Role of the UK in ending malaria and neglected tropical diseases

Malaria and neglected tropical diseases

Malaria

Malaria is a life-threatening infectious disease that is spread to humans through some types of mosquitoes.[1]  Mostly found in tropical countries, the disease can be prevented through avoiding mosquito bites and the use of antimalarial medicines. Two vaccines have recently become available for the vaccination of children against the disease in areas of risk.

UN Sustainable Development Goal 3.3 is to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases by 2030.[2]  However, despite ongoing action in this area, the World Health Organization (WHO) recently reported that cases of Malaria had increased. 

The World Malaria report, published in December 2023, stated that “despite strides in expanding access to insecticide-treated nets and medicines to help prevent malaria in young children and pregnant women, more people were getting sick with malaria.”  It set out the numbers affected and the threats to progress in this area:

In 2022, there were estimated 249 million malaria cases globally, exceeding the pre-pandemic level of 233 million in 2019 by 16 million cases. In addition to the disruptions caused by COVID-19, the global malaria response has faced a growing number of threats, such as drug and insecticide resistance, humanitarian crises, resource constraints, climate change impacts and delays in programme implementation particularly in countries with a high burden of the disease.

The report notes that “progress has stalled in recent years” and calls for a “substantial pivot with much greater resourcing, data-driven strategies and new tools[…] to rebuild momentum in the fight against malaria.”

The WHO ‘global technical strategy for malaria’ sets a target for “reducing global malaria incidence and mortality rates by at least 90% by 2030”.  A framework for malaria elimination sits alongside the technical strategy providing guidance on actions to achieve malaria elimination.

More information about Malaria and action to tackle the disease:

• WHO, Factsheet: Malaria, December 2023
• WHO, World Malaria report 2023, December 2023
• The Global fund, Malaria

Neglected tropical diseases

Neglected tropical diseases (NTDs) are a group of 20 conditions that are mainly prevalence in tropical areas. The Pan American Health Organisation said that in 2021, 16 countries accounted for 80% of the global NTD burden, and that an estimated 1.65 billion people required treatment for at least one NTD globally.

The World Health Organisation publishes fact sheets about each of the conditions. These include information on how common the conditions are, where they are most prevalent, and what causes them.  It explains that NTDs are called neglected because they “almost absent” from the global health agenda:

Even today, when the focus is on Universal Health Coverage, NTDs have very limited resources and are almost ignored by global funding agencies. NTDs are diseases of neglected populations that perpetuate a cycle of poor educational outcomes and limited professional opportunities; in addition, are associated with stigma and social exclusion.

The 2021 WHO, Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030, sets out targets and milestones towards preventing, controlling and eliminating twenty NTDs. It is aligned with the UN Sustainable Development Goals.

At the Kigali Summit on Malaria and NTDs, held alongside the 26th Commonwealth Heads of Government Meeting in June 2022, the Kigali Declaration on NTDs (PDF) was launched.  The declaration welcomes the progress made against NTDs, noting that “600 million people no longer require treatment for NTDs” but said there was more work to be done.  The summit also saw commitments made by a number of countries, including the UK, and private and charity sector organisations to support action to tackle Malaria and NTDs.

The following sources provide further information on NTDs and action to tackle these:

• WHO, Neglected tropical diseases
• United to Combat Neglected Tropical Diseases, Neglected tropical diseases (NTDs)

UK government action on Malaria and Neglected tropical diseases

In May 2022, the Foreign, Commonwealth and Development Office (FCDO) published a new ten-year strategy for international development. This set out four priorities for UK aid, one of which is global health. Under this priority, UK aid will help:

• Invest in vaccines, therapeutics and diagnostics to reduce the impact of disease
• Build stronger health systems
• Make investments in organisations such as Gavi, the vaccine alliance, and the Global Fund.
• Help end the preventable deaths of mothers, babies, and children.

