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Tackling Infectious Diseases

Volume 624: debated on Thursday 20 April 2017

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.

I congratulate my colleague from the International Development Committee, the hon. Member for Ealing, Southall (Mr Sharma), on his comprehensive speech, which covered a huge amount of ground. I also declare my interest as a member of the boards of the Liverpool School of Tropical Medicine and the Innovative Vector Control Consortium, which develops new insecticides to put on bed nets to counter mosquitos, and as chair of the all-party group on malaria and neglected tropical diseases.

I had the honour on Monday this week to chair a meeting in Washington, as chair of the Parliamentary Network on the World Bank and International Monetary Fund, with Madame Christine Lagarde of the IMF and Dr Jim Kim, president of the World Bank. Dr Kim spoke about infectious diseases and the threat posed by them. He pointed out that we had come together as a world with three countries in west Africa—Liberia, Guinea and Sierra Leone—to tackle Ebola. There was a huge cost of life there, particularly among medical workers, but the co-ordinated action enabled that epidemic to be curtailed; it could have been much worse. He talked also about Zika and the work done on it. He pointed out, too, that a major epidemic of an infectious disease, possibly a flu, which could affect as many as 30 million people resulting in a scale of deaths that we have not seen since Spanish flu in 1919, was perfectly possible and very much on the radar. That illustrates why this debate is so important.

The UK Government have been at the forefront in providing resources for research and development as to tackling infectious diseases and the deployment of those tools in the countries where they are needed, not only in the cases of Ebola and Zika, but, as the hon. Gentleman mentioned, in terms of the rise in the resistance to drugs, particularly for tuberculosis, but also for malaria. Resistance has been growing to the artemisinin-based combination therapy drugs, or ACTs, in south-east Asia, and, as we know, it is always from south-east Asia that resistance grows to malaria drugs; it did for chloroquine and it did for sulfadoxine-pyrimethamine, or SP, and now it is for the ACTs. That is where the real threat from malaria lies: if resistance grows there and then crosses to sub-Saharan Africa, we face the prospect of yet another drug becoming less effective. ACTs have played a huge role in cutting the number of deaths from over 1 million in 2000 to less than half a million last year.

The UK Government have played a major role through the funding of, for instance, the Medicines for Malaria Venture and the Innovative Vector Control Consortium, which I mentioned earlier, and I welcome the announcements this week by the Secretary of State on additional funding to combat neglected tropical diseases. I hope some of that funding will go into developing new drugs in the area, because we have shortfalls in the pipeline for tackling some of those diseases; some have very effective existing drugs, but others do not. We must also not forget the role that vaccines play, as the hon. Gentleman also mentioned, in respect of TB.

As the hon. Gentleman made clear, these are not commercial propositions in most cases. They are not drugs that companies can afford to develop on their own; they need the support of Governments and foundations. It is tremendous how Governments and foundations such as Wellcome and the Bill and Melinda Gates Foundation have stepped up, and indeed drugs companies in the case of neglected tropical diseases, where they have provided billions of doses free across the globe in the past 15 to 20 years.

I want to conclude by giving three reasons why we should be concerned about this matter and taking this action. First, that is absolutely the right thing to do: dealing with diseases that affect people across the globe, and not just the poorest people—the 1.5 billion who suffer from neglected tropical diseases and those who suffer from malaria, TB and HIV—but the people in our own countries who suffer from these diseases. Let us not forget that those people are right on our doorstep and in our midst.

Secondly, this is highly cost-effective. A ratio of about 40:1 has been mentioned, and I have seen that in many places. What we spend on international development has to be extremely effective. In many cases, what we spend on research and development and on treating these diseases is pretty much the best buy in international development, which is why I welcome the fact that the UK Government have concentrated more resources on these areas.

Thirdly, the UK is a world leader. That is even more important now that we are coming out of the European Union. We have institutions such as the London School of Hygiene & Tropical Medicine, Imperial College London, the University of York, the Liverpool School of Tropical Medicine, the University of Dundee and the University of Aberdeen. Many of our universities across the United Kingdom are world leaders in this area, and it is vital that, as we look to create a more global Britain, we do not neglect those areas in which we are already world leaders. That involves a number of things, such as investment in the form of Government support, primarily through DFID and in cash, but also ensuring that the best scientists such as the young researchers who want to come to this country because of our excellence can continue to do so and will not be blocked.

