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Volume 757: debated on Monday 8 December 2014

Question for Short Debate

Asked by

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.

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?

My Lords, it is a great pleasure to follow the noble Lord, Lord Collins, and to thank him for introducing this debate with great authority and conviction. I shall confine my remarks to tuberculosis.

Historians such as me are under no illusions about the dreadful threat that tuberculosis presents to mankind. Large numbers of people in our country have in the past fallen victim to it. In the 19th century, it was responsible for one in every four deaths in Britain. Our culture has been deeply marked by it. Harrowing accounts of the suffering that it inflicted can be found widely in English literature. It is a significant theme in opera, too, although often in unduly romanticised form.

In human affairs, final victories are hard to achieve over determined enemies of well-being. For a time, we came to believe that Britain had conquered tuberculosis and made it a spectre that belonged firmly in the past, but we now confront this terrible menace once again. Some 9,000 new cases are being diagnosed year by year. The threat to our country’s well-being is heightened by growing resistance to the drugs that are used to treat it. Medical advance is urgently needed to bring new, effective drugs into the service of mankind that can overcome the severe problems created by increasing resistance to the drugs that are currently being prescribed. These drugs were, in most cases, developed decades ago. I understand that only one new drug has been approved by the Food and Drug Administration in the last 50 years.

In Britain, we face a return of an old enemy. The world faces a pandemic. What is happening here surely sharpens our consciousness of the extent of the global threat and of our duty to do all that we can to tackle it, drawing on the highly developed skills and expertise that we possess and pressing for the medical advances on which so much depends. Across the globe, nearly 9 million new cases of tuberculosis occur each year. Well over 1 million people die of tuberculosis annually, part of the estimated 13.7 million who are victims of poverty-related and neglected diseases, to which the noble Lord, Lord Collins, referred. That is why the debate that he has initiated is to be welcomed so greatly. Once again, this afternoon, the noble Lord has demonstrated the deep concern and commitment that he consistently brings to global health issues. I much enjoy working with him on the cross-party basis that is so necessary in this area of policy, which includes combating the prejudice—particularly prejudice against gay people—that sets back progress in too many countries of the world.

Successive Governments in this country deserve the credit that they have been given for the major contributions that they have made to the global campaign to tackle poverty-related and neglected diseases. The significance of our country’s role was underlined in the impressive and authoritative report Dying for a Cure: Research and Development for Global Health, published in July by the All-Party Parliamentary Group on Global Tuberculosis. The report shows that Britain is the world’s second-largest provider of funds for global health research—only the United Sates provides more. The report sums up our record as follows:

“From policies, to levels of funding, to coordination and cooperation, the UK is at the forefront of R&D for global health”.

It is not the least of this Government’s achievements to have kept our country at the forefront of this vital work. The report acknowledges that what the Government have done, and are continuing to do, could have huge implications for global health.

The reason why Britain’s official contribution under successive Governments has been so important, and will remain crucial, has been emphasised by the noble Lord, Lord Collins. Although they often demonstrate deep concern for public welfare, pharmaceutical companies are not charitable undertakings. They invest in developing products where there is a potential for significant financial return, in order to pay for development costs and make a profit. Diseases such as tuberculosis mainly affect poor people, so there is little financial incentive to encourage pharmaceutical investment in research and development, to repeat the point made so effectively by the noble Lord.

It is widely agreed that in this overwhelmingly important sphere of global health the market has failed. The all-party group’s report in July was emphatic. It stated:

“The failure of commercially driven R&D for these diseases is a problem that affects us all”.

Public spending in Britain can help to overcome that failure. The report continues:

“From government departments to academic institutions, we support, fund and conduct outstanding research. Every penny of public funding should be spent as effectively and efficiently as possible. As a nation we excel at research and development, we should do more of it and we should share our expertise with our colleagues and neighbours”.

Against this background, the group recommends that the Department for International Development’s budget should be rebalanced to a certain extent, in order to enhance R&D capacity further in future.

