Neglected Tropical Diseases
Baroness Barker Excerpts(8 years, 11 months ago)
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Baroness Barker (LD)
My Lords, I thank the noble Baroness, Lady Hayman, not just for today’s debate but for the succession of world-leading scientists who she and Jeremy Lefroy bring into Parliament week after week so that some of us can begin to understand the complex science about which we are speaking tonight. Having listened to those scientists for over a year, I now understand that we are talking about three main types of disease when we talk about neglected tropical diseases. Those caused by worms and flukes are largely treated by very simple population management methods. Those which are vector-borne are much more complicated and need treatment in hospital; malaria is the classic example. The third group is made up of the very highly contagious epidemics which hit a population with a much more profound effect than they would do here when that population is, as noble Lords have said, living in poverty and without access to basic medicine.
The approaches to all three of these disease groups are quite distinct, and the hazards that they pose are quite different. They are also all happening, worryingly, against the background of multidrug resistance, for example for TB and malaria, which is probably the equivalent of climate change in medicine and something that we should be very focused on and frightened of. But a very important point is that the same institutions and scientists that work on drug resistance mechanisms are the same scientists who work on the mechanism behind NTDs. So the science is interconnected, and I want to talk about maintaining that science base.
Other noble Lords have spoken about the heritage that we have from our colonial past in the schools of tropical medicine in London and Liverpool, and it is time that we repaid what we took from the world, by ensuring that those institutions continue to work to provide the basic science to support pharmaceutical companies to take forward new compounds into development and clinical trials and on towards new medicines. In that, international funding from Governments, including for example from DfID, is really important. It does two different things: humanitarian aid, which is very important, but also funding for long-term scientific and medical development. That is the stuff which the public do not really see and which is therefore much more vulnerable to cuts. I hope the Minister might be able to assure the House that DfID will continue to play its leading role in humanitarian funding but will also not take its foot off the pedal in terms of funding the scientific research.
Other noble Lords have spoken about the fact that it is always the marginalised people in these countries who suffer the most, but I want to raise one other issue with the Minister. The disengagement from global health by the USA under the Trump Administration will have a huge impact on in-country programmes, particularly in Africa, where many institutions such as hospitals and universities are very dependent on American support for funding both their staff and the equipment and buildings. In Ethiopia, for example, the whole of the medical school expansion programme is funded from the USA via the World Bank. It remains to be seen whether organisations such as the Bill & Melinda Gates Foundation, the Carter Center and the Clinton Foundation can step up and fill that gap. US government institutions such as the CDC and American universities such as Johns Hopkins, we think, may also be forced to stand back.
It is really important when we are trying to deal with outbreaks of these diseases around the world that there is a standing body of people in countries who have the scientific expertise to bring about a response. Will DfID perhaps switch its funding, in light of the Americans’ withdrawal of funding from certain sexual and reproductive health programmes, to ensure that funding for those programmes continues? Will the Government also press the Trump Administration, who have less objection to work on NTDs, to place some of the money that they have withdrawn from the other programmes into programmes supporting the science and treatment of neglected tropical diseases?
US Overseas Aid: Global Gag Rule
Baroness Barker Excerpts(9 years ago)
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Baroness Barker
To ask Her Majesty’s Government what is their response to the reinstatement by the government of the United States of the global gag rule, which requires that overseas organisations in receipt of US aid cannot provide abortion services or information about family planning.
The Minister of State, Department for International Development (Lord Bates) (Con)
My Lords, the UK will continue to demonstrate leadership for comprehensive evidence-based sexual and reproductive health and rights, including safe abortion. We will continue to extend access to contraception for millions of women who cannot choose whether and when they have children.
Baroness Barker (LD)
I thank the Minister for that Answer. When similar policies have been enacted by previous US Presidents, they have had a devastating effect on maternal health programmes across the world. Has DfID made an assessment of whether this global gag policy will have a direct effect on any programmes it runs? What steps will DfID take, along with other Governments such as the Dutch Government, and the Gates Foundation, to try to offset the disaster that will befall millions of women as a result of this policy?
Lord Bates
The noble Baroness is absolutely right to say that we have been here before. This has been the policy of successive Republican Administrations since the Reagan presidency. Therefore, in a sense, people knew what was coming down the track. Clearly, a very important part of what we in the international community do is family planning, and the Government are committed to ensuring that that continues. Specifically on the Dutch initiative and the She Decides conference, which is being held next week, DfID will be represented there. Also, later in the year, we will host a family planning conference, similar to that which we held in 2012. We hope it will be an opportunity for the international community to come together and decide how we move forward and work through these issues.
