Breast Screening
Baroness Sheehan Excerpts(2 years, 11 months ago)
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Lord Kamall (Con)
In previous debates this week I have outlined what we are doing to increase recruitment. On the specific issue in the mammography workforce, Health Education England is providing £5 million to support a new training and development programme through the National Breast Imaging Academy. That itself will increase recruitment, improve screening targets and increase early diagnosis of cancer.
Baroness Sheehan (LD)
My Lords, while we wait for the routine screening programme to get back to normal, is there a fast-track mechanism for women who believe they have themselves detected a lump or a worrying change in their breast tissue to be screened and seen by a specialist?
Lord Kamall (Con)
The method for booking screenings has now changed, so people can book online on demand, rather than waiting for a referral.
Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)
Baroness Sheehan Excerpts(3 years, 1 month ago)
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Baroness Sheehan (LD)
My Lords, I also thank the noble Lord, Lord Patel. I joined the Science and Technology Select Committee just in time for the inquiry that led to this report, so was able to appreciate the consummate ease with which he chaired the complex scoping exercise and then of course the inquiry itself. I add my thanks to the clerks for their hard work and dedication. My remarks today will focus on the impact of the Covid pandemic on the fundamentals of the Government’s two-tier grand challenge strategy to, first, increase healthy independent living by five years by 2035 and, secondly, narrow the gap between the richest and the poorest.
Like all developed countries, the population of the UK is ageing. The report tells us that we will see a 51% increase in people aged over 80 to about 5 million from 2018 to 2035, and all the while the working-age population remains static. It was against that backdrop that in 2017 the Government named our ageing society as one of the four grand challenges in the now sadly abandoned industrial strategy. Between 1980 and 2018, life expectancy at birth rose to 79.3 years for males and 82.9 years for females. However, healthy life expectancy—the number of years for which a person is expected to live in good health without disability—has not improved at the same rate; it stands at 63.1 years for males and 63.6 years for females.
It will come as no surprise, given the heavy mortality rate due to Covid last year, that the ONS reports that, for the first time in four decades, life expectancy for men in the UK has fallen. Life expectancy for women remains unchanged. Are the Government assessing the impact that long Covid may have on healthy life expectancy? On the last page of their response to the report, the Government seem to imply that the ageing society grand challenge will no longer be identifiable as such in the more nebulous plan for growth, under the “build back better” soundbite that replaces the more solid industrial strategy. I hope that the Minister can offer reassurance that this will not be the case, and in particular that R&D funding into the science of ageing and support for SMEs at the cutting edge of technological innovation to aid independent living will be protected from any cuts to the promised £22 billion per annum investment in R&D. I would appreciate it if he could refrain from listing the Government’s historic support, as was the case in their response to the report, and instead tell us their future plans.
I turn to the second tier of the grand challenge: narrowing the gap between the richest and the poorest, which stands at nine and a half years for life expectancy and, distressingly, almost 20 years for healthy life expectancy. That will have been exacerbated by the country’s recent experience of those who bore the heaviest toll in lives lost during the pandemic. Covid hit the poorest hardest and, within that, hit people from ethnic minorities even harder. The report’s first recommendation is that the Government, along with NHS England and the erstwhile Public Health England, “prioritise reducing health inequalities” between the least deprived and most deprived areas, and asks that they set out a plan to do so over the next Parliament. In response, the Government in effect say that we will get the report due course when they come forward with proposals in response to the prevention Green Paper. What is the progress to date on that response?
My final remarks will focus on obesity, which is closely linked to deprivation. Food loaded with cheap harmful additives is leading to an increased number of lives lost and points to a failure by successive Governments to act on the prevention agenda by promoting healthier diets and a more mobile lifestyle. Frankly, it is a disgrace that poorer people have little choice but to buy food that is poor in nutrition and positively harmful to their health.
The experience of the pandemic illustrates starkly that the Government have not curbed the appetite of the food and drink industry to maximise profits at the expense of the health of their customers. Cheap and addictive additives such as sugar, salt and hydrogenated fats in heavily processed foods—to boost flavour and shelf life—have wreaked immeasurable harm on the population at large. Will the emphasis that the Government propose to place on prevention include tackling the food and drink industry’s role in increasing obesity? Will they, for example, extend the sugar tax to foods and drinks that are high in added cheap sugar? Trans fats, a form of processed hydrogenated cooking fats, have been identified as one of the most dangerous food additives. Are the Government rethinking their reluctance to introduce curbs on their use, if not their total ban?
