Global Health (Research and Development)

Stephen O'Brien Excerpts

Tuesday 8th July 2014 Westminster Hall

[Andrew George (St Ives) (LD)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I am delighted to have secured this debate on research and development for global health, particularly in the week when the all-party group on global tuberculosis, which I co-chair with the right hon. Member for Arundel and South Downs (Nick Herbert), publishes its report “Dying for a Cure: Research and Development for Global Health”. The role of all-party groups on health generally, particularly health in developing countries, is an important dimension of the work of parliamentarians. We often have opportunities to expand and probe these issues, which are important to many of our constituents; it is also important, of course, that we as a country play a leading role in the world in this respect.

This afternoon, I hope to provide a canvas on which hon. Members more expert than I on this subject can add their own, more expert comments. I want simply to go through a number of themes that I think are important for the Department for International Development as it develops its leading role in addressing the urgent need for advances in research and development for global health. I particularly want to emphasise the issue of tuberculosis.

The incidence of tuberculosis is falling marginally year on year. Currently, there are 8.7 million new cases each year. Tragically, 1.3 million people die of the disease, and there are about 650,000 cases of drug-resistant tuberculosis. That is largely a man-made disease, because of inadequate treatment with front-line drugs. Only about 10% of those cases are getting adequate access to diagnosis and treatment.

We in the United Kingdom cannot isolate ourselves from the issue because there are about 9,000 new cases of tuberculosis in this country each year, and the London area is the capital of Europe as far as tuberculosis is concerned. There were more than 400 new cases of drug-resistant tuberculosis in this country in one year, and that number is going up. This disease should concern us domestically as well as internationally.

We need to bear in mind not only the tragedy for those who contract the disease and their families, and the further tragedy for those who die from the disease; there is also, of course, a significant burden on the public purse. It costs £5,000 to treat a patient with first-line tuberculosis drugs and £50,000 to £70,000 per annum—sometimes, a great deal more—to treat drug-resistant forms of tuberculosis.

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. Those include TB, HIV, malaria, dengue, yellow fever and others.

Research and development is, of course, expensive. There are some estimates that developing a new drug through commercial routes costs at least $l billion. Pharmaceutical companies invest in developing products with the potential for a significant financial return, to pay for the original development costs and ultimately to make a surplus—a profit. They are not charities, and that is what their shareholders would expect them to do.

In addition, as the diseases I have mentioned primarily affect poor people, there is often no financial market to incentivise commercial sector pharmaceutical development. Accordingly, very few new products, whether they be new drugs, new diagnostics or new treatments, are developed. There is therefore a market failure in the development of drugs, diagnostics and vaccines for diseases that predominantly have an impact on low and middle-income countries. Although pharmaceutical companies will be developing the Viagras of this world for the west, it seems that crucial drugs that would save millions of lives in the developing world are very difficult to advance at all. That market failure is similar to the failure of the commercial sector to develop new antibiotics. Again, that is 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. There are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. There is a wider concern. The World Health Organisation, in its report in April, identified—rightly, I think—the serious risk of antimicrobial resistance as a very significant challenge for the world in the coming years.

Of course, it was very welcome that last week the Prime Minister announced a commission to undertake a wide-ranging, independent review led by the internationally renowned economist Jim O’Neill. It will look into the whole issue of antibiotic resistance, about which many Members of the House have been most concerned.

A lot of us are concerned about the improper prophylactic use of antibiotics generally, in many sectors. Of course, when we look at tuberculosis, we also see a significant problem in some countries. Often it is in the private sector, where drugs are doled out as first-line responses but the health systems are not in place to ensure that the patients will complete the course of treatment. That significantly increases the risk of drug-resistant tuberculosis.

Tuberculosis has been traced back 70,000 years, and the period for malaria is similar, but for the majority of that time the best cure for patients was rest, fresh air and lots of hope. In the 19th century, as many as one in four deaths in the United Kingdom were attributable to tuberculosis. Obviously, we have concerns now about the advancement of drug-resistant tuberculosis. If we are to avoid that fate and to accelerate the progress made against HIV, TB and malaria during the past decade, we must find new interventions that are more effective against these diseases and that can help to drive them towards elimination.