HIV Global Epidemic: Young People
Baroness Barker Excerpts(9 years, 3 months ago)
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Lord Bates
That is absolutely right and it is what we are focusing on. I think I am right in saying that HIV is still the largest killer of adolescent girls in sub-Saharan Africa. We need to move much further in that area. That is why it is encouraging that the Global Fund is spending a large proportion of its money in low-income countries. At the same time, we need to provide better civil society networks and social networks that can help young people when those tragedies happen so that they can access treatment and antiretrovirals. As my noble friend Lord Prior will be saying, people can have a better quality of life here living with AIDS, and that should be more widely available in southern Africa as well.
Baroness Barker (LD)
My Lords, PEPFAR and the Global Fund are of crucial importance across the world. Will the British Government encourage the incoming Administration in the United States to maintain the levels of funding and not diminish them?
Lord Bates
We must give credit to PEPFAR, and to George W Bush, who set it up, for the work it has done around the world in tackling this disease. Certainly, that would be our expectation. We have a very close working relationship with USAID in this area and we fully expect that it will continue, into the future, to tackle and achieve the global goal of eradicating HIV as a public health threat by 2030.
Neglected Tropical Diseases
Baroness Barker Excerpts(10 years, 1 month ago)
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Baroness Barker (LD)
My Lords, as the noble Baroness, Lady Hayman, said, in the last two hours the WHO has declared the Zika outbreak in Latin America a global public health emergency. A silver lining may be that, as a neglected tropical disease, Zika may now receive the attention that it perhaps should have done already.
As my noble friend Lord Bruce of Bennachie made clear, public health is now a global issue and we have, in the last 20 years or so, because of the HIV/AIDS crisis and others, developed ways in which we can globally address those issues. The Global Fund brought together the private sector, Governments and the research community, and has made a major impact not only in the development of new treatments but in the new ways to get those treatments to people as quickly as possible. The Global Fund is due for replenishment this year. Will the Minister say whether the UK will remain committed to its level of contributions to that fund and encourage other international donors to do the same? As my noble friend said, the co-incidence of these diseases on the world population makes it important for that reason.
Many noble Lords referred to the announcement in the spending review of £1 billion for the Ross fund. Will the Minister indicate whether that will be additional to the funding previously made available for neglected tropical diseases and HIV? Can she tell us about the structure of that fund and whether the research findings that it funds will be made publicly available? How will access to any medical tools produced as a result of that fund be ensured?
As many noble Lords have indicated this evening, our current model of R&D for medicines is failing. If we continue to rely on a solely market-led R&D, the discovery of new medicines and, crucially, the access to those medicines by neglected populations will be hampered severely. Will the UK Government consider commissioning an economic paper to analyse the economic impact of our current market-oriented R&D model and a future model for R&D development in which the cost of research into drugs is decoupled from potential profits to companies? Much of the basic research on which the drug companies base their work is already publicly funded by Governments through academic institutions and so on. It is time that we moved to do that.
Will the UK Government, strong leader and advocate as they have been on public global public health issues, initiate a dialogue with the pharmaceutical industry and civil society to see whether it would be possible to reach agreement over a new R&D treaty in the run-up to the World Health Assembly? Noble Lords will know about mechanisms such as product development partnerships. They have proven to be instrumental in making sure that the poorest people on earth get access to the best medicine in the world, much of which is produced by our academic institutions.
HIV and AIDS
Baroness Barker Excerpts(10 years, 1 month ago)
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Baroness Barker
To ask Her Majesty’s Government what assessment they have made of the report of the All-Party Parliamentary Group on HIV and AIDS Access Denied.
Baroness Barker (LD)
My Lords, I thank noble Lords who are about to participate in this debate for their patience. Normally when one does that, it relates to a matter of minutes, but in this case noble Lords have had to wait seven weeks. We were originally due to discuss this matter at the beginning of December, but we were bumped—I believe that is the term—because of events in Syria. I will return to that at the end of my speech because there is an interesting point to be made.
However, there is an upside. It means that we waited over the Christmas and new year Recess and one of the more enjoyable things about new year is to open newspapers and discover what has been released under the 30-year rule. This year, it was fascinating to read about everything that the noble Lord, Lord Fowler, did 30 years ago when as Health Minister he had to walk in and explain to Mrs Thatcher why we should spend money to deal with this controversial disease that affected people whom we did not particularly like and so forth. Some of us have long suspected that he was something of a hero in the way that he persuaded one of the most formidable right-wing politicians in the world to do the right thing for public health. I want to look at this report today in that spirit.
