International Development (Official Development Assistance Target) Bill (Money)

Andrew George Excerpts

Monday 3rd November 2014 Commons Chamber

[Andrew George (St Ives) (LD)]

I entirely endorse this motion, but as the Minister said a moment ago, its purpose is to give effect to the clearly expressed will of the House. The House also clearly expressed its will on 5 September when we debated the Affordable Homes Bill. I do not understand why the Government are not bringing forward a money resolution for Bill No. 1.

[Mr Swayne]

rose—

Global Health (Research and Development)

Andrew George Excerpts

Tuesday 8th July 2014 Westminster Hall

[Mr Gary Streeter (in the Chair)]

Before I call Mr George to introduce this important debate, I should point out that seven colleagues have expressed a wish to catch my eye, and that will be during a period of 50 minutes. If Back Benchers, not including Mr George, can restrict themselves to seven minutes each, that will give the shadow Minister and the Minister enough time to wind up the debate.

[Andrew George (St Ives) (LD)]

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

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

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

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

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

An estimated 13.7 million people die every year from, or in connection with, a group of diseases known as poverty-related and neglected diseases. Those include TB, HIV, malaria, dengue, yellow fever and others.

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

In addition, as the diseases I have mentioned primarily affect poor people, there is often no financial market to incentivise commercial sector pharmaceutical development. Accordingly, very few new products, whether they be new drugs, new diagnostics or new treatments, are developed. There is therefore a market failure in the development of drugs, diagnostics and vaccines for diseases that predominantly have an impact on low and middle-income countries. Although pharmaceutical companies will be developing the Viagras of this world for the west, it seems that crucial drugs that would save millions of lives in the developing world are very difficult to advance at all. That market failure is similar to the failure of the commercial sector to develop new antibiotics. Again, that is because there is insufficient financial return on offer for such products.

In the absence of the commercial sector, public and philanthropic organisations attempt to fill the gap, but progress is slow. There are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. There is a wider concern. The World Health Organisation, in its report in April, identified—rightly, I think—the serious risk of antimicrobial resistance as a very significant challenge for the world in the coming years.

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

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

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

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

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

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

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

Will my hon. Friend give way?

[Andrew George]

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

[Mr O'Brien]

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

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

[Andrew George]

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

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

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

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

--- Later in debate ---

[The Minister of State, Department for International Development (Mr Alan Duncan)]

I thank the hon. Member for St Ives (Andrew George) for securing this important debate—indeed, I thank all those who have contributed this afternoon. Thanks to the right hon. Member for Holborn and St Pancras (Frank Dobson), it looks as if the Chilcot inquiry will have to make a study of infected chickens.

I also thank and commend the hon. Member for St Ives, and the rest of the all-party group on global tuberculosis, for the publication of a thorough report. We all appreciate the group’s tireless work in keeping our collective focus on global health—particularly research and development, which we are discussing today. As I am sure the group will appreciate, as the report was made available to us only last night, I have not had a chance to read it in detail. However, an initial scan shows that there is much in it that we welcome.

The report seeks to answer two fundamental questions: why are diseases of the global poor so badly neglected in research efforts, and what potential solutions are available to unlock the puzzle? Following a cursory reading, I am delighted to say that the Department for International Development is widely praised for our commitment to research and development in global health, and I am also pleased to learn that our willingness to provide flexible and untied support is particularly valued. The Department will consider the report and its recommendations during the next few weeks. However, let me now say just a few words about how DFID’s approach to research and development will proceed more broadly.

In the last two decades, tremendous progress has been made in improving the health, and preventing the deaths, of those living in poverty around the world, particularly women and children. For instance, between 1990 and 2011 the mortality rate among children under five fell from 84 deaths to 53 deaths per 1,000 live births, which is a very positive and encouraging statistic. In fact, as was recently reported in The Economist, it is an astonishing result.

Africa is currently seeing some of the fastest falls in child mortality ever seen anywhere, and one of the ways in which the UK has contributed is through its outstanding research. UK Government funding and UK scientists have contributed to the development of long-lasting, insecticide-treated bed nets, which were mentioned a moment ago, and new diagnostic tests and drugs for malaria. However, the progress has not been evenly spread; more than 7 million women and children still die every year, many of them during pregnancy and birth, and the great majority from easily treatable or preventable conditions.

We need to do three things in our research for health: to develop new technologies, such as drugs, vaccines and diagnostic tests; to test them through trials; and to keep abreast of growing medical challenges such as drug resistance, which has been mentioned this afternoon. I assure the House, including all Members here today, that DFID is funding research in all those areas.

Let me highlight a few examples of what we have been doing recently. The first area of our work is about developing new technology. We know what the problem is, but we lack the technology sometimes required to fix it, so research is required to create innovative solutions. For instance, DFID support has helped the Foundation for Innovative New Diagnostics to develop GeneXpert, which my hon. Friend the Member for South Derbyshire (Heather Wheeler) mentioned earlier. GeneXpert is a new diagnostic test for tuberculosis that gives fast and accurate results. She said the results come within two hours; I might say within four hours—if we split the difference, the test is quick and that is what matters. Importantly, it also identifies drug resistance. The test is revolutionising the care and treatment of those suffering from this appalling disease.

