Tackling Infectious Diseases

Virendra Sharma Excerpts

Thursday 20th April 2017 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I beg to move,

That this House has considered research and development on tackling infectious diseases.

I am grateful for this comprehensive debate on an issue that is important for many people across the world. As the sponsor of the debate, I want to set out the issues that need to be raised, say a little about my area of greatest knowledge and allow as many Members as possible, on both sides of the Chamber, to raise the issues that matter most to them.

Tuberculosis, HIV and malaria are the world’s leading infectious killers. In addition to those three big diseases, 1.5 billion people have a neglected tropical disease, and another 1.5 billion are at risk of contracting one. Such people are trapped in a spiral of ill health and debt that blights not just their own lives but those of the people who rely on them. Many of the diseases are chronic and endemic to some of the most deprived communities in the world. Sadly, there is no market for curing these illnesses, because there is no profit to be had from doing so. There is no will to eradicate them, because the value of doing so is considered to be too far away.

But the costs of inaction are far higher than the costs of action. Although globally about $240 billion is spent on health research and development, almost none of that is directed at these diseases of poverty. Because there is no market incentive, procurement is likely to be carried out only by donor and philanthropic organisations, yet the UN has said that investment in treating these diseases can yield returns. For example, it says that every dollar invested in TB care yields a return of over $30.

For many conditions, treatment is a complicated matter requiring a cocktail of drugs taken according to a strict regimen. For too many, that is not possible. New drugs have been slow to come to the market. Antibiotics represent a cure for millions, but since 1990 virtually no new antibiotics have been developed and we know that diseases are becoming resistant. Approximately 700,000 people will die this year because of anti-microbial resistance, known as AMR. By 2050, this could cost 2% to 3.5% of global GDP, or $100 trillion of economic output. It will be a global catastrophe.

Our Government have already taken positive steps, replenishing the global fund with over £1 billion. Some 80% of the funding for the global fight against TB comes from that fund to which we are the second largest donor. I hope the Minister will restate his commitment to the fight. Prevention, diagnosis and treatment through the global fund cannot be the sole solution. It is clear that without new tools we will not meet the commitment made in the global goals to end the epidemics of HIV, TB and malaria by 2030.

At the current rate of progress, it will take at least 150 years to the end the TB epidemic. Moreover, the O’Neill review published last year made it quite clear that AMR will exacerbate this bleak outlook. I am a co-chair of the all-party group on TB. The group recently held an event on TB and AMR, which included contributions from the Minister and Lord O’Neill, who reiterated the review’s conclusion that tackling TB must be at the heart of any global action on AMR. TB already accounts for one third of AMR debts. If left unaddressed, it will by 2050 cost the economy over $16 trillion. As Lord O’Neill said at our event, the cost of investing in new drugs is minuscule compared with the cost of doing nothing. At present, treatment for drug-resistant TB involves an arduous two-year course of 14,000 pills, which can have severe side-effects including permanent deafness, as well as eight months of intravenous injections. It is little wonder that less than half of those who start treatment complete the course. Concerns about AMR are not limited to TB and HIV; it is also an issue of serious concern for other infectious diseases, including malaria.

Of the annual half a million deaths from malaria, most are of children under the age of five in sub-Saharan Africa. Artemisinin combination therapies are currently the frontline treatments against the most deadly malaria parasites. Although the treatments are working well in many parts of the world, there is serious concern that malaria parasites are once again developing widespread resistance to this vital treatment. Artemisinin resistance is spreading in the Greater Mekong area. If it spreads to the African continent, there will be devastating consequences for global control efforts. At the beginning of this year we witnessed, with four patients, the first failed malaria drug treatment in the UK. That was swiftly followed by the detection by researchers in Africa of malaria parasites that were partly resistant to artemisinin.

The Minister will be aware that AMR is one of the topics being considered by the G20 this year. Last year, the G20 tasked the OECD and others with creating a road map on incentivising research and development in relation to new antibiotics. In line with the O’Neill review’s conclusions that TB must be at the heart of the AMR response, will the Minister take steps to ensure that it is prioritised in the G20 discussions on AMR? Will he ensure that the Government push for agreement on new mechanisms to incentivise research and development to tackle AMR and, within that, drug-resistant TB, especially as half of all cases of TB and drug-resistant TB, as well as TB deaths, occur in G20 countries?

In February I was in India where I met Prime Minister Mr Modi, and I made similar representations there. Only by working with international partners can we make progress against the world’s leading infectious killer and only major airborne AMR threat. In that context, let me say something about the impact that medical technology can have. According to a report produced by the United Nations Secretary-General’s High-Level Panel on Access to Medicines and entitled “Promoting innovation and access to health technologies”,

“Despite this noteworthy progress”—

the development of vaccines and dramatically improved outcomes for HIV sufferers—

“millions of people continue to suffer and die from treatable conditions because of a lack of access to health technologies.”

