Pharmaceutical Research and Development Spending

Baroness Brinton Excerpts

Thursday 13th October 2022 Grand Committee

[Baroness Brinton (LD)]

My Lords, I too congratulate the noble Lord, Lord Hunt, on securing this debate and thank the noble Baroness, Lady Wheeler, for stepping in at such short notice and giving us such a comprehensive introduction. I also thank the ABPI, Roche, STOPAIDS, dementia awareness and the Lords Library for their very helpful briefing.

Four decades ago, I was a manager at Newmarket Venture Capital in the City. We funded the first wave of spinning out monoclonal antibodies. I remember one of the senior managers involved with it saying, “This will transform pharmaceutical treatments over the next few years”. She was right. A hundred years ago, my great-grandmother, who also had rheumatoid arthritis, had been told there was no treatment other than gold injections. She was in a wheelchair and unable to use her hands because they were so badly deformed.

Twenty years ago, I started on disease-modifying drugs and these days, along with many other people with my condition, I use a JAK inhibitor, which is a tablet that I take once in the morning and once at night. I used to have to spend a whole day in hospital having my infusion of a monoclonal antibody. We need to recognise the enormous advance in pharmaceutical work that has transformed the work of the NHS. It has reduced the number of beds needed and addressed a large number of other issues. But only one in 10,000 compounds and only 7.9% of medicines that get to clinical development actually make it to approval. It takes around eight to 12 years from initial discovery to launch, although I really hope that we have learned some lessons from the Covid pandemic and are able to start speeding things up somewhat.

Between 2015 and 2019, 43% of NICE recommendations were optimised for access to new medicines. This meant that they were recommended for a smaller patient population than the medicine had originally been approved for by either the European Medicines Agency or the MHRA. Of those optimised recommendations, around two-thirds recommended treatment in less than half the approved population. So, from a patient perspective, in the UK, a large number of patients are not getting access to the treatments that have been approved. The uptake of new medicines is a major concern. For more than 75 medicines recommended by NICE and launched between 2013 and 2019, the per capita utilisation in the first three years was around 64%, which was around the average in 15 comparator countries.

I want to focus on advanced therapy medicine products, the use of data and the voluntary pricing system, also known as VPAS. Advanced therapy medicine products are new, revolutionary medicines based on genes, tissues or cells and have the potential to save, lengthen and improve patients’ lives by treating the root cause of diseases. But they present challenges to health systems because they are so different from traditional medicines. Because they are used as a one-time-only treatment, they have a very high up-front cost, particularly if it takes 10 to 12 years to develop them and possibly up to £1 billion in research costs.

Currently, only a very small number of ATMP treatments are on the market and the NHS is managing to provide access despite these challenges. But, looking at monoclonal antibodies and the way that they are used now, it is likely that ATMPs will become the go-to drug for the future. Unfortunately, already we are behind other countries such as France, which is taking a very forward-facing example. France introduced a measure in its 2023 social security financing bill to allow innovative payment models to be used for ATMPs to share the risk between the manufacturer and the healthcare system.

We must not forget the transformative use of global pharma R&D, especially that which has been developed in the UK, in the spend on the wider world. It is one of the big lessons that we learned from the Covid pandemic. Oxford’s early R&D for the vaccine platform became the AstraZeneca vaccine, but unfortunately those technologies were unobtainable and inaccessible to most of the globe. Many noble Lords present spoke about that in your Lordships’ House during the Covid pandemic. We must make sure that that does not happen again, so I ask the Minister, what lessons have been learned from developing these drugs and how can we share that technology, probably through TRIPS waivers and other systems. in the future?

On data, during the passage of the Health and Care Bill, many Members across the House discussed the use of patient data and the safety net that we needed, but there is absolutely no doubt that the NHS has unique potential, given its large and diverse patient pool, to be one of the most effective engines for research. The Data Saves Lives strategy, announced earlier this year, is a good vehicle to overcome these barriers, and it was very much welcomed by the pharma sector. In implementing the strategy, I hope that the Government and the NHS will work to ensure that the national trusted research environment is fit for purpose, and has the necessary functionality to enable safe, high-quality research and the use of advanced analytical tools to derive insights. I am particularly concerned about this after the patient data—the care.data—and the GP data débâcles of this year and five years ago. It is really important that patients’ data can be protected.

Briefly, on VPAS, the Voluntary Scheme for Branded Medicines Pricing and Access between the UK Government and the pharmaceutical industry has historically been very useful, but Roche says that fluctuations of spend are now causing a rapid increase in VPAS payment rates, undermining the industry’s ability to sustain and invest in the UK. There has been a 10% jump from 5% to 15% over the last year and, worryingly, there is a projection that this may increase to over 30% next year. The worry is that this will impact the whole of the sector. Can the Minister say whether the Government are discussing VPAS with the extended life sciences sector?