Another example is that DFID supported the drugs for neglected diseases initiative to develop a new safer drug for sleeping sickness—one of the world’s worst diseases. The old drug, implicitly referred to by the right hon. Member for Neath (Mr Hain), was highly toxic, killing around 5% of those treated. The new drug, which is now available in 90% of the places where sleeping sickness exists, is a better drug that reaches more people.

Both those examples also demonstrate the importance of securing private sector support through product development partnerships, which hon. Members mentioned. These partnerships act like virtual pharmaceutical companies, where a small, central group of staff co- ordinates the development of new drugs and technologies, drawing on the strengths of academia and industry. The UK is a leading investor in PDPs—with the Gates Foundation, for instance—and we continue to champion their role in global health research and development.

Let me turn to some questions that I spotted being put to me in a co-ordinated way. I have to say, in all honesty, that lifting our research expenditure up to 5% of our budget is unlikely within the competing claims of a tight resource allocation round for the next three years. If one added up the many requests made to us to meet certain percentages for various causes, one would soon find that they are close to, or perhaps even beyond, 100% of our total budget. We have to be honest and should not pretend that we can meet the 10% here and the 5% there, or the nought point this or that everywhere else. We will, within the 0.7% to which we do adhere, try to apportion our budgets rationally and openly.

I hear what was said about tax credits, but hon. Members will appreciate that those are primarily a matter for the Department for Business, Innovation and Skills and the Treasury. On collective action, we agree that better co-ordination should almost invariably be welcomed and pursued.

The second area of our work concerns using research to test new ways of doing things, including through the use of clinical trials. Much of what is done in international development has not yet been properly tested by rigorous methods. The fact that many experts agree that an intervention should work does not necessarily mean that it will. Proper trials allow us to do new things, but they also allow us to call a halt to old, costly and sometimes dangerous things.

DFID helped fund research in Kenya recently on the treatment of children with severe infections, including malaria. While accepted medical wisdom suggested that one should rapidly increase fluids in children affected by these diseases, research showed that that course of treatment was actually detrimental to the health of the children and, in some cases, resulted in death.

Similarly, in Uganda, research has shown that the accepted practice of using expensive tests to monitor the progression of HIV in patients simply did not work. By stopping the tests, a third of the normal cost of treating someone with HIV can be saved, with no impact on mortality. That means that for the same amount of money, the Ugandan Government can effectively treat a third more people with HIV. That is all down to effective research. DFID is currently supporting more than 40 clinical trials under the joint global health trials initiative, in partnership with the Medical Research Council and the Wellcome Trust. We are funding new trials in TB, HIV and malaria, as well as other poverty-related neglected diseases.

There is a slight misconception that we do not fund UK research directly. We will fund the best research wherever it is located, through global, fair and open competition. However, as it happens, the largest proportion of DFID research contracts are won by UK institutions.

The Department is also breaking new ground in testing public health interventions in humanitarian crises—for example, through its partnership with the Wellcome Trust and Save the Children in the research for health in humanitarian crises project. This innovative partnership enables high quality health research to be carried out rapidly as acute emergencies unfold.

[Andrew George]

The Minister originally discounted the possibility of looking at the notional cap on research and development within DFID’s budget, but at the same time he has announced the doubling of economic development assistance to £1.8 billion. Given that we are talking about market failure, will he consider that budget as a route by which his Department can engage with the private sector, to enable further research and development that will achieve both the research and development gains and the economic development goals that his Department is seeking?

[Mr Duncan]

There is a lot that is constructive in what the hon. Gentleman has suggested. Whereas the money might not go into long-term research, there can certainly be work with private companies along the partnership lines that we already have, perhaps to extend activity in areas such as these. We are open-minded about the nature of the economic development activity that will emerge from this new approach—this refreshed emphasis—in private sector development, and I am pretty confident it does not rule out proposals such as the hon. Gentleman’s.

Oral Answers to Questions

Andrew George Excerpts

Wednesday 5th March 2014 Commons Chamber

[Justine Greening]

The hon. Gentleman will know that the Prime Minister co-chaired the high level panel that did a huge amount of work in that area and produced what could be a draft framework. It had much more focus on women and girls, and significantly develops the original MDG on gender equality. We will fight to make sure that we get as many specific targets on women’s rights and participation as we can.

[Andrew George (St Ives) (LD)]

T3. HIV and tuberculosis co-infection is a priority for action for the Government. Ministers will be aware of the 12 World Health Organisation recommended collaborative TB-HIV activities, but will they ensure that these are systematically integrated into all DFID HIV programmes in countries with high burdens of both HIV and TB?

[Justine Greening]

Yes, we can make sure that over time we integrate all those guidelines into our programme, and it is a key priority for us to make sure systematically that we do so.

Tuberculosis

Andrew George Excerpts

Wednesday 27th November 2013 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

Let me start in the past. In 1821, Maria Brontë died of consumption. Two of her daughters died of the disease in infancy and her four older children—Bramwell and his famous sisters, Anne, Emily and Charlotte—also died of it. According to the history books, they became

“ill from dampness and terrible living conditions”.

Consumption, or tuberculosis, is a disease that many people believe belongs to the past. Nothing could be further from the truth. TB kills more people in the world today than any other infectious disease. Every day, 3,800 people die from it. Sunday is world AIDS day, so it is worth remembering that TB is the leading killer of people living with HIV. At least one third of the 35.3 million people living with HIV worldwide are infected with latent TB. People co-infected with TB and HIV are about 30 times more likely to develop active TB disease than people without HIV. Given the devastating synergy that exists between the two infections and the impact that they have on people living in the developing world, it is absolutely vital that resources are stepped up now so that we not only effectively tackle TB-HIV co-infection but ensure that the health-related millennium development goals are achieved. The Department for International Development is about to launch its policy review paper on HIV/AIDS. I hope that it will make clear the importance of linking the approaches to TB and HIV, and that it will have clear commitments to tackle those diseases.

