Examination of Witnesses (Questions 520
- 539)
TUESDAY 25 JULY 2000
RT HON
CLARE SHORT,
MR DAVID
CLARKE, DR
JULIAN LOB-LEVYT
AND MR
BOB GROSE
520. Are you still acting Head of Department?
(Mr Grose) I was acting Deputy Chief Adviser for a
while, now full time, permanent.
521. I am sure the Committee would like to thank
you. I know that the Secretary of State has apologised for the
length of the submission but this took a lot of effort and a lot
of time and we are grateful for that and for the fact that you
responded to our questions by giving us a further memorandum on
questions that you were not able to answer at the time. The Committee
does appreciate the very hard work you put in. Perhaps you would
like to elaborate a bit on the outcome of Durban. I must say that
I was personally very disappointed that we had not got Mbeki on-line
and back into the mainstream and really promoting and leading
in a way that he could do if he chose to. That was my disappointment.
I am very interested in what you had to say, Secretary of State.
You thought, strangely, it had promoted discussion rather than
suppressed it?
(Clare Short) That is the optimistic view of life
which is the one I like to take. There is no doubt that HIV causes
AIDS. It is ridiculous to question that. The science is absolutely
clear. It is not helpful, although of course there are special
features of life where people are desperately poor. For example,
it spreads massively faster where there are untreated sexually
transmitted diseases and in populations where there has never
been or is very little availability of antibiotics. That is highly
linked to poverty and people's immune systems are weaker when
they are badly fed and in poor health. The opportunistic infections,
the spread of TB, that is endemic in poor populations. There is
no doubt that the speed of spread and the degrees of suffering
and other infection are made massively worse by poverty. That
part of what he said is absolutely true.
522. That must be right.
(Clare Short) But to question whether HIV is the cause
is just nonsense. All I am saying is I think the controversy—I
bet if you go to South Africa everyone is arguing about it in
every township, and in a funny way that might have helped and
I think everybody knows that HIV is the cause. But that is the
optimistic view of life.
523. Dr Lob-Levyt?
(Dr Lob-Levyt) Specifically on Durban I think it was
an extremely successful conference, and having it in Africa for
the first time was hugely important. Within the conference there
was an enormous amount of technical discussion as well which enabled
a much clearer picture to be established of what we can do, what
we know works and what we know does not work. The clear messages
which came out which were brought back by many colleagues showed
great optimism about the renewed or clearer African commitment
to do something about this and that is where we should focus our
efforts and we can make a difference. The shining examples of
Uganda and Senegal and other countries in fact that are now beginning
to show an impact on the epidemic, were hugely positive messages
that we could make a difference. Like the Secretary of State,
I think the debate generated was reflected by the international
coverage it got, not least from the United Kingdom press which
was enormous, much more than any other conference. That now needs
to be delivered but we are now more optimistic we can deliver.
(Clare Short) In the margins an initiative which we
had to work with SADC on a regional HIV/AIDS initiative was approved
and so can go ahead. We had our ministers there so that could
be agreed.
524. You were there, Secretary of State?
(Clare Short) No, but we had officials there. Okinawa?
(Dr Lob-Levyt) We did not have anybody at Okinawa.
(Clare Short) But we worked on the text and so on.
Because the second part of Bowen's question was what was the impact
of what was said at Okinawa and how helpful and useful is that?
(Dr Lob-Levyt) We were very heavily engaged in Okinawa
in preparing the brief so the United Kingdom inputs were largely
included in the final Communique«. It is very clear that
it raises HIV as being the challenge to development alongside
TB and malaria, specifically calling for a conference after Okinawa
to look at how we can mobilise the new resources that are coming
from the private sector, from donors, with increased international
commitment, and how we can translate that into more effective
action, and to see which agencies have the best chance to deliver
this new higher agenda, and to report back to G8 next year on
the progress that can be made. The setting of specific targets
for HIV was merely a reiteration of the international development
target that we have on HIV, but to have it included in the Communique«
is hugely important, as it is for those on TB and malaria.