Our report points to the damage that a lack of movement does to our bodies, let alone a lack of physical exercise. The sedentary lifestyle of a couch potato is one that will lead to an end of life riddled with multiple morbidities and a carrier bag full of drugs to treat symptoms of each disease, as well as drugs to counteract side effects. The Government have failed to provide central oversight of the volume or interactivity of these drugs. GP oversight is proving inadequate, to the detriment of the patient and NHS finances. I hope that the Minister will give us greater cause for confidence than the Government’s written response.
Health and Social Care Update
Baroness Sheehan Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
My Lords, I endorse completely the noble Baroness’s remarks that we depend on the generosity, public spirit and kindness of family carers who provide an enormous amount of support for their loved ones. Without them, the system could not possibly exist and the world would be a much graver place. I recognise that many carers have been pushed very hard by the pandemic. We have put a huge amount of resource into local authorities, which are responsible for providing support for those families, and that includes the kind of respite support that the noble Baroness has rightly pointed to. I am sure that more could be done and I would welcome any correspondence on this by way of follow-up that she would like to send my way.
Baroness Sheehan (LD)
My Lords, the Serum Institute of India is producing a billion doses of the Oxford/AstraZeneca vaccine this year. However, we hear that the rate of production may be compromised because of delays in the supply chain of essential items from the US. What dialogue have our Government had with their US counterparts at all levels about how these delays might be overcome?
Lord Bethell (Con)
My Lords, the noble Baroness is right to say that the Serum Institute of India is the world’s biggest vaccine manufacturer by far and we are enormously grateful for the strong relationship that this country has with the institute and the contribution that it is making to our vaccine rollout. The supply chains for the world’s vaccine production are unbelievably complicated, with ingredients and individual supply items coming from many different countries for each and every vaccine. It is not possible to provide a running commentary on the progress of each one; nor would it be wise to have a bilateral conversation with the country of origin of every vaccine ingredient. Our relations with India, America and the EU will, I am sure, return to the spirit of partnership and the respect of contract law that have characterised those relationships in the past.
Covid-19 Update
Baroness Sheehan Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
My Lords, I thank the noble Lord for his grim prognosis and I agree with his analysis. If there is one place in the world where a mutant variation is likely to happen, it will be in an area where you have high infection rates and a large amount of suppression of the virus by either a lockdown or a vaccine programme. If you look around the world, that country is most likely to be Britain. We must be on the balls of our feet to be prepared for unhelpful news on that front.
Can I reassure the noble Lord on the borders? The number of people travelling in and out of the UK has reduced dramatically and the traffic through our airports and seaports is down tremendously. The application of the red list programme is extremely effective and the use of quarantine hotels has been extremely rigorously enforced. The isolation, along with amber routes, has also had enormous resources and is much more effective than it once was. We are prepared to go further. We review the red list constantly and, should the threats mount up to being serious enough, we will extend the red list as far as necessary.
Baroness Sheehan (LD) [V]
My Lords, vaccines are key to getting us to a position where we can live with the virus, but we really must listen to scientists telling us that we must control the virus everywhere. While our support for the COVAX initiative is to be applauded, it cannot work effectively without reliable supplies of the vaccine. The Covid-19 Technology Access Pool is designed to do just that. Are we fully engaged in C-TAP?
Lord Bethell (Con)
My Lords, we are taking a leadership role in COVAX, CEPI, ACT, Gavi and all the international, multilateral initiatives to roll out vaccine around the world. We are looking at what to do with our own stock of vaccines, and the Foreign Secretary has made it very clear that distribution of the vaccines we have bought is very much on the agenda. The AstraZeneca vaccine is being used as probably the default vaccine of choice around the world, as it is low- cost and easily distributed. Through our G7 chairmanship, we entirely support the agenda of preventing further pandemic by ensuring that vaccines are fairly and widely distributed around the world.