In May 2023, the Government published its Global Health Framework: working together towards a healthier world.  This sets out the “ambition to play a leading role in improving health globally and in building resilience to future threats.”  It includes 4 strategic objectives:

• strengthen global health security through improved preparedness and response to future epidemics, pandemics, drug-resistant infections, and climate change
• reform global health architecture including through a strengthened World Health Organization, driving more coherent governance and collaboration across the international system (including the global health initiatives, financing institutions and the Quadripartite Collaboration for One Health) 
• strengthen country health systems and address key risk factors for ill health, working towards ending preventable deaths of mothers, babies and children in the world’s poorest countries and enabling women and girls to exercise their rights
• advance UK leadership in science and technology, strengthening the global health research base of UK and partner countries, while supporting trade and investment.

A May 2023 Lords Parliamentary question response from the former Minister of State for the FCDO, Lord Goldsmith, set out the Government’s commitment to eliminating Malaria:

The UK is a global leader in supporting work towards achieving Sustainable Development Goal 3.3 to end the epidemic of malaria by 2030. The UK recently pledged £1 billion for the seventh replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria which accounts for 63 per cent of all international funding for malaria programmes. We also continue to play a leading role in research and development, including supporting the Innovative Vector Control Consortium to develop novel bed-nets and Oxford University to develop a new generation of antimalarial medicines to address the threat from emerging drug resistance.

A large proportion of UK Government contributions to tackling Malaria and NTDs are provided through global health initiatives such as the Global Fund to Fight Aids, TB and Malaria, GAVI the Vaccine Alliance, and the WHO. In November 2022, the Government announced it would pledge £1 billion to the seventh replenishment. Some NGOs, such as STOPAIDS, expressed concerns that the pledge represented a cut from previous pledges. More information on the Global Fund, and the UK pledge at the Seventh replenishment is provided in a Library briefing, UK aid and the Global Fund to fight HIV, Tuberculosis and Malaria.  In its November 2023 White paper, International development in a contested world: ending extreme poverty and tackling climate change, the Government said it would work with partners to:

drive reform across the global health architecture through the next Global Health Initiatives (GHI) replenishments […] to ensure effective and co-ordinated GHIs, and a stronger WHO able to respond in health crises and deliver on health services and well-being.

The following chart provides information on direct UK Government aid spending on infectious diseases such as Malaria and NTDs. This shows that aid spending on these diseases has fallen since its peak in 2013, although total spending on infectious diseases rose sharply during the Covid-19 pandemic.

There have been concerns raised for the level of aid funding on infectious diseases following the Government’s decision to spend 0.5% of GNI (rather than the previous 0.7%) on overseas aid from 2021 as a “temporary measure”.  A Lords Library briefing provides further information on potential impacts of aid cuts on funding for control of malaria and other conditions, How have cuts to overseas aid affected the control of malaria and other diseases?  More information on the 0.7% target and the reduction in UK aid spending is provided in a Library briefing, The 0.7% aid target.

A March 2023 Parliamentary Question response from the Minister for Development and Africa, Andrew Mitchell, set out the Government’s support for the WHO roadmap on NTDs:

The United Kingdom was pleased to endorse the Kigali Declaration on Neglected Tropical Diseases (NTDs) at its launch, to support continued progress on delivery of the World Health Organisation 2030 road map on NTDs. The FCDO will continue to invest in research and innovation in new drugs and diagnostics for diseases of poverty, including NTDs, through world-leading Product Development Partnerships (highly successful public-private partnerships for developing health technologies such as vaccines, therapeutics and diagnostics) and other research organisations. Since January 2021, the FCDO has invested over £42 million into delivering services to prevent and treat NTDs, as well as strengthening health systems so they can provide these essential services.

In September 2023, at the UN General Assembly, International Development Minister Andrew Mitchell and Health Minister Will Quince announced investment for research and development on global health issues.  This included funding for the development of new vaccines, and for the Tackling Deadly Diseases in Africa programme II, which helps “detect and tackle future epidemics, drug resistant infections and climate change.”