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Mr Gary Streeter (in the Chair)
Before I call Mr George to introduce this important debate, I should point out that seven colleagues have expressed a wish to catch my eye, and that will be during a period of 50 minutes. If Back Benchers, not including Mr George, can restrict themselves to seven minutes each, that will give the shadow Minister and the Minister enough time to wind up the debate.
Andrew George (St Ives) (LD)
It is a pleasure to serve under your chairmanship, Mr Streeter. I am delighted to have secured this debate on research and development for global health, particularly in the week when the all-party group on global tuberculosis, which I co-chair with the right hon. Member for Arundel and South Downs (Nick Herbert), publishes its report “Dying for a Cure: Research and Development for Global Health”. The role of all-party groups on health generally, particularly health in developing countries, is an important dimension of the work of parliamentarians. We often have opportunities to expand and probe these issues, which are important to many of our constituents; it is also important, of course, that we as a country play a leading role in the world in this respect.
This afternoon, I hope to provide a canvas on which hon. Members more expert than I on this subject can add their own, more expert comments. I want simply to go through a number of themes that I think are important for the Department for International Development as it develops its leading role in addressing the urgent need for advances in research and development for global health. I particularly want to emphasise the issue of tuberculosis.
The incidence of tuberculosis is falling marginally year on year. Currently, there are 8.7 million new cases each year. Tragically, 1.3 million people die of the disease, and there are about 650,000 cases of drug-resistant tuberculosis. That is largely a man-made disease, because of inadequate treatment with front-line drugs. Only about 10% of those cases are getting adequate access to diagnosis and treatment.
We in the United Kingdom cannot isolate ourselves from the issue because there are about 9,000 new cases of tuberculosis in this country each year, and the London area is the capital of Europe as far as tuberculosis is concerned. There were more than 400 new cases of drug-resistant tuberculosis in this country in one year, and that number is going up. This disease should concern us domestically as well as internationally.
We need to bear in mind not only the tragedy for those who contract the disease and their families, and the further tragedy for those who die from the disease; there is also, of course, a significant burden on the public purse. It costs £5,000 to treat a patient with first-line tuberculosis drugs and £50,000 to £70,000 per annum—sometimes, a great deal more—to treat drug-resistant forms of tuberculosis.
An estimated 13.7 million people die every year from, or in connection with, a group of diseases known as poverty-related and neglected diseases. Those include TB, HIV, malaria, dengue, yellow fever and others.
Research and development is, of course, expensive. There are some estimates that developing a new drug through commercial routes costs at least $l billion. Pharmaceutical companies invest in developing products with the potential for a significant financial return, to pay for the original development costs and ultimately to make a surplus—a profit. They are not charities, and that is what their shareholders would expect them to do.
In addition, as the diseases I have mentioned primarily affect poor people, there is often no financial market to incentivise commercial sector pharmaceutical development. Accordingly, very few new products, whether they be new drugs, new diagnostics or new treatments, are developed. There is therefore a market failure in the development of drugs, diagnostics and vaccines for diseases that predominantly have an impact on low and middle-income countries. Although pharmaceutical companies will be developing the Viagras of this world for the west, it seems that crucial drugs that would save millions of lives in the developing world are very difficult to advance at all. That market failure is similar to the failure of the commercial sector to develop new antibiotics. Again, that is because there is insufficient financial return on offer for such products.
In the absence of the commercial sector, public and philanthropic organisations attempt to fill the gap, but progress is slow. There are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. There is a wider concern. The World Health Organisation, in its report in April, identified—rightly, I think—the serious risk of antimicrobial resistance as a very significant challenge for the world in the coming years.
Of course, it was very welcome that last week the Prime Minister announced a commission to undertake a wide-ranging, independent review led by the internationally renowned economist Jim O’Neill. It will look into the whole issue of antibiotic resistance, about which many Members of the House have been most concerned.
A lot of us are concerned about the improper prophylactic use of antibiotics generally, in many sectors. Of course, when we look at tuberculosis, we also see a significant problem in some countries. Often it is in the private sector, where drugs are doled out as first-line responses but the health systems are not in place to ensure that the patients will complete the course of treatment. That significantly increases the risk of drug-resistant tuberculosis.
Tuberculosis has been traced back 70,000 years, and the period for malaria is similar, but for the majority of that time the best cure for patients was rest, fresh air and lots of hope. In the 19th century, as many as one in four deaths in the United Kingdom were attributable to tuberculosis. Obviously, we have concerns now about the advancement of drug-resistant tuberculosis. If we are to avoid that fate and to accelerate the progress made against HIV, TB and malaria during the past decade, we must find new interventions that are more effective against these diseases and that can help to drive them towards elimination.
Of course, there is, as we fully understand, a commercial development process. Those of us who have been following the advancement of candidate vaccines for tuberculosis, for example, have been encouraged by the work of many companies, but we are talking about something that fundamentally requires public sector intervention and support. The pharmaceutical companies backing the initiatives are not putting all their money and resources up front; a partnership with Government is required.
Although many early scientific advances in disease control were discovered with public or philanthropic money, most pharmaceutical development is now carried out in the commercial sector. The costs of researching and developing a new treatment, vaccine or diagnostic can be extremely high, and estimates for the cost of drug development run to billions of dollars. Because of the high cost of research and development, pharmaceutical companies inevitably target their resources towards diseases and conditions likely to yield a financial return. That means that most companies focus their efforts on diseases and conditions that affect the west or developed countries, because those markets can pay the most for new drugs.
Another significant impediment is that when companies develop their products, they maximise their profits and protect their interests and investment by securing patents. That gives those companies monopoly rights, which may make the prices for the drugs so high that patients in poorer countries cannot afford them. That is a problem of access. Problems related to research and development for global health will not be fixed unless treatments are developed and made accessible to everyone who needs them. In the face of such market failure, alternative models must be created to ensure that those medical products are being developed, even if not through a commercial route.
Andrew George
I will just make my next point; my right hon. Friend may be pleased when I have. Thankfully, such models exist. Product development partnerships are an important group of organisations that work with academic, public and private partners to try to develop important new products where the market has failed. The Department for International Development, as my right hon. Friend knows from his work as an excellent Minister in that Department, is the world’s leading public funder of PDPs.