Let us not forget that researchers are often not well paid. If we set salary-based caps for immigration, we will automatically disqualify some of the brightest minds on the planet from coming here, so let us ensure that that does not happen. If we are to have immigration rules, they should be based on the task and not on the salary. Setting a cap of £30,000, for example, would probably exclude half the PhD and other doctoral posts in this country. This is absolutely critical. We also need to encourage our own researchers to go and work across the globe in collaboration with others. This kind of research is not national; it is international, and it requires the widest possible collaboration.

I want to conclude by thanking my hon. Friend the Minister, who is absolutely committed and who I know will have played a major role in the decision on neglected tropical diseases in the past week. This is something we have been waiting and calling for, and the Government’s announcement has exceeded our expectations. That is tremendous. It is great for the United Kingdom and, above all, for the people who are suffering from neglected tropical diseases.

That comes on top of a range of announcements on malaria, TB and HIV. As we come to the end of this Parliament, I hope that all the manifestos—particularly the Conservative manifesto—will contain a commitment to continue to spend 0.7% of our GDP on international development and a repeat of the commitment to make research and development on infectious diseases and the deployment of those resources a key priority for the new Government.

I congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate, along with two other members of the International Development Committee. As always, it is a pleasure to follow my hon. Friend the Member for Stafford (Jeremy Lefroy), who always speaks from great experience and with great knowledge of neglected tropical diseases. I know that he has done a huge amount of work on tackling malaria.

Today’s debate is timely. Last week, DFID announced a doubling of its support for the fight against neglected tropical diseases such as trachoma, Guinea worm and river blindness over the next five years. It was also announced that the UK would invest £360 million in programmes to tackle this type of disease. This week, the World Health Organisation is hosting a summit on neglected tropical diseases, and we have seen the coming together of Governments, non-governmental organisations, multilateral organisations, the private sector, and the Bill and Melinda Gates Foundation, which many Members have mentioned. That highlights the importance of tackling those terrible diseases that strike at the heart of some of the most vulnerable people in the world.

As a member of the International Development Committee and a co-chair of the all-party parliamentary group on the United Nations global goals for sustainable development, I wanted to speak in what will be perhaps the last international development debate in this Parliament and to take the opportunity to highlight some of the incredible work that UK aid has delivered. I am sure that the Minister will tell us more about the Department’s record over the past few years.

The UK is investing in research and development for new technologies to fight neglected tropical diseases with funding from the Ross fund, which is a £1 billion fund aimed at developing, testing and producing new products—particularly for malaria. We often hear of the importance of bed nets in the tackling of malaria, but that is not the only answer to the problem; we also need to look at drugs, insecticides and diagnostics. The importance of working to tackle antimicrobial resistance has also been mentioned.

We must not forget the impact of Ebola in recent years—a topic that the Committee has done an inquiry on. It is a terrible infectious disease that affected people not only in Sierra Leone and Africa; we know of a couple of British citizens who were seriously affected by it as well. That highlighted the importance not only of looking for ways of testing for the disease and curing it, but of having adequate healthcare systems.

Tackling neglected tropical diseases is clearly good news for those countries that are most badly affected by them. It is also good news for our universities, pharma companies and many of our NGOs and charities; they have vital roles to play in this, too. That also keeps us as British citizens safe. Many of us travel around the world, so it is important for our safe and secure passage to seek protection from and find solutions to those diseases.

I have mentioned Ebola and malaria, and the Zika virus is another infectious disease; we do not hear about many diseases until there is an epidemic or a really serious outbreak. To me, it also illustrates why the UK aid budget really matters. When we spend it wisely, it can make a difference to people’s lives—and it is in our interests to do that. We know that infectious diseases disproportionately affect the poorest people, exacerbate instability and put at risk our national security.

Last year, the UN high-level panel on access to medicines made a number of recommendations aimed at getting more medicines to more people who need them. It also recognised that research and development alone is not enough. Intellectual property law, competition law, procurement laws, drug regulations, public health obligations and patents are all part of this, as is price, which can be a major barrier to accessing treatment globally. For example, generic competition in antiretroviral medicines has led to the cost of first-line ARV drugs decreasing, but third-line ARVs remain prohibitively expensive—especially in middle-income countries. To make that even more pressing, by 2020 an estimated 70% of people living with HIV will be in middle-income countries.

