthcare systems. Ebola has shown us the devastating effect that infectious diseases can have on countries with weak and underfunded health systems. Investment in new diagnostics and treatments must be matched by investment in strengthening health systems. I, too, welcome the launch of the £1 billion Ross fund with the Gates Foundation. Like other noble Lords, I hope the Minister can clarify how much of the £200 million announced for NTDs through the fund is new funding and how much is existing allocated resource.

I should also like to know what steps are in place to ensure that money allocated from the Ross fund for research is complemented by investments in health system strengthening and efforts to deliver treatments and care to the people who are most in need. Finally, what steps will the department take to measure the impact of its NTD funding on women and girls, who disproportionately suffer from these diseases and the stigma attached to them?

My Lords, I, too, start by thanking the noble Lord, Lord Trees, for securing this debate and all noble Lords for their thoughtful contributions. I think that we should be proud of the role that the UK continues to play in its work on neglected tropical diseases, which I shall now refer to as NTDs. Her Majesty’s Government remain strong in their commitment to fighting these diseases, which, as my noble friend Lord Sheikh and the noble Baronesses, Lady Warwick and Lady Hayman, and others, said, affect the poorest of the poor. Every year neglected tropical diseases affect the lives of more than 1 billion people, causing disability, disfigurement, stigma and an estimated 500,000 deaths.

As noble Lords will be aware, at the high-profile London Declaration on Neglected Tropical Diseases in 2012, we made a commitment to spending an additional £195 million on NTDs, and last year the Chancellor announced the new £1 billion Ross fund, which has been mentioned by all noble Lords. I am pleased to inform the House that that includes support for NTDs—both for research into new drugs and diagnostics and for the implementation of programmes. These commitments are a clear indication of our continuing commitment to improving the lives of the poorest people in the world and to the principle of leaving no one behind that is at the heart of the global sustainable development goals.

I want to make two important points, one on results and the other on resources. I also want to congratulate the noble Lord, Lord Crisp, and the organisation Sightsavers International on their work, along with DfID, on the mapping of trachoma, a disease that results in blindness. As the noble Lord said in his remarks, it was the largest mapping programme in the world and has provided us with valuable information on the geographic distribution of the disease so that we can target resources where they are most needed.

Our support for tackling bilharzia—I may have pronounced that wrongly—which is a disease that often kills young people in young adulthood, is also yielding real results. Our programme here, as noble Lords have said, is delivered through Imperial College. It has already delivered 60 million treatments and aims to deliver a total of 200 million by 2018. Our support for combating elephantiasis, which is managed by the Liverpool School of Tropical Medicine, is also showing results. This is a disease which results in abnormal enlargement of parts of the body, causing pain, severe disability and social stigma. At least 24 million treatments are provided annually through the UK’s support, and 17 of the 73 elephantiasis-endemic countries are now able to stop treatment as they are thought to have achieved elimination. This is a huge achievement and the result of much effort by endemic countries and partners such as DfID.

Later this week, as the noble Lord, Lord Trees, alluded to in his opening remarks, former US President Jimmy Carter, who has led the international campaign for the eradication of guinea worm, will be speaking in the Robing Room. Over recent years the UK has been the second largest donor to the eradication effort after the Bill and Melinda Gates Foundation. In 1986 guinea worm disease affected 3.5 million people. In 2015 there were only 22 cases. Noble Lords will agree that this is an enormous achievement, but many challenges, as has rightly been pointed out, remain before we can consign this disease to history. I agree with the noble Lord, Lord Crisp, and others that we need to remain vigilant and push commitment to ensure that we can consign it to history.

Coming to my point on resources, the UK is the second-largest donor to support the implementation of the NTD programmes. At present, the donor base is far too narrow and the UK actively encourages efforts to raise additional funding from other partners. We are doing our bit, and as my noble friend Lord Sheikh said rightly, the 0.7% commitment demonstrates that the UK is delivering and is committed to what the UK firmly believes in—but we need others to do much more.