Mr O'Brien
I congratulate my hon. Friend on securing this timely and important debate. I draw the attention of the House to my registered interests in the field—albeit that they are all pro bono, I hasten to add—and I apologise for the fact that I cannot stay for the whole debate.
My hon. Friend is driving towards an optimistic point. There has been a model that has helped the normal incentivisation of product development through a potential return from a purchasing power market, so it seems to me that we have great grounds for optimism on diseases of poverty—malaria, HIV/AIDS and tuberculosis, but also the neglected tropical diseases where the motivation is often not to avert death but simply to improve well-being. DFID, as a partner, has been tremendous in its commitment not only to commissioned but to operational research, which is fundamental. I urge my hon. Friend to look at the growth and sustainability of public-private product development partnerships, because I think they are one of the most significant ways forward.
Andrew George
My right hon. Friend is much respected in his field, and I am sure that the Minister heard what he had to say. The leading role that DFID plays in funding and encouraging PDP is commendable and should be extended.
I want to ask my right hon. Friend the Minister some questions about DFID’s role regarding PDPs and the funding of research and development. It is important that DFID continues to be respected in the world as a leading player, so I would be grateful if my right hon. Friend agreed to look at lifting the apparent cap on the funding of research and development from, as I understand it, about 3% to perhaps 5% of DFID’s total budget. I know that funds need to be found from elsewhere, but I believe that that is an important issue.
I would be interested to know what my right hon. Friend has to say about the Department’s plans to take PDPs forward. Notwithstanding the Prime Minister’s welcome announcement last week of a commission on antibiotic resistance, will DFID press ahead with finding solutions in areas where we already know about problems of antimicrobial resistance, and not simply use the commission as an excuse to delay action in areas where problems have already been identified and research and development are urgently required? Will the Minister ensure that research and development include not only the development of pharmaceutical responses, but diagnostics research into biomarkers and bio-signatures, and the development of point-of-care and non-sputum-based tests for adult and paediatric tuberculosis?
I do not want to detain the Chamber for longer than necessary, particularly when so many others wish to speak. I want to highlight the importance of the work of the all-party group on global tuberculosis—particularly the report, which I encourage hon. Members to look at and which is on the group’s website. The Government must make sure that we sustain our leading role in research and development. We must recognise that there is a limit to what commerce can do, in terms of funding and creating sufficient market incentives, to put in the enormous amount of work required to fill the gap in research and development. That work must be sustained, and we must not simply wait for the commission on antibiotic resistance to provide the stimulus to take it forward.
Frank Dobson (Holborn and St Pancras) (Lab)
I congratulate the hon. Member for St Ives (Andrew George) on securing the debate. I have the privilege of representing probably the biggest concentration of biomedical research institutions in this country and in Europe, if not in the whole world. I must declare an interest as a member of the court of the London School of Hygiene and Tropical Medicine, and as a governor of the Royal Veterinary College—I believe I was originally the Privy Council governor.
The role of the London School of Hygiene and Tropical Medicine in this matter is obvious, because of its remarkable record of more than a century. It has tended to draw on home-grown talent, but it increasingly attracts people of worldwide distinction to do their research there. A splendid example of that is the present director, Peter Piot, who in the 1970s played a major role in identifying Ebola, and in the 1980s in helping to combat HIV/AIDS in Africa.
The reason for the inclusion of the Royal Veterinary College may not be quite so obvious, but the institution has done a great deal of work on the health of animals, particularly farm animals, in developing countries. That work has focused on improving those animals’ resistance to disease and thus helping to counter poverty, malnutrition and poor health. In more recent years, the college has put a huge amount of effort into zoonotics, which concerns the possible transfer of diseases from one species to another, and particularly from various other species to ourselves. The Royal Veterinary College has developed an expertise in avian flu that is unrivalled anywhere in the world.
Recently, Professor Dirk Pfeiffer and Dr Guillaume Fournié, in collaboration with the London School of Hygiene and Tropical Medicine and the university of Queensland, have started on a project on the zoonotics of poultry in Bangladesh. Professors Javier Guitian and Jonathan Rushton have started to do some immensely important work on brucellosis, also in collaboration with the London School of Hygiene and Tropical Medicine, in west and central Africa. Together with Professor Eric Fèvre of the university of Liverpool and in collaboration with the universities of Edinburgh, Nottingham and Nairobi, Professor Rushton has been doing a lot of work on zoonoses in livestock in Kenya. All that is soundly based research, in the field, with practical application.
If there were outbreaks of diseases caused by zoonotics, the poorest and least healthy people in the world would suffer most, but we too would suffer. Having looked at Professor Pfeiffer’s work, I have come to the conclusion that although we hear a lot of talk about weapons of mass destruction, both nuclear and chemical, in terms of worldwide death the most likely weapon of mass destruction is going to be an infected chicken. We must take the matter extremely seriously.
Along with Birkbeck college, the Institute of Neurology and the School of Pharmacy at University college London are doing important work in this sphere, and they are soon to be joined by the Crick Institute. He takes a lot of stick, but I must say that the institute will be there because of the drive of the previous Prime Minister, my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), who battled through all the bureaucracy that was obstructing it and used his authority as Prime Minister to secure the site and the funding. It is to the credit of the current Government that they took up that baton. We must keep up and extend our research in this sphere, particularly university and public funding.
The question then arises—it has already been mentioned and I am sure it will be mentioned by others—as to whether such work will be worth while for drug companies. It will not. It is no good pretending: in certain circumstances it will not be worth their while, so we must find a worldwide mechanism to find the funds and create the practical application worldwide. The G7 and the G20 need to turn their attention to this issue. They are very good at globalising capital flows, but they need to be concentrating on globalising medical flows. Perhaps we could link the two together with a worldwide Robin Hood tax on financial transactions, but not just for the money.
We need well-organised, practical projects, the best example of which was the World Health Organisation’s commitment to eliminate smallpox. Edward Jenner did his work in 1798; the last person to be treated for smallpox that was caught in the wild was treated by my late good friend, Professor Richard Madeley, who was subsequently at Nottingham university and treated a child in Bangladesh 200 years after Jenner first did his work. We clearly have to ensure that technology transfer speeds up. We do not want it to take 200 years—we do not want it to take 200 weeks. When things are discovered that work and will improve people’s health worldwide, we need the world institutions to put in place a mechanism that will ensure that everyone gets the treatment, not just us privileged folk in the developed countries.