Britain has a proud record in this field. We are leading the way in fighting these diseases through research, targeting and tackling the real root causes of avoidable infections and diseases. However, while we have achieved so much, as usual it is the case that much more can be done. I hope that the Minister will set out his Department’s plans. We know that he is committed to this area. As I began by saying, I welcome the work that DFID has done.

It is a privilege to be able to contribute to this debate, and I pay tribute to the hon. Member for Ealing, Southall (Mr Sharma) for bringing it to the House this afternoon. I also pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has done so much throughout this and the previous Parliament in the field of infectious diseases. In the work he does not only in this country, but globally, he really is an effective champion for this country in this area.

Several hon. Members have already highlighted that infectious disease research and development is a real success story for the UK. It is particularly fitting that we should be having this debate in the last days of this Parliament the week before World Immunisation Week, which celebrates the progress that we have made in tackling some of the biggest global health threats through vaccination. Closer to home, as the Member of Parliament who represents Porton Down, I have campaigned over the past six years on Wiltshire’s expertise in this area. I welcome the opportunity once again to focus the Government’s attention on this unique asset to the UK and its potential to contribute to the global fight against infectious disease.

I want to make clear the importance of UK aid and leadership and discuss how effective the UK aid budget can be if it is used creatively against the risks that exist. We often hear criticism of our development assistance budget, and people legitimately question whether aid is always in our national interest, but this area is a clear example of where our security at home can only be achieved by investment abroad. Epidemics may start far from our shores, but diseases do not respect national borders, and this country and this Government must continue to show leadership.

The national risk register rightly identifies emerging infectious disease as one of the most serious threats that we face. With over 2 billion passengers travelling by air every year, it remains firmly in the interest of national security to invest in vaccinations that can prevent outbreaks hundreds of miles away. However, this is not an issue that Government funding or intervention alone can address. It requires intelligent collaboration between academia, industry and the public sector to identify new vaccines, license them, manufacture them and then get them to where they are needed. Too often they remain stuck in the pipeline as unproven concepts in research papers.

The Ebola epidemic in 2014 galvanised international efforts to quickly mobilise vaccines, but it also identified several critical problems in the chain of development. First, as others have mentioned, too little economic incentive exists for the private sector to invest in vaccine research for rare emerging infectious diseases. Secondly, licensing vaccines is challenging, which has a further impact on their commercial potential. Thirdly, the UK has a limited manufacturing capability that needs to be enhanced. The British Society for Immunology told the Science and Technology Committee that

“we lack a truly effective and co-ordinated platform for the research, development, and manufacturing of new vaccines and treatments against novel or emerging disease threats”.

It is welcome news that the Government are taking significant steps to address that deficiency with the creation of the UK Vaccine Network and the £120 million in overseas development assistance to develop vaccines for infectious diseases with epidemic potential.

It can cost more than £1 billion to take a vaccine through development from concept to market. In particular, smaller firms face challenges in the translational gap of taking products through licensing, where costs can easily reach £100 million. Targeted investment at the right stages of research can help bridge those gaps, but so too can the right facilities in the right location, which is where we come to my constituency and the opportunities that exist therein.

As early as 2014, before the Ebola outbreak, life science experts at Porton Down were advocating for it to become a national centre for translational vaccinology. Their judgment was based on the concentration of expertise that exists there and the natural synergies between Government agencies and the private sector. Porton Down is currently home to Public Health England’s centre for emergency preparedness and response, the Defence Science and Technology Laboratory and a new £10 million science park that will be home to some of the most innovative biotechnology companies in the country.

Alongside those facilities, Salisbury district hospital and Southampton University, nearby, provide further complementary expertise in infectious diseases. Discussions are moving forward on how we can further strengthen that collaboration, perhaps through university status for Salisbury district hospital. Wiltshire has a large military footprint that will be further enhanced in the coming years, which could be of considerable benefit in tackling future outbreaks given the extensive involvement of our armed forces in the Ebola response. All those factors make Porton an ideal site for a Catapult centre for vaccine research and development.