The report was compiled by members of the All-Party Parliamentary Group on HIV and AIDS—some of us went to India and others went to South Africa—to look at this key question of access to HIV medicines. It is fair to say that there has been a tremendous success story in the world of HIV in the past 10 years or so. Because of international agreements by Governments and the pooling of resources, we have managed to curtail the impact of this deadly disease in an amazing way. In 2015, we reached a milestone of 15 million people on treatment compared with fewer than 1 million 10 years ago. It is estimated that nearly 16 million people are now accessing anti-retroviral treatments. HIV-related deaths have fallen to 1.2 million in 2014 from 3.2 million in 2005. Modelling—we have to model these things—suggests that nearly 74 million people have avoided acquiring HIV and 36 million HIV deaths were avoided between 1990 and 2013. That is an amazing global public health success. But across the globe, 60% of new infections are among young women, and HIV remains the leading killer of women of reproductive age. Noble Lords will appreciate that the report covers a number of large and in some cases very technical issues, and I will have to skate through just a few of them and hope that other noble Lords in the debate will follow me in.
The aim of the sustainable development goal is to end AIDS as a public health threat by 2030. To do that—to bend the curve of this epidemic—the bulk of progress has to take place over the next five years. If we do not manage to prevent young people, particularly women and girls across the developing world, from contracting the virus, infection rates will get ahead of us. The question for us, as a country that has led the international success to date, is: how will we manage to do that in times of austerity?
I want to highlight some of the things we need to do that emerge from this report. First, we must ensure continued access to affordable treatments. The success that has come about in the past 10 years has partly been due to the work of the Global Fund, but it is also because generic drugs are now widely available across the developing world. As noble Lords will know, the development of new drugs is a very risky business. That is why in highly developed countries it is a long and expensive process, although one of the most interesting things that came out of our evidence sessions is that there is no real relationship between the cost that drug companies attach to new drugs and the cost of producing them. They simply make a market decision about how much money they can make from new products.
However, those generic suppliers have managed to do wonderful things. They have managed to get the cost of the drugs to maintain a person in India for a year down from something like $2,000 per annum to $100 per annum. Those drug manufacturers told us that is now impossible to get those costs down even further. Some parts of the pharmaceutical world need more help. There is no great market for paediatric pharmaceuticals. Therefore, drug companies cannot put any more money into getting the costs of those drugs down. They look to Governments and international players for help in finding ways to make sure that they can keep the supply of those drugs coming.
The second thing is to focus on R&D. This Government have a proud record of making contributions to international research and development. Indeed, in the past few months there has been an announcement from George Osborne that there would be funding via the Ross fund for research into new diseases. It is not clear whether that funding will be in addition to existing HIV funding. Will the Minister commit to making a statement about the transparency of the different parts of funding that DfID and the Government are involved in? This is not a time to start robbing Peter to pay Paul. We have to be absolutely clear about the totals of funding and the projected outcomes.
The third thing that I want to focus on is the replenishment of the Global Fund. As a partnership between Governments, the voluntary sector and the private sector, the Global Fund has done truly remarkable work. One reason why it is so effective is that it focuses much of its work on women and girls. We know that the Government a few years ago led the way internationally by making a commitment of almost £1 billion into the Global Fund. The Global Fund replenishment is due shortly. Will the Government continue to give an international lead to funding that replenishment? It is so important and the most effective way in which to tackle this problem. We need to keep the pressure on other developed countries to continue with their funding and not to let it be dissipated.
I have a final question for the Minister. Middle-income countries have been de-prioritised in terms of UK Government direct aid. We understand the reasons for that. When we were researching the report in India, we heard lots of arguments about how India is now a successful economy that no longer needs to receive UK aid. But as noble Lords are aware, the poorest people on earth live in middle-income countries and the people most marginalised in those societies and most at risk fear greatly that their needs will be missed. I wonder whether the Minister will commit her Government to work with other international donors and funders to find new mechanisms to support those middle-income countries, as they transition away from direct aid from larger countries such as ourselves to a new order in which their own health systems and political systems are better equipped to deal with this ongoing issue. Finally, will the Minister explain to noble Lords where HIV will sit in the DfID strategy from 2016? It seems that it is being folded into a much broader remit on sexual and reproductive health, and there is some considerable concern out there that it is being deprioritised.
