‘A very cruel exit’: UK’s aid cuts risk rapid return of treatable diseases

By Lizzy Davies
People stand watching as a local worker gets out a trachoma treatment kit, Nigeria
Sightsavers has been working in Nigeria to eliminate the blinding eye infection trachoma using antibiotics donated by Pfizer that cost 35p per person per year to distribute. Now funding has stopped. Photograph: Graeme Robertson/The Guardian

A chandelier sparkling in the background, the grandeur of Downing Street gleaming behind him, Boris Johnson looks into the camera and speaks with solemnity. He is marking World Neglected Tropical Diseases Day, he says, to raise awareness of these “terrible afflictions … which impose an immense burden of suffering in developing countries”.

Huge progress has been made, he says, in the fight against the diseases, not least as a result of British aid to some of the poorest parts of the world. But there is more – much more – to be done: more than a billion people are still at risk, he warns, and that is why the UK “fully supports” the World Health Organization’s big elimination push over the next decade.

“There’s nothing inevitable about this weight of suffering. It can be avoided,” the prime minister intones, for the video broadcast at the end of January.

However, just three months later, as part of swingeing cuts to the aid budget, staff working on the government’s flagship programme to fight neglected tropical diseases were told it was going to be brought to a premature end. Known as Ascend (Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases), the £200m project had been divided into two, one in west and central Africa, the other stretching across eastern and southern Africa and parts of south Asia. Both had been due to continue until 2022. Instead they ended a fortnight ago.

Boris Johnson speaks of the need to tackle neglected tropical diseases in January 2021.

The move, say experts, has jeopardised years of slow, steady progress towards the elimination of NTDs, meaning that countries that could have realistically looked forward to stamping out a disease in the near future may no longer be able to do so. And with that comes millions of people suffering, in Johnson’s words, “the pain, disfigurement and poverty” of diseases that are – on paper at least – easily treatable.

“You can’t eliminate a disease in a year. You can’t do it in two,” says Simon Bush, director of NTDs at Sightsavers, the NGO that ran Ascend in west and central Africa. “It’s a very long-term approach, but we’ve proved it’s entirely possible: we’ve got countries like Ghana who have eliminated trachoma [an eye disease that can cause blindness]; Togo has eliminated lymphatic filariasis [a parasitic disease causing severe disfigurement].’

A banner in Nigeria with a picture of a young woman smiling
A banner in Nigeria celebrating the billionth treatment for river blindness by Sightsavers and its partners. Photograph: Graeme Robertson/The Guardian

“So it’s not just airy-fairy sort of stuff; it can actually happen. The UK government has invested in neglected tropical diseases for a number of years now, which is great. Now they’ve just pulled the rug, the carpet has been taken. We’re on the journey to elimination. Some countries have proved they can do it. But now that elimination is compromised.”

Bush says he had no reason to expect such a move from the Foreign, Commonwealth and Development Office (FCDO), even as it prepared to slash the aid budget from 0.7% to 0.5% of GDP as a response to the Covid-19 pandemic. Ascend, a public-private partnership with pharmaceutical giants that provided the drugs, had always been regarded by the FCDO – and before that the Department for International Development – as “fantastic value for the UK taxpayer”, he says.

There was even the Johnson video message, which Bush sent to his colleagues on the ground: “We sent it around and said, ‘look, this is the prime minister! Our prime minister said this, you should be really proud.’”

Those staff, he says, are now “devastated and bewildered” by the abrupt end. He adds: “They know the impact that this will have on the communities that they work in. Do they understand it? No. They don’t understand the rationale.”

Sightsavers says that, in its short lifetime, Ascend supported 137m drug treatments for neglected tropical diseases in 12 countries, among them Nigeria and the Democratic Republic of the Congo.

“If the project had continued as it was supposed to have done, around another 130m treatments would have been undertaken, covering five of the neglected tropical diseases. Around 30,000 health staff would have been trained to monitor and supervise the programme. But one of the key elements is around 450,000 community health workers who would have been trained to deliver the drugs,” says Bush.

Local workers administer treatment to prevent river blindness in Nigeria, which affects about one in five people across the globe
Local workers administer treatment to prevent river blindness in Nigeria, which affects about one in five people across the globe. Photograph: Graeme Robertson/The Guardian

Drug delivery was the cornerstone of Ascend, with teams of trained and trusted volunteers going house to house to inform, cajole and administer the medication necessary to keep the diseases at bay. Pharmaceutical giants such as Merck and GlaxoSmithKline are willing to provide billions of dollars of drugs free of charge only as long as there is a viable means of getting them to the people who need them, something that in the poorest countries often is not possible.

In Guinea-Bissau, for example, Bush fears that NTD targets will now not be met, including the aim of eliminating lymphatic filariasis by next year. He says: “There’s a very simple reason why they will not be met: the drugs that have been manufactured or are in the process of manufacture will not be delivered in that country. There’s no mechanism, there’s no funding now, for those drugs to be distributed.”

He is particularly worried about efforts to stamp out river blindness – a parasitic infection spread by flies that causes skin irritation, itching and, eventually, blindness. The path to eliminating this disease is longer than many others – about 15-20 years – but in west Africa measures to fight it have meant that cases do not generally lead to sufferers losing their sight. If several treatments are missed annually, however – it only requires between one and three pills a year – Bush fears the blinding will return.

“It’s not me just trying to instil horror in the situation; if you don’t treat, then there’s always going to be the risk of the return of the disease,” he says.

Surgeons perform trachoma operations at a makeshift operating theatre in a remote area of Turkana, Kenya
Surgeons perform trachoma operations at a makeshift operating theatre in a remote area of Turkana, Kenya. Photograph: Tommy Trenchard/Sightsavers

Sightsavers has been unable to fill the £38m funding hole left by FCDO, but this week a glimmer of hope in the global picture came from the not-for-profit international development company, Crown Agents, who were responsible for Ascend in eastern Africa. In a statement, it announced it had secured £10m of funding from the Children’s Investment Fund Foundation (CIFF) for a new NTD programme in Kenya, Mozambique, Uganda, Tanzania and Zanzibar, and Zambia.

There is no replacement, though, for the behemoth that was Ascend. Bush fears his staff will spend the next months writing funding proposals rather than working in the field. And the clock is ticking. His “major gripe” is that the FCDO gave him too little time to prepare an orderly departure that could have tapered activities and enabled some of the most important drug treatments to be carried out. Instead, in panic, he had to send out teams in Liberia during the rainy season, and they got stuck in the mud.

“I consider it,” he says, “a very cruel exit.”

An FCDO spokesperson said: The UK has made a significant contribution towards protecting millions of people around the world from such diseases, delivering treatment and care, and strengthening health systems. We will still spend more than £10bn this year on international development, including £1.3bn on global health.

“The seismic impact of the pandemic forced the tough decision to temporarily reduce the aid budget and exit some programmes, including Ascend.”

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