Select Committee on International Development Written Evidence


  1.  The Medical Research Council (MRC) is the UK's leading publicly-funded body charged with supporting and encouraging medical research for the improvement of human health. It welcomes the opportunity of responding to the International Development Committee's inquiry, and more specifically to address point 2(d) concerning the response of the international community. The other points highlighted in the Committee's notice are essentially beyond the MRC's remit.

  2.  The MRC has a significant and well-established portfolio of research relating to HIV/AIDS. At the same time, the MRC supports a significant amount of research relevant to developing societies, much of this specifically concerning HIV/AIDS. During 1998, the MRC considered its role in supporting research relevant to developing societies. It was agreed that the existing strategic investments in Africa (see below) continued to be of major importance scientifically and in relation to the MRC's overall mission to improve human health. Continued close interaction with DFID was encouraged—the current Concordat between the MRC and DFID covers the period 1998-2003, and DFID financially contributes to the MRC's work in developing countries.

  3.  It is notable that, whilst the predicted AIDS epidemic in the Western world has never reached the size initially feared, the disease is now one of the major causes of adult mortality in many countries in the developing world, especially in sub-Saharan Africa. The MRC's strategy in confronting this problem is essentially threefold:

    —  fundamental research into aspects of HIV/AIDS;

    —  research into prevention and public health;

    —  vaccine research (important for developing countries because of the high costs of drug therapy).

  Reflecting this approach, there are three major MRC programmes that will be of interest to the Committee, since they each represent a commitment to confront the impact of HIV/AIDS in an African context. It is noteworthy that the programmes are tailored to offer health solutions that reflect the needs of the host societies.


  4.  The MRC/Uganda Virus Research Institute (UVRI) Programme on AIDS in Uganda was established in 1988, as an integrated multidisciplinary research programme for the study of HIV-1 in Uganda. Professor Jimmy Whitworth has led this since 1995. As part of the 1998 review of the programme, the MRC agreed a five-year funding plan worth over £7.4 million.

  5.  Importantly, the programme of research in Uganda is multidisciplinary. It combines social science, epidemiology, statistics, clinical medicine, virology and immunology, and is supplemented by work in health promotion. The factors determining transmission of HIV infection and subsequent disease progression are being studied in two rural population cohorts, and a major intervention trial of behaviour change and improved management of sexually transmitted diseases will be completed by the end of this year. The future plans include expansion of the ongoing cohort studies and the development of further cohorts for secondary intervention studies and potential virucide and/or vaccine trials.

  6.  Moreover, the very substantial benefits of investment in basic research—in terms of the development of new (but expensive) therapies—have thus far had very little impact on the overall course of the epidemic in the developing world. The picture in Uganda does appear to be slightly more optimistic. Over a 10-year period, there has been a significant fall in the prevalence and incidence of HIV in the adult cohort of the MRC/UVRI Programme. Overall adult prevalence has declined from 8.2 per cent in 1989-90 to 6.6 per cent in 1998-99. The greatest decline has been mostly in young men aged 20-24 and young women aged 13-24 years. The incidence of new infection has also dropped significantly, from 7.6 per 1,000 person years at risk in 1990 to 3.2 per 1,000 person years at risk. This is the first evidence from Africa of falling HIV prevalence and incidence in general populations. The results of the research supported by MRC have contributed significantly to Uganda Government health policy and strategy development on the control of the epidemic.


  7.  The MRC Laboratory currently runs eight programmes of research relevant to the health of developing societies. These span HIV/AIDS, tuberculosis, malaria, reproductive health, viral diseases, respiratory infections and non-communicable diseases. In addition, the Laboratory co-ordinates a number of clinical trials, behavioural intervention programmes and maintains important cohorts.

  8.  The Laboratory represent a major investment. At its last review of the facility in 1997, the MRC approved research proposals with a value of £21.7 million over a five-year period. The Laboratory has 600 staff and runs four field stations, and has a very close and fruitful working relationship with the Gambia Government Department of State for Health.