There are many areas of global health in which decisive progress is needed, as the noble Lord, Lord Collins, has made clear. As regards tuberculosis, the search for new and more effective drugs is the highest priority in order to shorten basic treatment and to deal with the bacteria that to an increasing extent are resistant to existing drugs. To that end, DfID should surely consider investing more in drug developers such as the TB Alliance, which are not seeking a financial return. Would there not also be merit in considering a prize fund to encourage TB research and development, along the lines of the Longitude Prize, designed to stimulate diagnostics for microbial resistance?

At the recent global consultation on research for TB elimination conference in Stockholm, a Swedish spokesman said:

“There has been a 45% reduction in TB mortality since 2,000. A great achievement, but not enough. Investments in research and innovations now are crucial to reach the global targets”.

Here in Britain we look to our Government to continue and, if possible, to enhance the contribution that has brought them much well deserved praise. The world will not eliminate tuberculosis until an effective vaccine has been found.

My Lords, I, too, congratulate the noble Lord, Lord Collins, on initiating this debate and I echo the remarks of the noble Lord, Lord Lexden, about the contribution of the noble Lord, Lord Collins, to this field and his determined work to improve healthcare for some of the world’s poorest and most marginalised people. I draw attention to my interests in global health, particularly malaria and NTDs.

It is about those two areas and the need for more and innovatively funded research in them that I shall speak. I congratulate the All-Party Parliamentary Group on Global TB on its overall report, Dying for a Cure: Research and Development in Global Health, with its emphasis on TB and its recognition that the needs of the 1.4 billion people who suffer from neglected tropical diseases are tremendously important, as is the interaction of those disabling, disfiguring diseases with the big three killers, TB, AIDS and malaria. It has also recognised that these are diseases not only born of poverty but which create poverty. They undermine education, employment, health—all the opportunities that would allow people to claw their way out of poverty. Therefore, combating the diseases of the poor, including the big three, is an essential element of the fight against poverty and for social and economic development.

For some of those diseases, we already have treatments for which we need more resources—for example, for mass drug administration for soil-borne helminth diseases—but we still desperately need to develop better medicines, smarter diagnostics and, above all, vaccines if we are to make progress. If we look at the position with malaria, there is an urgency to do all those things and to develop new insecticides if we are not to face exactly the same problems of resistance that plague the current fight against tuberculosis.

The main point I want to make today echoes that made by the noble Lords, Lord Collins and Lord Lexden, in terms of the challenges that are born not of scientific difficulties and obstacles but of economic difficulties and obstacles in developing new products. I think it is now universally accepted that we have a market model in pharmaceuticals that will never, on its own, deliver for the poor.

Ebola is a very good example. Ebola was such a minority interest until this year that it was not even on the WHO’s list of 17 neglected tropical diseases—it was a neglected neglected tropical disease. But the reason that treatments and vaccines have not been developed for Ebola is not because it is a uniquely difficult scientific challenge but because so few people were considered at risk and those few people were considered to be poor and a long way away. As I understand it, the candidate vaccines and treatments now being rushed through are all compounds that had already been discovered but not developed because, although potentially valuable in therapeutic terms, they were not potentially valuable in commercial terms. Of course, we now have the recognition that in a global world, epidemics are a mere flight away, so the world has now pledged to spend $2.4 billion on combating Ebola but did not in the past invest the fraction of that which would have been necessary to develop a new vaccine.

Of course, progress has been made in the area of funding of research for such diseases. We should pay tribute to the UK Government and DfID for their support for the concept of product development partnerships and to the work of the philanthropic, academic and private sectors in coming together with Governments in important and fruitful partnerships such as the Drugs for Neglected Diseases initiative and PATH, and in malaria vaccine development. But the number of chemical compounds with potential being brought forward is still worryingly low. Ebola should have taught us that we cannot afford for potential drug candidates to be left on the shelf because pharma companies have no incentive to screen them against key diseases. We have to find a way to fund discoveries that are potentially life-saving, even when they are not in the current market, profit-making.