Covid-19
Baroness Sheehan Excerpts(3 years, 9 months ago)
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Lord Bethell (Con)
The noble Lord is right to cite the example of Israel. It is indeed extremely worrying. I touched upon this point when replying to my noble friend Lord Hamilton on the previous Statement. Undoubtedly the fear is that you vaccinate a large proportion of your most vulnerable population but those who have not been vaccinated—mainly the young—feel a licence to go out and socialise and create an enormous problem by spreading the disease on a large scale among the wider population. As I alluded to in my earlier answer, we currently have an infection rate of between 1% and 2%, It is not impossible that it could rise to 10% or 20%. Should that happen with the kind of proportions of people who then end up being hospitalised whatever their age, or suffering from long-term impacts of the disease, we would have a very big problem on our hands. That is why the Government are moving cautiously. I strike an optimistic tone in my answers, but I am extremely cautious and considered in my approach to policy, as are the Government.
Baroness Sheehan (LD) [V]
My Lords, hotel quarantine measures, albeit late and incomplete, are nevertheless welcome—better late than never. However, as things stand, mankind cannot outpace the mutating virus without a global vaccine plan in place. When do the Government think that the time will be right to call for a leader’s summit to develop a global collaborative effort to deal with this pandemic?
Lord Bethell (Con)
My Lords, I completely agree with the noble Baroness. As I said earlier, we are not safe until we are all safe. That is an absolute axiom. It will soon become a cheesy remark but that does not make it any less true. Britain is totally committed to the principle of global distribution of the vaccine. We are extremely proud of AstraZeneca, which has a profit-free approach to the intellectual property around the vaccine. It is quite possible that as a cheap, easily administered and portable vaccine, it may become the common global standard for vaccination. It is my hope that it will be rolled out globally, and that it is updated as necessary, as mutations and variants of concern begin to affect it. Britain is very committed to CEPI, Gavi and ACT. These are the major financial commitments that the world has joined in to get the vaccine to the developing world, and we are using our chairmanship of the G7 to champion that agenda.
Covid-19: Vaccination
Baroness Sheehan Excerpts(3 years, 10 months ago)
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Baroness Sheehan (LD) [V]
My Lords, can the Minister say how concerned the Government are that diminishing efficacy in partially immunised people among a population with high prevalence of the disease, as we have in the UK, will foster ideal conditions for the virus to mutate into vaccine-resistant forms?
Lord Bethell (Con)
My Lords, I do not quite agree with the premise of the question, which is the concept of being partially vaccinated. When you get your first vaccination shot, you are vaccinated, your body has been primed, B cells make the antibodies and you learn how to fight the disease. That is categoric. Where the noble Baroness absolutely has a point is that it is an uncomfortable truth that when we lean in to the virus, it will seek to escape and mutate, and that is the moment of absolute highest risk for the country. That is why we are trying to move as quickly as we humanly and possibly can: there is a moment in time, an opportunity to get the vaccine out to as many people as possible to avoid the mutation throwing up variants that escape our vaccine.
Mental Health Act Reform
Baroness Sheehan Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord is right; the numbers are inappropriate. Fifty-one thousand detentions under the Act in 2019-20 seems far too many. Detentions under the Act rose by 40% in the 10 years to 2015, and we thought of this Act to try to address that injustice. The £2.3 billion is new money, and it will make a huge impact on the mental health trusts he describes.
Baroness Sheehan (LD) [V]
My Lords, sadly, I have personal experience of having to invoke the Mental Health Act. It is a dreadful process. It concerns me that one of the reforms proposed is to tighten the criteria for civil patients’ detention by raising the threshold for risk of harm. Does the Minister agree that this reform risks increasing harm to the person who is ill and their family?
Lord Bethell (Con)
My Lords, that is not the intention of the report, and I confess to struggling to understand how that would be the case. I would welcome correspondence from the noble Baroness to detail her concerns so that they can be taken on board.
Covid-19: Vaccinations
Baroness Sheehan Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord makes the point extremely well, and I agree.
Baroness Sheehan (LD) [V]
My Lords, no one is safe until everyone is safe. Does the Minister agree? If so, what thought have the Government given to supporting the temporary TRIPS waiver proposal by South Africa and India, given that it will help the WHO’s efforts to co-ordinate the local supply of vaccines through its C-TAP initiative?
Lord Bethell (Con)
My Lords, I would put the truism slightly differently: the vaccine makes you pretty safe, but it does not mean you are not dangerous to other people. I think we all have to get used to that. Regarding the South African variant and the other variants popping up in Brazil and elsewhere, this is a manifestly different disease that is growing up around the world. It has a huge implication for international travel. We are working with the WHO and other groups to try to understand this, but it is certainly of grave concern to the country.