Nick Herbert (Arundel and South Downs) (Con)
I am grateful to be able to take part in this debate and I will speak briefly. First, I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing the debate. I am very proud to co-chair the all-party group on global tuberculosis, which he and I co-founded with our Labour co-chair, the hon. Member for Ealing, Southall (Mr Sharma). I am also very proud of the report that we have just produced, to which my hon. Friend referred, “Dying for a Cure: Research and Development for Global Health”, which covers precisely the issues he has raised in this debate.
May I say in parenthesis that there is much debate about the support provided to all-party groups. Our report simply would not have been possible without our all-party group’s first-class secretariat, which is funded by Results UK and other organisations and has enabled our excellent researcher, Matt Oliver, to help with the drafting of the report. That goes to show that not all external support for all-party groups is bad—far from it. Without that support we simply would not have been able to produce the report. It is important that Members speak up for legitimate all-party groups that have important work to do.
I want to focus particularly on tuberculosis, which still kills 1.3 million people a year—quite unnecessarily, given that it is a treatable and curable disease. There is a particular new threat because of drug resistance, which is a serious problem and a concern not just globally but in this country. I commend the Prime Minister’s stance on the significance of drug resistance as an issue that this country has to address in future. Our all-party group was reminded of that recently when we travelled to Bucharest in Romania and visited prisons and clinics around the country where TB is prevalent—not just TB but drug-resistant TB. In Romania, as well as in other developing and underdeveloped countries throughout the world where TB is a serious problem, the issue is not just access to drugs, which can of course be corrected by the west making significant interventions through the global health fund and other means to provide drugs where they are available; it is also a problem of availability.
Our report seeks to address the simple fact that there is insufficient availability of diagnostics and treatments for tuberculosis. I have mentioned this in a previous debate on the same issues in this Chamber, but I want to repeat myself because it is important: it is sobering that if TB had resurged in the west, pharmaceutical companies would by now have found the investment required to produce significant new tools for its diagnosis and treatment, as has happened for HIV. Amazing new cures and treatments are available for HIV. Why? Because HIV has been a disease of the west as well as cruelly affecting the developing world.
Although it has made something of a comeback in the west, TB has not been perceived in the same way. It has continued to claim the lives of millions, but only in developing countries, so it has not received the attention. Nor are there the straightforward financial incentives for pharmaceutical companies to develop the necessary tools. There is still no vaccine for TB. People believe that there is, but there is not: the BCG vaccine is partial and relatively ineffective for adults.
The first-line drugs that are used to treat TB were developed decades ago, must be taken over an extended period and are part of the reason why drug-resistant TB is a problem. The diagnostics for TB are old-fashioned and inadequate. All this is not the fault of drugs companies; in a free market they simply do not have the commercial incentive to develop new tools because there would be no market for them to sell to.
Mr O'Brien
I am grateful to my right hon. Friend for giving way to me, particularly on my second intervention in this debate. I have just returned from Papua New Guinea, where, given my interest in malaria, it was impressive to see Oil Search—to refer to his point about delivery—delivering across extremely difficult and hostile territory, in the complete absence of any other form of provision. Multi-drug-resistant tuberculosis was its main challenge. Often, pharmaceutical, distribution and oil and petrochemical companies are becoming part of the solution as they extend their provision, whether that includes GSK considering the pricing of its malaria vaccine or Novartis distributing malaria drugs. Equally, on TB, Oil Search is becoming part of the solution as part of its extended corporate social responsibility, as well as ensuring research and development for non-purchasing-power markets. I thoroughly endorse where my right hon. Friend is taking this debate.
Nick Herbert
I am grateful for my hon. Friend’s intervention. I think that corporate social responsibility can be part of the solution, but it will not be a sufficient solution. What we have here is significant market failure. Where there is market failure, there is an imperative for Government intervention. One can still believe in markets—the power of markets, and pharmaceutical companies’ freedom to do all the wonderful things that they do—yet understand that where there is market failure, there must be intervention. That is what we need. Given that it can cost about £1 billion to bring such drugs to the market, intervention is necessary, whether in the form of product development partnerships or an adjustment to tax credits for research and development. We make that particular proposal in our report, and I commend it to the Minister. That sort of intervention and Government support for research and development will be essential if we are to beat those diseases.
Michael Connarty (Linlithgow and East Falkirk) (Lab)
I declare an interest: I went numerous times with Results UK to see its work on the GAVI fund and other matters. I thank the hon. Member for St Ives (Andrew George) and his co-chair for outlining the problem that we face in R and D for global health. An estimated 13.7 million people die every year from or in connection with a group of diseases known as poverty-related and neglected diseases, including TB, HIV, malaria, dengue fever, yellow fever and many others.
As has been said, there has been a market failure in developing drugs, diagnostics and vaccines for diseases that predominantly impact low and middle-income countries. Significant improvements could therefore be made, as the co-chair of the all-party group said, in co-ordination, financing and the policies of public sector donors. The World Health Organisation has been the focus of efforts to develop a globally binding convention on R and D for nearly a decade, but has not made much progress. Progress has been dishearteningly slow, and given the figures that I just quoted, every year that passes without globally co-ordinated efforts to remedy the R and D market failure results in the unnecessary loss of millions of lives. However, despite that massive figure, we do not seem to get any progress.
One of the core proposals is for countries to contribute a fixed percentage of GDP to R and D for global health, as we have done with international development generally, in recognition that such diseases represent a threat to global human, social and economic development, just as the matters on which the Department for International Development focuses its contributions do. The percentage called for is 0.1% of GDP, which could be spent bilaterally or contributed to a central fund that would apportion money for key projects and programmes to develop the new drugs, diagnostics and vaccines that are missing.