My plea to the Government today would be for them to increase their commitment, and the resources they devote, to the vital work of PDPs. As the noble Lord, Lord Lexden, said, this is an area where we have tremendous skills and expertise. I recently took up the position of chair of Cambridge University Health Partners, and seeing the huge scientific potential we have for patient benefit on that fantastic campus is a real privilege. We also have a history of, and a great ability for, knowledge transfer through our academic institutions, particularly the London School of Hygiene and Tropical Medicine, and the Liverpool School of Tropical Medicine. I was in Zimbabwe and saw midwives and obstetricians from this country delivering training packages for midwives and skilled birth attendants in Zimbabwe, which then became sustainable programmes for supporting maternal health.

I have one other plea: we should not neglect the importance of the research that can take place in the countries and the communities where diseases are themselves endemic. Building capacity in those countries, as enlightened funders are now recognising, can have really powerful results in the quality and relevance of the research undertaken. Finally, I would encourage the Government to look at mechanisms to invest in local clinician-led research agendas in developing countries.

My Lords, I, too, wish to congratulate my noble friend on securing this important debate, in particular for his persistence, and for it happening so close to World Aids Day. I wish to concentrate my remarks on the need for better tools, research and development for HIV/AIDS, and why it is so necessary. Unfortunately, listening to the three previous speakers, the story is the same, which is a real tragedy.

HIV/AIDS has placed a huge burden on developing countries, where the majority of the 35 million people with HIV now live. The disease kills 1.5 million people each year. Two-thirds of those living with HIV are in sub-Saharan Africa, where families can ill afford to bear extra healthcare costs or care for orphan children. Initially seen as a male disease, HIV/AIDS is rapidly becoming a female epidemic, with further impacts on families, given the greater share of responsibilities of women within households. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa. The region’s young women are twice as likely to contract HIV as their male counterparts. This is in part due to a greater biological risk, and in part due to the unequal status of women, the effect of which constrains women’s ability to negotiate condom use, which is a major problem for those women, particularly those who are sex workers. Risk to sex workers stems from an increased number of sexual partners, greater exposure to sexual violence, being forced to have unprotected sex, or accepting more money to have sex without a condom. Sex workers can also face harassment from the police, who in many countries have been known to use the possession of condoms, or attendance at HIV clinics as a reason for arrest, or as a basis from which to extort further money or commit incidents of sexual violence. I found it strange, but I was told by a cousin who for many years was a sexual health worker in Africa, that in the 1960s and 1970s they wrapped condoms in coloured paper to make them look like sweets for exactly the same reasons. Is it not an indictment that all these years later we are still having exactly the same debates?

There are other identified groups who are particularly at risk of HIV. For example, the estimated 75 million male clients who visit the 10 million sex workers globally, and are a key transmission group to other women and men in the community. Men who have sex with men are 13 times more likely to be living with HIV than the general population due to the biological risk of transmission and having higher numbers of partners, yet they are stigmatised if they attempt to attend an HIV clinic. It is truly frightening to witness the current slide to criminalisation of homosexuality, for this impacts on the wider population, given that men who have sex with men will often have wives or other female partners. Ban Ki-moon, the UN Secretary-General, recently remarked:

“Not only is it unethical not to protect these groups; it makes no sense from a health perspective. It hurts all of us”.

Therefore, it is crucial that tools are designed to provide diverse groups with innovative and long-term ways of protecting themselves from HIV/AIDS.

The International AIDS Vaccine Initiative, which I was fortunate to visit earlier this year with my noble friend, is undertaking trials on several innovative approaches, from broadly neutralising antibodies to cell responses, and including replicating vectors for vaccine delivery. It is also carrying out follow-up trials to studies in Thailand that pointed to the efficacy of two vaccine candidate compounds when used together. We hope that those will be able to be developed. Such a vaccine would protect women, particularly those most at risk such as the female sex workers whom I mentioned earlier. Not only is it essential in helping to save those women’s lives but, from the decrease in the need for treatment alone, the savings are estimated to be $95 billion over the first 10 years.