In the UK, we can be tempted to believe that TB no longer poses a threat to public health. There is a widespread belief that the BCG vaccine is effective and that today TB only affects other countries. However, in a connected world of global travel, TB is never far away. That came home to me forcibly when an English student returned from foreign travel with the disease and subsequently infected other students attending the college of which I was principal. Students and staff found dealing with the anti-TB drugs to be an ordeal. For a standard, non-drug-resistant case, the treatment regime can require a six-month course of a cocktail of four drugs. Those “front-line” drugs are more than 40 years old now and have unpleasant side-effects. It was a challenge for me as college principal, working with the local NHS, to get people to take the drugs they had to take. It must be an even bigger challenge to help patients in the developing world who not have access to the type of care and support offered by the NHS.

The stigma attached to the disease here was a barrier to patients accessing treatment. In sub-Saharan Africa, the stigma is even greater. Dr Simon Blankley, a Voluntary Services Overseas chest physician working in Uganda, reported that patients could often be locked away in cupboards or forced to leave their villages, and that health care workers were worried for their own health when TB patients were admitted to wards. TB needs to be tackled in a sustainable way that reassures people and builds community resilience. Dr Blankley was able to use a team of VSO volunteers to provide education and reassurance, and to get TB patients in and around Kampala to complete their eight-month course of treatment. The team’s work drastically increased completion rates. He then expanded the work, adding work on TB to the community health education that was already in place. That sustainable approach can be replicated elsewhere.

Dr Mario Raviglione, director of the global TB programme at the World Health Organisation, said just last month, when he launched the WHO’s global TB report in partnership with the all-party group on global tuberculosis, that

“at the current rate of progress, we will not be rid of TB for over a century.”

The efforts of the global health fund and its partners have made fantastic progress against TB, HIV and malaria, and the Government are to be applauded for their recent pledge of up to £l billion for the fund. However, we need absolute urgency, unremitting determination and co-ordinated effort to tackle TB.

[Andrew George (St Ives) (LD)]

I congratulate the hon. Gentleman on securing this debate. I also warmly applaud the Government on the contribution and the commitment that they have made to the global health fund, which continues the work of the previous Government.

The hon. Gentleman mentioned the HIV position paper, which in fact was published only moments ago. He may be disappointed to note that the Government appear not to be putting quite as much emphasis on ensuring that they make the connection between HIV and TB. Will he insist that the Government continue a commitment to TB REACH and other programmes that address that serious problem?

[Jim Dobbin (in the Chair)]

Order. I suggest that when we have interventions, they are short.

--- Later in debate ---

[Nick Herbert]

The hon. Gentleman raises an interesting point. The starting position has been that we need the means to diagnose this disease.

Let us face up to the fact that if the resurgence of this disease had been in the west, it would already have been tackled by now. The pharmaceutical companies would have had a commercial interest in developing better diagnostics and tools, better drugs and, indeed, a vaccine. Another common misconception is that a vaccine is available to deal with TB, but only the BCG vaccine exists, and that is generally ineffective for most forms of TB and works for children for a limited time. Had this disease resurged in the west, by now we would already have these things, but we do not, because the drug companies did not have a commercial interest in developing them, essentially because the disease was found in developing countries without the economies or the wherewithal to pay for these new tools.

There can be no better example of the necessity for intervention by wealthy western Governments, who have the resources to ensure that such a disease can be tackled, not just in the interests of ensuring that lives can be saved—there is a profound moral reason to tackle this anyway—but in the west’s interests in securing the economic development of high-burden countries that are afflicted with this disease, which is a tremendous brake on economic development. Of course, TB is a disease that knows no borders, and with migration, and so on, we face the prospect of it resurging in our country. We have higher rates of TB in this country now—although they are low by comparison with high-burden countries in the rest of the world—than in the rest of Europe. We have failed to reduce rates in the past 10 years, as compared with the United States, for example, which has got on top of the problem. This is a pressing public health issue in this country.

There are lots of reasons for western Governments to be concerned about this issue. Therefore, I strongly endorse what my hon. Friend the Member for St Ives (Andrew George) said about the UK Government’s recent commitment, which has not been sufficiently noticed, to replenish the global health fund. That is a fantastic commitment, not just because of the absolute sums pledged to the global health fund—which is an effective means of tackling TB and is responsible for 80% of the funding for TB programmes across the world—but because it sends a powerful message, ahead of the replenishment summit next Monday, to other potential donor countries about the value of stepping up our efforts at this time.

The west faces a choice. We have the opportunity, with the potential emergence of new treatments, diagnostics, and so on, to get on top of this disease. If we relax our efforts and fall victim to the idea that, at a time of austerity, the west might pull back from some commitments that it is making, our efforts to tackle TB would go into reverse. This is an important moment to step up to the plate. Britain has done so admirably. I commend the work of the Secretary of State for International Development and Ministers in making that commitment, and I encourage other countries to do the same.

