Pharmaceutical Research and Development Spending

Baroness Bennett of Manor Castle Excerpts

Thursday 13th October 2022 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Brinton. I thank the noble Lord, Lord Hunt of Kings Heath, for securing this debate, and the noble Baroness, Lady Wheeler, for so effectively introducing it.

I start this debate from a philosophically different position from other speakers. What we in the UK— and the world—need is not just or even primarily the most effective, efficient pharmaceutical research and development; more than that, we need the best possible health research and development, which often may not involve pharmaceuticals at all but instead improving public health by addressing the social and environmental determinants of health, so pharmaceuticals are needed less and can be reserved—saved—for the most essential, important and unavoidable uses, some of which the noble Baroness, Lady Brinton, just outlined. The noble Lord, Lord Goodlad, just focused on dementia, but of course huge and increasing amounts of research show that addressing issues such as diet, exercise and air pollution can have a tremendous impact on reducing the impact of dementia, and we must not forget that focus.

We are now living in the age of shocks. We have already had one pandemic shock in Covid-19, still continuing, both in the spread of the SARS-CoV-2 virus and the huge and little-understood impacts of long Covid, and we know that others threaten, including the avian flu virus that is cutting such a dreadful swathe through our wild bird populations—and the factory farming systems that incubated it.

So, were I to be wording this question, I would rather ask how the UK most effectively contributes to global health, and in pharmaceutical research—with our current academic and industry frames—we certainly play an important part. But some of our role should surely be to promote and support research and development of pharmaceuticals in the global south to strengthen systems there. I will restrain myself from venturing off into the disgraceful state of ODA funding, although I directly ask the Minister what assessment the Government have conducted on the dangers of the UK failing to deliver the support that others do to the Global Fund, given the assessment that the UK’s current plans could put over 700,000 lives at risk and lead to over 17 million new infections across the three diseases it covers?

What I will focus on specifically is influenced by an issue that many may have seen highlighted last week in the New Statesman in an interview with Dame Sally Davies, the first female Chief Medical Officer of England. It focused on antimicrobial resistance, on which Dame Sally said:

“I do wonder how long I have to go on pushing this. Have I failed? Well I haven’t succeeded, have I, or we wouldn’t be sat here.”


I have to warn the Committee that I am planning on pushing hard on this in the coming months, with the assistance of two brilliant senior interns, Julze Alejandre and Emily Stevenson, whose work is supported by the British Society for Antimicrobial Chemotherapy.

So how is this relevant to pharmaceutical research in the UK? As a rich nation with a well-developed health system, we need to provide a framework for drug development and purchase that acknowledges the need not just to look at the immediate impact of a treatment on a patient but its full impact on public and environmental health. How biodegradable is a drug, what is its ecotoxicity, and what will be the complete impacts of its development, manufacture and use? The Environment Agency has just started providing funding to a new research group looking at the impact of biocides and cross-resistance—but that is starting at the other end, after the damage has been done.

If we think of the UK as a place that truly seeks to understand the impact of medicines, both existing and developing, we can look to the pharmaceutical formulary used in the Stockholm region in Sweden, which considers not just the efficacy and safety, pharmaceutical suitability and cost effectiveness of drugs, as does the NHS, but their environmental impacts. Should not the UK, to provide “world-leading” research and treatment, be operating on the same basis?

I turn now to some specific questions, of which I have given prior notice, about the environment for research, development and use of drugs, particularly relating to the Government’s approach to the European Commission’s water framework directive, which sets out a watch list of priority substances. Once they are included on the watch list, EU states are required to monitor these substances, and the inclusion of these compounds helps to raise research interest in these agents, including their AMR selective potential at environmentally relevant concentrations. Until recently, the data used to inform selection of compounds on the watch list determined ecological risk based only on ecotoxicology tests, and it was only in 2020 that AMR selection risk was also considered as an end point.

Featured on the watch list, updated in August this year with five more drugs, are a variety of compounds with a host of essential applications, including antibiotics, antidepressants, synthetic hormones, diabetes maintenance medication and both human antifungals and agricultural fungicides. Can the Minister update me on how this EU update will be treated in the UK, and how talk of sweeping aside regulatory frameworks transferred from the EU to the UK after Brexit that has arrived with the new Prime Minister will be treated in this area of assessing water issues?

In the post-Brexit era and considering the potential risks of these pharmaceuticals on the environment and in terms of AMR, as a proportion of the UK’s pharmaceutical research and development budget, what is the commitment of His Majesty’s Government to ensuring that the monitoring and reporting of these pharmaceuticals will be done in the UK in a more robust, comprehensive and transparent manner? We were after all promised stronger environmental protections after Brexit. In addition, what are the Government doing to ensure that the results of these environmental monitoring assessments are available for researchers and healthcare providers so that they can make informed and wise decisions in choosing and developing pharmaceuticals that have less ecological impact and risk in terms of AMR?

A number of noble Lords will remember that one of the first votes that I called in your Lordships’ House was as a result of sheer exasperation at the Government’s failure to take seriously in the Medicines and Medical Devices Act, as it now is, the environmental, particularly AMR, risks of human medicines, to mirror the terminology in the Bill used for veterinary medicines. The Minister today has the opportunity to reassure me that, with even more concerning scientific research in the area since then, the Government are now taking it seriously.