House of Commons - European Scrutiny

Select Committee on European Scrutiny Twenty-Second Report

1 Programme for Action on three major communicable diseases

(24344)

7115\03

COM(03) 93

Commission Communication: Update on the EC Programme for Action — Accelerated action on HIV/AIDS, malaria and tuberculosis in the context of poverty reduction: outstanding policy issues and future challenges.

Legal base —

Document originated 26 February 2003

Deposited in Parliament 12 March 2003

Department International Development

Basis of consideration EM of 18 March 2003

Previous Committee Report None

To be discussed in Council No date set

Committee's assessment Politically important

Committee's decision For debate in European Standing Committee B

Background

1.1 The Commission's Programme for Action (PfA) on HIV/Aids, malaria and TB was adopted in February 2001.[1] It runs from 2001 to 2006 and is designed to provide an important EC contribution to the international response to the "global emergency" caused by these three major communicable diseases. It links country-level actions, aimed at increasing people's access to existing interventions, goods and services, with global action on making key pharmaceuticals affordable and on increasing investment in the research and development of specific Global Public Goods (GPGs)[2] to confront HIV/AIDS, malaria and TB. Three areas for action were identified: impact, affordability and research. These areas are inter-related and complementary.

1.2 Now that the programme has been running for two years, the Commission considers this an appropriate juncture at which to assess how it is being implemented and whether there are any outstanding policy issues, and to look ahead.

The Commission Communication

1.3 The Communication addresses the overall context and the outstanding challenges globally. It then assesses the results to date under the headings impact, affordability and research. A separate section is devoted to monitoring and evaluation, followed by recommendations for the future.

The overall context

1.4 The number of people affected, infected and dying from these diseases continues to increase. In 2001 three million people died from AIDS, while another five million were newly infected by HIV. On current trends, by 2020 nearly one billion people will have become infected with TB, 200 million will have developed the disease and 35 million of them will have died. Both TB and malaria are contributing factors in another two to four million deaths annually.

1.5 There is a consensus in the international community that there is an urgent need to tackle these diseases in developing countries, and about the procedures to use. There is no vaccine for any of the three. However, consideration is now being given to incentives to encourage the production of specific GPGs, in the form of products, services and knowledge. Success will depend on action being taken internationally. Health targets feature prominently in the Millennium Development Goals,[3] the key objective of which is a reduction in the proportion of people living in extreme poverty by 50%, by 2015. The report of the WHO[4] Commission on Macroeconomics and Health of December 2001 presented clear evidence of how a heavy disease burden[5] reduces economic growth. It estimated the return on investment in health in developing countries at 18% per annum.

Assessing the impact of the programme

1.6 The Commission finds that progress has been slow. It says:

"The ambitious target in the Programme for Action to increasingly prioritise in-country/regional allocation for improved 'health' outcomes, in partnership with developing countries and other partners, has so far brought relatively indistinct results. A longer time-scale will be needed before [the] real impact becomes clearly visible".

1.7 The current level of funding allocated for 'health as a focal sector' under the 9^th EDF[6] is 3.7% (€280 million). EC spending on social infrastructure is planned to rise, dormant programmes have been re-directed, and spending has been better focused on those priorities established by the PfA. At EU level, several resolutions have been adopted by the Council and the European Parliament confirming the priorities established by the PfA. The Commission has also adopted a Communication on Health and Poverty,[7] which identifies four broad approaches toward improving health outcomes, and proposes a Regulation on Poverty Diseases (HIV/AIDS, malaria and TB) in developing countries.[8] The latter includes a substantial increase in financial resources.[9] The EC is exploring efforts to boost local manufacturing capacity for essential medicines.

Affordability

1.8 Substantial advances were made in 2001 and 2002 in discussions between the EC and other WTO[10] members on intellectual property rights and public health, culminating in the adoption of the Doha Declaration on relations between TRIPS[11] and Public Health. The Commission says that the EU's advocacy of tiered pricing (i.e. different levels of prices in different countries) was successfully pursued and its strategy for improved supplies of essential pharmaceuticals to developing countries has yielded tangible results. During the last two years, the tiered pricing concept has gradually become widely accepted within the EU as an effective way of providing access to key pharmaceutical products for people living in poverty. In 2002, the Commission adopted a proposal for a Council Regulation to avoid diversion into the EU of certain key medicines sold at very reduced prices to the poorest developing countries.[12] The EC has also commissioned a study on tariffs and other duties paid when pharmaceuticals are imported into developing countries. It is also providing technical assistance to countries on conducting trade negotiations. Although not part of the PfA, the EC is launching a set of Round Tables on corporate social responsibility, dealing separately with issues such as health, gender, HIV/AIDS, and core labour standards.

Increasing investment in research and development

1.1 A substantial increase of €400 million has been allocated from the 6th Framework Programme for Research and Development to HIV/AIDS, malaria and TB research. The new European and Developing Countries Clinical Trials Partnership (ECDPT)[13] specifically targets interventions for use in developing countries. €200 million has been earmarked for this initiative. Additional direct and indirect incentives for research and development of specific GPGs to fight the three diseases will be given increased attention.