Another study by the International Partnership for Microbicides is undertaking clinical trials of its new ring. It is a simple and affordable product. It is worn internally and works by releasing an antiretroviral drug that has been found to prevent HIV infection. Other studies are looking into gels and films that work in similar ways. If there is ever going to be a reduction in, or the elimination of, the 2.3 million new cases each year, prevention is key. It is absolutely essential, and the funding and the resources have to be found to make that possible. There are four new cases for every three people who are started on treatment. Detailed modelling has estimated that, even after significant scaling up of treatment efforts, there will still be 1.4 million new cases each year. Add a vaccine to that, however, and the number drops to 400,000, and very likely, with herd immunity, it will be brought down still further year by year.

Moreover, we must look at what can be done to change a situation where diseases affecting richer countries are prioritised for research and development above diseases that affect those less able to pay. I found it absolutely shocking to discover that 15 FDA-approved drugs were initiated to treat hay fever in the last 50 years compared with the one drug for TB mentioned by the noble Lord, Lord Lexden. Health programmes must be targeted at the poorest and most marginalised groups, not at those where the pharma companies are going to make the most profit.

The millions of women I mentioned earlier who cannot protect themselves from HIV/AIDS desperately need leadership from people such as us. However, there is another side to this debate. I have talked about availability—the need for drugs to be developed—but there is also a need for the drugs to be affordable. The excellent report of the HIV/AIDS all-party group, Access Denied, records how the generic medicine industry has been pivotal in bringing down the price of antiretroviral drugs from more than $10,000 per patient to less than $100. This has allowed nearly 10 million people to access HIV treatment, with 1.6 million of these beginning their treatment in 2012. To put this in context, 28.6 million people are estimated to be eligible for treatment under new World Health Organization guidelines, and that figure is expected to be 55 million by 2030. However, only 34% of the millions in need can access treatment in low and middle-income countries. That is just for adults. Access to treatment for the 3.3 million children living with HIV in developing countries is only 18%—how disgraceful; that is half the adult rate.

Surely the partnerships that have been talked about should also agree that the price of essential drugs and vaccines should not be out of reach of those who need them—perhaps through voluntary or compulsory licensing of patented products. My noble friend rightly referred to this as market failure. De-linking the final cost of a drug from research and development incentives could not only spur investment in work on diseases of poverty but also ensure that those drugs can be marketed at a price affordable to the greatest number of people, and so save many millions of lives. After all, if we think about it, manufacturing a drug is a remarkably low-cost exercise. We should be looking to pharmaceutical companies to ensure that there is more transparency in their research costs, to make it possible better to access the level of finance needed.

The UK, as a global leader, can ensure that the partnerships can continue their work, but only if they get adequate funding to do so—funding that allows long-term planning to progress potential candidates through the many stages their work requires—and take steps to explore how a reformed system might work that pushes companies to do the right thing, which will allow us, one day, to cross World AIDS Day off our agenda.

My Lords, I congratulate my noble friend Lord Collins of Highbury on securing this debate on a subject so important to a world which contains an estimated 35 million people living with HIV.

Today’s debate is focused on investment in research and development in global health, in particular to develop new tools and treatments for TB. I welcome the fact that the TB Alliance has four combinations of drugs in late-stage development and will soon launch a trial of a combination of drugs suitable for those who are co-infected with TB and HIV. More people living with HIV die from TB than any other coinfection, but the first new drug available for TB in 50 years, Bedaquiline, is still not reaching the 1 million people who may need it because of its high price, as the noble Lord, Lord Lexden, mentioned.