[Andrew George]

Again, I congratulate the Government on their efforts regarding the global health fund, which sets the tone, but is my right hon. Friend and co-chair of the all-party group aware that just before this debate the Government published the HIV position paper, which appears to suggest that the UK’s contribution to eradicating TB can largely be delivered through the global health fund, whereas for HIV it can also be delivered by a significant strategy pursued by the Department?

[Nick Herbert]

I hope the Minister has noted my hon. Friend’s point, because TB control programmes rely on funding from the global health fund. We need to send that message to the global health fund as it determines resource allocations and to other countries as they consider replenishing their support.

My final point is that although the Government’s support for the global health fund is welcome, it is important to understand that that is not the only thing we need to do if we are to get on top of TB globally. Setting aside the action that needs to be taken domestically—Health Ministers are making progress on what needs to be done through a TB control programme—we cannot rely on the generous commitment to the global health fund for the international effort that is needed.

I want to raise the cause of an important programme run by the Stop TB Partnership called TB REACH, which addresses the problem of the missing 3 million cases to which the hon. Member for Scunthorpe referred. Until we find those who are affected by TB, we have no chance of treating them or getting hold of the disease. The power of TB REACH is that it funds innovative programmes on the ground that are finding new ways to go out and identify the missing 3 million cases. TB REACH has been robustly evaluated and shown to deliver value for money. It is relatively cost-effective, but its funding is coming to an end. TB REACH was largely set up with funding from the Canadian Government and now does not have sufficient funding to identify all the necessary cases. TB REACH has helped to identify some 500,000 cases in the past year, and it needs to do more. If we are serious about the level of the challenge we face, it would be worth while for the Government to seriously consider contributing to the ongoing work of TB REACH to ensure that the programme can survive.

Oral Answers to Questions

Andrew George Excerpts

Wednesday 17th July 2013 Commons Chamber

[The Prime Minister]

The right hon. Gentleman speaks as a member of Unite and someone who receives £6,000 for his constituency party. Adrian Beecroft produced an excellent report on encouraging enterprise, jobs and wealth creation. Let me explain the big difference one more time. The trade unions that give money to the Labour party can pick the candidates and vote for them, pick the leader and vote for him, and pick the policies and vote for them. I was elected by a one member, one vote system; the leader of the Labour party was elected by a trade union stitch-up.

[Andrew George (St Ives) (LD)]

Any Government should of course be able to introduce a reasonable cap on very high claims for taxpayer-funded benefits. However, if we are all in it together, why are the Government resisting the introduction of a cap on the taxpayer-funded benefits amounting to hundreds of thousands of pounds and, in some individual cases, more than £1 million that go to the largest and wealthiest landowners in the country through the farm support system?

[The Prime Minister]

This Government have done a huge amount on tax reform to ensure that people pay the taxes they owe. Of course, we always look at the common agricultural policy to make sure that it is fair.

Drug-resistant Tuberculosis (Developing Countries)

Andrew George Excerpts

Tuesday 4th June 2013 Westminster Hall

[Jim Fitzpatrick]

I agree with the hon. Gentleman, and I am sure that the Minister will repeat that agreement on the positive outcomes that result from appropriate treatment.

First, the report recommends that we strengthen the global fund by doubling the UK’s contribution. International donor funding, including the majority of the UK’s response to TB in developing countries, comes almost entirely through the global fund. In 22 high-TB-burden countries, six are totally reliant on the fund and in another 15 it accounts for two thirds of their budget. To scale up access and treatment for DR-TB, which remain woefully low, the resources the global fund has at its disposal need to increase. The Government have a key role to play in the replenishment of the fund, having been a key driving force behind the recent reforms it undertook. I commend the Government for that policy. What are their thoughts on our contribution to the fund to address the threat of TB and DR-TB? A lead from the UK should happen as soon as possible, to help leverage more from other donor Governments in this important replenishment year.

Secondly, the report recommends investment in innovation through TB REACH and continued investment in research and development. The Government have already shown leadership in support of developing new, badly needed tools to tackle TB—a policy of successive Governments that I hope will continue. Some of those tools have come to market, specifically new rapid diagnostics, but despite that, 3 million people each year still fail to access diagnosis and treatment for TB, which includes a large portion of people with drug-resistant strains. We need to accelerate our efforts to diagnose TB by rolling out new technologies, and it is clear that we need to think outside the box. TB REACH is one way to do that.

As the Minister knows, TB REACH is a Stop TB Partnership-hosted initiative that gives small grants of up to $1 million to find and treat those who do not have access to TB diagnosis or treatment. It is an incubator for innovation and pushes the frontiers of technology. It works closely with DFID-funded UNITAID. In short, TB REACH goes where others cannot and shows Governments and donors how to reach the unreachable. Critically, it often demonstrates with data what projects could be scaled up. The Minister may wish to express a view on whether she agrees with that assessment. Beyond their contribution of core funding to the Stop TB Partnership, which does not cover TB REACH, I ask that the Government become a donor to TB REACH, to maximise their investments in UNITAID and support the expansion of new diagnostic tools to detect and ultimately treat cases of TB, in addition to the work of the global fund. The funding allocated should be directed by the evaluation of the Stop TB Partnership later this year. I will be interested to hear her view on that recommendation.