525. First of all, on the Durban meeting, are
you really saying that the optimism arises because the Conference
realised that you could actually manage this disease, this infection
and that there were things that could be done to mitigate, but
of course not cure yet, the HIV/AIDS problem? Was that the source
of the optimism, because I think it would sound to the general
public very strange that there was optimism coming out of Durban
given the figures presented at Durban on the level of infection
in Africa. Some of the evidence given to this Committee suggests
that live births in Botswana in some of the clinics attended by
women are at the horrendous figure of 70 per cent being HIV positive.
That would be a depressing figure to the general public but you
are now saying we are very optimistic after Durban and I think
one needs to explain why.
(Clare Short) Even within a country the levels of
infection vary by area and region, so it will be particular communities
with risk behaviour and so on rather than the whole of Botswana.
Let us be clear, we were already clear about the horrendous figures,
the horrendous suffering and the horrendous economic consequences,
the massive reversal of development gains, measured most clearly
in the loss of life expectancy. These are tragedies piled upon
tragedies for human beings and economically. It is desperately
destructive. We knew the scale of the challenge already. We as
a Department have been frustrated in our work in some countries
by the unwillingness of governments in Africa and in other countries
to face up to the challenge and what they need to do. Governments
were moving anyway. President Moi had moved and so on and Zambia
was moving. We have had some movement recently and Durban catalysed
and moved forward the willingness to face it and the willingness
to take the action from the agenda that we know is the best action
to take. Obviously we are not being optimistic about the scale,
the challenge, the suffering and the economic loss.
(Mr Grose) I would just make one point about ex-President
Mandela's statement at the end of the Conference which really
lifted the tone of the meeting tremendously—
526. He has been very brave on this issue the
whole time.
(Mr Grose) He set out an agenda we would all sign
up to. He summarised the real priorities. As an advocacy event,
that encapsulated the main messages for other African leaders.
(Clare Short) But even under President Mandela when
he was the President, although he did stand up and talk about
HIV, South Africa did not have a clear, forward-looking programme
even with someone who has been brave about talking about it like
President Mandela. We have got to get governments to take it so
seriously that they start taking the actions that are needed right
across their countries.
527. Exactly. Okinawa is important, is it not,
because as you said, Secretary of State, Britain alone cannot
do this. It has got to be a co-ordinated world programme, involving
all those countries suffering from HIV/AIDS, which is the whole
world really. Were you not disappointed that we did not have a
specific sum of money agreed in Okinawa to combat HIV/AIDS?
(Clare Short) No, I was not, because this is the great
ruse of international development conferences, in my view. "We
need more primary education. Let's have a fund." "What's
the fashion this week? Deserts. Let's have a fund." "Trees
this year. Let's have a fund." Of course that is how it goes
and then everyone can go away, it can be in the newspapers and
everyone can pretend we have done trees, deserts, HIV, or whatever
it is this year. They are notional funds and if there is not a
follow through and if programmes cannot be driven forward—in
our own Department the restraint has not been the unwillingness
of the Department to spend more on HIV/AIDS; it is being able
to find governments where you can spend effectively and really
help. So, no, I am not and I really get fed up with demands for
a fund as a cheapskate way of pretending action is being taken.
The same happened at Dakar with education. The restraint on driving
forward the commitment to primary education in the poorest countries
in the world is not just availability of funds. Many, many developing
countries prioritise higher education and spend far more money
on it and have little motivation about primary education for poor
children. A notional fund that might tie up money of ours which
is not spent effectively does not help anyone. It is gesture stuff
and I am rather against things like that.
528. The Okinawa Communique« linked the
fight against HIV with that against TB and malaria, which are
opportunistic diseases, as we call them, related to HIV/AIDS.
In what sense will there be a combined effort against these three
diseases?
(Clare Short) The growth of the incidence of TB is
linked to the HIV pandemic and, as I said earlier, poor populations
where it is endemic, and it is amongst many poor populations in
many parts of the world, if HIV is there, TB will flare up, and
that needs to be treated just for the quality of life for those
people and I suppose the risk of more people being infected. On
top of that we have got this multi drug resistant TB spreading
in the world. It is very prevalent in jails in Russia. That is
a danger to the world. It is very expensive and difficult to treat.