What are the challenges of reaching such a consensus? Among donors, there is a general reluctance to support a global R and D convention; the push for it is coming from developing countries. The countries that conduct the majority of research and host the biggest pharmaceutical companies want to maintain their sovereignty over their research programmes. Countries have competed over scientific research for centuries, and it is important to developed economies. Many Governments even direct money from their aid agencies directly to domestic research only. The UK can be proud that it does not do this, meaning that DFID’s contributions and aid are spent on the best research, wherever it is carried out. Nonetheless, co-ordination of funding and priorities is extremely important to ensure that there is no unnecessary duplication between research in different countries. I see the sense in that, but of course it is not how the capitalist market works.
Why should the UK back such reforms? First, they are ultimately in our own self-interest and that of other developed countries; I always like to appeal to self-interest when a Conservative Government are in power. We will not eliminate TB or HIV unless we find quick, safe and effective cures for those diseases. They have a small but significant presence in the UK: HIV treatments alone, for example, cost the NHS more than £630 million every single year.
Frank Dobson
Is it not also the case that in order to protect blood products and blood transfusions, this country has been spending the best part of £1 billion for the same reason?
Michael Connarty
I know that when my right hon. Friend, a former Health Secretary, speaks, he tells only the truth, so I accept that £1 billion figure. It is a frightening sum, and it could be used in other ways. If we return to a situation in which TB and HIV are essentially untreatable, the cost of handling those diseases in the UK could become more costly than investing in finding further cures.
The second reason is that UK academic institutions are some of the best in the world, as my right hon. Friend the former Health Secretary outlined. It would therefore lead to more money, not less, being devoted to UK research establishments. Thirdly, the reform process could lay the foundation for new mechanisms and new systems of developing drugs, diagnostics and vaccines that would otherwise never be brought to market under the competitive capitalist system. The co-chair of the all-party group mentioned antibiotics, which have recently been brought to our attention. A global convention could implement new approaches and prevent microbial resistance, which has been discussed by the Government and the Chief Medical Officer.
Fourth, as a major funder of global health programmes and with their stated 0.7% commitment, the UK Government must acknowledge the enormous benefits of accelerating progress against HIV, TB and other diseases. From treating diseases, we could turn to preventing them. In Cambodia, Kenya and Rwanda, I have seen the cost of treating diseases once they have caught hold in a country. Driving those diseases back will result in savings for country health programmes, improved health and educational outcomes for children, increased work productivity for adults and overall reduced dependency on preventive foreign aid, which is the model that we want. We want to raise people out of complete dependency so they can generate their own futures.
A WHO convention, bringing new money and new resolve to global health R and D, is the best way to develop a new intervention that will accelerate our progress against global diseases. I have a question for the Minister, although I must apologise for the fact that I cannot remain in the Chamber for his reply, as I will be trying to speak in the debate on the Modern Slavery Bill, with which I have been engaged for the last couple of years. Will DFID and the UK Government commit to supporting a WHO convention on R and D in 2016 and lead the world towards the eradication of some of mankind’s deadliest diseases?
Heather Wheeler (South Derbyshire) (Con)
I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing this important debate on the future of global health, and specifically on the current position of research and development. I call Members’ attention to my trip to Ethiopia in the Register of Members’ Financial Interests. It is a pleasure to speak under your chairmanship, Mr Streeter.
I will focus my comments on the diagnostics aspects of research and development, which I was fortunate to witness and learn about at first hand during my time in Ethiopia. As part of our trip, we were taken around a hospital and shown an incredible set-up for diagnosing tuberculosis. The incidence of TB in Ethiopia is 274 cases in every 100,000 people, which ranks the country at approximately 20th in the world. That ranking is extremely good for a low-income country, thanks to its excellent diagnostic skills.
Diagnostics are often the forgotten third in the trilogy of drugs, vaccines and diagnostics. We need to change that thinking radically, as failure to diagnose diseases quickly is one of the key factors in the continuation of major epidemics. As Ethiopia has shown, excellent diagnostics can have a dramatic impact on reducing the incidence of infectious diseases. Shockingly, as many as half of those with HIV worldwide are undiagnosed, and one third of those with TB are not officially diagnosed or treated. We desperately need to rectify that, because the lack of diagnostics and of swift care and treatment can exacerbate endemics and heighten immunity to vaccination.
Specific diagnoses are extremely stilted, so it is imperative that doctors take the time to ascertain which strain of the disease the patient has. For example, TB can be drug resistant, but it can take months for tests to determine which drugs a strain of TB is resistant to. In the meantime, doctors often put patients on a standard regime of drugs, which can be disastrous, because some TB drugs unfortunately have severe and often permanent side effects, with several patients being left permanently deaf as a result.
DFID money has helped to develop GeneXpert, a machine that can diagnose TB in two hours and that can also diagnose certain strains of drug resistance. It is because of GeneXpert that patients are being diagnosed and starting treatment within hours, instead of weeks or months. GeneXpert machines have helped to oversee a transformation in some local health services. Owing to services’ increased capacity, health workers can collect samples, take them back to a central area for diagnosis, return to the patient and treat them at home. I actually saw that in the bush in Ethiopia. Such an approach reduces stress on the patient and on the health system, and it is much more efficient. Furthermore, battling TB worldwide has knock-on effects on TB in the UK. For example, the DFID-funded development of GeneXpert is now paying off, as the machine can now be used in UK hospitals.
Maximising the effectiveness of diagnostics requires intensive research in the field after a product has been developed, to ensure that the systems are in place to diagnose as many people as possible. In closing, I would like to ask the Minister whether DFID will commit, in future budgets, to supporting operational research programmes such as TB REACH to maximise the impact of new interventions.
Mr Gary Streeter (in the Chair)
Order. Colleagues have been very disciplined, so the last two Members to speak before we get to the winding-up speeches can be a little more relaxed. [Hon. Members: “No!”] I’m sorry.
Mr Peter Hain (Neath) (Lab)
Thank you, Mr Streeter—it is a delight to see you in the Chair. Like others, I congratulate the hon. Member for St Ives (Andrew George) on securing the debate and on the work that he, along with others in the room, has done with the all-party group on global tuberculosis, of which I am a member.
As I declared in the Register of Members’ Financial Interests, I visited South Africa in February 2012 with the charity Results UK, which does such important work on one of the most important questions in global health today: how do we move from struggling to control the world’s deadliest diseases to eliminating them? We can control diseases such as TB and HIV, but they continue to represent a terrible burden on individuals, families and communities across the world. In the 90 minutes of this debate, nearly 500 people will lose their lives from just those two diseases.