Policy dialogue

1.10 The Commission says that the European Community has been "proactive" in addressing the issues covered by the PfA in global fora such as EU/US, EU/Canada, EU/Japan and G8 summits. It has helped shape global agendas, for instance on the development and implementation of the Global Fund to fight AIDS, TB and Malaria (GFATM) and the Global Alliance for Vaccines and Immunisation.

Monitoring and evaluation

1.11 The PfA stipulated that appropriate mechanisms, resources and partnerships be put in place to monitor implementation and to participate in a global monitoring system encompassing the efforts of all the international partners. The Commission reports that it is participating in international efforts to develop "impact indicators" that are sensitive to "pro-poor" goals, and to achieve the Millennium Development Goals, and is strengthening developing country ownership and statistical capacities. Examples include working with the OECD/DAC[14] Network on Poverty Reduction and the GFATM Monitoring and Evaluation framework.

The Government's view

1.12 The then Secretary of State for International Development (Clare Short) noted in her Explanatory Memorandum of 18 March that the:

"EC proposes a set of new actions, some of which will require new regulations. These include the creation of a 'Stakeholders Forum on Communicable Diseases in the Context of Poverty Reduction' to convene Commission, EU Member State officials, representatives of developing countries, NGOs, industry and others to allow for ongoing consultation on the actions identified in the PfA.

"EC proposes to study measures that could be introduced to improve access to information on pharmaceutical prices and pharmaceutical manufacturing capacity in developing countries. It will be important that any efforts do not duplicate WHO actions.

"EC will consider the need for a specific legislative instrument to provide incentives to industry to undertake research and development for neglected and poverty-related diseases (similar to EU Orphan Drug Regulation)."

1.13 She commented that:

"The Government welcomes the update. The EC's approach to combating these three diseases of poverty generally accords with DFID's approach to optimising the impact of responses to the diseases. The EC has been an important ally regarding the shaping of the Global Fund to Fight AIDS, TB and Malaria and share[s] a view that the fund strengthen[s] country strategies, programmes, and processes to deliver sustainable improvements. The EC recognises the UK's efforts regarding improving access to medicines (as well as the High Level Working Group on Access to Medicines).

"Whereas the update focuses on EC action to address these three diseases, it does not discuss the need to strengthen underlying health systems in order to deliver services."

Conclusion

1.14 The Communication is testimony to a great deal of work by the Commission in this field over the last couple of years. It also demonstrates that the European Community recognises that, in order to make an impact on what the Commission describes as "the global emergency" caused by these three communicable diseases, additional funds need to be allocated to tackling it. We recommend the document for debate in European Standing Committee B.

1.15 Issues which might be raised with the Minister could include:

· why the programme has made slow progress in having an impact and what lessons have been, or should have been, learnt;

· whether the additional financial resources described in the document are sufficient and whether sufficient staff have been allocated to the task;

· whether the Government thinks that there is a case for a specific legislative instrument to provide incentives for industry to undertake research and development for neglected and poverty-related diseases;

· whether the EC should be more active on the issues related to the objectives of this programme, or should leave them to be dealt with at the international level;

· what the likelihood is of the Doha Declaration on relations between TRIPS[15] and Public Health being implemented and in what timeframe there could be practical steps on tiered pricing of key medicines; and

· whether the Minister believes that the programme can achieve really successful outcomes during the period to 2006.

1 (22234) 6802/01; see HC-28-xi (2000-01), paragraph 8 (4 April 2001) and HC-28-xiii (2000-01), paragraph 13 (2 May 2001). Back

2 Global public goods (GPGs) are public goods, the provision or associated benefits of which spill over national boundaries. For example, reducing communicable disease or conflict in one country produces benefits, if not globally, then at least for neighbouring countries. Back

3 The development goals in the UN Millennium Declaration include eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, combating AIDS, malaria and other diseases, and ensuring environmental sustainability. Back

4 World Health Organisation. Back

5 The impact of ill health on individuals, and on their societies, is measured by estimating the number of lost years of healthy life they lose as a result of each illness. Cumulatively, the total number of healthy life years lost as a result of the illness can be described as the "disease burden" that it causes. The total diseases burden in a society represents the gap between the actual health of the population and an ideal situation where everyone lives into old age in full health. Back

6 European Development Fund. Back

7 (23351) COM(02) 129; see HC-152-xxix (2001-02), paragraph 10 (15 May 2002). Back

8 (23323) 6863/02; see HC 52-xxxi (2001-02), paragraph 1 (22 May 2002), HC 152-xxxv (2001-02), paragraph 6 (3 July 2002) and (24449) 8371/03; see HC-63-xxi (2002-03), paragraph 9 (14 May 2003). Back

9 €300 million over the period 2003-06 was proposed in the latest draft, scrutinised by us on 14 May 2003. Back

10 World Trade Organisation. Back

12 (23976) 14113/02; HC-63-v (2002-03), paragraph 23 (18 December 2002). Back