Although the last Parliament took the decision to move much of the Public Health England footprint to Harlow, I am absolutely clear that we must maximise the significant potential that still remains at the facilities in my constituency. That is not merely about the interests of the local economy I represent in Wiltshire; it is about the effectiveness of the UK’s world-leading life science research base. Let us use our assets and resources intelligently. Porton Biopharma was corporatised out of Public Health England in 2015 specifically to capitalise on Porton’s long-established expertise in developing, manufacturing and bringing vaccines to market, and I am working closely with its leadership team to identify the best operating model for the company. I urge the Minister and his colleagues, as they consider the options for future vaccine development facilities in the UK, not to overlook the facilities and infrastructure that already exist and to build on them as far as possible.

Every year, existing vaccines avert an estimated 2 million or 3 million deaths globally. We all know that prevention is the best cure, and we must now ensure that the Government’s financial commitments translate into meaningful improvements in vaccine research and development sites at Porton Down.

As all Members think about the election and their manifestos, and as they make representations to those who will put the manifestos together, I urge the Minister to think creatively about the often-discussed size of the ministerial budget for which he is in part responsible and to think carefully about how it can be maximised for international aid purposes while using this country’s existing infrastructure. We can do so much more through such intelligent investment, and I hope there will be further opportunities for me to raise this issue if I am fortunate enough to be returned in the next Parliament.

I congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing this debate. He mentioned the three big killers worldwide—HIV, TB and malaria—and I will talk a little about them, too. The hon. Member for Stafford (Jeremy Lefroy) introduced the work on Ebola and Zika. He spoke about the possibility of a new worldwide killer disease, which could have devastating consequences, and how we might react to it. The increased UK Government funding to tackle neglected tropical diseases was mentioned by the hon. Member for Aldridge-Brownhills (Wendy Morton). Although that funding is very welcome, it is probably a drop in the ocean, given what is required to tackle these diseases properly. The hon. Member for Salisbury (John Glen) mentioned the Ebola outbreak, the difficulties in developing vaccines and treatments when there is no economic incentive to do so, and the lack of manufacturing facilities in the UK for such a huge programme.

Vaccination, antimicrobial drugs and improved hygiene mean that infectious diseases are not the massive killer they once were in the UK, but they are still a major health and economic burden for us. In other parts of the world, they are a major killer. We know that HIV and other forms of sexually transmitted infection are rampant just now in sub-Saharan Africa, but even in the UK 100,000 people are living with HIV. The number of cases of genital warts has decreased as a result of the increased use of the human papillomavirus vaccine, but rates of syphilis and gonorrhoea have significantly increased, with many cases being diagnosed late. Those conditions will have huge health implications, even here in the UK.

I wish to discuss the three diseases that the hon. Member for Ealing, Southall, talked about. Malaria is currently threatening half the world’s population, and it claims the life of a child in Africa every minute, so 50 children will have died as a result of Malaria in Africa while this debate has been going on. That is a damning statistic. Tuberculosis has killed more than any other disease in history, and last year it killed 1.8 million people globally—5,000 people every day. TB—the world’s leading killer—is airborne, which makes things difficult as it means it is hugely infectious. It is also increasingly resistant to drugs. TB does not just affect the developing world; we are seeing recurrences of it in major world cities, including London. As the hon. Gentleman mentioned, our response to TB is chronically underfunded, but as he also said, for every $1 invested in TB care, we have a yield of $30, which means there should be an incentive—a moral and economic case—for increasing our efforts.

Alexander Fleming warned in 1945 that micro-organisms could develop resistance to his new antibiotics, and unfortunately that prediction has proven correct. A report published by the World Health Organisation in 2014 said that antibiotic resistance was now a global threat, on a par with other global threats. The inappropriate prescription of antibiotics affects our ability to tackle diseases. I found some statistics about Scotland, and the picture there reflects that in the rest of the UK. In 2014, 55,000—1% of our population—were taking antibiotics at any one time. The problem is that in up to 50% of those cases, antibiotics were unnecessary and the condition would have improved without them. It is essential that we seek to educate people on the use of antibiotics, and that our GPs and others doing the prescribing use them far less.

Resistance is, of course, a natural biological phenomenon, but it is increased by the misuse of medicines and poor infection control. It is a particular concern with regard to antibiotics. Many of the medical advances we have made over recent years—such as organ transplantation and even chemotherapy—need antibiotics to prevent and treat the bacterial infections that such treatments can cause. Without effective antibiotics, even minor surgery and routine operations become high-risk here in the UK.