I am the chair of trustees of a remarkable charitable organisation called the Donald Woods Foundation, in Nelson Mandela’s impoverished homeland of the Transkei, in the Eastern Cape, in South Africa, where it is battling to control the twin epidemics of TB and HIV and to strengthen health services in remote, rural communities. It works closely with the South African Department of Health, and it has screened 150,000 people for TB. It also has nearly 10,000 people on HIV treatment, and it supports outreach to those who would otherwise not be reached. In addition, it has pioneered clinic design for infection control and TB testing.
Despite the huge and highly commendable efforts of the South African Government and of civil society organisations such as the DWF, South Africa continues to battle enormous health challenges, one of the most significant of which is drug-resistant TB. In one small sub-district last year, the DWF reported 49 cases of extensively drug-resistant tuberculosis. XDR-TB has evolved to be resistant to our best drugs, and the few treatments that remain are old, toxic and associated with terrible side effects. Treatment success with XDR-TB and multidrug-resistant TB—MDR-TB—is rare. The drugs involved, taken over years with daily injections, steadily destroy quality of life, often leaving patients with permanent disabilities. The burden of treatment is so heavy that many patients choose to default—to give up—and they discharge themselves from hospital rather than continue with what are, essentially, useless drugs that are causing them pain.
I have met people with XDR and MDR in South Africa, and their examples are tragic. I remember the story of a girl who had been confined in a hospital ward for more than two years. The drugs made her physically sick practically every day, she was losing her hearing because of them and her liver was being destroyed by the disease—TB ruined her life. Before the disease, she was doing well in school, and she had a bright career ahead of her, as well as close friends and a good family, but then the disease struck. Eventually, I am sorry to say, she discharged herself from hospital, knowing that, in doing so, she was most likely surrendering her chances of surviving. She returned to her family home, but it was empty—both her parents had died from the same disease. Soon, she also passed away—pale, sick, deaf and alone.
Sadly, that is not an isolated story. South Africa has the highest rate of TB in the world, and behind the statistics are thousands of tragic, grim stories. The worst cases are in gold mining. The deep gold mines are a source of a tremendously lethal form of TB, with all the consequences that brings.
Progress is being made against TB and HIV, but it is far too slow. The diseases continue to ravage health systems across southern Africa. Only 2% of South Africa’s TB burden is drug resistant, although that number is increasing, but that 2% accounts for fully 32% of the national budget for tackling TB.
Our weapons against these diseases are becoming less effective with every passing day, and I am struck by the similarities between drug-resistant TB and antimicrobial resistance, which was such a topic for conversation last week, with the Prime Minister launching his own special commission. We need new drugs that the TB bacteria have not already encountered, and we need a vaccine that kills or prevents infection so that resistance never gets the chance to develop. We need to remember that we have TB here in the UK and that a small but growing percentage of cases in the UK are drug resistant.
When drugs are developed, they must be affordable. Of course, commercial sector organisations must generate a profit, and developing a new drug can cost hundreds of millions of pounds and take years of sustained effort and research. None the less, while we want to find a way to unlock a new generation of drugs for diseases such as TB, we must not find ourselves in a situation where the poorest people cannot afford treatment or where the cost of buying drugs cripples local health services in poor countries.
What is required, then, is an alternative model—one that separates the requirement to generate a profit from the direction of research and that separates the cost of research from the price of the final product. Such a model, which is often described as de-linked, is the only way we will be able to encourage research and development for diseases for which there are no significant financial markets and to ensure that the products that are developed are accessibly priced. Will the Minister therefore commission a report examining the costs and implications of commercially driven development, as against de-linked development models, and use the findings to make the case to other Governments? Perhaps he could respond to that request in his reply.
We know that the system is not working; we know that the imperative to act and to find solutions to these problems is as strong as ever, and we know that the challenge of correcting market failure will dictate the future of efforts to control humankind’s deadliest infectious killers, yet we are no closer to breaking the deadlock. For the sake of the world’s poorest, our own national health service and, ultimately, our health in this country—these diseases are very infectious—I ask that DFID champion alternative, non-commercial models of development and thus help to develop the new drugs, vaccines and diagnostics that will help us to see the end of TB, HIV and malaria in our lifetimes.
Jeremy Lefroy (Stafford) (Con)
It is a privilege to serve under your chairmanship, Mr Streeter. I thank my hon. Friend the Member for St Ives (Andrew George) for securing this important debate.
It is extremely important for the UK, and indeed the whole world, to take seriously the question of research and development for global health. I want to outline why it is also important for it to play, as it does, a major role in the work of the Department for International Development. I believe that to be so for five reasons, the first of which is that the aims in question are global public goods. The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about institutions that grew out of a desire to give treatment, including the London School of Hygiene and Tropical Medicine, which I believe was for seamen. The Seamen’s hospital was at the royal docks, and seamen from all over the world who had contracted diseases went there. The hospital that eventually became the London School of Hygiene and Tropical Medicine was set up to help them. The Liverpool School of Tropical Medicine was founded by a ship owner who saw that if he and his colleagues in Liverpool were to engage in trade around the world, there was a need for treatment for diseases that might prevent their trade from continuing. If half of a crew who had been sent overseas succumbed to deadly diseases, it would not be possible to continue to trade. Thus the school came from a compassionate interest in people’s lives, and a commercial interest linked to compassion.
Secondly, the work in question is a matter of global public goods; the diseases are not diseases of far away people in far away lands. My right hon. Friends the Member for Arundel and South Downs (Nick Herbert) and for Eddisbury (Mr O'Brien) have already said that they are the diseases of the poorest people on earth. I declare an interest as chairman of the all-party group on malaria and neglected tropical diseases. Those diseases—some 17 of them—affect well over 1 billion people a year who are among the poorest on earth. Malaria is similar, although like TB it can affect anyone. Those of us who travel to countries where it is endemic catch it, as I have on several occasions. When we invest in global research and development for global health we invest in tackling poverty and helping economic growth and prosperity. When people are sick they cannot engage in economic activity.