It is all too easy to focus solely on pharmaceuticals in tackling infectious diseases, but without technology, even the most basic, tackling an outbreak is almost impossible.

I recently heard from representatives of Becton Dickinson, a company that manufactures diagnostic products and lab equipment here in the UK and exports it all over the world. They told me about the measures that we could be taking right now to tackle AMR, including better use of blood testing. We must take steps immediately to improve diagnosis times, and to ensure that the most appropriate antibiotics are administered. BD has been leading research on the development of blood test bottles that counteract the effects of antibiotics so that they can be administered immediately in life-threatening cases. It has also worked on technology to control TB quickly, including new tools that enable the rapid testing and reporting of new second-line drugs for extensively drug-resistant TB. In the event of an outbreak of any infectious disease, timely treatment is crucial, and BD’s work in the field of technology—not just pharmaceuticals—can contribute to the tackling of infectious diseases throughout the world.

I ask the Minister to look more closely at how better use of diagnostics, including blood cultures, can tackle AMR. Some targeted research and development has worked. In 2002, more than half a million children a year were becoming newly infected with HIV; that number has now halved. In 2015, the Government created the cross- departmental Ross fund to invest in research and development in respect of

“drugs, vaccines, diagnostics and treatments to combat the most infectious diseases”.

Although that was a welcome announcement, the fund must be used to complement, rather than to substitute, DFID’s existing commitments on infectious disease research and development, particularly its historical commitment to not-for-profit product development partnerships.

At the APPG on global TB event for World TB day, we heard from Aeras and from the TB Alliance, which have both benefited from UK investment, but developing new tools is not a short-term project. The Minister should reaffirm the Government’s commitment to these partnerships. We cannot afford to step away from them. For example, we currently have one vaccine for TB, the BCG, which dates back to the 1920s and is only moderately effective in preventing severe TB in young children. It does not adequately protect adolescents and adults, who are most at risk of developing and spreading TB.

There are also regulatory issues. It is expected that by 2020 some 70% of those living with HIV will be in middle-income countries and will no longer have access to affordable treatment. The British Government have been keen to come to arrangements that have allowed the countries with the greatest burden a longer time to comply with patent regulations. That positive attitude has not always been shared by the US Administration, and I am worried that the new President will be even less inclined to come to sensible arrangements.

Similarly, as the Government negotiate new trade agreements in the wake of our exit from the European Union, we must ensure access to medicines by protecting TRIPS—trade-related aspects of intellectual property rights—flexibilities. There is growing global momentum on the shortcomings of our R and D model and a number of solutions have been put forward, including the UN High-Level Panel report on access to medicines. The UK must prioritise and plan how to move such recommendations forward, particularly in the lead-up to the World Health Assembly in May. I would be grateful if the Minister could outline in his response whether the UK plans to develop a cross-departmental code of principles for biomedical research and development. That should be based on the recommendations from the high-level meeting on AMR for research and development to be

“guided by principles of affordability”

and ready for the 70th World Health Assembly in May.

We should ensure that R and D leads to health technologies that are affordable and accessible to those that need them. The real game changer will be finding a way to encourage the development of more therapies, new medicines and innovative vaccines. Change will come from a change to the regulatory environment. That cannot be achieved by UK action alone. Could the Minister please commit to ensuring that encouraging DFID best practice is a key plank of future international efforts?

I thank the APPGs that have made this debate possible—those on TB, HIV and Aids, and malaria and neglected tropical diseases. I am keen to hear what my hon. Friends and colleagues have to say, so I will leave it there, although there is sadly so much more to say.

--- Later in debate ---

[Mr Virendra Sharma]

First, I thank colleagues on both sides of the House for their contributions, not only this afternoon but to the International Development Committee and other platforms whenever we have touched on these issues, which affect a large number of disadvantaged groups in poverty.

I also thank the Minister for his detailed response. I am sure that there is more to come—we have missed some issues—but I welcome the present Government’s commitment to contributing 0.7% and look forward to that continuing under the future Government, whoever comes back after June. As has been said, the cross-party consensus was achieved many years ago and I am sure that it will continue.

It is unfortunate that this debate has come after the election announcement. When it was secured, a large number of colleagues on both sides of the House were willing to speak in it. Unfortunately they could not be here today, but their spirit and their contributions to other platforms have been recorded and have encouraged us. Thank you for your patience, Madam Deputy Speaker.

Question put and agreed to.

Resolved,

That this House has considered research and development on tackling infectious diseases.