I agree with the noble Lord, Lord Trees, that it is important that we recognise the very substantial contribution of the pharmaceutical companies. Most of the medicines used for neglected tropical diseases are donated. Without that vital contribution, our progress would be much slower and much more costly. For the period 2014 to 2020, pharmaceutical companies have pledged drugs valued at $17.8 billion.

Of course, national government leadership in endemic countries is essential and domestic resources must increase if progress on NTDs is to be sustained. In turn, we will continue to show leadership in our health system strengthening work, supporting health worker capacity and access to essential medicines and equipment.

The noble Lord, Lord Stone, asked if I would meet him and others. I am always happy to meet noble Lords with their interested groups. I very much take the view that sharing best practice is a good way of learning how we can better our own strategic and effective delivery. The noble Lord will just have to do what noble Lords do: contact my private office. I am sure that that meeting will be put in place.

I shall now respond to some of the questions that were asked. If I run out of time, as always, I will write to noble Lords. The noble Baroness, Lady Barker, and others asked about the Global Fund replenishment. As one of the largest and longest-standing donors to the Global Fund, we are working hard to ensure a successful replenishment for 2017 to 2019, but we will make our own decision on the contribution in a few months’ time, after we have seen the outcomes of the multilateral aid review that is currently being undertaken by the department.

The noble Lord, Lord Crisp, the noble Baroness, Lady Hayman, and a number of other noble Lords asked how we are integrating NTD programmes with other sectors such as water sanitation. It is absolutely right that we look at integration across sectors, with water and sanitation being very important. We are increasingly doing so. We also have to encourage our partners to do the same. I hope that noble Lords who are involved in a number of organisations will take that message out because it is very important that we speak with one voice on these issues.

The noble Lord also asked how we are supporting the development of health systems in developing countries. I am pleased that DfID is a leader in supporting countries to strengthen their health systems. The noble Lord, Lord Collins, and a number of other noble Lords spoke about Ebola, where we saw that the response was slow in the beginning because of the weakness of those health systems. It highlighted to us that we need to make sure that we not only provide the funding but ensure that the capacity on the ground can respond to the issues and challenges that those people face. So it is essential that we ensure that they have the proper capacity and access, and proper medicines and equipment.

The noble Lord, Lord Patel, the noble Baroness, Lady Hayman, and others asked whether the Ross fund would be used to support clinical trials. The £1 billion Ross fund will include funding for research, including funding to develop, test and deliver a range of new products, including drugs and vaccines.

The noble Baroness, Lady Warwick, asked what further steps the UK can take in research, including product development partnerships. We support the Drugs for Neglected Diseases Initiative, or DNDi, a product development partnership developing new drugs for a range of NTDs, but we also support product development partnerships for new diagnostics. So it covers a wide range, not just of products with partners but the diagnostics behind them.

My noble friend Lord Sheikh rightly spoke about his experiences. He has vast experience in Africa. I am glad that he reminded us all of our commitment to 0.7%. Working with the Gates Foundation, we have demonstrated our joint ambition to see an end to malaria. My right honourable friend the Chancellor of the Exchequer made that announcement very recently.

All noble Lords said that we need to encourage others to step up. I absolutely agree. These issues and challenges will never be dealt with by individual countries or individual organisations. Part of our undertaking as a department is to make sure that we press at different fora and conferences for others to step up. We worked at the recent G7 meeting, which committed to address NTDs, and we are also working with developing countries to encourage them to commit domestic resources.

I have fast run out of time. I still have a couple of responses, but I will finish by saying that while much progress is being made, millions of people still need treatment and do not get it. The international community sees DfID as a global leader in tackling NTDs, but we cannot and must not be complacent. We need to continue to strive to have a transformational impact on the lives of the most vulnerable people across the world, ensuring, as we deliver our promise of leaving no one behind, that no one is left behind.