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Anti-retroviral Drugs (Africa)

2 pm

Mr. Deputy Speaker : I warmly welcome the Secretary of State for International Development to Westminster Hall. It is not often that we benefit from the highest Minister in a Department, and I think that this indicates the seriousness with which he takes his job and this subject.

Mr. Hugo Swire (East Devon) (Con): I am very grateful to the House for this opportunity to highlight an appalling situation, particularly in the presence of the Secretary of State, and to highlight again—I think for the second time in as many months—Africa's difficulties in its struggle to combat AIDS. The horrors that this relentless disease inflicts on Africa's people in so many ways—socially, demographically, economically, politically and culturally—are well known, and I do not wish to dwell on that aspect of the crisis just now.

I should like to point out recent figures provided by a 2004 United Nations AIDS report that show the scale of the crisis that Africa still faces. Many people are by now aware that AIDS has been acknowledged as the biggest threat to Africa's development and the No. 1 overall cause of death in Africa, but fewer realise that, on top of that, rates of HIV infection continue to rise in sub-Saharan Africa. Last year alone, an estimated 3 million people in the region became newly infected. The figures are worrying, and all the more so since they come after a decade of international efforts to highlight the devastating effect of AIDS, particularly in Africa.

We must ask ourselves why, after 10 years of campaigning and effort to focus world attention on the issue, only 50,000 of the 4.1 million Africans suffering from AIDS are currently receiving any treatment. That   figure is so minimal that it cannot but call into    question the entire premise on which the international community's efforts have hitherto been based. Worldwide efforts to generate more publicity for the AIDS pandemic have sadly failed to translate into increased drugs availability for those who need it most: those on the African continent. I want to focus on the best way of tackling that problem to ensure that victims of this terrible disease are provided with the best possible treatment in the 21st century.

The importance of anti-retroviral therapy cannot be stressed enough. Of course, that treatment is not a cure, and it presents new challenges with side effects and drug resistance, but it has dramatically reduced rates of mortality, revitalised communities and significantly improved the quality of life of people with AIDS. Most importantly, because of those drugs, AIDS is now perceived as a manageable chronic illness, rather than as a plague. Sadly, very few African countries can share in that vastly improved prognosis. Currently, the number of people receiving anti-retroviral treatment is minimal. The World Health Organisation estimates that nine out of 10 people who urgently need HIV treatment are simply not being reached. Around 5 million to 6 million people in developing countries will die in the next two years if they do not receive anti-retroviral drugs.

The greatest examples of the production of generic anti-retroviral drugs are in India and Brazil, where the cost of drugs has been successfully reduced. Mumbai in
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India launched the first generic anti-retroviral drug in 1994 and since then, India has had great success in developing combinations of that original drug. Brazil, meanwhile, is now home to up to a third of all people being treated for AIDS and has successfully reduced its HIV/AIDS related deaths by more than 85 per cent.—a laudable figure.

Furthermore, the Brazilian Government have estimated that anti-retroviral drugs have made savings of about $2.2 billion in hospital care that would otherwise have been needed by people living with HIV. The other major advantage of that treatment is the opportunity it creates to help prevent HIV transmission by encouraging many more people to learn their HIV status. Those countries with success stories are proof that many more people are willing to learn their HIV status when there is the promise of treatment at the end of it.

Above all, the abiding lesson to take away from countries such as Brazil is the vital importance of the production of generic drugs. It lowers the cost of anti-retroviral therapy and, in doing so, increases the numbers of people able to participate in treatment. I concede that there has been movement in the right direction. However, sadly, the prices that multinational pharmaceutical companies charge for those drugs remains way beyond the affordability of those in developing countries. Africa is all too familiar with that situation, and it must change.

A non-profitable drugs solution to the AIDS crisis in Africa is urgently needed—a solution that has nothing to do with self-interest and everything to do with improving the lives of Africa's AIDS victims. The three-by-five initiative, which was launched by the World Health Organisation and UNAIDS in September 2003, is a perfect example of that. The aim is to provide anti-retrovirals to 3 million people in developing countries by the end of 2005, and the initiative is part of a global movement to mobilise support for AIDS treatment. It is crucial that Africa is made a primary focus of such campaigns, and I would welcome the Secretary of State's support for and comments on that.

