International Development Committee Inquiry

Call for evidence into Extreme Poverty and the Sustainable Development Goals (SDGs)

Submission by the Drugs for Neglected Diseases Initiative

February 2022

SUMMARY AND RECOMMENDATIONS: 

•       People living in extreme poverty, with limited access to safe and secure water, sanitation, food and shelter are at great risk of sickness, disability or death from disease including neglected tropical diseases. Becoming sick, with loss of income or catastrophic medical expenses, can also push people into extreme poverty.
•       Neglected tropical diseases (NTDs) are ancient diseases of poverty that impose a devastating human, social and economic burden on more than 1 billion people worldwide, predominantly in tropical and subtropical areas among the most vulnerable, marginalized population[1].
•       Supporting research, development and universal access to appropriate and affordable health  tools to prevent, diagnose and treat NTDS is an important part of alleviating the human and economic burden they impose on the world’s most disadvantaged communities and in achieving  the Sustainable Development Goals.
•       Whilst the UK Government, and the FCDO’s, focus on immediate investments in research and development (R&D) for COVID-19 is laudable, to effectively target extreme poverty, it is critical that continued investment into research and development of products for other health issues, including neglected tropical diseases, is not overlooked. 
•       The FCDO should include the research and development needs of climate-sensitive neglected tropical diseases into its climate agenda and priorities.
•       The UK Government should ensure that resources to support Product Development Partnerships (PDPs) working on poverty and related NTDS are included in the 2022/2023 budget at a level similar to previous years.  
•       Global health R&D should therefore play a key role as part of the UK Governments ambition to invest 2.4% of GDP in research and development by 2027[2].
•       The FCDO should considering leading the UK Government in establishing a cross government global health strategy to guide ODA allocations to health with an SDG lens. 

INTRODUCTION: 

The Drugs for Neglected Diseases initiative (DNDi) welcomes the opportunity to contribute to the International Development Committee’s inquiry into Extreme Poverty and the Sustainable Development Goals (SDGs).  

DNDi is a collaborative, patients’ needs-driven, non-profit drug research and development (R&D) organization, that is developing new treatments for neglected diseases. Our mission is to improve the quality of life and the health of people suffering from neglected diseases, by using an alternative model to develop drugs for these diseases, and by ensuring equitable access to new and field-relevant health tools.   

DNDi’s primary focus has been the development of drugs for the most neglected diseases. These include Human African Trypanosomiasis (sleeping sickness), American trypanosomiasis (Chagas Disease), leishmaniases and mycetoma. We also engage in R&D for other neglected patients (e.g. malaria, paediatric HIV, Hepatitis C and filarial infections), support development of diagnostics and/or vaccines to address unmet needs and have responded to the pandemic by developing therapeutics for COVID-19.  

With offices in 9 countries around the world (Brazil, The Democratic Republic of Congo, India, Japan, Kenya, Malaysia, South Africa, Switzerland, and the USA), we work closely with research institutions, clinicians and patients' groups in endemic countries and leverage the support of 180 institutional partners worldwide.  

UK Government funding has significantly contributed to DNDi’s ability to deliver 8 new treatments for five diseases in 15 years - building on global collaborations with the public and private sectors and ample collaboration with UK scientists. Core funding from FCDO enables DNDi to approach drug development in a results-oriented and cost-effective manner. This results in significantly lower costs for drug development than seen in the private sector, and treatments which are adapted for the needs of, and are affordable and accessible to, patients in resource-limited settings.  

Question 1: How well is UK Official Development Assistance (ODA) targeted towards tackling extreme poverty and how effectively do the FCDO policies and programmes contribute to the achievement of Target 1.1 of SDG 1?

1.1  Action to address Neglected Tropical Diseases (NTDs) is an important example of how ODA can be targeted towards tackling extreme poverty. They are a proxy for poverty and disadvantage, affect populations with low visibility and little political voice, cause stigma and discrimination, especially of girls and women, have an important impact on morbidity and mortality, and are relatively neglected by research. NTDs are, in effect, a litmus test that reveal the existence and quality of Universal Health Coverage. 

1.2  NTDs, are a diverse set of 20 diseases or disease groups[3] with one thing in common: their impact on impoverished communities, sometimes referred to as diseases of poverty because of their impact on poor and neglected patients and populations. For example, in Bihar, over 80% of households affected by Visceral Leishmaniasis belonged to the poorest 40%[4].

