International Covid-19 Response: Innovation and Access to Treatment

Sarah Champion Excerpts

Thursday 5th November 2020 Commons Chamber

[Sarah Champion (Rotherham) (Lab)]

I thank the hon. Member for North East Fife (Wendy Chamberlain) for calling for the debate, and I hope that my speech will amplify the points that she is making.

The International Development Committee, which I chair, has been examining the impact of the coronavirus on developing countries, and the contribution of the UK Government to initiatives to help the global south tackle the pandemic. A key part of the UK’s strategy for the global south is funding an array of partnerships and collaborations aiming to develop, at speed, vaccines, therapies and tests for preventing, treating and diagnosing the disease. The Government have allocated the lion’s share of their global coronavirus funding to the race for those products—£388 million initially for vaccines, therapies and tests and, more recently, another £571 million for the production, purchase and distribution of vaccines. That is very welcome, but a key concern that emerged throughout the evidence that we received was about the importance of legal and practical measures to guarantee equitable access to corona vaccines, medicines and tests around the world, based on need, not economic power. The former chief scientific adviser to the Department for International Development, Professor Charlotte Watts, told the IDC:

“It is not only about finding a vaccine that is going to work, but how to ensure that there are the resources and future investment in production capability, so that that can be distributed to low and middle-income countries.”

It is worth recalling why equitable access to medicines is such a concern. First, let me take the example of the antiretrovirals for HIV and AIDS. In Durban in 2000, at the XIII International AIDS Conference, Justice Edwin Cameron of the South African Constitutional Court famously declared that he had been living with AIDS for 33 months, but that,

“there are 24 or 25 million people in Africa who at this moment are dying, and they are dying because they don’t have the privilege that I have of purchasing my life and health.”

In 2000, the anti-retroviral drugs capable of transforming AIDS into a manageable illness were far beyond the means of most South Africans, costing up to $10,000 a year—much more expensive than any other country when compared with generic substitutes. When South Africa passed legislation to facilitate the use of cheaper, generic and imported products on public health grounds, 39 multinational pharmaceutical companies banded together to sue the Government for violating WTO rules. Rightly, that resulted in a PR disaster for the pharmaceutical industry. The case was dropped and the WTO recognised member states’ rights to take such measures to protect public health and, in particular, to promote access to medicines for all. But even now, the use of that safeguard is largely limited to the original HIV/AIDS drugs because of the complexities required in legislation, health system weaknesses and political pressure.

Let us look at cancer. Cancer drugs are a lucrative pharmaceutical market—for example, representing 27% of the sector’s revenue in the US. Efforts to set prices to recoup research and development costs over a set period are one thing, but funding the inflated billion-dollar trade in whole companies holding just one or two attractive patents seems less defensible. Whatever the reason, low and middle-income countries invariably find the prices set to take advantage of demand in a high-income country an insurmountable barrier to access. Pricing invariably results in wide variations in survival rates. For example, the US five-year overall survival rate for breast cancer is 84%, compared with just 12% in Gambia. That is hardly equitable.

Finally, I want to talk about polio. The polio story is essentially a triumph, with a 99% reduction in cases since the start of the global effort in 1985. However, each year, the oral polio vaccine, which is widely used in the global south, is linked to outbreaks of the disease where the wild virus has been eliminated. The injectable vaccine is an inactive virus, but it costs about $3. The oral vaccine, at about 12 cents, contains live virus. Unfortunately, children can shed a mutated version of the live virus in their stools, which can then infect unvaccinated children in areas with poor sanitation. Clearly there are other considerations than just costs when comparing injected and ingested doses of medicine, but the reality is that cost kills.

Let us hold these examples in our mind as we consider equitable access to future coronavirus products. And let me be blunt: the prospect of the international community behaving morally, or at least rationally, on a global scale over the distribution of an effective vaccine, or even accurate and simple tests, at an affordable price, is not good. In his September speech to the first virtual United Nations General Assembly, the Prime Minister rightly lambasted the international community over its fractious and competitive reaction to the procurement of personal protective equipment during the first wave of the pandemic—and that was just over masks and aprons. Imagine the pressure on every Government to deliver the long-awaited panacea of covid-19 immunity to their own populations.

Any rational response to the pandemic must surely take account of the science and the almost unique status of this crisis by incorporating the sustainable development principle of leaving no one behind. No one will be safe and secure until everyone is covid-free. For once, everyone’s interests are overtly aligned. The UK finds itself in a unique moment in time when we can reposition ourselves as a global leader for good. The soft power gained by doing the right thing for the very poorest in the world, and by standing up to those looking to profit from others’ misery, will be immeasurable. I am grateful for the leading role the UK has taken to date in the development of covid vaccines and products.