With the help of non-governmental organisations, such as the World Health Organisation, African nations can really start to advance their management of the disease. One hopeful advantage for Africa, arising from the successful use of generic drugs in Brazil, is the big advance in co-operation between continents. The 2004 UNAIDS report states:

It is vital to exploit that attitude of preparedness among Africans, to allow them to move on to the next phase in tackling AIDS.

Some African countries have already made significant advances in tackling AIDS—for example, Uganda. The success of that nation highlights the crucial importance of generic competition. In that country, despite the fact that the big five pharmaceutical companies had agreed under the accelerated access initiative to reduce the price   of anti-retrovirals, the introduction of generic equivalents from India in October 2000 led to a dramatic fall in the price of the brand-name medicines.

The conclusions of an Oxfam survey report reinforce the need for generic competition. The report discovered that, when generic medicines entered the market, the
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price of patented medicines fell dramatically. Competition will therefore provide an enormous boost to the accessibility of anti-retrovirals. The report also drew attention to the urgent need to fund health services to deliver treatment. The Secretary of State is nodding—I hope in agreement—because that is an absolutely key part of the argument. The funding of those essential services should go hand-in-hand with massive cuts in prices. The Global Fund to Fight AIDS, Tuberculosis and Malaria provides opportunities for countries such as Uganda to deliver comprehensive programmes, which include treatments using anti-retrovirals. Those health services must be introduced into many more African nations if progress is really to take place.

Naturally, it would be naive to imagine that every African nation is at the same stage of readiness to begin drug production. Some face huge internal obstacles, as one New Scientist report pointed out:

The South African political system is an example of exactly that kind of difficulty. We all know that, largely because of the personal effects of AIDS on close members of his family, Chief Buthelezi is much more open than President Mbeki, who seems to live in a world of his own on the question of AIDS. Some of his pronouncements on South Africa's AIDS problem beggar belief.

Such political reticence to stand up and confront the truth about AIDS too often translates into a lack of practical support to put in place vital infrastructure components. Unless Governments are committed to providing efficient distribution systems, the benefits of increased drug production will be unattainable to those most in need in isolated communities. The international community and the WHO must therefore remember the need to focus on a political evolution in some places, as well as on a technological one. Attitudes must change before the advances of drug production can begin to take real effect.

My final thought is an extension of that last point. In a speech to the Commission for Africa on 7 October 2004, Bob Geldof spoke about the importance of addressing local cultures. While that may seem unconnected, there is a valuable point to make. Whereas westerners are more likely to seek a medical or a biological explanation of a problem, Africans tend to seek one that is spiritual or politically related. Strategies that do not address local culture will fail. For example, one large AIDS-testing scheme among pregnant women found that only 30 per cent. returned after the birth of their child to get the results. The test did not seem relevant to their needs, nor did it offer sufficient incentive to return, in the form of treatment, to those who tested positive. The answer to that is, naturally, to provide people with an incentive to return through proper drug production and availability. Alongside that, we must ensure that people want to receive treatment. Otherwise, all our efforts will be in vain.

2.12 pm

Tom Brake (Carshalton and Wallington) (LD): I   congratulate the hon. Member for East Devon (Mr. Swire) on securing this debate on a critical issue. I am pleased that we have the opportunity to return to the issue of HIV/AIDS in Africa on so many occasions.
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I shall focus on the report produced by African AIDS Action, with which I know the Secretary of State is familiar. I commend African AIDS Action for the persistence—in a positive sense—with which it has pushed the idea and for obtaining responses from the Government, including a clear statement of where they stand on the issue.

African AIDS Action helpfully set out at the beginning of its report some of the statistics, which it is worth repeating to remind us of the scale of the problem. Last year, AIDS killed 10 times more Africans than did all the armed conflicts in Africa combined. It is now the leading cause of death among Africans of all ages. Africa is home to 70 per cent. of adults and 80 per cent. of children living with HIV worldwide. In African countries, between one fifth and one third of children have already lost one or both parents to AIDS.

Some 40 million children in Africa are expected to be orphaned by the disease. In 2001, 3.4 million new infections occurred in sub-Saharan Africa. A total of 28.5 million Africans are living with HIV/AIDS in the region. Fewer than 30,000 of them—0.1 per cent. or one in a thousand—are getting treated with anti-retroviral drugs. Those statistics clearly illustrate why African AIDS Action and other organisations are pressing as hard as they can to ensure that a much larger volume of ARVs is made available in Africa for HIV/AIDS sufferers.

