Tuberculosis

Baroness Hayman Excerpts

Monday 8th December 2014 Grand Committee

[Baroness Hayman (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Collins, on initiating this debate and I echo the remarks of the noble Lord, Lord Lexden, about the contribution of the noble Lord, Lord Collins, to this field and his determined work to improve healthcare for some of the world’s poorest and most marginalised people. I draw attention to my interests in global health, particularly malaria and NTDs.

It is about those two areas and the need for more and innovatively funded research in them that I shall speak. I congratulate the All-Party Parliamentary Group on Global TB on its overall report, Dying for a Cure: Research and Development in Global Health, with its emphasis on TB and its recognition that the needs of the 1.4 billion people who suffer from neglected tropical diseases are tremendously important, as is the interaction of those disabling, disfiguring diseases with the big three killers, TB, AIDS and malaria. It has also recognised that these are diseases not only born of poverty but which create poverty. They undermine education, employment, health—all the opportunities that would allow people to claw their way out of poverty. Therefore, combating the diseases of the poor, including the big three, is an essential element of the fight against poverty and for social and economic development.

For some of those diseases, we already have treatments for which we need more resources—for example, for mass drug administration for soil-borne helminth diseases—but we still desperately need to develop better medicines, smarter diagnostics and, above all, vaccines if we are to make progress. If we look at the position with malaria, there is an urgency to do all those things and to develop new insecticides if we are not to face exactly the same problems of resistance that plague the current fight against tuberculosis.

The main point I want to make today echoes that made by the noble Lords, Lord Collins and Lord Lexden, in terms of the challenges that are born not of scientific difficulties and obstacles but of economic difficulties and obstacles in developing new products. I think it is now universally accepted that we have a market model in pharmaceuticals that will never, on its own, deliver for the poor.

Ebola is a very good example. Ebola was such a minority interest until this year that it was not even on the WHO’s list of 17 neglected tropical diseases—it was a neglected neglected tropical disease. But the reason that treatments and vaccines have not been developed for Ebola is not because it is a uniquely difficult scientific challenge but because so few people were considered at risk and those few people were considered to be poor and a long way away. As I understand it, the candidate vaccines and treatments now being rushed through are all compounds that had already been discovered but not developed because, although potentially valuable in therapeutic terms, they were not potentially valuable in commercial terms. Of course, we now have the recognition that in a global world, epidemics are a mere flight away, so the world has now pledged to spend $2.4 billion on combating Ebola but did not in the past invest the fraction of that which would have been necessary to develop a new vaccine.

Of course, progress has been made in the area of funding of research for such diseases. We should pay tribute to the UK Government and DfID for their support for the concept of product development partnerships and to the work of the philanthropic, academic and private sectors in coming together with Governments in important and fruitful partnerships such as the Drugs for Neglected Diseases initiative and PATH, and in malaria vaccine development. But the number of chemical compounds with potential being brought forward is still worryingly low. Ebola should have taught us that we cannot afford for potential drug candidates to be left on the shelf because pharma companies have no incentive to screen them against key diseases. We have to find a way to fund discoveries that are potentially life-saving, even when they are not in the current market, profit-making.

My plea to the Government today would be for them to increase their commitment, and the resources they devote, to the vital work of PDPs. As the noble Lord, Lord Lexden, said, this is an area where we have tremendous skills and expertise. I recently took up the position of chair of Cambridge University Health Partners, and seeing the huge scientific potential we have for patient benefit on that fantastic campus is a real privilege. We also have a history of, and a great ability for, knowledge transfer through our academic institutions, particularly the London School of Hygiene and Tropical Medicine, and the Liverpool School of Tropical Medicine. I was in Zimbabwe and saw midwives and obstetricians from this country delivering training packages for midwives and skilled birth attendants in Zimbabwe, which then became sustainable programmes for supporting maternal health.

I have one other plea: we should not neglect the importance of the research that can take place in the countries and the communities where diseases are themselves endemic. Building capacity in those countries, as enlightened funders are now recognising, can have really powerful results in the quality and relevance of the research undertaken. Finally, I would encourage the Government to look at mechanisms to invest in local clinician-led research agendas in developing countries.