Thirdly, there is a need for long-term funding. That is why the role of DFID, development organisations and private foundations is so important. We are not talking about a budget for one, two, three or four years, but about long-term commitment. That is why I applaud schemes set up with the influence of, or sometimes by, the previous Government, such as the International Finance Facility for Immunisation, which I believe committed UK funds for up to 20 years, to develop vaccines. It is not possible to develop them over the short term. The Government have committed up to £500 million a year to tackling malaria. That is not just for research. As my hon. Friend the Member for South Derbyshire (Heather Wheeler) mentioned, diagnostics are key. The money will go on diagnostics research and delivery, as well as bed nets and drugs, but a substantial part of that £500 million a year will go towards research. So will part of the £40 million a year that the Government have rightly committed to tackling neglected tropical diseases.
Fourthly, there is a question of partnership and leverage. We must work with others. As so many right hon. and hon. Members have said, the task is not one that can be carried out by the commercial sector alone, although it has an important role to play; by Government alone, because Governments do not really do research; or by the foundations and NGOs alone. I have found from my work on malaria and neglected tropical diseases, as I am sure colleagues have, that it produces some of the finest examples of people working together—the commercial and private sectors, NGOs and Government —to tackle a common global problem.
The final reason I want to outline is one that was eloquently pointed out by the right hon. Member for Neath (Mr Hain), and my right hon. Friend the Member for Arundel and South Downs: resistance. We sometimes think that the problems are solved. They are not. I know far less about TB than the right hon. Gentleman and my right hon. Friend, but they pointed out the problems of increasing resistance to TB drugs. The same is being experienced with malaria, although the problem is perhaps not so advanced. Already the artemisinin combination therapies that have been a life saver for malaria around the world are facing resistance in places such as Myanmar. That is of course where resistance to chloroquine started, before it spread across Africa, resulting in the drug’s becoming almost useless. We must take the situation seriously, and I welcome DFID’s work in Myanmar to help to counter the spread of artemisinin resistance there.
Resistance develops not only against drugs, but against the insecticides with which bed nets are treated. Increasingly the mosquito is becoming resistant to some of them. That is why we must begin to use combinations of insecticides, or develop new ones. There is no doubt that insecticide-treated bed nets in the past 10 to 15 years have dramatically reduced malaria incidence and the death rate.
The debate is incredibly important because investment in research and development for global health is not an option but a necessity. I am proud that the UK takes a lead in research and in development. As the right hon. Member for Holborn and St Pancras has said, there is much of that concentrated in the UK. Also, NGOs and foundations in this country take a lead, and a huge amount of work is done by DFID. I welcome what has been done, but the problem is a long-term one and we need long-term commitment. So far we have had that from DFID, and I urge the Minister to say that the issue remains at the heart of DFID’s work and will do for years to come.
Gavin Shuker (Luton South) (Lab/Co-op)
I am grateful, Mr Streeter, for your chairmanship and for your maths, which has allowed a good period of time in which to express the Opposition’s support for the work of the all-party group, and for the Minister’s response.
The debate has been well informed and well attended, and there were welcome speeches by people who are hugely knowledgeable about the field. I want to refer to the disease that is predominant among those we have been discussing, and some of the recommendations in the report. I also want to consider structural and systemic issues about the delivery of effective care.
It is crucial in such debates to avoid becoming too fixated on high-level statistics and market processes, or too absorbed in the clinical mechanics of disease prevention and control. As my right hon. Friend the Member for Neath (Mr Hain) pointed out, in his hugely passionate speech, that absorption can cause us to forget the lived reality for the many people who have those terrible diseases. Death from tuberculosis, and life with it, is horrible. Cavities form in the lungs, causing bleeding, or resulting in pus-filled infection, blocking vital airways and causing difficulty in breathing. Each breath becomes a battle, because tuberculosis weakens the body and causes weight loss so extreme that, to the outsider, it can appear as if the body is literally consuming itself. When it affects children, it can mean that a child of six weighs 8 kg, which is barely the weight of a newborn baby. Long-term pulmonary damage, collapsed vertebrae, brain damage, lesions so severe that they change the structure of the body: that is the reality. Those are just some of the complications that survivors of the disease face, in addition to the stigma that besieges this disease of poverty and proximity.
As many right hon. and hon. Members have said, tuberculosis continues to ravage the lives of millions of people worldwide. There were 8.6 million new infections in 2012 alone. There are regions of the world
“teetering on the brink of a tuberculosis epidemic”.
If it is left unchecked over the next 20 years almost 1 billion people will be newly infected with TB; 200 million will develop the disease; and 35 million people will die of it. Given that it is curable, that is an unforgivable tragedy. That situation—alongside malaria, HIV, dengue, yellow fever, rabies, sleeping sickness, river blindness, leprosy and many others on the World Health Organisation’s list of neglected diseases—is a spur for our timely, if not overdue, debate.
As Members have pointed out, fundamental market failures have meant that the development of affordable and accessible treatments has simply not been prioritised in the way it should have been. In the past 40 years, just one Food and Drug Administration-approved TB drug has been introduced to market, compared with 15 FDA-approved products introduced for hay fever. Yes, hay fever is debilitating and it is certainly an uncomfortable irritation for many people, but it is not a global killer.
The inquiry and report that sparked today’s debate offer a number of pragmatic solutions that could underpin the currently failing commercial model or support the development of alternative structures and models for product development. It is crucial that these recommendations receive the attention they deserve.
The Department for International Development is already a world leader in research and development for global health, which this Government have prioritised in their parliamentary term, just as the previous Labour Government did in their last parliamentary term. It is vital that DFID’s reputation is maintained and further enhanced if the threats of pandemic proportions posed by these neglected diseases are to be abated.
The Prime Minister’s welcome recent announcement on antibiotic resistance and the £1 billion UK commitment to the Global Health Fund must also be celebrated, but such leadership must be shown across the board. A focus on research and development must not crowd out other important health care considerations. For example, the World Health Organisation’s recommended approach to tuberculosis—commonly known as directly observed treatment, short-course, or DOTS—requires daily supervision by a qualified health professional. That is an impossibility for the 2 million Somalians who have no access to health care services, or even for the 8 million Somalians who have access to such services but for whom it takes an average of four hours’ travel to reach them.