I congratulate the hon. Members who secured the debate and apologise for having been unable to attend it from the start and take part more fully. I agree with a lot of the points my hon. Friend is making. Antimicrobial resistance is hugely important. I do not know whether she is aware of the antibiotic champion scheme, which encourages policy makers, decision makers and others in the professional field to sign up to promote the various steps we can take to tackle antimicrobial resistance. Those steps include completing the course of antibiotics, which is particularly important if people have taken them prophylactically when they have travelled in developing countries, to prevent malaria and so on.

I thank my hon. Friend for his intervention. I am an antibiotic champion and I have signed the pledge, but we need more people to not just be aware of that pledge, but take action and follow the steps that it includes.

Inaction on antimicrobial resistance will mean the loss of effective antibiotics, which will undermine our ability to fight infectious diseases, not only in the UK but worldwide. There are many challenges in the current antibiotic funding landscape. The expected returns and associated risks mean that antimicrobials are not competitive with other therapeutic areas. Innovative new antibiotics often have a low price, because society expects antibiotics to be available easily and to be economical, but that low price means that it is not in the interests of the pharmaceutical companies to go ahead and develop new antibiotics. We need to think about that. No new category of anti-TB drug has entered the standard treatment list since 1967—in 50 years—because although TB does occur in major cities around the world, it is still a poor-country disease and there is no economic incentive to provide new treatments. We should be pushing on that from a moral point of view, though, because there is a moral incentive.

When talking about development, we should not underestimate the effects of Brexit. As a couple of hon. Members, particularly the hon. Member for Stafford (Jeremy Lefroy), have said, the EU nationals who work in research and development in the UK’s world-leading centres must have their ability to remain here guaranteed. A large percentage of the staff at the University of Glasgow’s Centre for Virus Research, which is in not my constituency but that of my hon. Friend the Member for Glasgow North (Patrick Grady), are EU nationals—postgraduate and postdoctorate researchers who are doing outstanding work in the field and advancing our knowledge and ability to treat disease.

I thank my hon. Friend for giving way again. I had the huge pleasure of visiting the Centre for Virus Research in my constituency just a couple of weeks ago. The staff there undertake world-leading work, so the point she is making about our need to continue to attract the best talent from the European Union is vital. She mentioned the moral case; does she agree that it is also vital that the funds, particularly those that come through the Government’s commitment to the 0.7% aid target, are still available for research? I hope that when the Minister responds, he will be able to reinforce the Government’s commitment to that 0.7% target, unlike some of his colleagues earlier today.

I very much agree on the 0.7% target. That figure for aid is as important to tackling infectious diseases as guarantees for the EU nationals who are fighting infectious diseases worldwide.

I welcome the opportunity to reply to this debate on behalf of the Opposition. The debate was secured by my hon. Friend the Member for Ealing, Southall (Mr Sharma). I congratulate him and the hon. Member for Stafford (Jeremy Lefroy) on their excellent work in this area. I declare an interest: my partner works in the NHS and higher education sector in research and diagnosis of neglected tropical diseases.

I will begin by addressing the Department for International Development’s capacity for research and development to tackle infectious diseases, before turning to some of the international opportunities that lie ahead. The Labour party has a proud history of supporting international development. It created DFID and worked to bring development issues up the political agenda. We supported the Bill that enshrined our commitment to spending 0.7% of our gross national income on official development assistance, and I am pleased that, to date, the Government have adhered to that.

Earlier this month, Government figures projected that health would be the biggest spend of ODA over 2017 and 2018. That is the correct thing to do, as health is a public good and a building block of sustainable democracies and strong economies that work for all. As my hon. Friend the Member for Ealing, Southall, said, infectious diseases such as HIV, TB, malaria and neglected tropical diseases are all related to poverty and are often associated with stigma. Tackling them should be at the heart of our investment in global health. After all, the primary aim of ODA is poverty reduction.

Infectious diseases do not respect borders. In our increasingly globalised world, we must take steps, domestically and internationally, to address epidemics of infectious disease. That makes sense in the interests of global health security, too. Within the commitment to spend 0.7%, the Government have pledged to spend around 3% of the total on research and development. In last October’s DFID research review, it was stated that this commitment, together with cross-Government investment in the Ross fund, would equate to £390 million over four years.