There is a case for doing something about TB separately. It is
linked to HIV but there is that threat from TB. On malaria, it
still kills a million people a year, mostly in Africa, mostly
children, separately from HIV. Before the HIV epidemic or in countries
where it is not very high, there is massive suffering, loss of
life, use of health facilities. You will find lots of people in
hospitals with the consequences of malaria. We now understand
very much more clearly than we used to that it is the poor that
get sick, but sickness in a family creates poverty. Families with
a sick family member will borrow or sell their animals to buy
drugs and it drives people back into poverty who have been working
together to get themselves up. There is a need to attend to malaria,
again because of human suffering, again because it is spreading
in the world. I do not think there is a malaria link to HIV, is
there?
(Mr Grose) No.
(Clare Short) There is this Roll Back Malaria initiative.
We could do better on malaria if we applied systematically the
knowledge we have got. For example, the use of insecticide-dipped
bed nets can massively reduce the incidence of malaria and therefore
the loss of human life and the sickness and the economic consequences.
There is a separate initiative to Roll Back Malaria. On top of
that we need to work with the drug companies to get appropriate
drugs because of course if the drugs are badly used they become
irrelevant. There is an overlap with TB and HIV. Malaria is separate
but that is also very important. This multi drug resistant TB
is a big danger to the people who suffer from it, and also internationally.
Mr Rowe
529. I just wanted to ask does DFID, for example,
contribute to the work that is being done to genetically modify
the mosquito, for instance? Is that an appropriate thing for DFID
to do or do you feel it belongs to some other part of government
like the Department of Health or something?
(Clare Short) No, we think that on appropriate drugs
for some of these illnesses—given that pharmaceutical companies
will not invest in a lot of research for markets that are so poor
they will not get a rate of return, and yet the best science we
have got in the world is in the private sector (we have got some
very good people in the public sector but nonetheless the capacity
of pharmaceutical companies is so great) we are very interested,
with the World Bank and the World Health Organisation, in creating
partnerships to get the best of the science taken forward in a
way that left to itself the market would not do. We need the knowledge
of the private sector to be part of the research and to create
partnerships, to develop the best medicines and remedies, like
a vaccine against HIV for Africa which the market would bring.
It is a different strain of HIV so if you leave it to research
done in Europe and North America we will not get a vaccine for
Africa. We are very interested in working in that way. Julian
might want to add something. It is a new way of working but it
is very important. If we leave it to the private sector it will
not deal with the diseases in poor countries because the market
will not get the return. If we do not engage with the private
sector we will lose access to some of the best and most advanced
scientific thinking and research. We need to bring them together
and leverage a partnership way of working that produces the drugs
and the remedies for poor countries that otherwise will not be
developed.
530. Thank you.
(Dr Lob-Levyt) Specifically on malaria we support
the Medicines For Malaria venture which is a private venture capital
company, a partnership between the public and private sectors
managed originally by the WHO, now set up as a separate institution
itself. That is funding exactly that kind of work trying to find
new drugs and new technology. Specifically, the mosquito genetic
engineering you talk about is an example of that. We have not
funded that particular piece of research but we are funding many
other aspects of basic research where we think the use of public
funds in a private partnership can really get people to focus
on the needs of developing countries.
Chairman: Andrew Robathan, you were going
to lead us on the DFID expenditure programme but you want to preface
it with another question.
Mr Robathan
531. Secretary of State, as you know, I feel
that you and your Department have taken a very sensible, realistic
and responsible attitude to AIDS. It is not Britain that should
be alone responsible; I entirely agree with that. You have shown
a very responsible attitude. I do not disagree with anything you
have said in your opening statement, which is a bit of a difficult
position to find myself in. Following Okinawa you particularly
mentioned that we should not be over-optimistic about this. Do
you think that the targets that were set were over-optimistic?
I know the AIDS target and possibly the TB and malaria targets
were previously set by the UN, but is not the target of reducing
TB deaths by 50 per cent in ten years completely out of kilter
with the graph which is pretty much on the up dramatically? I
have not got it in front of me.
