HIV and AIDS

Catherine McKinnell Excerpts

Tuesday 10th December 2013 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is a pleasure to serve under your chairmanship this morning, Mr Dobbin, and to have the opportunity to speak in this important and timely debate. I congratulate my hon. Friend the Member for Airdrie and Shotts (Pamela Nash) on securing the debate and making an incredibly powerful opening speech. It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made an equally knowledgeable and powerful speech.

My hon. Friend the Member for Airdrie and Shotts poignantly—and rightly, at this time—highlighted the work done by Nelson Mandela in his lifetime to improve the situation for people with HIV and AIDS. He made the incredibly powerful statement:

“AIDS is no longer just a disease; it is a human rights issue.”

It is timely to think of that today, as it is international human rights day. It is an honour to mark that day with colleagues who feel equally strongly about these issues.

I want to focus on access to medicine and the human rights injustice that too many people still face in that regard. Hon. Members are already aware of the figures, but they are worth repeating: at the end of 2012, 9.7 million people worldwide had access to antiretroviral therapy in low and middle-income countries, compared with just 300,000 10 years earlier. We should recognise that achievement, but should guard against the complacency that the hon. Member for Stafford identified so poignantly.

Antiretroviral drugs have changed the way that HIV is viewed, from being a death sentence to being an illness. That achievement was propelled by a surge in donor funding and by the drastic reduction in the costs of first-line antiretroviral treatments, from $10,000 per patient 10 years ago to around $100 today. My hon. Friend the Member for Airdrie and Shotts referred to the Government’s recent review of their position paper on HIV and AIDS, “Towards Zero Infections”. I want to bring a few issues that remain of concern to the Minister’s attention.

Although remarkable progress has clearly been made in ensuring access to treatment for many, the World Health Organisation estimates that another 16 million people out of a total of 26 million are eligible for HIV treatment but lack access to it. Added to that is the fact that by 2050 it is estimated that over 50 million people will need HIV treatment. The situation is described powerfully in the excellent report by the all-party group on HIV and AIDS, “The Treatment Timebomb”. Millions of people who will need treatment in future will need more expensive medicines, as they will have become resistant to the basic HIV combination therapy; also—and this is welcome—people with HIV are living longer. Second and third-line treatments currently cost at least seven times more, and when the basic treatment stops working, getting access to them is a matter of life or death. That combination—more people needing more complex treatment—needs to be addressed now to avoid a potential crisis later.

The all-party group’s report gives a cogent argument as to how it is possible to make those medicines more accessible. Ten years ago, the basic HIV treatment cost $10,000 per person per year; today, thanks to generic production, the same medicines are available for $87 per person, enabling 3 million people to access treatment across the world. To avoid a treatment crisis, those kinds of price reductions need to happen again with newer HIV medicines. The report therefore urges pharmaceutical companies to co-operate by allowing generic manufacturers to produce HIV medicines cheaply specifically for developing countries, asking them to put their medicines into a patent pool for that purpose. That would also allow researchers to work on making HIV medicines suited to the developing world. Currently many HIV medicines are designed for a developed country market, and issues such as what happens when a patient needs to take HIV medicines in combination with TB medicines have not been considered—I know hon. Members have looked at that matter closely. There are also not many special HIV drugs for children because, thank goodness, not many children in the developed world have developed HIV.

At the request of the international community, the medicines patent pool was created. It negotiates with the patent holders of priority HIV medicines to sub-license their products to generic manufacturers to manufacture and sell them at a lower cost. Since last year we have seen a more encouraging uptake from pharmaceutical companies, from GlaxoSmithKline to Roche and Gilead Sciences, but there is still clearly a long way to go. Will the Minister outline what steps the Government are taking to ensure a much greater take-up by pharmaceutical companies? In the meantime, what alternative strategies are the Government pursuing to ensure that global access to medicines is being fully considered?

Although that issue was touched on in the Government’s review, it is a major challenge facing us. What steps are the Government taking to ensure that intellectual property rights and patent protections do not, as my hon. Friend the Member for Airdrie and Shotts aptly put it, prevent necessary treatments from being accessed by the millions around the world who are currently without the drugs they need and the millions who will need those drugs in the future?

The final issue I want to highlight concerns middle-income countries. “Towards Zero Infections” outlined plans to focus bilateral HIV funding on a narrower range of countries, in line with the Department for International Development’s 2011 bilateral aid review. It concluded that the UK should end bilateral programmes in 16 countries, many of them middle-income countries. That shift is based on the view that aid should be focused on low-income and fragile countries that are not able to eradicate poverty themselves.

The Government have decided to end their bilateral relationships with South Africa and India. But the fact is that three quarters of the world’s poorest people currently live in middle-income countries, as do 58% of people living with HIV; the projection is that that figure will rise to 70% by 2020. Three of the top five countries with the highest HIV burdens globally are middle-income countries, as are eight of the 10 countries with the highest tuberculosis burdens.

Middle-income countries also have far lower rates of antiretroviral coverage for people living with HIV than low-income countries, and much higher rates of multi-drug resistant tuberculosis. The concern has been expressed that withdrawing funding to middle-income countries too quickly could undermine the gains that have been made through scaling up access to reach key populations, which so far have prevented a global HIV pandemic. Will the Minister comment on the extent to which a more transitional approach has been considered—one that recognises the need to build countries’ capacities for the longer term?

Médecins Sans Frontières has warned of the consequences for middle-income countries of tiered pricing—the practice of selling drugs to different countries at different rates according to their socio-economic status. That is another reason why the middle-income label must be used with caution: it must not hide the fact that the majority of the poor live in those countries. MSF has voiced strong concerns about the potential consequences of those countries being locked into bad deals. I will highlight one example. Although generic competition brought the price of first-line HIV drugs down by close to 99%, from over $10,000 per person per year a decade ago to $120 today, tiered pricing leaves middle-income countries paying as much as $740 per person per year for the second-line drug combination lopinavir/ritonavir. That is over 60% more than what pharmaceutical company Abbott is charging low-income countries. What are the Government doing to address those concerns and ensure that we do not create a ticking time bomb?

To conclude, I thank my hon. Friend the Member for Airdrie and Shotts again for securing this debate and for the work that both she and the all-party group on HIV and AIDS do. Given events today, it is fitting to reflect once more on the words of Nelson Mandela, who we know experienced at first hand the suffering that HIV and AIDS can bring. He famously said:

“Poverty is not an accident. Like slavery and apartheid, it is man-made and can be removed by the actions of human beings.”

That poverty is a barrier to life-saving medicines for millions of our brothers and sisters. That is our call to action today.