African AIDS Action—I shall call it AAA from now on, to avoid repeating myself—aims to produce large quantities of essential anti-AIDS drugs and to price them at an affordable level so that Africans, assisted by the international community, can have universal free access to HIV treatment. It considers itself an humanitarian, not-for-profit mission. It has no intention of seeking profits as conventional pharmaceutical manufacturers do, and it believes that it will be able to make significant cuts to the price and to reduce it to an historical low. We can all agree with those objectives. I thank the Secretary of State for his very detailed reply to my letter to him on this subject. I accept that there may be questions about whether AAA's aims can be achieved on this scale and within the proposed time frame, but I think that the objectives are sound.

The AAA document clearly sets out where it sees its target market, which it has identified in theory as the 28.5 million HIV-positive Africans. Given the number of countries that AAA believes to be in a position to acquire the drugs, however, the scale will be much smaller. It will initially focus its efforts on a core group of countries that it has identified as having a very high level of political commitment to tackling the HIV/AIDS problem, without which there is no point in trying to get drugs to those markets, but it will also focus on countries where the per capita income is more than $500 a year and there is therefore the potential to pay for the drugs.

Clearly, there are doubts, which I am sure the Secretary of State will set out when he responds. To a certain extent, however, AAA's aims have already been achieved, although perhaps not on the same scale, in Thailand and Brazil. In Thailand, the Government Pharmaceutical Organisation produces seven ARV preparations that are two to 25 times cheaper than the
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cheapest brand equivalents. The use of generic drugs has also allowed the treatment programme to expand more than eightfold in the past three years, with only a 40 per cent. increase in the budget.

Médecins sans Frontières has identified several assets that Thailand has in its favour: a public health system that works well and that has trained doctors—an area that the Government and other organisations believe to be a priority; strong political resolve to combat the AIDS problem; and capability of producing its own ARV medication at a reasonable cost.

Similar things have been achieved in Brazil, where manufacturing laboratories have developed generic ARV drugs. Incidentally, Brazil is promoting the transfer of technology, and I will be interested to hear from the Secretary of State whether he has had any contact with Brazil about the offer that it has made; I    understand that it has signed undertakings or agreements with a number of English-speaking countries in Africa, such as Namibia, Zimbabwe, South Africa and Kenya. Brazil has seen one of the most significant drops in the price of drugs produced domestically by private national companies and especially by public manufacturing bodies, and elements of its success story may be relevant to producing drugs in Africa.

I wrote to the Secretary of State about this matter on 8 September and received a detailed reply, for which I   thank him, on 13 October. I apologise if I have incorrectly given the impression that AAA met a Minister of State. I understand that that is not the case, although it has met officials from the Department for International Development. I thought that I should correct that point on the record. In his letter, the Secretary of State sets out his concerns about the AAA proposal. The Government have concerns about potential intellectual property challenges, the AAA market forecasts and its six-month production target for producing ARVs for 7.7 million people.

A separate study initiated by the Department also identified problems associated with achieving international quality standards, with a dependence on imported active pharmaceutical ingredients and with the manufacturing capacity that exists in most developing countries, although, as I said, in Thailand and Brazil there seems to be an indigenous manufacturing capacity that is delivering a substantial quantity of drugs to their own domestic markets. I would be interested to know whether the Department has been able to analyse whether there are ways in which Brazil and Thailand have gone about the production of ARVs that would be relevant to Africa and might be relevant to AAA's proposal.

The Secretary of State also refers in his letter to AAA being provided with additional information about alternative funding sources. I hope that he will expand a little on what alternative funding sources might be available for such initiatives.

I also received a briefing from GlaxoSmithKline, and I want to highlight something that I anticipate that the Secretary of State will also emphasise: the importance of health care infrastructure and resources. If there are no medical staff on the ground to deliver ARVs, simply producing them will not be of assistance. One would expect GSK to highlight that issue, but surely those two
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things can be progressed in parallel and we can work with the health care infrastructure in a country at the    same time as trying to introduce some locally produced   ARVs that could be distributed through that strengthened health care infrastructure. AAA needs to respond to that issue and to say how it sees ARVs being delivered, even in the limited number of countries that have been identified, if the health care infrastructure is not there to support the distribution.

In conclusion, I want to ask the Secretary of State a couple of questions. First, what further dialogue does his Department intend to have with AAA on its proposal? Secondly, will his Department be able to work with AAA to address the genuine concerns that he has set out, such as achieving international quality standards? I am sure that, working with the Department, those are the sort of issues that could be satisfactorily addressed.

