World Summit on Sustainable Development and Aid for Poverty Diseases

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Mr. Johnson: The Minister makes a good point about leverage. Does she agree that it is important to keep the cards in the hands of national Governments, as it is often difficult to exert the same leverage through the Council owing to the difficulties of getting a collective decision?

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Ms Keeble: I agree, but it is excellent that the EU spends some of its vast budget on the developing world. We have increased the support that we provide, whether through direct budgetary support for Governments or through projects with NGOs and the like. As I said at the outset, about 15 per cent. of our direct support is provided through direct budgetary assistance and 85 per cent. through other means.

Some governance problems are not solely of the developing countries' making. We have successfully provided support for cheap textbooks for schools in Africa, which is valuable and important. Unfortunately, it has not provided best value for money, partly because of scams run by British publishers, which have inflated the prices. That is a major problem and the measures that had to be taken in Uganda to tackle it included involving the monitoring groups responsible for the selection of the publishers for the textbooks in an SAS-style operation to prevent them from being interfered with by the publishers.

The fault does not always lie with the developing countries. Some of our own publishers played a role in making less effective an extraordinarily important development project conducted by the Government with money from the British taxpayer.

Mr. Hopkins: In a sense, my hon. Friend reinforces my point that direct Government involvement in the pharmaceutical sector is required to ensure that the companies do what they should.

Ms Keeble: We could not publish all the textbooks ourselves, although that is a separate matter. I shall return to the pharmaceuticals issue.

The hon. Member for Surrey Heath made a point about the Secretary of State annoying some NGOs. I am sure that Members who have travelled through developing countries will have encountered the glowing support given to this country and, especially, to my right hon. Friend owing to the fact that she has championed developing countries. She has raised development's profile not only in this country, but internationally, and she has pressured other Governments into supporting development goals, for which she succeeded in getting extra money from our Government. In the light of those facts, the hon. Gentleman's criticism on NGOs is misguided.

I do not want to take up the Committee's time with details, but I should point out that our working group dealing with access to medicine includes representatives of GlaxoSmithKline. I am not sure whether that company operates in the area to which the hon. Gentleman referred. The working group also includes the Association of the British Pharmaceutical Industry, so industry is closely involved in working with the Government on differential pricing. He also referred to Novartis, which provides differential prices for a drug to treat malaria.

My hon. Friend the Member for Luton, North was clear about his commitment and the depths of his concern. His criticisms of EU aid were well made, and many would share them, but our concern is to ensure that the EU focuses its aid on the needs of the poorest

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and does not provide aid to more affluent countries for geopolitical reasons. That is what the hon. Member for New Forest, East described, and we all share his sense of urgency on dealing with illnesses and easing suffering. However, he may want to think more carefully about the mechanics of achieving that.

I envy the hon. Member for Henley his opportunity to visit countries such as Uganda, where the incidence of HIV/AIDS was halved over 10 years through a variety of measures—one was the political lead and commitment from the Ugandan Government in tackling the problem. Senegal has also tackled it, and even Kenya has managed somewhat to stabilise the incidence, although its efforts are at an early stage. The role of Mbeki shows that money is not the only consideration; people must front up to other issues if the incidence of AIDS is to be reduced.

We must consider the changes in the illness. In many countries, mother-to-child transmission is the main source of infection, which is a tragedy, but it is a mistake to minimise the problems of distribution, because we must sustain delivery beyond one generation. We cannot immunise a population once only—we must keep on doing it. That is a major issue.

I can give the example of an unannounced visit that I made to a clinic in Kenya, where the drugs and syringes were provided free. The clinic made a service charge alone. However, when I asked where the vaccines were kept, I was shown a fridge, but I was then told that there had been no electricity for a month. The vaccines were kept in the kind of coolbox that we give our children to take their lunch to school on a hot day. To deny that there are substantial issues, not only of cost and provision but of distribution and the country's health service, is to underestimate the problem. I do not want to detract from what hon. Members have said, but we must take the big problems seriously.

Dr. Lewis: The Minister's point about distribution is well made, although it was originally put by the hon. Member for Broxtowe. Will she please address the central point made by hon. Member for Luton, North, which is that we will get a better result if the aid is channelled in the form of drugs rather than as simple financial assistance?

Ms Keeble: I am not quite sure what point is being made. Even if we ship a lot of drugs out to those countries, the distribution problems will remain. If we provide the money, the drugs can be sourced at a lower price in the developing countries or bulk purchased elsewhere. The three key issues are the cost of the drugs, access to them—there must be enough in the countries concerned—and distribution. On the first two, we are dealing with the point made by my hon. Friend the Member for Luton, North about nationalised production, but I doubt whether the hon. Member for New Forest, East, knowing his political position, is advocating that. I think that he was talking about drugs versus money.

Mr. Hopkins: I thank my hon. Friend for giving way once again. That is a component of what I was suggesting, but only that, as it would ensure that the Government had control of the supply of drugs.

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Portable refrigeration units could be delivered at the same time as the drugs, and then sufficient supplies could be delivered as the drugs would not break down or run out.

Ms Keeble: My point is that there are a lot of issues. One is storage, which is a notorious problem. Another is that although one can provide something free, service charges could be a problem if the governance issues are not sorted out. There are other difficulties. For instance, in some areas the nurse has to wait until the mother brings the child, and there is the question whether the service is provided through outreach or in local clinics.

Dr. Lewis rose—

Ms Keeble: I do not want to delay the Committee, so I must move on.