The Secretary of State has identified tackling infectious disease as one of the global challenges that her Department aims to address, but this challenge requires not only revenue investments in healthcare programmes, but sustained investment in research and development to ensure that we have the right tools to take on the fight.

We have heard today about the inadequacy of current treatments, diagnostics and prevention strategies, and we are certainly not on course to meet the third global goal for sustainable development—to end epidemics of the major global infectious diseases by 2030. It specifically highlights the threat of HIV, TB, malaria and the neglected tropical diseases.

I have four questions for the Minister. First, will the Minister provide the House with a breakdown of resources allocated to infectious disease research and development? I hope that he will give us some figures today. The Ross fund, which is the £1 billion portfolio of investments mentioned in today’s debate and announced in 2016, is jointly administered by DFID and the Department of Health. The fund was established to invest in research and development

“for drugs, vaccines, diagnostics and treatments to combat the most serious infectious diseases in developing countries”.

That Government commitment is correct, but there has been a lack of transparency on how exactly the fund is to be allocated, and as of last night, the website portal was still not live, and we are well into 2017.

Secondly, will the Minister provide the House with details of how the fund will be used to achieve its aim of combating the world’s deadliest infectious diseases, namely HIV, TB and malaria? We want the details.

Members have mentioned product development partnerships, of which DFID has been a long-standing supporter under Governments of different political persuasions. These not-for-profit partnerships have proved to be a useful vehicle for bolstering DFID’s research capacity; for gaining an understanding of the epidemics in communities most at risk; and for building research capacity in developing countries. With that in mind, may I pose my third question to the Minister? Can he reassure the House that DFID will continue to support product development partnerships and show the international leadership required to bring other donors back to the table and ensure that our investments to date are not lost? If my research is correct, we have lost some other donors to the programme. The question from the Labour Benches is: what are the Government doing to regain the leadership on that crucial question?

A vaccine for malaria has completed clinical trials and is due to be piloted in sub-Saharan Africa soon, but HIV is as yet without a vaccine, and although we might think that we are adequately protected from tuberculosis by our BCG—bacillus Calmette-Guérin—that vaccine actually dates back to the 1920s and is only moderately effective in preventing TB in young children, and it does not adequately protect adolescents and adults. We know that many people who begin courses of TB treatment in third-world countries do not complete them because of the cost. My fourth and final question is therefore this: will the Minister confirm that DFID will continue to support vaccine development in particular?

Let me turn to opportunities for international collaboration. Members have mentioned access to medicines. The recent report by the UN Secretary-General’s high-level panel called for the cost of research and development to be delinked from the price charged for medicines, and for pharmaceutical companies to reveal the details of their spending on research and development, marketing and drug promotion. That added layer of transparency would help to ensure fairness in drug pricing and assist international agencies more effectively to support drug and vaccine deployment in countries where they are needed.

The final, and perhaps most pertinent, issue that I wish to raise is drug resistance. We have talked at length about antimicrobial resistance, so I will not repeat what other Members have said. I hope that the Minister will speak about Lord O’Neill’s report and his response to it.

In conclusion, my hon. Friend the Member for Ealing, Southall began today’s excellent debate by talking about the failure to address a number of these issues—not just antimicrobial resistance but TB, malaria and other tropical diseases. We have heard about the excellent work done by our all-party parliamentary groups. We have heard the commitment, at least across the Back Benches, to the 0.7% commitment on overseas development aid. I can certainly give an assurance on behalf of the Labour party on that front. I look forward to hearing the Minister respond to my four questions and share his knowledge—if he has any yet—of the manifesto commitment that his party will be putting forward in a few short weeks.

What a pleasure it is to speak in this debate. Given recent announcements and national events, it is perhaps the last opportunity I will have to speak in a debate in my current role in the Department for International Development. Whatever happens, my interest in this work will certainly continue, even if my work itself does not, although of course I would like it to continue—it is hardly necessary for me to put that on the record. But it is subject to the will of the people and we will see what takes place.