The Doha declaration of 2001 must continue to be enforced and respected by all countries to ensure that public health is prioritised over profits. Currently, a number of free trade agreements are causing concern. Most, if not all, FTAs involving the EU or the USA contain provisions on intellectual property rights that are TRIPS-plus and have the potential or likely effect of hampering or preventing the use of one or more TRIPS flexibilities—TRIPS being Trade Related Aspects of Intellectual Property Agreements. Where there is a public health imperative, countries can issue a compulsory licence to a generic manufacturer on payment of a royalty to the owner of the patent.

We need to examine the role of the pharmaceutical companies as part of the debate. In 2002, the world watched as 39 pharmaceutical companies took the South African Government to court. Their complaint was that the Government, under the presidency of Nelson Mandela, had passed legislation paving the way for the purchase of cheap anti-HIV drugs from India to tackle the worst HIV epidemic in the world. By buying those cheap drugs, the companies claimed, the South African Government would be breaching their intellectual property rights. Thankfully, the case was eventually dropped, but the issue of intellectual property rights in that context remains controversial.

In 2003, the Labour Government launched a commission to explore the relationship between IP and development. They published a landmark document recognising the enormous impact of intellectual property legislation on international development. The commission recommended that further research be carried out, and the Labour Government led the way by supporting the establishment of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health. The commission sought to create global consensus around research and development for global health, and led to a series of reform proposals. Progress on these reforms has stalled and has been pushed back to 2016, as my noble friend has already highlighted, but the progress of diseases such as HIV and TB has not stalled, and the time wasted in coming forward with new research and possible vaccines sees 2.7 million people die from these two diseases alone every year.

As noble Lords have already emphasised, intellectual property is not, in itself, a bad thing, but IP is designed to incentivise innovation by helping innovators to make a profit on the products they invent. Companies will concentrate on developing drugs to address the illnesses besetting the developed West more quickly than addressing the needs of the developing world, as my noble friend Lord Collins has already mentioned. The disparity in wealth between high- and low-income countries means that the markets which offer greatest returns are those in the developed countries. The pharmaceutical companies predominantly invest in developing products with the greatest potential to generate sales in high-income countries, and price their products accordingly.

The establishment of the Medicines Patent Pool—MPP—in 2010 to address intellectual property barriers to generic production is of course welcome and is already making a difference, but there is still a time lag from the period when a licence is agreed, given the two to three years it takes for a generic manufacturer to develop a new drug. More pharmaceutical companies need to be encouraged to sign up and there is still a need for greater investment in R&D.

The Government need to show the same leadership as the previous Labour Government did in this field by commissioning a new report to examine the differences in overall costs between a commercially driven model of development and models that are open access and do not include IP protection, so that global solutions can be found to global health problems. The aim of such a study would be for the UK Government to find the most effective ways of creating incentives to encourage investment in R&D, and to look at the benefits and challenges with different approaches to drug development.

As my noble friend Lord Collins highlighted, there is a concern about this Government’s reduction of funding into research and development around a vaccine for AIDS by more than 80% for the period 2013 to 2018. The new grant for the next five years has been reduced to only £5 million—one-eighth of its previous level. Does the Minister support the recommendations in the report launched by the All-Party Parliamentary Group on HIV and AIDS, Access Denied, to carry out an inquiry into alternative models of research and development investment which separate the cost of R&D from the demands of profitability? As my noble friend Lord Collins has already mentioned, a new global research and development fund could reward all who contribute to it, and the UK Government could negotiate with the pharmaceutical industry and civil society to create a research and development treaty to provide the framework for such a fund. Notably, the report calls on,

“the UK government, the pharmaceutical industry and multilateral organisations to work together to make second and third-line ARV drugs available and affordable to all, including marginalised populations and people living”,

in middle-income countries. The report also says:

“DFID should lead the way in harnessing donor support for the Global Fund to cover the cost burden of the increased numbers of people (28.6 million) now eligible for ARV treatment under WHO guidelines”.