[Patrick Grady]

I will be brief, because there is pressure on time, but I just want to say that the hon. Lady is making an incredibly powerful speech that is demonstrating the importance of the scrutiny that her Select Committee has been able to provide. I want to re-emphasise the point I made to the hon. Member for North East Fife (Wendy Chamberlain) that the Scottish National party fully supports the continuation of that Committee, either as a non-departmental Select Committee or as a wider official development assistance-scrutinising Committee. I hope that those on the Government Benches will bear that in mind.

[Sarah Champion]

I am extremely grateful for the hon. Member’s support of the International Development Committee. Development is a specific and key area of the work that we do, and it demands parliamentary scrutiny.

I ask the Minister to give us some certainty today on the Government’s commitment and resolve to fight to ensure that covid drugs and treatments are accessible to everybody, not just those with the deepest pockets. Will the Government support the proposed waiver of all intellectual property monopolies related to covid-19 tools, as put forward by India and South Africa to the WTO? Can the Minister confirm that, for all R&D projects that the UK has funded, transparency on finances and an obligation for resulting products to be free from monopolies were embedded in those contracts at the start and will be enforced? Finally, will the Government follow Germany, Australia, Canada and Israel in championing the use of legal safeguards that all World Trade Organisation members can implement to override patent monopolies if public health is at risk?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Wendy Morton)]

I thank all Members for contributing to the debate. In particular, I am grateful to the hon. Members for North East Fife (Wendy Chamberlain) and for Rotherham (Sarah Champion) for securing the debate. I also pay tribute to the hon. Member for Rotherham for her work on this issue in her role as Chair of the International Development Committee. As a former member of that Committee, once upon a time, I recognise the work that it has done over many years.

I am conscious that Members asked a number of specific questions of me on a number of themes. I will do my best to answer as many of them as I possibly can, but I shall also make some comments of my own.

Innovation and equitable access to treatments are critical in the fight to end the covid-19 pandemic. The UK is committed to ensuring rapid and equitable global access to safe, effective vaccines, therapeutics and diagnostics. On 26 September, the Prime Minister told the United Nations General Assembly that

“no one is safe until everyone is safe”—

a phrase that I have heard Members use in this Chamber on many occasions. It is that important that I am sure we will continue to use it.

The Prime Minister also told the UN General Assembly:

“The health of every country depends on the whole world having access to”

safe and effective vaccines, treatments and tests. The Government are working to deliver on that commitment through our innovation and scientific co-operation, our leading levels of funding and our close collaboration with other nations and multilateral partners. Scientific co-operation has led to swift breakthroughs and enhanced our collective knowledge of how to tackle this virus. The UK has played its part by supporting clinical trials of life-saving treatments and backing vaccine research at the University of Oxford and Imperial College London.

In June, the recovery trial based at the University of Oxford announced that dexamethasone, a low-cost corticosteroid, was the first treatment in the world shown to reduce the risk of mortality in hospitalised covid-19 patients who required oxygen or ventilation. Dexamethasone is a widely available and—crucially—affordable drug that is now being used to help covid-19 patients. This was the first robust clinical trial anywhere in the world to show a treatment that significantly reduces patient mortality for those with covid-19. Such a breakthrough was possible only thanks to our world-class British life sciences, and has been described by Dr Tedros, director-general of the World Health Organisation, as a “lifesaving scientific breakthrough.”

From the beginning of the pandemic, we have focused on robust clinical research. This enables us to take evidence-based decisions, backed by rigorous science, to improve access to effective treatments both in the UK and around the world. More broadly, the UK is committed to collaborating with public and private partners at home and abroad to accelerate development and equitable access in all countries to affordable health technologies to respond to covid-19. This includes exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing that promote affordable access for all while also providing the incentives that help to foster the innovation needed to create new vaccines, treatments and tests.

The UK is proud to be the largest donor to the access to covid-19 tools, or ACT, accelerator. The ACT accelerator brings together leading international organisations in global health to support collaboration in developing and ensuring access to the new vaccines, treatments and diagnostics that will be needed to bring this pandemic under control.

[Sarah Champion]

Just out of curiosity, I am interested why we did not join ACT when it was initiated in April.

[Wendy Morton]

I will cover that point off later, if I may, but I make clear that we have made commitments to the ACT accelerator partners across the health technologies of up to £813 million. Our commitment is very clear. That includes up to £500 million to Gavi, the vaccine alliance, for the COVAX advance market commitment. The support will also help to ensure access to covid-19 vaccines for up to 92 low and middle-income countries, providing up to 500 million people with vaccinations. The UK is also the largest ACT accelerator donor to the Foundation for Innovative New Diagnostics, or FIND, which is leading the way in developing diagnostic tools for the world’s poorest countries.

In terms of treatments, the UK is providing up to £40 million to the covid-19 therapeutics accelerator, alongside the Bill and Melinda Gates Foundation, the Wellcome Trust, Mastercard and other funders. The covid-19 therapeutics accelerator and Unitaid lead the work of the ACT accelerator therapeutics partnership. Unitaid has a track record of helping companies to bring affordable health technologies to developing country markets quickly, and the UK is the second largest funder.