Medicines and Medical Devices Bill
Baroness Sheehan ExcerptsTuesday 12th January 2021
(3 years, 10 months ago)
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Baroness Sheehan
“(d) the importance of prioritising the protection of human rights including citizens’ right to access medicines as part of the right to the highest attainable standard of physical and mental health as stated in the International Covenant on Economic, Social and Cultural Rights of 1966;(e) the public health safeguards within the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights which include but are not limited to the right to grant compulsory licences and the freedom to determine the grounds upon which licences are granted.”
Baroness Sheehan (LD) [V]
My Lords, I rise—metaphorically—to move Amendment 10 in my name and those of the noble Baroness, Lady Bennett of Manor Castle, and the noble Lords, Lord Alton of Liverpool and Lord Crisp. It is a pleasure to have their names on an amendment to ensure that affordable medicines for all must be a consideration when regulations are made with respect to human medicines.
The price of a medicine is often determined not by the cost of production but by artificial and opaque determinants by big pharma. Egregious examples of price gouging abound. With such opportunities for eye-watering profits, the temptation to protect them is great. Big pharma has developed myriad unethical practices to do just that. Many of these were detailed in Committee by a number of noble Lords; I do not propose to repeat them today. However, I do not want to skate over the consequences. People, even those under NHS care, suffer and/or die because of a lack of medicines that are available but not affordable.
Let me give a couple of examples. The row over the cystic fibrosis drug Orkambi went on for three years, with the NHS held to ransom, as the manufacturer Vertex refused to lower the price to an affordable one. A House of Commons debate on Orkambi was finally triggered after an online petition reached more than 100,000 signatures. A threat by the government Minister to invoke a compulsory licence, known in the UK as a Crown use licence, to allow the manufacture of the drug by a third party at a more reasonable price was all it took for Vertex to reduce its price. It is estimated that, in those three years, more than 200 people died here in the UK for lack of a drug that should have been affordable much earlier. Let us just think about that for a moment.
Just last year, we had the unacceptable behaviour of Gilead over remdesivir, then thought to be the only effective drug against Covid-19. At the height of last year’s spike in cases, rationing of the drug had to be put in place in the NHS because the US had bought up all available supplies of the drug. Australia, Canada and Germany have revised their national patent laws to enable them to issue compulsory licences to respond to Covid-19 more effectively. Here, the Commons International Trade Committee made this recommendation:
“The Government should also evaluate the case for enabling compulsory licensing of therapeutic drugs or vaccines in respect of COVID-19 to make them available as quickly, widely and cheaply as possible.”
Can the Government assure us that they will invoke a Crown use licence without hesitation if necessary? I hope that the Minister can give that assurance at the Dispatch Box; we have had some conversations about this. If she does so, there will be no need for me to seek the opinion of the House.
I want to move on to the subject of non-exclusive voluntary licensing. Even though he is not at the Dispatch Box, I thank the noble Lord, Lord Bethell, for his letter in response to the questions asked in Committee. In that letter, he restated the Government’s view that non-exclusive voluntary licensing is providing enough incentives to create new inventions and accelerate the development of health technologies.
However, evidence from European studies shows that over half of newly patented drugs have no added therapeutic value. Have the Government carried out any reviews into whether patents are incentivising research and development into the drugs and health technologies that the public need? For example, are pharmaceutical companies putting resources into the development of vaccines for new virus threats as they emerge, and into vaccines against existing diseases such as TB and HIV? Are they working at full throttle to develop a new generation of antibiotics that will be effective against antimicrobial resistance? I am grateful to the noble Baroness, Lady Bennett of Manor Castle, for bringing this up in her earlier speech this afternoon. However, is it these companies’ job to safeguard public health? Can we rely on them to do it on our behalf? We need a review to know whether they are doing it.
If there are no plans to carry out this useful investigation, will the Minister give an assurance that she will advocate for one? That will go some way to reassuring me and other noble Lords that the Government’s confidence in the existing system of patents to deliver the public health goods to safeguard us all is justified. It will also go some way towards answering those who believe that the current model works only to the advantage of unscrupulous pharmaceutical companies, whose sole raison d’être is to garner extreme profits.
To summarise, my two asks of the Government are, first, whether they will give an undertaking of their willingness to use Crown use licences and, secondly, whether they will meet me and other interested parties to explore terms for a government review into whether big pharma meets public health needs.