If we do not continue to fund public health initiatives such as this one around the world, desperate people will become the migrants that Europe has to help. Please can we maintain what to date has been a very successful track record and not be pushed away from that by the politics of the moment?
UN: Sustainable Development Goals
Baroness Barker Excerpts(10 years, 8 months ago)
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Baroness Barker (LD)
My Lords, I, too, thank the noble Lord, Lord McConnell—my fellow VSO volunteer—for introducing this debate. I have come recently to international development and, frankly, it is a vast, complex picture to try to understand. I want to echo in part the words of the right reverend Prelate the Bishop of St Albans, but also the message from the noble Viscount, Lord Ridley, which I took very much to heart, about trying to identify those things that are strategic, sustainable and make sense. It always strikes me in international development that there are people with great hearts who are motivated by seeing local problems and issues, trying to work at a strategic level and battling time and again—not with a default position that they think that money is endless but with a lack of data about what works. All of us in these debates are trying to help our Government to work towards a position of having the maximum influence in these very important discussions over the next few months.
I want to talk about HIV/AIDS and ageing, two issues that concern me. In HIV, the concentration and focus brought about by the existence of the millennium development goals have made a true difference. The number of people accessing treatment now is 13.6 million. It was 1 million 10 years ago. In 2013 there were 2.1 million new infections, compared to 3.4 million in 2001. In 2013 there were 1.5 million AIDS deaths, compared to 2.3 million in 2005. This is not perfect but in dealing with the AIDS pandemic the international community has registered a considerable success and we need to tell our fellow citizens in this country, who are sceptical about the benefits of international aid, that this is an important development. As we know from the scientists, if we cannot beat HIV/AIDS in Africa, we are never going to conquer it here.
That said, we have not met all the targets on HIV/AIDS. The zero draft of the outcomes document has a very ambitious target for AIDS but it is important that we refocus and make sure that there are resources behind that, because we have a very small amount of time—a number of years—within which we have to try to get ahead of the curve on HIV or else the epidemic is going to go out of control. UNAIDS has released 90/90/90 targets: by 2020, 90% of people living with HIV will know their status; 90% of those people will be accessing treatment; and 90% of those will be virally suppressed. If we can do that, we can truly begin to make the progress that we need in order to finally overcome HIV/AIDS. The opportunity to control the epidemic is finite, which is why we have to do it within the framework of international development agreements. To achieve that change, we have to deal with people who are deeply unpopular and marginalised within their own societies—those such as gay people, sex workers and so on. These are the people to whom their own Governments find it difficult to give political priority, so although it is a soft touch for us politically it is important that we stick with the programme.
One other important thing to mention on HIV/AIDS is that we need to keep up the focus on research and development. Much of the success that has happened over the last 15 years has come about because of the development of generic drugs. The cost of those drugs has plummeted. That has come about because manufacturers in different parts of the world have been able to benefit from research done by countries in the West, which they usually kept to themselves to maximise their profits. But through the intellectual pooling arrangements we have enabled a sharing of intellectual property, which has had a profound impact on the development of new drugs. On trade agreements, too, it is important that low and middle-income countries should have those trade flexibilities which enable them to provide generic versions of medicines to their populations. That is unbelievably important in places such as India and the whole of southern Africa, where, again, if we do not contain the virus it will be a public health disaster of unlimited proportions for the whole world.
On the subject of ageing I simply say that, at the moment, there are more than 868 million people aged over 60. By 2050, there will be more than 2 billion and we will have reached the unimaginable point where there will be more people aged over 60 than children under 15. That in itself must have an extensive impact on all sustainability and on health systems. I reiterate the point that I made to the noble Baroness the other day: that in all these negotiations, our Government should press for the generation of more age-related and gender-specific data so that we can begin to drill down into the patterns of what is happening. Older women need to be included in those targets for gender equality, as they are just as likely as younger women to be subject to violence. The noble Lord, Lord Rea, was also right to say that non-communicable diseases fall disproportionately on older people, and if we do not include them in this we will never make an impact on them.
The noble Viscount, Lord Ridley, is right that this could be a bit like a Christmas tree. We could put so many baubles on it that it falls over. None of us wants to do that. We all want to make sure that the analysis is correct and that the data generated enable our Government, and other Governments, to make that informed assessment about what is most effective and how we could all make limited resources go further to reduce poverty.
Developing World: Women
Baroness Barker Excerpts(10 years, 8 months ago)
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Baroness Barker (LD)
My Lords, I congratulate my noble friend Lord Loomba on securing this debate. I have never witnessed the work of the Loomba Foundation up close, but I have been a fan and I have watched his work from afar over these last 10 years or so, and it is deeply impressive. His ongoing commitment to the cause of widows in particular is something of which I am tremendously proud, as I hope his family are.