Our funding to the ACT accelerator is supporting a pipeline of promising treatments, including monoclonal antibodies and new antivirals. New clinical trial data will emerge in coming weeks. The ACT accelerator is also preparing the way for the rapid deployment of new therapeutics as soon as possible after they have proved effective. We have seen some impressive results so far, but we recognise that the scale of the crisis means more funding will be needed across all three health technologies. We will continue to work with our international partners to encourage them to join us in stepping up their support and to support new and innovative solutions to address this challenge.

The UK is proud to be at the forefront of international efforts to develop vaccines, treatments and tests and ensure equitable access for the world’s poorest countries, but we recognise that we cannot do that alone. Only through global collaboration with our international partners and working through effective multilateral systems will we bring the pandemic under control. That is why on 30 September, the Foreign Secretary co-hosted a side event at the UN General Assembly with the UN Secretary-General, the World Health Organisation director-general and the Health Minister of South Africa. The event raised up to $1 billion in bilateral contributions for the COVAX advance market commitment. The World Bank also announced a package of $12 billion of support for countries to access vaccines, treatments and tests, and a coalition of 16 industry leaders announced a shared commitment to equitable access, including not-for-profit pricing. The commitments by this range of partners are a powerful demonstration of the international support for the ACT accelerator and the need for partnership across the international system.

Vaccine nationalism was raised by Members on the Opposition Benches. In the UK, we are challenging vaccine nationalism. We are a leading supporter of the COVAX facility, which is open to all countries and aims to make vaccines widely available when they are proven. At the UN General Assembly, we used our diplomacy to convene countries in support of that and announced UK aid to fund the COVAX advance market commitment.

Intellectual property rights provide incentives to create and commercialise new inventions, such as life-changing vaccines. They keep innovators innovating, creators creating and investors investing. The UK believes that a robust and fair intellectual property system is a key part of the innovation framework that allows economies to grow while enabling society to benefit from knowledge and ideas. Multiple factors need to be considered to ensure equitable access for all to covid-19 vaccines. These include increasing manufacturing and distribution capacity, measures to support or incentivise technology transfer, ensuring that global supply chains remain open, and ensuring that effective platforms are utilised to voluntarily share IP and know-how.

The UK has long supported affordable and equitable access to essential medicines. We have not signed the solidarity call to action, but we remain committed to collaborating with public and private partners, including by exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing.

[Wendy Morton]

I would just like to make a bit more progress so that I can cover as many points as possible.

Several hon. Member asked about the allocation of vaccines. I assure them that this is being considered. The World Health Organisation’s allocation framework recommends the highest priority populations by age, underlying conditions and health workers—estimated at about 3%. We cannot prevent a country from administering doses as they want, but there is a framework and countries will submit national deployment plans that will be reviewed by the WHO and COVAX.

The hon. Member for Strangford (Jim Shannon) raised the issue of inequalities for minority groups. I assure all hon. Members that we are working closely with organisations such as UNICEF and Gavi in that regard. These are organisations that we have worked with for many years.

I really hope that the House is reassured by the Government’s comprehensive approach to supporting innovation and equitable access to covid-19 vaccines, through scientific co-operation, working with industry, funding and multilateral collaboration. The UK is leading efforts to respond to the pandemic by developing and delivering the medical tools that are essential to ending the pandemic for everyone everywhere, but we must all work together to develop safe, effective and affordable vaccines, treatments and tests that can be produced quickly and made available to all.

[Sarah Champion]

I appreciate the Minister giving way. I just want to challenge her on the use of the word “voluntary” when it comes to intellectual property sharing and access to the vaccine. With all respect, big industry—particularly big pharmaceuticals—is not known for equitable sharing on a voluntary basis, so will the Minister please answer this specific point? When the UK taxpayer has been putting money into R&D, what right do we have to ensure that the information that we are paying for is shared in an equitable way?

[Wendy Morton]

As I explained, we believe that a robust and fair intellectual property system is a key part of an innovation framework that allows economies to grow while at the same time enabling society to benefit from knowledge and ideas. There are existing mechanisms that facilitate the sharing of IP—for example, expanding the mandate of existing organisations such as the Medicines Patent Pool to cover covid-19.

We have played a leading role, with our international and national partners, to identify end-to-end solutions that ensure affordable access for all, such as mechanisms to support the voluntary sharing of IP and know-how, manufacturing at scale and ensuring that no one is left behind, including the poorest and most vulnerable. We are committed to collaborating with public and private partners in the UK and internationally, including by exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing, to help deliver what we all want, which is the promotion of affordable access while providing incentives to create those new innovations.

To conclude, it is fair to say that, if we are to defeat covid-19, and if we are to achieve a global recovery and avoid a future pandemic, we must work together across borders. Covid-19 is a virus that has no respect for borders or barriers, which is why the UK is promoting multilateral solutions to end the pandemic, working with international organisations, our partners in the G7 and G20 and industry.