Tuberculosis

Lord Collins of Highbury Excerpts

Monday 8th December 2014 Grand Committee

Asked by

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to work with global stakeholders to address investment in research and development in global health, and particularly to support the development of new tools and treatments for tuberculosis.

[Lord Collins of Highbury (Lab)]

My Lords, an estimated 13.7 million people die every year from or in connection with a group of diseases known as “poverty-related and neglected diseases”. These include TB, HIV, malaria, dengue fever, yellow fever and many others.

Research and development is expensive. Some estimates claim that developing a new drug through commercial routes can cost £1 billion. Naturally, pharmaceutical companies therefore invest in developing products where there is a potential to see a significant financial return to pay for the original development costs and, ultimately, to make a profit. Because the diseases that I have mentioned primarily affect poor people, there is no financial market to incentivise commercial sector pharmaceutical development and accordingly very few new products are developed.

Where there is an affluent market, as is the case with adult HIV drugs, we can see significant private investment. In comparison, there are very few formulations of paediatric HIV drugs, where the market is smaller and more heavily based in developing countries. There is therefore a market failure in developing drugs, diagnostics and vaccines for diseases that impact predominantly on low-income and middle-income countries. This market failure is similar to the failure of the commercial sector to develop new antibiotics—again because there is insufficient financial return on offer for such products.

In the absence of the commercial sector, public and philanthropic organisations attempt to fill the gap, but progress is slow. The purpose of today’s debate is to highlight that there are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. In 2002, DfID launched the Commission on Intellectual Property Rights, which looked at the impact of intellectual property on development policy. In a landmark document, it recommended that Governments should invest more to explore the impact of IP on development. DfID supported this recommendation by sponsoring the establishment in 2003 of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health, which paved the way for global reform efforts.

However, those efforts have since stalled and significant controversy remains over the role of IP within global health research and development, particularly around de-linkage, a term meaning separating the incentive for R&D from the potential financial returns, a point that I made in an Oral Question to the Minister last week, on World AIDS Day. During that exchange, I also mentioned the launch that day of Access Denied, a report by the All-Party Parliamentary Group on HIV and AIDS, which the noble Baroness confirmed that she was attending, and of course I saw her there. In response to questions at the launch about the absence of a formal response from the Government to the report, the Minister promised to share her speech notes with the all-party group so that they could be viewed publicly. Does she still intend to do so? Can she tell me whether her department will be championing within government the recommendation from both the All-Party Parliamentary Group on Global TB and the HIV/AIDS all-party group that the UK commission an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a de-linked model?

Global reform efforts have stalled. There is a lack of global consensus around the reforms necessary to drive improved investment in global health and there is a lack of global co-ordination around what is funded. What steps will the Minister take to initiate dialogue between the pharmaceutical industry, civil society and the Government to reach an agreement over a possible R&D treaty in the run-up to the World Health Assembly in 2016?

Product development partnerships, of which I am sure we will hear more in today’s debate, are non-profit organisations which attempt to fill the gaps in global health R&D. They receive public and philanthropic donations, build partnerships with pharmaceutical companies and attempt to develop new drugs, diagnostics and vaccines. Successful examples of these are found in the TB field, with Aeras helping to bring a new vaccine through trials and TB Alliance aiming to bring a new drug regimen to the market. There are many other examples of successful partnerships in the fight against malaria. Again, I am sure that we will hear more of that in this debate. Nevertheless, products from PDPs, despite often being publicly funded, are sometimes protected by patents, which make them more expensive.

On a similar theme, the UN Secretary-General recently stated:

“Public funding often subsidizes private sector research, at times leading to the public being priced out of the benefits through disadvantageous licensing and patent”.

The reports from the all-party groups on HIV and TB—the latter came out last year, which prompted me to table this debate—recommend that DfID should continue to support R&D through product development partnerships. However, both argue for a commitment to open access, generic production and a non-patent-monopoly-based approach. Will the Government commit to reviewing PDP funding with regard to a potential top-up of funding and will they commission a paper examining the impact of open access requirements on products generated with public money? Can the Minister tell me what her department will be doing to address the growing problem in middle-income countries, as highlighted in the Access Denied report, of funding being pulled out from all directions, including from the Global Fund, while the pharmaceutical industry continues to expect such Governments to afford higher prices for ARV treatment?

DfID is one of the world’s leading funders of global health. Its commitment to the Global Fund will save a life every three minutes. Commitments to Gavi could save a life every two minutes. The work of these organisations relies on having appropriate drugs, diagnostics and vaccines to test and treat people. If we are to move beyond investments to control diseases such as TB, HIV and malaria and towards eradication, we desperately need new tools. We will not eliminate HIV unless we have a cure, nor wipe out TB without an effective vaccine.

DfID’s R&D strategy expired at the end of 2013 and has not been replaced. Will the Minister state the UK Government’s long-term strategy to secure the development of the new drugs, diagnostics and vaccines needed to eliminate HIV, TB and malaria? Will the Minister reassess the Government’s decision to cut funding for the development of AIDS vaccines as part of a larger review of the scale of investment that the Government are making to ensure that we have the pipeline of new medical tools that the world so desperately needs?