Thirdly and finally, I want to mention a national strategy for TB in the UK and the importance of a global target within that. A national strategy for TB has never been developed, despite the public health risk the disease presents. The UK has seen rising rates of TB since the 1980s and DR-TB increased by 26% in the past year alone. I welcome that the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) indicated that her Department is supporting Public Health England to develop a strategy. I bumped into her before the Division and thanked her for her leadership on the matter, in which I have a constituency as well as a personal interest. I was recently invited to a seminar, organised by the Barts and Royal London TB unit, by Dr Veronica White, the consultant in respiratory medicine. Unsurprisingly, it is the biggest TB team in the UK and does sterling work locally and nationally.

With all that in mind and given the clear link between global and UK rates, will the Government set a specific target on their contribution internationally to tackling DR-TB as part of a comprehensive TB strategy, led by Public Health England?

[Andrew George (St Ives) (LD)]

I thank the hon. Gentleman for highlighting the all-party group on global tuberculosis, which it is my privilege to chair—I am not paid. Not only does the work on TB help to deliver the Government’s international development objectives, but it is also in Britain’s interest to get it right.

[Jim Fitzpatrick]

The hon. Gentleman makes a critical connection between our national interest and the international case, which the Minister and her team acknowledge. I am grateful that she is here. I look forward to her response. I thank her and her officials for the excellent work that they have been doing on this subject. I know that members of the all-party group are also grateful for the engagement that she and her team have had with them, and we look forward to it continuing.

HIV (Developing Countries)

Andrew George Excerpts

Wednesday 19th December 2012 Westminster Hall

[Pauline Latham (Mid Derbyshire) (Con)]

It is a particular pleasure to serve under your chairmanship today, Mr Bayley, because this debate is probably of more interest to you than many debates you have to chair, given your membership of the Select Committee on International Development.

I thank Mr Speaker for selecting this important debate on the rights, risks to and health of HIV patients in developing countries. I also thank the Under-Secretary of State for International Development, the hon. Member for Hornsey and Wood Green (Lynne Featherstone), for attending, and I hope she has fully recovered from her recent illness. Before I start—as this would not be appropriate at the end—I wish everyone a happy Christmas and a peaceful new year.

The Global Commission on HIV and the Law, chaired by the former President of Brazil, recently published a report the findings of which are the reason why I wanted to secure this debate. If there is just one point that I want everyone to take away with them today, it is this quote from the commission’s chairman:

“The end of the global AIDS epidemic is within our reach.”

We have the unprecedented opportunity of a generation to have a world where no one dies of AIDS-related illnesses or newly acquires HIV. It is now a realistic ambition to imagine an HIV-free generation.

Some three decades ago, the HIV epidemic was first discovered. Since then, 30 million have died of AIDS, and 34 million more have been infected with HIV. The epidemic became one of the greatest public health challenges of our time. However, as the report makes clear, the crisis is also one of law, human rights and social justice. We are now fortunate enough to live in an age where we have all the research and tools to slow radically the rate of new HIV infections and stop HIV-related deaths, but the AIDS epidemic is not over. This time, it is not nature that is getting in our way of achieving success; this time, we are the problem. Bad laws, political obstacles and straightforward discrimination are preventing us from combating one of the greatest challenges ever to face humankind. We, as members of the human race, are standing in the way of ourselves.

Before I go on, it is important to praise United Kingdom Governments over the past 30 years—Conservative, Labour and now the coalition—for their work and for being global leaders in the response to HIV for much of the past 30 years. Tribute should be paid to Lord Fowler, who, as Health Secretary, opened up the discussion about HIV/AIDS at a time when many hesitated to speak its name, and initiated the striking “tombstone” adverts to alert the public to the nature of the new and dangerous disease. That is something the British people should feel proud of and that should continue, as I am sure we all agree. Perhaps we are ready again for a public health awareness campaign.

As many Members present will be aware, I undertake a lot of work on international development, and an issue that almost always arises in developing countries is gender inequality. Women and girls account for half the people living with HIV in the world. In Africa, the rate is even higher. Poverty repeatedly features, as almost all women with HIV—98%—live in developing countries. Why are women so vulnerable to HIV there? Their vulnerability can partly be put down to biological reasons, but the real reason is the gender inequality and discrimination enshrined in the customs and law and sexual and domestic violence that rob women of power. The United Nations special rapporteur on violence against women found that the majority of sexually active girls in developing countries aged 15 to 19 are married, often to much older men, and such married adolescents tend to have higher rates of HIV infection than their peers.

Sexual violence is the accomplice of HIV, depriving women of their ability to control their lives and thereby protect their health. In 2005, a World Health Organisation study found that in a broad range of settings, men who were violent towards their female partners were also more likely to have multiple partners, with both violence and infidelity being expressions of male privilege. I have previously spoken in this Chamber about rape being used as a tool of war. Increasingly, it is a weapon to break the spirits of women and girls, because, as the global commission’s report rightly points out, it destroys what holds people together—a community.

Disclosure of positive HIV status puts women at risk and in fear of more violence. I recently visited Pakistan, and when I returned home, I read about a Pakistani woman who had been gang-raped. She later discovered that she was both pregnant and HIV-positive. Her husband then abandoned her and her children. The commission’s report cites an example that demonstrates that education and class do not necessarily insulate women from such outcomes. It describes how a Tanzanian woman who led a middle-class life and was happily married to a professional man was affected. When she told him of her positive status, he was furious and started blaming her for their sons’ illnesses. He exposed her to stigma and torture, expelling her from the matrimonial home that she had paid for with her own money. The divorce courts did nothing to uphold her rights or to help her children.

