Tuberculosis

Baroness Gould of Potternewton Excerpts

Monday 8th December 2014 Grand Committee

[Baroness Gould of Potternewton (Lab)]

My Lords, I, too, wish to congratulate my noble friend on securing this important debate, in particular for his persistence, and for it happening so close to World Aids Day. I wish to concentrate my remarks on the need for better tools, research and development for HIV/AIDS, and why it is so necessary. Unfortunately, listening to the three previous speakers, the story is the same, which is a real tragedy.

HIV/AIDS has placed a huge burden on developing countries, where the majority of the 35 million people with HIV now live. The disease kills 1.5 million people each year. Two-thirds of those living with HIV are in sub-Saharan Africa, where families can ill afford to bear extra healthcare costs or care for orphan children. Initially seen as a male disease, HIV/AIDS is rapidly becoming a female epidemic, with further impacts on families, given the greater share of responsibilities of women within households. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa. The region’s young women are twice as likely to contract HIV as their male counterparts. This is in part due to a greater biological risk, and in part due to the unequal status of women, the effect of which constrains women’s ability to negotiate condom use, which is a major problem for those women, particularly those who are sex workers. Risk to sex workers stems from an increased number of sexual partners, greater exposure to sexual violence, being forced to have unprotected sex, or accepting more money to have sex without a condom. Sex workers can also face harassment from the police, who in many countries have been known to use the possession of condoms, or attendance at HIV clinics as a reason for arrest, or as a basis from which to extort further money or commit incidents of sexual violence. I found it strange, but I was told by a cousin who for many years was a sexual health worker in Africa, that in the 1960s and 1970s they wrapped condoms in coloured paper to make them look like sweets for exactly the same reasons. Is it not an indictment that all these years later we are still having exactly the same debates?

There are other identified groups who are particularly at risk of HIV. For example, the estimated 75 million male clients who visit the 10 million sex workers globally, and are a key transmission group to other women and men in the community. Men who have sex with men are 13 times more likely to be living with HIV than the general population due to the biological risk of transmission and having higher numbers of partners, yet they are stigmatised if they attempt to attend an HIV clinic. It is truly frightening to witness the current slide to criminalisation of homosexuality, for this impacts on the wider population, given that men who have sex with men will often have wives or other female partners. Ban Ki-moon, the UN Secretary-General, recently remarked:

“Not only is it unethical not to protect these groups; it makes no sense from a health perspective. It hurts all of us”.

Therefore, it is crucial that tools are designed to provide diverse groups with innovative and long-term ways of protecting themselves from HIV/AIDS.

The International AIDS Vaccine Initiative, which I was fortunate to visit earlier this year with my noble friend, is undertaking trials on several innovative approaches, from broadly neutralising antibodies to cell responses, and including replicating vectors for vaccine delivery. It is also carrying out follow-up trials to studies in Thailand that pointed to the efficacy of two vaccine candidate compounds when used together. We hope that those will be able to be developed. Such a vaccine would protect women, particularly those most at risk such as the female sex workers whom I mentioned earlier. Not only is it essential in helping to save those women’s lives but, from the decrease in the need for treatment alone, the savings are estimated to be $95 billion over the first 10 years.

Another study by the International Partnership for Microbicides is undertaking clinical trials of its new ring. It is a simple and affordable product. It is worn internally and works by releasing an antiretroviral drug that has been found to prevent HIV infection. Other studies are looking into gels and films that work in similar ways. If there is ever going to be a reduction in, or the elimination of, the 2.3 million new cases each year, prevention is key. It is absolutely essential, and the funding and the resources have to be found to make that possible. There are four new cases for every three people who are started on treatment. Detailed modelling has estimated that, even after significant scaling up of treatment efforts, there will still be 1.4 million new cases each year. Add a vaccine to that, however, and the number drops to 400,000, and very likely, with herd immunity, it will be brought down still further year by year.

Moreover, we must look at what can be done to change a situation where diseases affecting richer countries are prioritised for research and development above diseases that affect those less able to pay. I found it absolutely shocking to discover that 15 FDA-approved drugs were initiated to treat hay fever in the last 50 years compared with the one drug for TB mentioned by the noble Lord, Lord Lexden. Health programmes must be targeted at the poorest and most marginalised groups, not at those where the pharma companies are going to make the most profit.

The millions of women I mentioned earlier who cannot protect themselves from HIV/AIDS desperately need leadership from people such as us. However, there is another side to this debate. I have talked about availability—the need for drugs to be developed—but there is also a need for the drugs to be affordable. The excellent report of the HIV/AIDS all-party group, Access Denied, records how the generic medicine industry has been pivotal in bringing down the price of antiretroviral drugs from more than $10,000 per patient to less than $100. This has allowed nearly 10 million people to access HIV treatment, with 1.6 million of these beginning their treatment in 2012. To put this in context, 28.6 million people are estimated to be eligible for treatment under new World Health Organization guidelines, and that figure is expected to be 55 million by 2030. However, only 34% of the millions in need can access treatment in low and middle-income countries. That is just for adults. Access to treatment for the 3.3 million children living with HIV in developing countries is only 18%—how disgraceful; that is half the adult rate.

Surely the partnerships that have been talked about should also agree that the price of essential drugs and vaccines should not be out of reach of those who need them—perhaps through voluntary or compulsory licensing of patented products. My noble friend rightly referred to this as market failure. De-linking the final cost of a drug from research and development incentives could not only spur investment in work on diseases of poverty but also ensure that those drugs can be marketed at a price affordable to the greatest number of people, and so save many millions of lives. After all, if we think about it, manufacturing a drug is a remarkably low-cost exercise. We should be looking to pharmaceutical companies to ensure that there is more transparency in their research costs, to make it possible better to access the level of finance needed.

The UK, as a global leader, can ensure that the partnerships can continue their work, but only if they get adequate funding to do so—funding that allows long-term planning to progress potential candidates through the many stages their work requires—and take steps to explore how a reformed system might work that pushes companies to do the right thing, which will allow us, one day, to cross World AIDS Day off our agenda.