Of course, there is, as we fully understand, a commercial development process. Those of us who have been following the advancement of candidate vaccines for tuberculosis, for example, have been encouraged by the work of many companies, but we are talking about something that fundamentally requires public sector intervention and support. The pharmaceutical companies backing the initiatives are not putting all their money and resources up front; a partnership with Government is required.

Although many early scientific advances in disease control were discovered with public or philanthropic money, most pharmaceutical development is now carried out in the commercial sector. The costs of researching and developing a new treatment, vaccine or diagnostic can be extremely high, and estimates for the cost of drug development run to billions of dollars. Because of the high cost of research and development, pharmaceutical companies inevitably target their resources towards diseases and conditions likely to yield a financial return. That means that most companies focus their efforts on diseases and conditions that affect the west or developed countries, because those markets can pay the most for new drugs.

Another significant impediment is that when companies develop their products, they maximise their profits and protect their interests and investment by securing patents. That gives those companies monopoly rights, which may make the prices for the drugs so high that patients in poorer countries cannot afford them. That is a problem of access. Problems related to research and development for global health will not be fixed unless treatments are developed and made accessible to everyone who needs them. In the face of such market failure, alternative models must be created to ensure that those medical products are being developed, even if not through a commercial route.

[Mr Stephen O'Brien (Eddisbury) (Con)]

Will my hon. Friend give way?

[Andrew George]

I will just make my next point; my right hon. Friend may be pleased when I have. Thankfully, such models exist. Product development partnerships are an important group of organisations that work with academic, public and private partners to try to develop important new products where the market has failed. The Department for International Development, as my right hon. Friend knows from his work as an excellent Minister in that Department, is the world’s leading public funder of PDPs.

[Mr O'Brien]

I congratulate my hon. Friend on securing this timely and important debate. I draw the attention of the House to my registered interests in the field—albeit that they are all pro bono, I hasten to add—and I apologise for the fact that I cannot stay for the whole debate.

My hon. Friend is driving towards an optimistic point. There has been a model that has helped the normal incentivisation of product development through a potential return from a purchasing power market, so it seems to me that we have great grounds for optimism on diseases of poverty—malaria, HIV/AIDS and tuberculosis, but also the neglected tropical diseases where the motivation is often not to avert death but simply to improve well-being. DFID, as a partner, has been tremendous in its commitment not only to commissioned but to operational research, which is fundamental. I urge my hon. Friend to look at the growth and sustainability of public-private product development partnerships, because I think they are one of the most significant ways forward.

[Andrew George]

My right hon. Friend is much respected in his field, and I am sure that the Minister heard what he had to say. The leading role that DFID plays in funding and encouraging PDP is commendable and should be extended.

I want to ask my right hon. Friend the Minister some questions about DFID’s role regarding PDPs and the funding of research and development. It is important that DFID continues to be respected in the world as a leading player, so I would be grateful if my right hon. Friend agreed to look at lifting the apparent cap on the funding of research and development from, as I understand it, about 3% to perhaps 5% of DFID’s total budget. I know that funds need to be found from elsewhere, but I believe that that is an important issue.

I would be interested to know what my right hon. Friend has to say about the Department’s plans to take PDPs forward. Notwithstanding the Prime Minister’s welcome announcement last week of a commission on antibiotic resistance, will DFID press ahead with finding solutions in areas where we already know about problems of antimicrobial resistance, and not simply use the commission as an excuse to delay action in areas where problems have already been identified and research and development are urgently required? Will the Minister ensure that research and development include not only the development of pharmaceutical responses, but diagnostics research into biomarkers and bio-signatures, and the development of point-of-care and non-sputum-based tests for adult and paediatric tuberculosis?

I do not want to detain the Chamber for longer than necessary, particularly when so many others wish to speak. I want to highlight the importance of the work of the all-party group on global tuberculosis—particularly the report, which I encourage hon. Members to look at and which is on the group’s website. The Government must make sure that we sustain our leading role in research and development. We must recognise that there is a limit to what commerce can do, in terms of funding and creating sufficient market incentives, to put in the enormous amount of work required to fill the gap in research and development. That work must be sustained, and we must not simply wait for the commission on antibiotic resistance to provide the stimulus to take it forward.