  9.  The prevalence of HIV infection is still lower in West Africa than in other parts of the continent, but while the HIV-2 epidemic remains stable, the incidence of HIV-1 is increasing. The main aim of the Laboratory's research in HIV/AIDS is to gain an understanding of the differences between HIV-1 and HIV-2 in their natural history and pathogenesis. The most striking differences between the infections occur in the asymptomatic phase, which in HIV-2 is prolonged and characterised by a low level viraemia, low transmission rates and a low mortality. A few HIV-2 infected individuals, who are infected with a more pathogenic virus or are genetically susceptible, die rapidly. The opposite is true of HIV-1, which rapidly kills most of those infected. These differences are being related to the molecular biology of the two viruses and their recognition by the host's immune system.

  10.  The Laboratory's research effort in HIV/AIDS is based on three broad approaches:

    —  clinical studies, made largely possible thanks to the Laboratory's genito-urinary clinic—the MRC is the national referral centre for HIV care in The Gambia;

    —  community studies, notably HIV-2 studies in a rural area of neighbouring Guinea-Bissau and the study of mother to child transmission of HIV-1 and HIV-2 in The Gambia; and

    —  laboratory studies of cytotoxic T lymphocytes and viral load in the two infections.


  11.  In 1998, the MRC committed almost £6 million over five years to set up the Human Immunology Unit at Oxford University. It was established to formally bring together groups working in different disciplines in immunology, with Professor Andrew McMichael as the Director. He guides a number of programmes of research that comprise a multidisciplinary approach to understanding the human immune response and its role in disease processes.

  12.  The Unit is initially focusing on infectious diseases, especially HIV infection. Programmes of research going on at the Unit notably include the preparation for, and trials of, HIV vaccines in the UK and Kenya. Others are: AIDS disease progression; characterisation of HIV specific immune responses; and HIV the role of breast feeding in infection of infants.

  13.  There is currently renewed interest in vaccines against HIV. Almost 20 years of research has failed to produce an effective vaccine. Professor McMichael's research suggests that one reason for this might be the slow arrival of a particular type of immune cells called Cytotoxic T Lymphocytes (CTLs) that destroy virus containing cells. New viruses are therefore produced and released before the body's natural defences can kill the original invaders. If a vaccine could boost the production of CTLs, the body might be able to protect itself against HIV infection. It is known that different types of vaccine stimulate different parts of the immune response. The approach being taken at the MRC Human Immunology Unit is to use a combination of vaccines to target particular responses.

  14.  As a complement to MRC investments, Professor McMichael has received funding from the International AIDS Vaccine Initiative (IAVI) to begin a trial testing for an HIV vaccine, in collaboration with the University of Nairobi. The trial is a combination of a naked DNA vaccine plus a modified Vaccinia Ankara (MVA) virus vaccine. There is encouraging data that this approach might work in the long term. Therapeutic vaccines—to stimulate the immune system in individuals that are already infected—are also of interest for AIDS treatment. For example, the potential exists for using anti-retroviral drugs to decrease HIV load and then vaccination to boost the immune system to eliminate the virus completely. In addition, because there are many common mechanisms that exist between diseases such as AIDS, Malaria, TB, Cancer and autoimmune diseases, this research has wider implications for public health.

  15.  The first phase of the trial, currently scheduled to begin in August this year, involves testing on a small number of low-risk volunteers in the UK. Phase one will be repeated in Kenya on a similarly small scale, under the direction of Dr J J Bwayo of the Department of Medical Microbiology at the University of Nairobi; subject to local ethics committee approval, this is expected to start in December. Pending a successful outcome, phase two of the trial would take place in Kenya, targeting those at high risk, such as prostitutes in Nairobi. The intention would be to accompany the trial with high quality nursing and social service support. Phase three—the final stage—would be a trial of people at normal risk, possibly in rural Kenya.

Dr D Mulkeen

Head of Secretariat and Policy

Medical Research Council (MRC)

July 2000

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