Most importantly, Access Denied suggests that,

“DFID should use its leverage as a donor to ensure multilateral institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, WTO, WHO, World Intellectual Property Organization (WIPO) and UNITAID are doing enough to bring prices down. It must use its voice to demonstrate leadership on this issue”.

My Lords, first, I thank the noble Lord, Lord Collins, for securing this important debate. I also thank all other noble Lords who contributed to the debate this afternoon. This is indeed a very important area and I am glad that we have recently had Oral Questions on it and that my noble friend Lord Fowler has a related debate on the Global Fund on Thursday. I was very glad to speak at the All-Party Group on HIV and AIDS, of which I used to be an officer, at the launch of its report Access Denied, and I am very happy to share my speech.

As the noble Baroness, Lady Hayman, pointed out, these are not only diseases of poverty; they are diseases that cause further poverty. I thank the noble Baroness for her tribute to DfID. Like her, I pay tribute to our outstanding institutions that are working in this area, and I welcome her new involvement with Cambridge University Health Partners. We have a formidable academic record in the United Kingdom in this area.

The noble Lord, Lord Collins, pointed to a market failure in drug development in relation to diseases of poverty. Other noble Lords made reference to this as well. Between 1975 and 2000, just 13 new drugs were registered for use against the so-called diseases of poverty. That is about 1% of the total number of new drugs developed globally. Of course, the question is: why have those diseases been so badly neglected? As noble Lords have indicated, the answer lies in the lack of incentives for the pharmaceutical industry. Developing and bringing a new drug to market is an extremely costly and risky business and the industry did not see the incentives to bring those drugs forward. If we add the extremely limited profit margins associated with making those badly needed drugs available, it is not hard to see that fundamental market failures have meant that the development of affordable and accessible treatments has not been prioritised in the way it should have been. Noble Lords were quite right in their analysis of that.

The noble Lord, Lord Collins, and others mentioned the product development partnerships—PDPs. These have changed the situation, harnessing the best of the private sector so that it is channelled for the public good. The noble Lord, Lord Collins, also spoke about de-linking and several noble Lords spoke about intellectual property. All PDPs negotiate access to intellectual property for all products developed in order to ensure affordability and access. We need a number of approaches, not just de-linking, to ensure that many players can be involved and to bring in the expertise and resources from the private sector that may contribute to the PDPs.

The noble Lord, Lord Collins, and the noble Baroness, Lady Healy, asked whether we would commission a report on de-linking. I assure them that a number of groups are already looking at this, including a Treasury-sponsored group looking at antimicrobial resistance. If they want further details of that, I am sure that we can assist in that regard.

Since the emergence of PDPs, we have seen 10 new technologies brought to market and there are more than 350 candidates in the pipelines of PDPs collectively, including 90 drug and vaccine candidates and 32 diagnostic or vector control candidates. The UK is a leading investor in PDPs; in 1999, we were the first Government to provide support to a PDP, and currently support 10 PDPs covering neglected diseases. Since 2008, we have committed approximately £323 million to PDPs.

I assure the noble Lord, Lord Collins, that DfID has an open access policy. All research funded by DfID has to be placed in the public domain. For product development research, all new products must be made available for the lowest possible price. The noble Baroness, Lady Gould, rightly emphasised the key importance of such access to medicines and vaccines. I hope that they are reassured by what I have just said.

I am pleased to report that the DfID-funded PDPs have a strong track record of delivering a wide range of new technologies for diseases of poverty and of getting those into use in the developing world. This has included five new diagnostic tests for TB and six new drug combinations for malaria.

My noble friend Lord Lexden referred to the long history of TB and humankind. Like him, as a former historian, I am fully aware that that history is very different from the situation today. However, TB disproportionately affects the most vulnerable and marginalised in society. In 2013, 9 million people fell ill with TB and 1.5 million died. TB ranks as the second leading cause of death from an infectious disease worldwide, after HIV. The UK remains committed to help achieve the goals of the Global Plan to Stop TB to reduce deaths and prevalence of TB by half, compared to 1990 levels, by 2015 through our bilateral and multilateral support. A big part of that effort is investing in research into more effective diagnostics, treatment and vaccines. Noble Lords are absolutely right about that.