In that context, let me start by recognising the tone of the debate and the approach taken by so many colleagues of different political persuasions, representing different parties and different parts of our country, to this important subject, and indeed to the range of issues that the Department covers. I have infrequently known an area of policy that has brought together so many people who care passionately about such important global issues, or about which there is so little disagreement or division across party lines. It stands as a testament to the sort of politics that many members of the public wish could be demonstrated more often, with Members bringing forward issues they care about in a constructive way, engaging with Ministers and getting a response that I hope they feel is equally constructive, because together we can make a difference to the lives of countless millions of people in some of the world’s poorest countries facing some of the world’s most challenging circumstances.

I was reminded of that not just this afternoon while listening to the contributions of hon. Members, but earlier this morning when I received a picture message from my sister, who this morning gave birth to Joy Megan Fiske, my new niece, at 10.54 am in North Tees hospital, which is just outside my constituency. It reminded me how lucky we are to have such a good health service, to have it on our doorsteps, and to have all the advantages that living in this society brings. It stands in stark contrast to what I sometimes see when I travel in my ministerial role, given the challenges we have heard so much about today, and with which hon. Members are rightly concerned. Many people across the world do not have the safety and the advantages that we have, and they are, sadly, affected by many different challenges, one of the most significant of which is the topic of this debate: infectious diseases.

The scale of the challenge the global community faces is extraordinarily significant. In 2015, 10.4 million people fell ill with TB, and there were 1.4 million deaths. There were 212 million cases of malaria, with over 400,000 deaths. Some 2 million people were infected with HIV, and there were around 37 million people living with HIV and an estimated 1.1 million deaths from AIDS-related diseases. Neglected tropical diseases—a subject on which my hon. Friend the Member for Stafford (Jeremy Lefroy), like others, has been a passionate advocate and on which he spoke with great knowledge—affected 1.6 billion of the world’s poorest people, causing disability, disfigurement and stigma, with an estimated 170,000 deaths.

As hon. Members recognised—they spoke about this in some detail—the situation is exacerbated by the global health threat of antimicrobial resistance, which is as real a threat to us here in the UK as it is to so many millions across the world. Antimicrobial resistance will lead to the greater spread of infections, longer illnesses, higher mortality, increased costs and greater economic impact from infectious diseases. It is a global challenge, and we all have a role in tackling it and an obligation to do so.

On that note, I would particularly like to congratulate the hon. Member for Ealing, Southall (Mr Sharma), who has done sterling work in this area. I have enjoyed attending all-party group meetings with him, and I have enjoyed the constructive relationship we have had. He spoke with a great depth of knowledge and understanding about the scale of the challenges we face and about the need to continually develop and innovate and to ensure we do everything we can to find the solutions of the future. He spoke of his concerns about antimicrobial resistance, and he referred to a meeting he and I recently attended at which that very issue was explored at some length, particularly in the context of TB.

I also congratulate my hon. Friend the Member for Stafford, although he has had to leave the Chamber for reasons that are perhaps related to other commitments. He has been a passionate advocate on these issues. He has been an excellent Member of Parliament, not just for his constituency but in terms of the topics he has pursued. He has been a great help to me in my role, as I try to take forward the portfolio for which I am responsible in DFID. He is a global leader in this area; he knows a great deal about that about which he speaks, and it is always a pleasure to listen to him.

Similarly, the sterling work of my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) on the Select Committee is always helpful and constructive, if sometimes a little challenging—but, then, that is what she is there to do. That work makes a real difference in helping the Department to shape policies in the spirit of the cross-party co-operation I spoke about earlier and to ensure that we get the maximum value and benefit from the money we spend. That is incredibly important as we continue to make the case for a global Britain and for the work we do to help some of the world’s poorest. That work makes a real contribution, and I congratulate my hon. Friend and look forward to working with her in the future.

I also congratulate, and recognise the comments of, my hon. Friend the Member for Salisbury (John Glen). As ever, he was a passionate advocate for his constituency. He was able effortlessly—or at least with the appearance of effortless delivery—to weave constituency interests into an international debate, and he made some very good and valid points about ensuring that we use the assets we have to the best and maximum effect and utility to make a difference to some of the world’s poorest and to retain our position as world leader in some of the areas of research about which he spoke. I thank him for his contribution, which was useful, and I look forward to continuing our discussions after the next seven weeks are over.

I also recognise the comments of the hon. Member for Glasgow North West (Carol Monaghan), I thank her for her contribution. She spoke with great knowledge and insight about a wide range of topics, many of which hon. Members have taken an interest in over months, if not years, in this Parliament, and I am sure they will take an interest in them into the future. I hope to touch on many of those issues as I make my specific comments about some of the issues that have been raised in the debate.

