Tuberculosis

Baroness Healy of Primrose Hill Excerpts

Monday 8th December 2014 Grand Committee

[Baroness Healy of Primrose Hill (Lab)]

My Lords, I congratulate my noble friend Lord Collins of Highbury on securing this debate on a subject so important to a world which contains an estimated 35 million people living with HIV.

Today’s debate is focused on investment in research and development in global health, in particular to develop new tools and treatments for TB. I welcome the fact that the TB Alliance has four combinations of drugs in late-stage development and will soon launch a trial of a combination of drugs suitable for those who are co-infected with TB and HIV. More people living with HIV die from TB than any other coinfection, but the first new drug available for TB in 50 years, Bedaquiline, is still not reaching the 1 million people who may need it because of its high price, as the noble Lord, Lord Lexden, mentioned.

The Doha declaration of 2001 must continue to be enforced and respected by all countries to ensure that public health is prioritised over profits. Currently, a number of free trade agreements are causing concern. Most, if not all, FTAs involving the EU or the USA contain provisions on intellectual property rights that are TRIPS-plus and have the potential or likely effect of hampering or preventing the use of one or more TRIPS flexibilities—TRIPS being Trade Related Aspects of Intellectual Property Agreements. Where there is a public health imperative, countries can issue a compulsory licence to a generic manufacturer on payment of a royalty to the owner of the patent.

We need to examine the role of the pharmaceutical companies as part of the debate. In 2002, the world watched as 39 pharmaceutical companies took the South African Government to court. Their complaint was that the Government, under the presidency of Nelson Mandela, had passed legislation paving the way for the purchase of cheap anti-HIV drugs from India to tackle the worst HIV epidemic in the world. By buying those cheap drugs, the companies claimed, the South African Government would be breaching their intellectual property rights. Thankfully, the case was eventually dropped, but the issue of intellectual property rights in that context remains controversial.

In 2003, the Labour Government launched a commission to explore the relationship between IP and development. They published a landmark document recognising the enormous impact of intellectual property legislation on international development. The commission recommended that further research be carried out, and the Labour Government led the way by supporting the establishment of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health. The commission sought to create global consensus around research and development for global health, and led to a series of reform proposals. Progress on these reforms has stalled and has been pushed back to 2016, as my noble friend has already highlighted, but the progress of diseases such as HIV and TB has not stalled, and the time wasted in coming forward with new research and possible vaccines sees 2.7 million people die from these two diseases alone every year.

As noble Lords have already emphasised, intellectual property is not, in itself, a bad thing, but IP is designed to incentivise innovation by helping innovators to make a profit on the products they invent. Companies will concentrate on developing drugs to address the illnesses besetting the developed West more quickly than addressing the needs of the developing world, as my noble friend Lord Collins has already mentioned. The disparity in wealth between high- and low-income countries means that the markets which offer greatest returns are those in the developed countries. The pharmaceutical companies predominantly invest in developing products with the greatest potential to generate sales in high-income countries, and price their products accordingly.

The establishment of the Medicines Patent Pool—MPP—in 2010 to address intellectual property barriers to generic production is of course welcome and is already making a difference, but there is still a time lag from the period when a licence is agreed, given the two to three years it takes for a generic manufacturer to develop a new drug. More pharmaceutical companies need to be encouraged to sign up and there is still a need for greater investment in R&D.

The Government need to show the same leadership as the previous Labour Government did in this field by commissioning a new report to examine the differences in overall costs between a commercially driven model of development and models that are open access and do not include IP protection, so that global solutions can be found to global health problems. The aim of such a study would be for the UK Government to find the most effective ways of creating incentives to encourage investment in R&D, and to look at the benefits and challenges with different approaches to drug development.

As my noble friend Lord Collins highlighted, there is a concern about this Government’s reduction of funding into research and development around a vaccine for AIDS by more than 80% for the period 2013 to 2018. The new grant for the next five years has been reduced to only £5 million—one-eighth of its previous level. Does the Minister support the recommendations in the report launched by the All-Party Parliamentary Group on HIV and AIDS, Access Denied, to carry out an inquiry into alternative models of research and development investment which separate the cost of R&D from the demands of profitability? As my noble friend Lord Collins has already mentioned, a new global research and development fund could reward all who contribute to it, and the UK Government could negotiate with the pharmaceutical industry and civil society to create a research and development treaty to provide the framework for such a fund. Notably, the report calls on,

“the UK government, the pharmaceutical industry and multilateral organisations to work together to make second and third-line ARV drugs available and affordable to all, including marginalised populations and people living”,

in middle-income countries. The report also says:

“DFID should lead the way in harnessing donor support for the Global Fund to cover the cost burden of the increased numbers of people (28.6 million) now eligible for ARV treatment under WHO guidelines”.

Most importantly, Access Denied suggests that,

“DFID should use its leverage as a donor to ensure multilateral institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, WTO, WHO, World Intellectual Property Organization (WIPO) and UNITAID are doing enough to bring prices down. It must use its voice to demonstrate leadership on this issue”.