1.3  Not only are NTDs diseases of poverty with heavy health impacts and burden, but the cost of treating NTDs can push households further into poverty. In Cambodia and Vietnam, research found that “between half and two-thirds of affected households have incurred debt as a result of treatment for dengue” and in “Bangladesh, India, Nepal, and Sudan, 25 percent to 75 percent of affected households experience some type of financial catastrophe in obtaining a diagnosis and treatment, even when tests and medicines are provided free of charge[5].”

1.4  In addition to contributing to alleviating poverty, successful interventions against NTDs would contribute to other SDG goals and indicators: the elimination of NTDS by 2030 (Goal 3), hunger (Goal 2), enabling people to pursue an education (Goal 4) and lead productive working lives (Goal 8) and promoting equality, for example with regard to gender (Goals 5 and 10).

1.5  DNDi’s core mission, to research and develop for new treatments for diseases of poverty,  has been largely due to the flexibility and model of our funding. Leadership and core funding from the UK has been crucial in supporting the work of DNDi, to ensure that, neglected diseases and neglected patients are not left behind.

1.6  Although it is, as yet, unclear exactly what the impact of the FCDO budget cuts will be on DNDi in coming years, overall UK Aid has historically provided 21% of DNDi funding. DNDi is committed to delivering 15 to 18 new treatments between 2021-2028. However, a quarter of these innovations may not be delivered without continued investment, pushing patients to access the treatment they need at a much later stage impacting the lives of millions of people affected by deadly diseases that fuel the cycle of poverty. 

1.7  The risk of losing support from the UK to DNDi, and others engaged in R&D for NTDs, is compounded by ongoing shortfalls in funding for R&D to meet neglected patients’ needs. The 2021 G-FINDER report, a yearly  report which tracks such funding, highlights this continuing and worrying trend. In 2020, NTD R&D funding between 2009 to 2019 was essentially flat. In 2019, of all funding towards R&D for neglected diseases (i.e. including HIV, TB, and malaria) only 8.5% ($328m) went to R&D specifically for neglected tropical diseases[6]. Yet, the ongoing burden of NTDs is high. With a fifth of the world requiring ongoing treatment, specifically 600 million people or more at risk of visceral leishmaniasis, 217.5 million people at risk from river blindness, 75 million at risk from Chagas disease, 5.6 million at risk from sleeping sickness, and more than 200,000 people dying each year from snakebite venom, rabies and dengue[7].  

1.8  In addition, the impact of the complete withdrawal of funding with immediate effect from the  NTD implementation programme, ASCEND, threatens years of hard-fought progress toward eliminating NTDs in several countries, and possible disease resurgence in areas once free of these devastating diseases. 

1.9  Whilst the UK Government, and the FCDO’s, focus on immediate investments in research and development (R&D) for COVID-19 is laudable, to effectively target extreme poverty, it is critical that continued investment into research and development of products for other health issues, including neglected tropical diseases, is not overlooked.  With health threats currently heavy on the public consciousness, it is an opportune time to champion efforts to end preventable deaths through UK-funded science and innovation.

1.10 Through a decade of investment in Product Development Partnerships (PDPs), UK Aid has helped develop and deploy more than 65 products to combat many of the world’s deadliest diseases – including tuberculosis, malaria, HIV/AIDS and a host of other neglected tropical diseases. Products from these investments have reached more than 2.4 billion people around the world, including the most vulnerable women and children.  The UK government should commit to ensuring that resources to support PDPs are included in the 2022/2023 budget at a level similar to previous years. 

1.11 COVID-19 has highlighted the lack of international collaboration in preparing for and responding to pandemics, that no country can do so alone and that more investment is needed. However, there is a risk that by focusing on a narrow definition and scope of health threats that the FCDO will miss an opportunity to address unmet needs with the broadest benefit to global public health and poverty alleviation. Poverty reduction will only be achieved through the development of stronger health systems and a range of new tools which can respond quickly to current and emerging health priorities.  

1.12 The FCDO should therefore ensure its objectives are aligned with the Sustainable Development Goals and the principle of leaving no one behind, ensuring they maximise global health outcomes. Ending extreme poverty will require increased efforts to effectively tackle diseases of poverty including reaching targets set by the WHO 2030 Roadmap on NTDs. Current tests and treatments for most NTDs have serious limitations that hamper the provision of lifesaving medical care and impede disease control and elimination efforts. Much needs to be done including sustained investment in innovation and access to new health tools to prevent, diagnose, and treat neglected diseases. 

Question 2: How might the FCDO’s strategy, policies and programmes need to change as the number of people in extreme poverty grows due to the global pandemic or the effects of climate change? 