Finally, I thank the hon. Member for Hornsey and Wood Green (Catherine West) who again demonstrated an understanding of the importance of the matters we are here to discuss. As always, she asked questions that were carefully calibrated to elicit the most helpful, useful and constructive responses. I always endeavour to respond to questions, even where I cannot answer them, and I will of course try to respond in my comments to some of the issues she raised.

Several Members have asked about the future commitment to the 0.7% aid budget target. As the Minister has said, the 2015 legislation was passed on the basis of cross-party consensus. Does he share my hope that that cross-party consensus continues into the next election and that all parties’ manifestos will contain a commitment to the 0.7% target?

The hon. Gentleman knows very well that I am delighted to see cross-party consensus on any policy that the Government—whoever they may be, although I rather hope they will be of my party political colour following the next seven weeks of campaigning—might look to bring forward. I hope and trust that there will be cross-party consensus because I am sure that we will be doing the right thing.

Let me remind the House—not that it needs reminding—of the significant record of achievement and work in this area that we have demonstrated collectively in the UK over recent years. The UK pledged £1.1 billion towards the fifth replenishment of the global fund, including a commitment to double private sector contributions to tackling malaria up to a maximum of £200 million, making a real difference in key areas that affect the lives of countless millions of people—I mentioned the huge numbers of individuals affected. The UK is one of the leading nations in tackling some of the diseases that have the most devastating effect on some of the world’s poorest.

The UK will continue to use its position as one of the world’s leading aid donors to challenge, change and reform the aid system, with our pledge to secure a demanding new £90 million performance agreement designed to push the already high-performing global fund to deliver even more. We do not just contribute to these organisations and make a difference through the money that we spend; we push them to reform and to be efficient, and we offer and share with them our expertise. That is something of which we should all be proud.

In November 2016, the Department for International Development launched its first ever research review highlighting Britain’s global leadership in this field. The review set out how the UK will focus 3% of its budget per year over the next four years on research and innovation to help address the great global challenges of the 21st century. That 3% of our budget will be invested in high-quality, high-impact research. In addition, we will invest £357 million to fund research into infectious diseases through the Ross fund portfolio. This means that we are spending over £1.5 billion on research over the next four years, cementing and reinforcing the UK’s place as a leading country in this field and delivering real change in some of the areas that hon. Members spoke about. UK-funded research is saving lives and changing lives all over the world. We have supported fast new tests for detecting tuberculosis, child-friendly malaria drugs now used in more than 50 countries, and a new rotavirus vaccine for preventing life-threatening diarrhoeal disease in infants. We are making a real difference to people who need this support most.

We are also a leader in neglected tropical diseases, which a number of hon. Members commented on. This week marked the fifth anniversary of the landmark London summit on NTDs and the high-level summit on NTDs in Geneva. At that summit, the UK made a clear commitment to continued investment that is both ambitious and focused on outcomes. We will invest £360 million in implementation programmes to treat and eliminate neglected tropical diseases between 2017-18 and 2021-22. That funding will provide 1 billion treatments for people in developing countries. We have played a leading role in tackling NTDs through our commitment to UK aid, through our leading NGOs, through our pharmaceutical companies’ generous donations, and through our world-class universities and researchers all working together. Since 2009, UK aid—working, for example, with GlaxoSmithKline and the Liverpool School of Tropical Medicine—has provided 217 million people with treatment against lymphatic filariasis. I apologise for my pronunciation; despite my mother’s best intentions and desires, I did not make it to medical school. However, I do recognise the impact that much of this can have.

This week the UK also announced that we are investing in pioneering research to drive the development of drugs and diagnostics against neglected tropical diseases, including £48 million for the Drugs for NTDs initiative, £30 million for the Foundation for Innovative New Diagnostics, and £10 million for the Coalition for Operational Research on NTDs. That is making a difference.

Bill Gates said this week:

“UK aid and Britain’s world-leading research institutions are playing a major role in protecting the world’s poorest people from neglected tropical diseases and enabling them to live healthier, more prosperous lives…With our foundation, I am proud to partner with the UK on global health”.

The UK is leading on AMR, NTDs and global health challenges. We are making a real difference and all hon. Members should be proud of that.

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.


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