We know that many women in the Democratic Republic of the Congo suffer rape, often in front of their husbands and children, who are then murdered in front of them. As a result, the women are frequently victims of HIV/AIDS, and they have few places to go for help. Antiretroviral drugs are much more difficult to obtain, administer and take consistently in such a chaotic place.

I welcome the commitment of the Department for International Development to putting women and girls at the centre of its work in the developing world. However, the Government have to urge other Governments, particularly at the G8 next year, to adopt the same strategic priority in their international development policies.

Another issue is Governments such as Uganda’s wishing to introduce laws making gay sex illegal and punishable by the death penalty. Many Governments in Africa are intolerant of gay sex. If challenged by UK Members of Parliament such as the late David Cairns, their Ministers try to tell us that they are just continuing with the laws we left with them following independence. That is some 50 years ago, so it is absolutely no excuse. We have moved on in the past 50 years and so should they.

There was a debate in Westminster Hall about the brutal murder of Ugandan gay rights activist David Kato. Since then, I have met a number of young gay men from African countries who are frightened for their lives. Such repressive laws must be outlawed, and it is up to our Ministers in the Foreign Office and DFID to stand up to Governments in countries where such laws are a problem.

Not only are the laws frightening gay men; they are a recipe for disaster in the fight against HIV/AIDS. Men will go underground; they will not see their doctor if they suspect they have HIV, because they are terrified they will be labelled as gay. They will not even want to collect drugs from a pharmacy for exactly the same reason.

A Bill has been tabled in Uganda—it is supposed to go through by the end of the year, so it is not long—proposing to expand the scope of criminalised activities and provide harsher punishments on conviction, including life imprisonment and, unless the clause in question is definitively removed, the death penalty for some offences. The Bill will force anyone who is aware of an offence under the Bill or an offender to report the offender within 24 hours, or be liable to a fine or three years’ imprisonment. There are indications that the clause might be dropped or amended, but if it remains the draconian provisions will punish any parent who does not denounce their lesbian daughter or gay son to the authorities. They will face fines of 2,650 dollars or three years in prison. Any teacher who does not report a lesbian or gay pupil to the authorities within 24 hours will face the same penalties. That must not happen, and I call upon the Minister to try to do something to stop it.

As the global commission’s report states, children and young people have the most to lose from HIV. It also states that such children are far more likely to become poor or homeless, drop out of school, face discrimination and violence, see their opportunities dwindle, or grow ill and die long before their time. The research quoted in the report states that globally, there are 3.4 million children living with HIV, roughly 16.6 million of whom have lost one or both parents to AIDS, and millions more have been affected. Fewer babies are now born with HIV, thanks to an increase in programmes to prevent vertical transmission. However, less than one quarter of children who qualified for the standard antiretroviral therapy actually received it in 2010. Despite that treatment, 2,500 young people still acquire HIV every day.

Young people in developing countries are also affected if their parents become ill or die. That point is in many ways linked to the gender rights issues I raised earlier, as older children, especially girls, are often forced to leave school to care for the family if a parent dies. That becomes a vicious circle for girls, trapping them for life, meaning they cannot have a long enough education to become economically independent, and elevating their risk of being infected by HIV. We must ensure that when parents die, developing states are well enough equipped to provide children with human rights and to make sure that their legal interests are protected, and that they are being cared for by suitable people.

Then, there is the issue of discrimination against families living with HIV. Adults living with HIV may be denied rights to see their children. Agencies prohibit HIV-positive children from living with their parents in state-sponsored housing, and school and child care administrators shut the door to HIV-positive pupils, believing that they will infect others. For example, in Paraguay,

“People who suffer from chronic contagious disease”

are forbidden to marry or adopt. Challenging those legal obstacles is a particularly important role for non-governmental organisations. Gidnist, the Ukrainian legal aid NGO, challenged the Ukrainian court to protect the rights of an HIV-positive child who was denied access to the paternal home. Thanks to that legal action, the child’s access to his paternal home was restored.

Studies cited in the global commission’s report state that age-appropriate, comprehensive sex education, including information on HIV prevention, serves the health of young people. Those studies show that such programmes reduced sexual risk-taking. If we are serious about working towards an HIV-free generation, it is therefore vital that age-appropriate sex education be available in schools worldwide.

As I briefly mentioned, among the things that stand in our way are the laws and political thought in some developing countries. The global commission’s report makes it clear that HIV is not just a health issue. The report makes for sober reading, informed as it is by those at the sharp end of the making and breaking of HIV-related laws in more than 140 countries. The global commission heard from people living with HIV who are deprived of the medicines they need because of intellectual property laws that put the prices out of reach. Men who have sex with men, and female sex workers, told the commission of their harrowing experiences of arbitrary arrest and abuse by police. People who inject drugs spoke of their time in detention, when they were denied clean needles or substitution therapy to help them reduce the harms associated with their habit. The commission heard about the experiences of migrant workers expelled from countries with laws that ban the entry of, or deport, foreigners with HIV, and the experiences of HIV-positive citizens denied health care, schooling, employment or housing because of stigma and discrimination.