I would like to say a few words about the supply of vaccines for Covid-19. In his letter to me and the noble Lord, Lord Alton, the Minister, the noble Lord, Lord Bethell, stated that the Government are exploring the role of the WHO’s COVID-19 Technology Access Pool, or C-TAP, to see whether it can improve access to vaccines. Please can they get a move on? Events of the past several weeks have shown us with pinpoint clarity that we are in a race against time, as new and more transmissible variants emerge.
The fact is that UK support for the Medicines Patent Pool and the eventual agreement of pharmaceutical companies to share their patents on antiretroviral drugs made the production of more affordable drugs possible. This transformed the HIV response; we need to do the same again now. We need the UK Government to support the C-TAP and get companies to share their technologies, otherwise the situation we have with shortages of vaccines in the UK will continue—not just here but everywhere, to the detriment of us all. If, however, companies refuse to share their vaccines, medicines and tests then the UK Government, and all Governments, must use their legal rights to implement the public health safeguards within the TRIPS Agreement. At the very least, that means invoking compulsory licences.
If the Government are serious about getting this vaccine to everyone in the UK and the rest of the world, they must also support the TRIPS waiver so that unhelpful intellectual property protections on Covid-19 tools can be removed. The TRIPS waiver is a proposal put recently to the WTO TRIPS council by South Africa and India, meaning that certain parts of the TRIPS Agreement should be waived for the duration of the pandemic to help us all combat its effects, because this would allow countries to collaborate in the research and manufacture of vaccines, medicines and tests to meet global demand.
With almost 2 million lives lost due to Covid-19, this is no time for restrictions in manufacturing capacity in the name of pharma profiteering. We know the power of the pharmaceutical lobby, and the influence it can bring to bear, but in this crisis human rights must take priority over intellectual property rights.
Baroness Sheehan (LD) [V]
My Lords, this has been a stimulating debate and I sincerely thank all noble Lords and noble Baronesses who have taken part. That very much includes the Minister, who responded with her customary courtesy and thoughtfulness.
I thank the noble Baroness, Lady Bennett of Manor Castle. As ever, she brought up the issue of human rights and how they must not be trumped by intellectual property rights—sentiments I agree with 100%.
I thank the noble Lords, Lord Alton of Liverpool and Lord Crisp, who raised a question central to the whole issue of intellectual property rights: who actually pays for the investment in drug development? This is shrouded in secrecy and we must try to shed some light on it. I hope that we can explore that in discussion when we have the meeting the Minister has very kindly agreed to. Drug development is done not just by private companies; taxpayer-funded research and R&D institutions play a huge part, as do philanthropic organisations and NGOs.
I am very grateful to my noble friend Lady Walmsley for raising Section 57A, which the noble Lord, Lord Bethell, brought up as a defence against using compulsory licensing. It is a moot point, as my noble friend said. I think that the argument the Government used would in fact nullify the whole concept of Crown use.
I thank my noble friend Lady Jolly for the focus she placed on the major challenges developing countries face, even more so now that DfID no longer exists and 0.7% has been reduced to 0.5%.
I thank the noble Baroness, Lady Wheeler, for her words. She was absolutely right to draw attention to the collated briefing of the Royal College of Physicians and its partners in highlighting prices in the NHS for both generic medicines and those that enjoy patent rights.
I thank the Minister, and I will take her up on her offer of a meeting in due course. I beg leave to withdraw the amendment.
HIV: Ending Transmissions
Baroness Sheehan Excerpts(3 years, 11 months ago)
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Baroness Sheehan (LD)
The Global Fund to Fight AIDS, Tuberculosis and Malaria warns that additional support is badly needed to prevent a reversal in “hard-won gains”. Will we, as a lead funder, join Germany, Italy, Canada and South Africa to increase our contribution to the fund as a matter of urgency? A Written Answer will suffice if that is not in the Minister’s briefing notes.
Lord Bethell (Con)
The noble Baroness makes a very good point. The UK Government will continue to be a world leader in our HIV response through our considerable investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as through supporting the Robert Carr Fund to advocate for the rights and needs of the most marginalised groups, such as LGBTQ people and sex workers. In relation to reassurance on the point she asks about, I cannot provide that from the Dispatch Box, but I reassure her that our commitment to these international causes remains robust.