I assure my noble friend Lord Lexden that DfID is already the second-largest government funder in this regard. Following a funding gap for TB drugs this year, we gave an extra £5 million to the TB Alliance. I want to highlight the work of two DfID-funded PDPs in particular. The Foundation for Innovative Diagnostics has developed GeneXpert, a new diagnostic test for tuberculosis that gives fast and accurate results in four hours, compared to a previous wait of between six and eight weeks. Noble Lords will appreciate immediately how important that is. The Global Alliance for TB Drug Development is about to start a registration trial for a new combination of TB drugs. If successful, it has the potential to reduce treatment times for drug-resistant TB from between 24 and 30 months to six months—another issue that my noble friend raised.

What are we doing to change the global landscape? We recognise that effective co-ordination is crucial but challenging, given the number of different players in the field, including Governments, philanthropic organisations, the private sector and others. As well as investing directly in research and development, the UK will continue to play our part, working with others to improve co-ordination and maximise overall returns for the global poor. We are working with the WHO Secretariat as it develops a mechanism to implement the recommendations of the recent consultative expert working group process.

We welcome the proposed global observatory for health R&D, to be based at the WHO, which will provide an opportunity for co-ordinating information about what health research is going on globally. In tandem, the WHO Secretariat is developing a mechanism to operationalise the pooled WHO member states fund for product development, which, if established, will aim to attract new funders and donors to support product development. We currently chair the PDP funders group—an informal group of bilateral agencies and philanthropic foundations that provide support to PDPs and encourage others to invest.

The noble Baroness, Lady Hayman, emphasised the need to build research capacity. We are working not only within the United Kingdom but she will know, I hope, that we are also working within Europe generally, supporting the European & Developing Countries Clinical Trials Partnership, which has a UK lead—the Medical Research Council. The EDCTP is a partnership of 16 European and 48 African member states to pool resources and skills and to co-ordinate and implement clinical research.

I note what my noble friend Lord Lexden said about the incentive of a prize. I suggest that he might look to a major donor with an interest in naming such a prize. Given the impact on India, he might initially look to that country.

The noble Lord, Lord Collins, also mentioned HIV funding. We discussed this the other day. He will know that past vaccine research looked promising but looks less promising now and needs a basic research approach. That work is therefore much more appropriately taken forward by the MRC and the Wellcome Trust, which have been increasing their funding for AIDS vaccine research. I note that an incredibly interesting research paper may indicate that HIV may be weakening slightly. Let us hope that it heads in that direction.

The noble Baroness, Lady Gould, mentioned the Ring Study. DfID has committed £15 million to the International Partnership for Microbicides, and I hope that she will be encouraged by that.

The noble Baroness, Lady Healy, talked about TRIPS. DfID supports countries that use provisions to overcome IP barriers through TRIPS.

Solving many of the challenges that we will face tomorrow will rely on the R&D investments that we make today. DfID has an outstanding record in this area in terms of its support over the last few years. We are committed to maintaining our record of funding high-quality, high-impact research and playing our part in improving global communication. We are committed to putting that knowledge into use so that ultimately it will save lives. We also emphasise that rights should underpin our support for the poorest and most marginalised, as my noble friend Lord Lexden made clear should be the case.

Noble Lords mentioned Ebola. That has shown how interlinked we are. It will not have escaped the notice of the pharmaceutical industry that a disease that was seemingly limited to a poor area geographically and socially may well have a far wider impact. Those who had Ebola vaccines on their books are now able to power ahead. We need to ensure that we support those suffering from the so-called diseases of poverty. We also need to recognise that we are in a changing world, and we need to do our best to ensure that that is fully recognised.