Many companies help their own work forces by providing antiretroviral drugs, antimalarial drugs and other drugs that families need, in order to keep a healthy work force. In Uganda, we saw people from Nile Breweries give such drugs not just to their own workers but to the farmers who provide the agriculture for them—I forget which plant they make beer from. However, they also provide condoms for sex workers. There are people out there trying to help, and they are not just from NGOs and Governments, but from companies. That is encouraging to hear.

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for making a very strong case, particularly with regard to the attitudes that must be overcome in order to address this issue. Does she agree that one answer clearly must be further integration of HIV systems—not a separation of HIV systems—within an integrated health systems approach, particularly in circumstances in which TB is the major killer of people with HIV? In view of those circumstances, does she agree that what we can do in this country is to ensure that the UK continues to take a leading role in addressing the replenishment issue with regard to the Global Fund to Fight AIDS, Tuberculosis and Malaria?

[Pauline Latham]

I thank my hon. Friend for those comments. I will come on to those points in a moment, but they are very important because we do need an integrated approach. It cannot be a stand-alone approach; it has to work together with other things.

The global commission’s findings clearly demonstrate that the myriad laws, across multiple legal systems, have one thing in common: by punishing those who have HIV or the practices that may leave them vulnerable to infection, they serve simply to drive people further away from disclosure, testing and treatment—fostering, not fighting, the global epidemic.

To quote Dr Shereen El Feki, the representative from Egypt on the global commission,

“It is time to say, ‘No more.’ Just as we need new science to help fight the viral epidemic, we need new thinking to combat an epidemic of bad laws that is undermining the precious gains made in HIV awareness, prevention and treatment over the past thirty years.”

I absolutely support her position. She argues, and I agree, that deliberate and malicious transmission of HIV is best prosecuted through existing laws on assault, homicide or bodily harm, rather than the special HIV criminal statutes that have sprung up in recent years and that sweep up those—pregnant women among them—to whom they should never apply.

In relation to pharmaceuticals, existing intellectual property laws require a complete overhaul to ensure that the interests of public health are balanced against incentives for innovation, and that the best new HIV medicines are available to all. Laws that criminalise sex work, drug use, same-sex relations or transgender identity do little to change behaviour aside from discouraging the people most at risk of infection from taking measures to protect themselves and their communities from HIV. Laws against gender-based violence and towards the economic empowerment of women are badly needed, and need to be enforced, to reduce women’s vulnerability to HIV. To work towards making an HIV-free generation a human reality, the world needs to take a joined-up, 21st-century approach to, as I said, one of the greatest public health challenges of our time.

Let me now discuss what my hon. Friend the Member for St Ives (Andrew George) mentioned in his intervention. Since the Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002, it has saved an estimated 7 million lives, disbursed antiretroviral drugs to more than 3 million people, treated 8.6 million cases of TB and distributed 230 million insecticide-treated bed nets.

[Pauline Latham]

I thank the hon. Gentleman for that intervention. We need drugs to be regularly available at an affordable price, but many countries where the problem is rife are chaotic and often in conflict, so the drugs would not necessarily get to where they are needed.

We have a role to play with DFID, because we provide a lot of health strengthening in different countries, but we must ensure that the health strengthening in the Governments is true. Often a Government will take money out of the health system, because we have put it in. We must ensure that the systems we put money into to fight this huge epidemic are absolutely transparent. It is also important that drugs are age-related; a drug for a young child will not be the same as a drug for somebody in their 50s. The hon. Gentleman makes an important point.

The global fund is the largest international financier of the fight against the three diseases. It channels two-thirds of the international financing provided to fight TB and malaria and half of all antiretroviral drugs to people living with HIV and AIDS. It also funds the strengthening of health systems. Inadequate health systems are one of the main obstacles to scaling up interventions to secure better health outcomes for HIV, TB and malaria. In contrast to other multilateral institutions, the global fund has been ranked by DFID as performing very highly on transparency and accountability. However, 2011 was a difficult year for the global fund, as the cancellation of the round 11 funding caused great concern among non-governmental organisations delivering services through the fund in developing countries.

In 2012, the Select Committee on International Development, of which I have been a member since the 2010 general election, held a short inquiry into the global fund. It concluded that the UK Government should release the additional funding promised to the fund without delay. In the Government’s response to the inquiry, DFID unfortunately states that they will wait until after the second multilateral aid review, which is due to be published in spring 2013.

The global fund has gone through a huge transformational process, developing a new strategy and recently appointing a new executive director, Mark Dybul. It now has a new funding model. Due to financial constraints, however, the fund has withdrawn its programme from some middle-income countries, such as Ukraine, where the figures on the HIV epidemic are rising. Will the Minister look urgently at that?

On drugs, it is worth noting that approximately 80% of the 8 million people currently taking ARVs are prescribed generic versions. Competition in generic drugs has enabled the cost to be reduced at least tenfold to around $100 a year for first-line treatment. That was only possible due to India’s pre-2005 patent laws and protracted discussions with the pharmaceutical industry in the late 1990s and early 2000s. Since India’s patent laws have become compliant with the agreement on trade-related aspects of intellectual property rights—TRIPS—it is not possible for Indian companies to make generic versions of newer medicines within the 20-year patent period. We are, therefore, reliant on the good will of pharmaceutical companies to reduce prices for poorer countries.

During 2012, it is estimated that about half a million people will need second and third-line treatment, which is patented and at least three times the price of first-line treatment. Third-line treatment is as much as 20 times the price. One initiative to deal with the cost of drugs is the medicines patent pool, which would enable free generic competition on newer patented medicines. Unfortunately, only one company—Gilead Sciences Inc—has signed up and more companies need to join for the system to be viable. Will the Minister comment on what she plans to do to help that happen?