My hon. Friend the Member for Broxtowe, who has particular knowledge of European procedures and of the drugs industry, raised a number of points. I agree with him on prevention, which is of major importance with AIDS, as Africa is in the lull before the storm. The death rates are not yet high and people are living with it, but the real problem is that some AIDS orphans are infected. Many thousands of children are growing up with one or both parents dead from AIDS. The incidence of AIDS has hit some countries hard, particularly in public services such as education and health. It is crucial to reduce its incidence, which means dealing with people's behaviour, not just the symptoms of the illness.

The hon. Member for Henley gave us an interesting description of his travels. My note says that he was right about the procedures. I shall read out a little of it, but if he wants more, I shall write to him in detail. There needs to be agreement between the Council and the European Parliament, which is a co-decision process, and negotiations are ongoing. That will lead, if necessary, to the formal conciliation process. If there is no success at all, the regulation will not be agreed and it will be unable to proceed. That outcome would be a complete tragedy, because the regulation would make it possible to provide the money for the global fund. I hope that that deals with the hon. Gentleman's concerns.

Mr. Johnson: I am so grateful to the Minister for dealing with the procedural question. It seems that the nub of it is that the Council has the final say, and that the matter falls without agreement. Will she clarify exactly what the Government object to in the Parliament's amendments? Is it that third-world countries such as South Africa and Zimbabwe should have licences to produce drugs? Paragraph (i) on page 8 of the regulation states that the Council will

    ''encourage capacity building in developing countries, to enable them to co-ordinate, host and conduct large-scale population trials''.

Do the Government object to that? I want to be absolutely clear about what they object to in the compulsory licensing proposal.

Ms Keeble: The fact that compulsory licensing is advocated, when we are making progress on voluntary

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measures. It is in no one's interests to reopen and unpick an internationally agreed declaration. The amendments give prominence to compulsory licensing, but our approach is based on achieving agreement and on an action plan that will introduce a voluntary differential pricing system as the operational norm. That approach has the potential to bring medicines to the poor in developing countries on a more widespread and sustainable basis. We oppose the amendments because they would not help us make progress in that regard. I hope that that clarifies our position.

The hon. Member for Henley also asked about bilateral as opposed to multilateral aid. We still provide bilateral aid, some of which goes directly to Governments, as we discussed, while some goes through NGOs and is project based.

There was some misunderstanding about the purpose of the regulation, and the hon. Member for New Forest, East implied that we are being mealy-mouthed and woolly about wanting to go ahead with it. However, it is under the regulation that we shall contribute to the global fund, which already provides 40 programmes in 30 countries. It has provided $378 million over two years, and we have pledged $200 million over five years. The Commission's continued contributions and involvement in the fund are obviously important for its success, and that is what the regulation is all about.

That, however, is not all that the international community is doing on health. We and other donors provide bilateral help, and there is a clear need for co-ordination between donors. There is also the global polio eradication initiative. That international partnership was launched in 1988 and it is making considerable progress, with the support of Governments, NGOs, UN agencies and others. In that regard, I thought that we would be criticised because the regulation mentions only three of the diseases that have ravaged developing countries, when other, preventable diseases have done so too.

The hon. Member for New Forest, East asked why water is such a priority. The reason is that many people get sick because of bad water supplies. We are therefore considering such issues and taking active steps to deal with them.

The hon. Gentleman also said that he cannot not understand why natural resources are such a priority for the world summit, but 75 to 80 per cent. of people in the poorest countries live in rural areas and they depend on natural resources or fishing for their livelihood. Logging that is carried out to suit the developed world's needs and extensive fishing off the coast of Africa have an excruciating impact on those people. We should deal with the priorities identified by the EU, most of which are also the Government's priorities.

The Government will continue to work with other member states and the European Commission to ensure that there is a successful outcome at the world summit. Doha and Monterrey have given us a strong platform on which we must build.

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The debate has clearly shown the importance of the proposed regulation on aid for poverty diseases. As everyone in Committee has said, it is crucial that we combat those illnesses. It is also clear that the Commission is well placed to make an invaluable contribution to that by providing money for the global fund. The Government will continue to press for the regulation to be appropriately resourced, although the views of our colleagues in the European Parliament in coming weeks will be critical in determining the final allocation. I hope that that deals with all the points that have been raised.

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Question put and agreed to.


    That the Committee takes note of European Union Document No. 7727/2/02, draft Council Conclusions for the preparation of the World Summit on Sustainable Development and No. 6863/02, draft Regulation of the European Parliament and of the Council on aid for poverty diseases (HIV/AIDS, malaria and tuberculosis) in developing countries; and welcomes the Government's approach to the World Summit and to discussions on differential pricing of medicines and other key issues.

Committee rose at twenty minutes past Six o'clock.

The following Members attended the Committee:
O'Hara, Mr. Edward (Chairman)
Cairns, David
Farrelly, Paul
Francis, Dr.
Hopkins, Mr.
Johnson, Mr. Boris
Palmer, Dr.
Picking, Anne
Tami, Mark

The following also attended, pursuant to Standing Order 119(5):
Caplin, Mr. Ivor (Hove)
Hawkins, Mr. Nick (Surrey Heath)
Keeble, Ms Sally (Parliamentary Under-Secretary of State for International Development)
Lewis, Dr. Julian (New Forest, East)
Watkinson, Angela (Upminster)

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Prepared 8 July 2002