Global Health (Research and Development)

Alan Duncan Excerpts

Tuesday 8th July 2014 Westminster Hall

[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 Hain]

Unless the Minister is to respond later to my specific request for a report, might I press him on DFID’s specifically considering the de-linking question and resourcing for it, conceivably within its budget? That is essential for delivering what we all want.

[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 Hain]

rose—

[Mr Duncan]

I sense that the right hon. Gentleman wants to chip in again. Of course I shall give way, because we have time—thanks to Mr Streeter’s mathematics.

[Mr Hain]

Will the Minister or his colleague make an assessment of and write to me with a view on how this issue, particularly the resourcing, can be approached?

[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]

Will my right hon. Friend give way?

[Mr Duncan]

I have only three lines of my speech left, but since it is my right hon. Friend, I will.

[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.