Moreover, research and development alone will not address the issue of those people who might never be diagnosed. They are prevented from accessing basic medical assistance because of poverty, stigma or discrimination. They are also isolated from the respite that decent health care can offer and, in the case of communicable diseases, they are unknowingly or helplessly infecting those around them. For these people, the urgent need for universal health care coverage is clear.
The UK death rate for TB is admittedly high in some areas. As many Members have highlighted in today’s debate, TB is a disease that shows no respect for national boundaries. Nevertheless, the reason the UK death rate for TB is low in comparison to other nations is down to the progress made by our NHS, which is undoubtedly my party’s greatest legacy. The NHS is a world-leading health care system built on the principles of fairness, providing high-quality and accessible health care that is free at the point of use.
In addition to responding to the specific recommendations of the report, I invite the Minister to set out how the UK will ensure that the laudable goal of universal health care coverage, which this Government have signed up to, will remain on the post-2015 development agenda, because it is only when we achieve universal health care coverage that the links between disease, poverty and inequality can begin to be broken.
If the main earner in a family becomes ill, the family can be driven even deeper into poverty; disease destroys their ability to earn money, or even their ability to subsist through work. That problem is compounded by the direct medical costs that patients face—such as consultation fees, drugs, diagnosis or hospitalisation—or by the indirect costs associated with ill health, such as travel to the nearest health centre, or increased nutritional or heating needs. Children miss out on school because of illness, or have to earn money to compensate family incomes that have fallen when parents or siblings become sick. So, in considering what support to give, it is essential that we not only look at the specific diseases that have been mentioned but at the mechanisms for delivering treatment.
The gendered impacts of ill health must not be ignored either. Women and girls are not only less likely to seek help, but are often saddled with caring responsibilities on top of their existing work loads. Frequently, they are even expected to give up their own work or education, undermining their chance to reach their potential, which traps the most vulnerable in cycles of poverty, disease and poverty again.
The ability to enjoy free access to health care services as envisaged by universal health care coverage would not only ensure access to treatment but would increase medical visits, which would raise the rates of diagnosis that the report makes clear are crucial in the fight against communicable diseases.
A holistic approach to health requires going beyond even universal health care coverage to include consideration of water and sanitation, inequality, housing and education, so it is clear that the challenges faced by the world in responding to the needs identified in the report are massive. However, it is only in adopting such an approach that we can be clear about the true impact of the neglected diseases that we have been discussing today, and about how we can address them.
We face some of the gravest global health care challenges of our time. Addressing them will require a co-ordinated international effort, and I am sure that the efforts of the hon. Member for St Ives (Andrew George), who I congratulate on securing this debate, will go a long way towards holding our feet to the fire and ensuring that we do address them.
The Minister of State, Department for International Development (Mr Alan Duncan)
I thank the hon. Member for St Ives (Andrew George) for securing this important debate—indeed, I thank all those who have contributed this afternoon. Thanks to the right hon. Member for Holborn and St Pancras (Frank Dobson), it looks as if the Chilcot inquiry will have to make a study of infected chickens.
I also thank and commend the hon. Member for St Ives, and the rest of the all-party group on global tuberculosis, for the publication of a thorough report. We all appreciate the group’s tireless work in keeping our collective focus on global health—particularly research and development, which we are discussing today. As I am sure the group will appreciate, as the report was made available to us only last night, I have not had a chance to read it in detail. However, an initial scan shows that there is much in it that we welcome.
The report seeks to answer two fundamental questions: why are diseases of the global poor so badly neglected in research efforts, and what potential solutions are available to unlock the puzzle? Following a cursory reading, I am delighted to say that the Department for International Development is widely praised for our commitment to research and development in global health, and I am also pleased to learn that our willingness to provide flexible and untied support is particularly valued. The Department will consider the report and its recommendations during the next few weeks. However, let me now say just a few words about how DFID’s approach to research and development will proceed more broadly.
In the last two decades, tremendous progress has been made in improving the health, and preventing the deaths, of those living in poverty around the world, particularly women and children. For instance, between 1990 and 2011 the mortality rate among children under five fell from 84 deaths to 53 deaths per 1,000 live births, which is a very positive and encouraging statistic. In fact, as was recently reported in The Economist, it is an astonishing result.
Africa is currently seeing some of the fastest falls in child mortality ever seen anywhere, and one of the ways in which the UK has contributed is through its outstanding research. UK Government funding and UK scientists have contributed to the development of long-lasting, insecticide-treated bed nets, which were mentioned a moment ago, and new diagnostic tests and drugs for malaria. However, the progress has not been evenly spread; more than 7 million women and children still die every year, many of them during pregnancy and birth, and the great majority from easily treatable or preventable conditions.
We need to do three things in our research for health: to develop new technologies, such as drugs, vaccines and diagnostic tests; to test them through trials; and to keep abreast of growing medical challenges such as drug resistance, which has been mentioned this afternoon. I assure the House, including all Members here today, that DFID is funding research in all those areas.
Let me highlight a few examples of what we have been doing recently. The first area of our work is about developing new technology. We know what the problem is, but we lack the technology sometimes required to fix it, so research is required to create innovative solutions. For instance, DFID support has helped the Foundation for Innovative New Diagnostics to develop GeneXpert, which my hon. Friend the Member for South Derbyshire (Heather Wheeler) mentioned earlier. GeneXpert is a new diagnostic test for tuberculosis that gives fast and accurate results. She said the results come within two hours; I might say within four hours—if we split the difference, the test is quick and that is what matters. Importantly, it also identifies drug resistance. The test is revolutionising the care and treatment of those suffering from this appalling disease.
Another example is that DFID supported the drugs for neglected diseases initiative to develop a new safer drug for sleeping sickness—one of the world’s worst diseases. The old drug, implicitly referred to by the right hon. Member for Neath (Mr Hain), was highly toxic, killing around 5% of those treated. The new drug, which is now available in 90% of the places where sleeping sickness exists, is a better drug that reaches more people.
Both those examples also demonstrate the importance of securing private sector support through product development partnerships, which hon. Members mentioned. These partnerships act like virtual pharmaceutical companies, where a small, central group of staff co- ordinates the development of new drugs and technologies, drawing on the strengths of academia and industry. The UK is a leading investor in PDPs—with the Gates Foundation, for instance—and we continue to champion their role in global health research and development.
