Global Health (Research and Development)

Debate between Stephen O'Brien and Andrew George

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.

Oral Answers to Questions

Debate between Stephen O'Brien and Andrew George

Wednesday 17th November 2010 Commons Chamber

[Mr Speaker]

Order. I am grateful, but the Minister must cut it short. Work needs to be done on these things. The answers are often far too long.

[Andrew George (St Ives) (LD)]

As the Minister said, the current Government strongly support, as did the previous Government, the Global Fund to Fight AIDS, Tuberculosis and Malaria. What is the Minister’s assessment of the success of the country co-ordinating mechanisms, and particularly the efforts to ensure that co-infection of HIV and TB is well managed on a country basis?

[Mr O'Brien]

The hon. Gentleman makes an informed point. One way of ensuring that the global fund, which scores well on its effectiveness, gets even better is to ensure that when there are conflicts in the country co-ordinating mechanisms, they are addressed. The co-infection of HIV and TB is an increasingly well understood area of research and practice, and that understanding is shaping the programmes through the multilateral aid review, and will therefore inform those programmes going forward.

Oral Answers to Questions

Debate between Stephen O'Brien and Andrew George

Wednesday 2nd June 2010 Commons Chamber

[Mr O'Brien]

I am very grateful to the hon. Gentleman for his kind remarks, and he is aware that we are committed to spending up to £500 million as he notes, in particular in relation to developing an effective malaria vaccine. Theoretically, there is a real hope of such a vaccine in the future, and we believe that vaccine research therefore plays in important part, but at the same time should not detract from the need to get better at delivering what we know works now. Work on a future vaccine will be focused on what will be capable of being safely delivered, accessible to the poor and with sufficient efficacy to be one of the key tools in the armoury that will continue to have to be used in the battle against malaria.

[Andrew George (St Ives) (LD)]

Further to that answer, what commitment can the Minister give to the Government’s approach to the talks on the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will take place in September?

[Mr O'Brien]

I am very grateful to the hon. Gentleman for his question. He will be aware that that issue is currently being considered, and we are looking at all the representations received not only to work towards a negotiation of the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, but most importantly to build on the very good work that that fund, which is now the world’s largest health fund, has already demonstrated to date.