(Clare Short) Julian will come in and talk with medical
expertise. I would say on targets that basically the international
development effort has been full of rhetoric about poverty and
very unfocused and not output driven and not measuring its effectiveness.
As you know, we as a Government and since the White Paper have
tried to drive targets. There is always a danger that everyone
wants to proliferate targets and that will not do because they
have got to be serious targets that we can get the whole international
system to co-ordinate around. It focuses the effort and you can
measure the effectiveness. That is why we are keen on targets.
We are getting some increase in the efficiency in the international
development system because of targets and it could massively improve
before we got any more resources into it. The AIDS target was
Cairo plus five and was a 25 per cent reduction in the rate of
infections for young people. I think that was aimed at focusing
on effort that was not going on. More than half of new infections
are young people and more than half are young women, and that
is not where people's minds are and there needs to be a shift,
lots of educational effort and self- protection. Again on TB I
am sure we can be more effective by being more focused. The realisticness
or otherwise of the target, I will ask Julian to comment on.
(Dr Lob-Levyt) These targets come from the WHO who
have looked at this with the current technologies that we have
and the kind of resources that might be required to do that. We
believe that target is achievable.
(Clare Short) WHO, as you probably know, has not been
a particularly effective organisation for some considerable time.
Gro Brundtland is a great new leadership for it and our own dear
David Navarro, who used to do Julian's job, is there as Chief
of Staff. It is an organisation that is improving the quality
of its leadership. If people of that quality tell us that these
are useful targets, we would be inclined to support them.
532. Specifically on the HIV infection target,
looking at Uganda, which has been held up at least twice this
morning as the best example we have, started their HIV programme
in 1987. Have they managed to reduce infections by that amount?
(Clare Short) I asked Bob Grose that question in preparation
for this meeting. On this question of how much you can achieve
if you really campaign, the Uganda example is very important.
If Bob can respond to your question.
(Mr Grose) They have cut their levels of HIV infection
from about 14 per cent to about eight per cent. They have not
quite got to the 50 per cent target yet.
533. But nevertheless they are getting towards
it?
(Mr Grose) They are heading in the right direction.
534. That is encouraging. You mentioned how
important political leadership was. I do not criticise you, Secretary
of State, in any shape or form, but were you in the Chamber yesterday
to hear the Prime Minister's statement?
(Clare Short) No, I am afraid I was not.
535. I think it is very worrying that the Prime
Minister's statement, written by his office, said that he supported
"concrete quantitative targets for reducing deaths from AIDS,
malaria and tuberculosis by 25 to 50 per cent ..." I think
we would all agree that to try and reduce deaths by AIDS by 25
per cent in the next ten years, given the lead time, the incubation
period, and so on, is probably not what we are talking about and
not within the Communique«. I think it is rather distressing.
Do you think the Prime Minister understands the complexities of
the AIDS situation?
(Clare Short) He has taken a lot of interest, since
his first visit to South Africa, in the question of HIV and AIDS.
Of course, as you know, the quality of our government system might
not be perfect but we are reasonably joined up. We do not have
Prime Ministers wandering around the world unbriefed. I know Julian
was highly involved in the targets prepared for Okinawa. Presumably
he quoted in his statement the target agreed in the statement
from the summit, or not?
536. No is the answer. He came up with a new
target which is not the target. Furthermore, I do not think this
target is meetable.
(Clare Short) We had a seminar on competition policy
and the contribution it could make to countries more rapidly reducing
poverty, so I was not there. I will look into that and write to
the Committee and consult with Number 10.
537. You might write to the Prime Minister as
well.
(Clare Short) I cannot comment because I do not know
what was said.
Chairman: I think we should get on.
Mr Robathan
538. It is a very important question about political
leadership.
(Clare Short) Can I add that all of us have sometimes
slipped in what we have said in the Chamber.
539. Not when you have got a written statement
in front of you.
(Clare Short) No, but I will find out exactly what
was said, what should have been said.
Chairman: I do not want to encourage
the prolongation of this discussion mainly because, Secretary
of State, you have only got an hour longer to spend with us.
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