The scale of the HIV/AIDS pandemic requires the international community to investigate all possible avenues. The production of ARVs in Africa, as set out by AAA, may have the potential to deliver significant quantities of cheap ARVs. I hope that the Secretary of State will make it clear that he does not consider that option a dead end.

Mr. Deputy Speaker : I am advised that there may be two Divisions in the House at 2.30. I inform hon. Members so that they can plan accordingly. Clearly, we shall have to wait for two votes—if there are two—but depending on how long the first takes, I suggest that we return to Westminster Hall 10 minutes after the second vote. Given the lack of hon. Members who wish to speak on this important matter, we should be able to complete the debate by the appropriate time of half-past 3. Of course, I do not wish to shorten what the Secretary of State has to say, because of the critical nature of the subject.

2.25 pm

Mr. Alan Duncan (Rutland and Melton) (Con): Thank you for your guidance, Mr. Deputy Speaker. It looks as though I shall be cut off in my prime, but the timing may work in such a way that we can all say what we want to say. I thank my hon. Friend the Member for East Devon (Mr. Swire) for initiating the debate. The issue is enormously important; it affects tens of millions of people. As you point out, Mr. Deputy Speaker, it is a pity that more hon. Members are not present to discuss it, but what we lack in quantity we certainly have in quality this afternoon.

The issue of AIDS and HIV in sub-Saharan Africa is   central to our attempts to lift that continent out of   poverty, and it rightly forms a central plank of the      millennium development goals. Millennium development goal 6 aims:

Target 7 of that goal is even more explicit:

That is a sensible and necessary goal, but sadly—let us face the truth—there appears to be no chance of meeting it at the moment on current trends. That shows the scale of the problem that we face.
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The worldwide epidemic is worsening. In sub-Saharan Africa, AIDS is the leading cause of death, as my hon. Friend the Member for East Devon said. A total of 25 million people there have it, 2.2 million people died from it last year and a further 3 million became infected with it. By any yardstick those are horrifying figures, but they become even more so when one examines the sort of people affected. They are often the most productive people, the ones who are embarking on their working life or who are already employed and are the breadwinners for their families. The destructive effect of the disease on both family life and the economic life of many African countries is such that it undermines any attempt to build economic growth and to lift those countries out of poverty.

Sadly, while progress is being made in some countries—for example, Uganda—progress in tackling the disease globally is pathetically patchy. Despite the very good intentions of those involved—I fully respect the sincerity of the Secretary of State in all that he is doing—I fear that we are hardly scratching the surface of the problem. Often, at international community level, we are engaging in piecemeal schemes on a scale that is utterly inadequate. Whatever the opposite is of using a sledgehammer to crack a nut, that is it.

I read on page 3 of the Department for International Development factsheet on AIDS that drugs to treat AIDS—they get a one-line mention—are

Although undeniably true, that is a stark statement. I am afraid that the international community will fall   woefully short of achieving the target of treating 3 million people by 2005.

Any comprehensive policy will entail education, treatment and cure. Much that has been said and much that I say today will, I hope, enjoy support on both sides of the House. We all recognise the complexity of the problem that we face and its many facets. Today, we are concentrating on treatment, which, in itself, is a hugely complex area of debate with important differences of opinion about patented or generic drug production. It is also true that not all infected people require anti-retroviral drugs, but most do.

Most of those who do need ARVs, if they get them, can convert their death sentence into a lifelong illness. It    is probably an exaggeration to say that even 100,000 people in Africa are being treated with ARVs, and most of those are in South Africa, so hardly 0.1 per cent. are receiving treatment. We are not watching failure; we have a ringside seat at an unfolding catastrophe. DFID's factsheet speaks of a

at international level, which is what we are trying to overcome.

The agreement signed in 2001 as part of the Doha round of WTO talks—the declaration on trade-related aspects of intellectual property rights and public health, which is known as TRIPS—stated that public health takes priority over private patents, which is an important landmark in respect of ARV production and the use of generics.

2.30 pm

Sitting suspended for Divisions in the House.
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2.54 pm

On resuming—

Mr. Duncan : Since 2001, various countries have taken advantage of the clause that allows Governments to use compulsory licences to override patents on public health grounds.