Let me turn to some questions that I spotted being put to me in a co-ordinated way. I have to say, in all honesty, that lifting our research expenditure up to 5% of our budget is unlikely within the competing claims of a tight resource allocation round for the next three years. If one added up the many requests made to us to meet certain percentages for various causes, one would soon find that they are close to, or perhaps even beyond, 100% of our total budget. We have to be honest and should not pretend that we can meet the 10% here and the 5% there, or the nought point this or that everywhere else. We will, within the 0.7% to which we do adhere, try to apportion our budgets rationally and openly.
I hear what was said about tax credits, but hon. Members will appreciate that those are primarily a matter for the Department for Business, Innovation and Skills and the Treasury. On collective action, we agree that better co-ordination should almost invariably be welcomed and pursued.
The second area of our work concerns using research to test new ways of doing things, including through the use of clinical trials. Much of what is done in international development has not yet been properly tested by rigorous methods. The fact that many experts agree that an intervention should work does not necessarily mean that it will. Proper trials allow us to do new things, but they also allow us to call a halt to old, costly and sometimes dangerous things.
DFID helped fund research in Kenya recently on the treatment of children with severe infections, including malaria. While accepted medical wisdom suggested that one should rapidly increase fluids in children affected by these diseases, research showed that that course of treatment was actually detrimental to the health of the children and, in some cases, resulted in death.
Similarly, in Uganda, research has shown that the accepted practice of using expensive tests to monitor the progression of HIV in patients simply did not work. By stopping the tests, a third of the normal cost of treating someone with HIV can be saved, with no impact on mortality. That means that for the same amount of money, the Ugandan Government can effectively treat a third more people with HIV. That is all down to effective research. DFID is currently supporting more than 40 clinical trials under the joint global health trials initiative, in partnership with the Medical Research Council and the Wellcome Trust. We are funding new trials in TB, HIV and malaria, as well as other poverty-related neglected diseases.
There is a slight misconception that we do not fund UK research directly. We will fund the best research wherever it is located, through global, fair and open competition. However, as it happens, the largest proportion of DFID research contracts are won by UK institutions.
The Department is also breaking new ground in testing public health interventions in humanitarian crises—for example, through its partnership with the Wellcome Trust and Save the Children in the research for health in humanitarian crises project. This innovative partnership enables high quality health research to be carried out rapidly as acute emergencies unfold.
Andrew George
The Minister originally discounted the possibility of looking at the notional cap on research and development within DFID’s budget, but at the same time he has announced the doubling of economic development assistance to £1.8 billion. Given that we are talking about market failure, will he consider that budget as a route by which his Department can engage with the private sector, to enable further research and development that will achieve both the research and development gains and the economic development goals that his Department is seeking?
Mr Duncan
There is a lot that is constructive in what the hon. Gentleman has suggested. Whereas the money might not go into long-term research, there can certainly be work with private companies along the partnership lines that we already have, perhaps to extend activity in areas such as these. We are open-minded about the nature of the economic development activity that will emerge from this new approach—this refreshed emphasis—in private sector development, and I am pretty confident it does not rule out proposals such as the hon. Gentleman’s.
Mr Duncan
I do not lead on this topic, but my understanding of the Department’s approach at the moment is that we are not wholly convinced about the solution that simple de-linking would offer for the problems that the right hon. Gentleman has identified. Pharmaceutical markets are much too complicated for us to be able simply to segregate a research budget and the price at which a product is sold. The competitive structure has to be considered. Is a new drug competing with something, directly replacing something or marketing itself into a completely new field? There are many more aspects to the pricing and distribution of drugs than the simple de-linkage proposed by the right hon. Gentleman.
We do not have a closed mind on anything of this sort. The least we can say to the right hon. Gentleman is that we will get our very clever people working on it, although I do not think we will commission a great report at this stage. However, we are happy to engage with him in further detail, if he thinks that we are missing something.
Mr Duncan
We will, of course, write to the right hon. Gentleman, as requested, with our thoughts and views on his proposal. I have no doubt that officials will be happy to discuss with him, in person, what he thinks should be done, should he so wish it.
DFID is also utilising research and development techniques to understand better the environment in which we operate and it is working out how we can anticipate future trends. One example is in antimicrobial resistance, which has been mentioned today—a future threat on which the UK Government are taking a leadership role globally. DFID is supporting an initiative to track drug resistance to malaria in south-east Asia as it potentially spreads through the region and, critically, towards Africa. That will help target new antimalarial drugs, the development of which is also being supported by DFID.
Research alone will not alleviate poverty, which is why DFID also invests heavily into putting research into practice. Our programme, Research into Results, which is designed to convert theory into practice, is a perfect example of that. In my recent visit to Edinburgh university, I saw the good work being done in setting up small-scale businesses able to take the best research ideas coming out of universities and get them into widespread use. So many of the development challenges we face today rely on solutions from research, and solving many of the challenges we will face tomorrow will rely on the research and development investments that we make today.
Nick Herbert
I am grateful. I welcome everything that my right hon. Friend has said, the commitment that DFID has shown to this area and his undertaking that the Department will look carefully at the report. Does he think, in the overall scheme of things, that the global response to these diseases, many of which are pandemics, is equal to the task? It has taken an enormous global effort in other respects to tackle these diseases, such as with the establishment of the global fund. Only one TB drug has been approved by the Food and Drug Administration in the past 50 years. It was developed by Janssen Pharmaceuticals, by doctors who were not authorised to take it forward because they knew it would not be commercial. Finally, the company allowed the drug. Unless there is a step change in the response in the developing world to this problem, I wonder whether we will deal with it.
Mr Duncan
I agree with my right hon. Friend. We had a passionate debate on TB just a few months ago, in which he spoke on a subject on which he commands the House. The scale of the activity is not yet equal to the task, and it needs to be. That is why I urge all developed countries to match the 0.7% commitment that we have made. We, having taken the lead, should be followed by others. We can be proud that we are in the lead, and if others did what we did, we might well be up to the scale of the task that he illustrated. On that purposeful note, I say that we are committed to maintaining our record of funding high quality, high impact research and to putting that knowledge into use, so that we all, in the work we do, can save many thousands, if not millions, of lives.