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Neglected once more: UK government report on infectious diseases excludes the ‘NTDs’

5 Aug 2008

Paul Chinnock

Source: TropIKA.net

When the British government established a committee, ‘to consider how contemporary issues of international policy are addressed through United Kingdom membership of intergovernmental organisations’, the new committee had then to decide which contemporary issue should first receive its attention.

To quote from the subsequent report of the House of Lords Intergovernmental Organisations Committee: ‘We considered a number of areas of IGO [Intergovernmental Organization] activity which would be suitable for inquiry, including Peacekeeping, Human Trafficking, Disarmament and Controlling the Proliferation of Weapons of Mass Destruction. One subject, however, commanded clear support as deserving a clear-cutting and urgent inquiry – namely, controlling the global spread of infectious diseases.’

It is encouraging for anyone concerned with the infectious diseases of poverty to see this area accorded such priority status. Nevertheless, those who read the 80-page report – Diseases Know No Frontiers: How effective are Intergovernmental Organisations in controlling their spread? – will be disappointed to see that only four diseases received the committee’s attention: TB, malaria, HIB/AIDS and pandemic influenza.

The report explains that the committee recognises that there are, ‘...many other serious infections, including ebola, SARS, pneumococcal disease and leprosy, and our choice does not imply that there is not a need for concerted intergovernmental action to deal with them. The ones we have selected are intended simply as working examples of how IGOs are going about their task.’

However, HIV/AIDS, TB and malaria (often called the ‘big three’ infectious diseases) share one important feature – they have attracted considerable increases in funding for research and control efforts in recent years. Pandemic influenza is well recognized as a potential threat to rich and poor nations alike and is therefore another a disease that already commands the attention of governments, the media and the general public.

Many articles featured on TropIKA.net and elsewhere have highlighted the colossal scale of the global disease burden caused by infections that do not receive such attention. The so-called neglected tropical diseases (NTDs) afflict an estimated 1.1 billion of the 2.7 billion people who live on less than US$2 per day. When combined, the global disease burden of the most prevalent NTDs rivals that of any of the big three (1). Nevertheless, the UN Special Programme for Research and Training in Tropical Diseases (TDR) is not amongst the IGOs considered in the report.

In choosing to focus on un-neglected diseases, the committee squandered an opportunity to analyse the performance of IGOs in dealing with less high-profile infections, such as trypanosomiasis, schistosomiasis and filariasis. (See the TropIKA.net ‘Diseases’ item in our menu, top left, for a more extensive listing of the infectious diseases of poverty.)

It must of course be recognized that the task of the committee was to consider the issue from a British perspective and, for example, the risk of pandemic flu causing serious problems within the UK considerably exceeds the chances of the country experiencing a major outbreak of sleeping sickness. Nevertheless, as the report notes, the UK does play a major role in international efforts to combat disease in developing countries. It is thus surprising that the committee did not take a broader view.

Restructuring: are regional offices WHO’s ‘weakest link’?

Diseases Know No Frontiers is nevertheless a document of some interest. In its search for evidence on the performance of the IGOs, the committee obtained input from many expert witnesses. These witnesses agreed on the central role played by the World Health Organization. For example Dr Stewart Tyson, from the UK’s Department for International Development (DFID), told the committee ‘WHO is the body that governments trust. They see that it is their organisation, it is the first place they will go to for a source of technical advice and they [WHO] are in a very privileged position’. The report notes that ‘the landscape of international health has become, in the government’s words, “crowded and poorly coordinated”.’ It therefore concludes that leadership is essential and that WHO should fulfil the leadership role.

For WHO to succeed, however, the committee considered that it will need both further support from governments and considerable restructuring as an organization. The report’s recommendations in this area focus on the relationship between WHO headquarters and its regional offices. Dr Tyson is again quoted; he told the committee that, ‘if you ask any DFID adviser in Africa, they would say the weakest link of WHO is the Regional Office.’ While similar comments have been made before, it is significant that they now appear in a government document. Diseases Know No Frontiers may therefore have a part to play in promoting further reforms within WHO.

Training on TRIPS

Amongst other issues raised by the committee is the question of patent protection on medicines, which can put the price of newer medicines beyond the reach of people in the world’s poorer countries. This is an issue relevant to the treatment of many of the NTDs.

TRIPS – the World Trade Organisation (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights – requires WTO Member States to adopt minimum standards of intellectual property protection that are often greater than the protection previously granted. However, the Doha Declaration states that the TRIPS Agreement ‘does not and should not prevent Members from taking measures to protect public health … and, in particular, to promote access to medicines for all.’

The report urges that the British government should support development of health diplomacy training to enable developing countries to make the fullest use of the flexibilities in the Doha Declaration. It suggests that the UK should go further and organise a series of courses for appropriate officials from developing countries, or sponsor them to attend existing courses.

Such comments demonstrate that this is a committee that does its work thoroughly and is prepared to be innovative in its recommendations. It is indeed a great pity that it did not give more consideration to the infectious diseases of poverty in this report. Its assessment of IGO performance in this area could have been of great value.

See also the TropIKA.net News story on the publication of the report.

Reference

1. Hotez P (2007) A New Voice for the Poor. PLoS Negl Trop Dis 1(1): e77. Available from : http://dx.doi.org/10.1371/journal.pntd.0000077