Tuberculosis

Baroness Northover Excerpts

Monday 8th December 2014 Grand Committee

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, first, I thank the noble Lord, Lord Collins, for securing this important debate. I also thank all other noble Lords who contributed to the debate this afternoon. This is indeed a very important area and I am glad that we have recently had Oral Questions on it and that my noble friend Lord Fowler has a related debate on the Global Fund on Thursday. I was very glad to speak at the All-Party Group on HIV and AIDS, of which I used to be an officer, at the launch of its report Access Denied, and I am very happy to share my speech.

As the noble Baroness, Lady Hayman, pointed out, these are not only diseases of poverty; they are diseases that cause further poverty. I thank the noble Baroness for her tribute to DfID. Like her, I pay tribute to our outstanding institutions that are working in this area, and I welcome her new involvement with Cambridge University Health Partners. We have a formidable academic record in the United Kingdom in this area.

The noble Lord, Lord Collins, pointed to a market failure in drug development in relation to diseases of poverty. Other noble Lords made reference to this as well. Between 1975 and 2000, just 13 new drugs were registered for use against the so-called diseases of poverty. That is about 1% of the total number of new drugs developed globally. Of course, the question is: why have those diseases been so badly neglected? As noble Lords have indicated, the answer lies in the lack of incentives for the pharmaceutical industry. Developing and bringing a new drug to market is an extremely costly and risky business and the industry did not see the incentives to bring those drugs forward. If we add the extremely limited profit margins associated with making those badly needed drugs available, it is not hard to see that fundamental market failures have meant that the development of affordable and accessible treatments has not been prioritised in the way it should have been. Noble Lords were quite right in their analysis of that.

The noble Lord, Lord Collins, and others mentioned the product development partnerships—PDPs. These have changed the situation, harnessing the best of the private sector so that it is channelled for the public good. The noble Lord, Lord Collins, also spoke about de-linking and several noble Lords spoke about intellectual property. All PDPs negotiate access to intellectual property for all products developed in order to ensure affordability and access. We need a number of approaches, not just de-linking, to ensure that many players can be involved and to bring in the expertise and resources from the private sector that may contribute to the PDPs.

The noble Lord, Lord Collins, and the noble Baroness, Lady Healy, asked whether we would commission a report on de-linking. I assure them that a number of groups are already looking at this, including a Treasury-sponsored group looking at antimicrobial resistance. If they want further details of that, I am sure that we can assist in that regard.

Since the emergence of PDPs, we have seen 10 new technologies brought to market and there are more than 350 candidates in the pipelines of PDPs collectively, including 90 drug and vaccine candidates and 32 diagnostic or vector control candidates. The UK is a leading investor in PDPs; in 1999, we were the first Government to provide support to a PDP, and currently support 10 PDPs covering neglected diseases. Since 2008, we have committed approximately £323 million to PDPs.

I assure the noble Lord, Lord Collins, that DfID has an open access policy. All research funded by DfID has to be placed in the public domain. For product development research, all new products must be made available for the lowest possible price. The noble Baroness, Lady Gould, rightly emphasised the key importance of such access to medicines and vaccines. I hope that they are reassured by what I have just said.

I am pleased to report that the DfID-funded PDPs have a strong track record of delivering a wide range of new technologies for diseases of poverty and of getting those into use in the developing world. This has included five new diagnostic tests for TB and six new drug combinations for malaria.

My noble friend Lord Lexden referred to the long history of TB and humankind. Like him, as a former historian, I am fully aware that that history is very different from the situation today. However, TB disproportionately affects the most vulnerable and marginalised in society. In 2013, 9 million people fell ill with TB and 1.5 million died. TB ranks as the second leading cause of death from an infectious disease worldwide, after HIV. The UK remains committed to help achieve the goals of the Global Plan to Stop TB to reduce deaths and prevalence of TB by half, compared to 1990 levels, by 2015 through our bilateral and multilateral support. A big part of that effort is investing in research into more effective diagnostics, treatment and vaccines. Noble Lords are absolutely right about that.

I assure my noble friend Lord Lexden that DfID is already the second-largest government funder in this regard. Following a funding gap for TB drugs this year, we gave an extra £5 million to the TB Alliance. I want to highlight the work of two DfID-funded PDPs in particular. The Foundation for Innovative Diagnostics has developed GeneXpert, a new diagnostic test for tuberculosis that gives fast and accurate results in four hours, compared to a previous wait of between six and eight weeks. Noble Lords will appreciate immediately how important that is. The Global Alliance for TB Drug Development is about to start a registration trial for a new combination of TB drugs. If successful, it has the potential to reduce treatment times for drug-resistant TB from between 24 and 30 months to six months—another issue that my noble friend raised.

What are we doing to change the global landscape? We recognise that effective co-ordination is crucial but challenging, given the number of different players in the field, including Governments, philanthropic organisations, the private sector and others. As well as investing directly in research and development, the UK will continue to play our part, working with others to improve co-ordination and maximise overall returns for the global poor. We are working with the WHO Secretariat as it develops a mechanism to implement the recommendations of the recent consultative expert working group process.

We welcome the proposed global observatory for health R&D, to be based at the WHO, which will provide an opportunity for co-ordinating information about what health research is going on globally. In tandem, the WHO Secretariat is developing a mechanism to operationalise the pooled WHO member states fund for product development, which, if established, will aim to attract new funders and donors to support product development. We currently chair the PDP funders group—an informal group of bilateral agencies and philanthropic foundations that provide support to PDPs and encourage others to invest.

The noble Baroness, Lady Hayman, emphasised the need to build research capacity. We are working not only within the United Kingdom but she will know, I hope, that we are also working within Europe generally, supporting the European & Developing Countries Clinical Trials Partnership, which has a UK lead—the Medical Research Council. The EDCTP is a partnership of 16 European and 48 African member states to pool resources and skills and to co-ordinate and implement clinical research.

I note what my noble friend Lord Lexden said about the incentive of a prize. I suggest that he might look to a major donor with an interest in naming such a prize. Given the impact on India, he might initially look to that country.

The noble Lord, Lord Collins, also mentioned HIV funding. We discussed this the other day. He will know that past vaccine research looked promising but looks less promising now and needs a basic research approach. That work is therefore much more appropriately taken forward by the MRC and the Wellcome Trust, which have been increasing their funding for AIDS vaccine research. I note that an incredibly interesting research paper may indicate that HIV may be weakening slightly. Let us hope that it heads in that direction.

The noble Baroness, Lady Gould, mentioned the Ring Study. DfID has committed £15 million to the International Partnership for Microbicides, and I hope that she will be encouraged by that.

The noble Baroness, Lady Healy, talked about TRIPS. DfID supports countries that use provisions to overcome IP barriers through TRIPS.

Solving many of the challenges that we will face tomorrow will rely on the R&D investments that we make today. DfID has an outstanding record in this area in terms of its support over the last few years. We are committed to maintaining our record of funding high-quality, high-impact research and playing our part in improving global communication. We are committed to putting that knowledge into use so that ultimately it will save lives. We also emphasise that rights should underpin our support for the poorest and most marginalised, as my noble friend Lord Lexden made clear should be the case.

Noble Lords mentioned Ebola. That has shown how interlinked we are. It will not have escaped the notice of the pharmaceutical industry that a disease that was seemingly limited to a poor area geographically and socially may well have a far wider impact. Those who had Ebola vaccines on their books are now able to power ahead. We need to ensure that we support those suffering from the so-called diseases of poverty. We also need to recognise that we are in a changing world, and we need to do our best to ensure that that is fully recognised.