--- Later in debate ---

[Nick Herbert (Arundel and South Downs) (Con)]

I am grateful to be able to take part in this debate and I will speak briefly. First, I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing the debate. I am very proud to co-chair the all-party group on global tuberculosis, which he and I co-founded with our Labour co-chair, the hon. Member for Ealing, Southall (Mr Sharma). I am also very proud of the report that we have just produced, to which my hon. Friend referred, “Dying for a Cure: Research and Development for Global Health”, which covers precisely the issues he has raised in this debate.

May I say in parenthesis that there is much debate about the support provided to all-party groups. Our report simply would not have been possible without our all-party group’s first-class secretariat, which is funded by Results UK and other organisations and has enabled our excellent researcher, Matt Oliver, to help with the drafting of the report. That goes to show that not all external support for all-party groups is bad—far from it. Without that support we simply would not have been able to produce the report. It is important that Members speak up for legitimate all-party groups that have important work to do.

I want to focus particularly on tuberculosis, which still kills 1.3 million people a year—quite unnecessarily, given that it is a treatable and curable disease. There is a particular new threat because of drug resistance, which is a serious problem and a concern not just globally but in this country. I commend the Prime Minister’s stance on the significance of drug resistance as an issue that this country has to address in future. Our all-party group was reminded of that recently when we travelled to Bucharest in Romania and visited prisons and clinics around the country where TB is prevalent—not just TB but drug-resistant TB. In Romania, as well as in other developing and underdeveloped countries throughout the world where TB is a serious problem, the issue is not just access to drugs, which can of course be corrected by the west making significant interventions through the global health fund and other means to provide drugs where they are available; it is also a problem of availability.

Our report seeks to address the simple fact that there is insufficient availability of diagnostics and treatments for tuberculosis. I have mentioned this in a previous debate on the same issues in this Chamber, but I want to repeat myself because it is important: it is sobering that if TB had resurged in the west, pharmaceutical companies would by now have found the investment required to produce significant new tools for its diagnosis and treatment, as has happened for HIV. Amazing new cures and treatments are available for HIV. Why? Because HIV has been a disease of the west as well as cruelly affecting the developing world.

Although it has made something of a comeback in the west, TB has not been perceived in the same way. It has continued to claim the lives of millions, but only in developing countries, so it has not received the attention. Nor are there the straightforward financial incentives for pharmaceutical companies to develop the necessary tools. There is still no vaccine for TB. People believe that there is, but there is not: the BCG vaccine is partial and relatively ineffective for adults.

The first-line drugs that are used to treat TB were developed decades ago, must be taken over an extended period and are part of the reason why drug-resistant TB is a problem. The diagnostics for TB are old-fashioned and inadequate. All this is not the fault of drugs companies; in a free market they simply do not have the commercial incentive to develop new tools because there would be no market for them to sell to.

[Mr O'Brien]

I am grateful to my right hon. Friend for giving way to me, particularly on my second intervention in this debate. I have just returned from Papua New Guinea, where, given my interest in malaria, it was impressive to see Oil Search—to refer to his point about delivery—delivering across extremely difficult and hostile territory, in the complete absence of any other form of provision. Multi-drug-resistant tuberculosis was its main challenge. Often, pharmaceutical, distribution and oil and petrochemical companies are becoming part of the solution as they extend their provision, whether that includes GSK considering the pricing of its malaria vaccine or Novartis distributing malaria drugs. Equally, on TB, Oil Search is becoming part of the solution as part of its extended corporate social responsibility, as well as ensuring research and development for non-purchasing-power markets. I thoroughly endorse where my right hon. Friend is taking this debate.

[Nick Herbert]

I am grateful for my hon. Friend’s intervention. I think that corporate social responsibility can be part of the solution, but it will not be a sufficient solution. What we have here is significant market failure. Where there is market failure, there is an imperative for Government intervention. One can still believe in markets—the power of markets, and pharmaceutical companies’ freedom to do all the wonderful things that they do—yet understand that where there is market failure, there must be intervention. That is what we need. Given that it can cost about £1 billion to bring such drugs to the market, intervention is necessary, whether in the form of product development partnerships or an adjustment to tax credits for research and development. We make that particular proposal in our report, and I commend it to the Minister. That sort of intervention and Government support for research and development will be essential if we are to beat those diseases.