2.1               The COVID-19 pandemic has exposed the deep inequities, vulnerabilities, and limitations of the current biomedical research and development system for ensuring innovation and access to all essential medical technologies, leaving people living in extreme poverty behind. Market-based incentives alone have often been insufficient to develop and ensure access to all necessary countermeasures. This is particularly true for poverty related diseases, including neglected tropical diseases, and other areas such as antimicrobial resistance, where traditional market incentives fail to respond to, prioritize, and ensure R&D investments in the needs of patients who do not necessarily represent a ‘lucrative market’ or where the demand is low or uncertain. Thus, the world needs public investments and alternative needs-driven business models to deliver health benefits to all and address the health consequences of racial and economic disparities within and between countries.   

2.2  Poverty related diseases are, or persistently threaten to be, of epidemic character and resistance levels are increasing. Neglected Tropical Diseases already have a debilitating impact upon economies, societies, and health systems across low- and middle-income countries. Yet, both climate change and migration increase the current and future burden of these diseases in both developing and developed countries.

2.3  For example, Dengue is a climate-sensitive disease and variations in weather and temperature affect the growth and development of dengue-carrying mosquitoes, as well as the time the virus takes to incubate and replicate, and of incidences of mosquito-human interaction. As a result, rising temperatures are expected to see dengue intensify in endemic areas through faster viral amplification, increased vector survival, reproduction and biting rate, leading to longer transmission seasons and an increase in infections, including of severe dengue. At the same time as increased and more severe outbreaks in already endemic areas, dengue will also spread to new areas, often with explosive outbreaks – such as those already being seen in parts of Europe. Dengue is also spreading as a result of mass population growth, increased global movements and migration and an increase in breeding sites through rapid, and often poorly designed, urbanization. People living in densely populated areas in badly constructed housing, without adequate clean water and poor sanitation are particularly vulnerable.

2.4  Efforts to support pandemic preparedness and adapt to climate change therefore warrant a greater focus on the development and access to health tools for other diseases, including climate-sensitive NTDs, designed to meet the needs of vulnerable populations living in poverty.

2.5  Therefore, the FCDO should include innovation and research and development needs of  NTDS in  pandemic preparedness and response, and climate-sensitive neglected tropical diseases into its climate agenda and priorities.

Question 7  How can the FCDO play a more effective part in the eradication of poverty as a convener, thought leader and investor? 

7.1  The UK is already a convenor, thought leader and investor as a global science superpower in relation to global health R&D which must be sustained play a more effective part in the eradication of poverty. It has a long history in preventing and controlling major epidemics, pandemics and deadly infectious diseases which have a disproportionate effect on people living in poverty. Global health R&D should therefore play a key role as part of the UK Governments ambition to invest 2.4% of GDP in research and development by 2027[8].

7.2  The UK is home to cutting edge research institutions, scientists, biotech SMEs and industry working on global health. DNDi has worked with almost 50 UK partners including Universities, Research Centres, and Pharmaceutical and Biotech companies[9]. It is essential that the UK Government builds on the R&D partnerships and expertise it already holds for neglected diseases.

7.3  An example of where the UK Government, via DFID, played a catalytic and global thought leading role in the understanding of the ecosystem for public health R&D, was as one of the first public donors in 2006 to fund efforts to address these shortcomings in the commercially focused R&D system, and until 2021 remained a leader in funding public health R&D via ODA. It is unclear whether the UK Government, via the FCDO, will continue to support alternative models of global health R&D for neglected diseases and populations in coming years but we strongly encourage them to do so, including via Product Development Partnerships (PDPs).

7.4  Product Development Partnerships (PDPs) are an example of such need driven not for profit business models designed to deliver health tools to meet public health priorities. PDPs develop new health tools for diseases and health threats, for those in extreme poverty, underserved by commercial approaches, by building partnerships between the public, private, academic, and philanthropic sectors focused on the areas of greatest need. Due to their unique approach, PDPs have been able to develop and distribute new health technologies designed from the start to be appropriate, accessible, and affordable for the places and people that need them.  In disease areas where traditional market incentives have been insufficient to encourage significant investment by the private sector, PDPs and their partners are the primary drivers of innovation, developing health solutions that would otherwise likely not exist. 

7.5  The pipeline of new products from PDPs is more promising than ever. Today, PDPs are working on more than 375 new health technologies for some of the world’s deadliest infectious diseases - approximately 25% of them are in late-stage trials.  

7.6  Diseases of poverty must be overcome if we are to meet the SDG target of ending the epidemics of neglected tropical diseases by 2030 and to ensure universal health coverage. We therefore recommend that the UK Government, building on its expertise as a ‘Scientific Superpower’, commits to ensuring that resources to support PDPs are included in the 2022/2023 budget at a level similar to previous years. 

8