I am delighted to take part in today’s debate to tell noble Lords about last month when I visited a shop. I had the great good fortune to be asked by VSO to be a volunteer, and as part of my volunteering placement I visited a project in Lesotho, which is run jointly by an ex-mineworkers association and VSO and is called Phoning Out Poverty and AIDS. All across southern Africa there are women whose men went off to work in the mines of southern Africa and who have succumbed to pneumoconiosis, TB or HIV, and those women live in abject poverty. With the aid of a phone company they were given a container, in which they have established a community phone shop. It is the sort of shop that, if it were in Manchester, would be the subject of an ongoing soap documentary, because it is at the centre of the village and has all the bits and bobs.
There are three great things about it. Number one: a woman who was so ill with HIV and AIDS, having been impregnated by a teacher when she was a schoolgirl, and who had nothing and was bed-bound, has now earned enough money not only to get some furniture but to be able to afford the fares to the local clinic to get some treatment. She is back on her feet. Number two: the project has not only allowed people to make phone calls but is giving them HIV and AIDS information, and increasing the health of that village. Number three: a veritable battalion of grannies work in that shop. Grannies are unmistakable the world over. These particular grannies go to that shop and between them secure income for over 50 of their grandchildren, who were previously starving. That is the economic empowerment of young women and girls, and as the granddaughter of a former migrant mineworker it has impressed me greatly.
Part of my overall placement with VSO was to talk to and train parliamentarians across southern Africa to campaign for sex and relationship education, but in particular to end the scourge of child marriage. Child marriage and early pregnancy are two of the biggest determinants of poverty and ill health of girls across the world. Billions of young women are forced into relationships way before they are physically ready for them, and as a result are enduring lives of poverty.
Will the noble Baroness, Lady Verma, say what the current Government are doing to continue the work that was started by my noble friend Lady Northover and Lynne Featherstone in the previous Government to ensure that DfID continues to work with parliamentarians across the world to ensure a decrease in the rate of child marriage? There are areas of the world where rates of child marriage are going down. There are successful programmes, which we should be supporting and extending.
My noble friend Lord Loomba talked about the critical importance of the next few months. We all know that we are in the final run-up to the meetings at which the new strategic development goals will be determined and, crucially, the budgets—the resources—that go with them. There will be a meeting in Addis Ababa in a few weeks at which our Government will be present to talk about financing for those development goals.
It is significant that many of the international development charities, building on the work of Amartya Sen, have come to the conclusion that it is not possible to achieve overall empowerment and enrichment of societies if you do not work through the empowerment of women and girls. So will the Government, through their coming work over the next few months, ensure that there is a strong stand-alone goal on gender equality and women’s rights, that there are specific targets for increasing women’s full and effective participation, and that programmes to go behind that development goal are funded to make sure that, from small corner shops in Lesotho to national Governments and internationally, there is a coherent programme of economic development?
Finally, I commend to noble Lords a report that was published in January this year by Age International, which talks about the truth of ageing and development. It is a series of essays, one of which was written by the noble Baroness, Lady Greengross. In it, she sets out a number of points that are often overlooked about the role of gender and older women’s inequality in development. In so far as we have data, we know that women are likely to live longer but are much more likely to have longer periods of ill health due to the fact that they have had little in the way of economic or educational choices throughout their lives. That, together with poor nutrition and inattention to their sexual and reproductive health, all takes a toll in later life. Even within countries there will be some communities where the effect is disproportionate. In Serbia, for example, the overall position of older women is relatively good, but within the Roma community in Serbia there is a very difficult problem in relation to older women and poverty.
The noble Baroness, Lady Greengross, draws attention to a fact about international development that I had not previously thought about, and that is the impact of dementia. Not only are women increasingly engaged in what is called family care, although it is really female care, for growing numbers of people with dementia, but occasionally, because of a lack of knowledge and awareness in communities, they become vulnerable. People accuse them of witchcraft and so on, and there have been a growing number of incidents where older women have been killed as a result. The noble Baroness, Lady Greengross, opened up in her essay a new area for research, and I ask the Minister whether she will consider looking not just at gender-specific data but at age and gender-specific data to back up some of this work.
The noble Lord, Lord Loomba, was absolutely right to return our attention to this subject, and I hope that if noble Lords ever get the chance to go to Lesotho, they will drop by a very special corner shop.