As we move towards 2015, a lot of work is being undertaken to put together a post-millennium development goals framework. One risk we face as the MDGs come to an end is that the global community will turn its back on the gains made in the past decade. It is important to consider the linkages between HIV/AIDS and other diseases. A post-MDG framework must continue to work towards the unmet MDGs. There is an urgent need for continued action on HIV: each day more than 7,000 people are newly infected with HIV; and 7 million people are still in need of HIV treatment—a number set to increase dramatically as all 34 million people living with HIV will ultimately require it.

TB is the leading cause of death among people infected with HIV/AIDS in developing countries, and 1.1 million people were living with HIV-acquired TB in 2010. Because HIV infections attack and weaken the immune system, an HIV-positive person with latent TB is 20 to 40 times more likely to develop active TB than someone who is not infected with HIV. Promoting and implementing the linkages between HIV and other relevant areas—including gender, sexual and reproductive health, maternal and child health, TB, education, and hunger and nutrition—brings wider benefits for development. A post-2015 framework must therefore ensure that goals and targets support synergies between areas. In particular, it must ensure that addressing HIV is part and parcel of a coherent and holistic approach to strengthening overall health, social protection and legal systems. Will the Minister tell us what progress she hopes will be made at the G8 next year?

[Andrew George]

My hon. Friend has made an extremely important point, which echoes my intervention on the integration of services. Does she agree that it is a serious false economy if developing countries do not ensure that the drugs are delivered on the ground? The cost of treating drug-resistant strains of TB—such strains are an increasing problem—is much greater than the cost of investment on the front line to treat such cases in the first place.

[Pauline Latham]

My hon. Friend is right; if we cannot get the drugs out to the people, they will not do well, so systems need to be put in place. It is ironic that many African countries have appalling transport systems and yet organisations such as Nile Breweries, which makes beer, can get drugs to people, no matter how difficult it may be, because beer gets everywhere, whereas Governments do not always think it important to ensure that pharmacies and health clinics do not have stockouts. All African countries need to ensure that there is blanket coverage of such drugs and that there is never a shortage, because, as my hon. Friend mentioned, to do otherwise is a false economy. They need to work hard to move forward on prevention, because so many people are living with, and still dying from, HIV/AIDS.

I started by saying that the key point I wanted everyone to take away today is that the end of the global AIDS epidemic is within our reach. Working towards an HIV-free generation is now a possibility, but it will become a reality only if we have the will to make it a reality. I shall repeat what I said earlier: nature is not standing in our way; we, as members of the human race, are standing in our way. We must urge the Governments of the world to take a joined-up approach to combating HIV/AIDS.

I also started by praising the work of UK Governments over the past three decades. The UK has provided excellent political and financial support. It is clearly an example of best practice and has set the standard for others to follow. The UK Government will review their HIV programmes in 2013. I agree with the Stop AIDS Campaign, which urges that the 2013 review becomes a blueprint or strategy for the future of the UK’s global HIV work. It is a chance to demonstrate the UK’s continued leadership in the field.

The strategy would map the UK’s contribution to delivering the combination of game-changing interventions necessary to ensure that we reach the tipping point and have a generation in which no one dies of an AIDS-related illness or newly acquires HIV and in which the rights of all those living with or affected by HIV are upheld. I also agree with the Stop AIDS Campaign that the blueprint should include three key themes: first, commit to maintaining the UK’s investment in HIV/AIDS; secondly, commit to putting all people living with and affected by HIV at the centre of the response, regardless of where they live; and thirdly, commit to leading the way in the UK and globally.

It was a privilege to secure this debate and speak on this important issue. I thank you for your chairmanship, Mr Bayley. I thank everyone who has attended and the various organisations that provided me with briefings ahead of the debate. I look forward to hearing other Members’ contributions and particularly the Minister’s response.

Oral Answers to Questions

Andrew George Excerpts

Wednesday 7th December 2011 Commons Chamber

[Mr Mitchell]

My answer is yes. We will be working in the most difficult countries. The aim of the review currently being undertaken under the chairmanship of an excellent British official, Simon Bland of the global fund, is to ensure that over the next four years we save 10 million lives and prevent something like 180 million new AIDS, malaria and TB infections.

[Andrew George (St Ives) (LD)]

Given that more than two thirds of TB and malaria programmes and more than half of all antiretroviral drugs are delivered through the global fund, what does the Secretary of State say about the crisis in the talks on that programme and its cancellation until 2014? What interim measures can be put in place?

[Mr Mitchell]

It is true that the 11th round has been converted into a new funding approach, but we will sign grants between now and 2013 of something like $10 billion, so long as we can ensure that our priorities of securing lower prices and good value for money, focusing on the poorest and most vulnerable and considering the longer-term sustainability of programmes, are met.

Oral Answers to Questions

Andrew George Excerpts

Wednesday 17th November 2010 Commons Chamber

[Mr Speaker]

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

[Andrew George (St Ives) (LD)]

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

[Mr O'Brien]

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

Oral Answers to Questions

Andrew George Excerpts

Wednesday 2nd June 2010 Commons Chamber

[Mr O'Brien]

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

[Andrew George (St Ives) (LD)]

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

[Mr O'Brien]

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