Both the Government and the EU supported the implementation of the declaration. While I appreciate the sensitivities of this subject and the complexities of    the issue, I think it right that we recognise the   possibilities offered by the declaration. The key issue    remaining, however, was that TRIPS still restricted drug-producing countries from producing and exporting generic medicines to countries that do not have the domestic capacity to produce them, even if their Governments were to make use of compulsory licences. An agreement was reached in 2003, but it is fair   to say that it is complex, requiring importing and exporting countries to issue compulsory licences. However, that solution for dealing with the competing rights and arguments is the best that has been reached so far, and it is surely right that we explore how it works in practice and whether it delivers the improvements in public health that we all seek.

Let us first consider the costs. The cost of treatment for AIDS used to be a prohibitive $10,000 a year. It is now anything from $200 to $400. That is only $1 a day, but it is $1 a day for those who have only $1 a day. Various options and theses are advanced about how best to address the issue and overcome the financial constraints under which many African economies labour. For instance, given the background that I have outlined, can they not simply import from existing producers, using the compulsory licensing scheme? It is certainly right to test that option, which may yet work. Simplification of the compulsory licensing rules may offer the best way forward. I would appreciate hearing the Secretary of State's views on that, but perhaps it is also right that we consider some other alternatives.

My hon. Friend the Member for East Devon pointed out that Brazil has achieved an 85 per cent. reduction in AIDS-related deaths by establishing local production of ARV drugs. I do not presume to offer a comprehensive solution today—that has eluded everyone for a long time—but I hope that we can consider some options today and widen the debate on the subject.

One option that was forcefully expressed to me recently was also detailed today by the hon. Member for Carshalton and Wallington (Tom Brake). It has been promoted by the charity African AIDS Action, which plans to focus on locally produced ARVs in Africa. The logic of the case, as it was put to me, is to ring-fence a production capability for the area of greatest need, thereby avoiding all the inherent problems of cross-border trade. The plan—the objective—is to make ARVs locally, for local use.

Conventional wisdom says that 50 million people and a gross domestic product of $100 million are necessary for such a production facility to be viable, but I would argue that that is not applicable in this case. We must apply some unconventional wisdom to abnormal economic circumstances. What is needed is not-for-profit production combined with international funding, so that those on $1 a day can win access to the drugs that they so desperately need.
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At present, ARVs can be produced at a far lower cost than ever before and there is massive need, but the extreme demand is not accompanied by the necessary purchasing power among the needy. A key policy option would be to bridge that gap by combining the most economic production of ARVs with a dramatic extension of the ability of patients to pay for them.

Like other hon. Members, I find African AIDS Action's case interesting. I look forward to the Secretary of State's response. I fully appreciate the problems inherent in such a proposal; but, equally, I can understand the need for some original thought if we are to address this massive problem. We should explore every option, and that seems a cogent one.

I also fully appreciate that drugs must be distributed once they are made and that patients need proper instruction in how to take them and proper diagnosis in the first place to determine which drugs they need. One of the greatest problems with focusing on generic production in Africa is that not many African countries have the necessary health infrastructure to carry out diagnoses, advise patients and deliver the medicines to the people who need them. However, such problems do not negate the basic concept of producing ARVs locally in Africa. We must be willing to invest, in parallel, in the production of the necessary drugs to treat AIDS and in the infrastructure needed to deliver them to patients.

The call for an African-based production facility puts the spotlight on the efficacy of the Department's entire AIDS assistance strategy. I hope that the Secretary of State will be able to comment not just on the specific suggestions that we have made today, but in broader terms on his Department's strategy for tackling AIDS and the ways in which our forthcoming presidencies of both the EU and the G8 might best be used to drive forward the fight against this dreadful disease.

I well remember that we debated this important subject a little over a month ago, but I am sure that the Secretary of State would agree that we must continue to debate it whenever the opportunity arises and that we must deliver results by taking effective action on the ground. How we approach that dreadful challenge will have a profound effect on how our world develops over the coming decades. The volume production of ARV drugs that can be delivered to the people in the numbers in which they are needed could make an enormous difference to the future health and prosperity of the world.

3 pm

The Secretary of State for International Development (Hilary Benn) : I echo the remarks of the hon. Members for Carshalton and Wallington (Tom Brake) and for Rutland and Melton (Mr. Duncan) in congratulating the hon. Member for East Devon (Mr. Swire) on having picked this subject and secured this debate. It is his second contribution on this subject in the past month, and I congratulate him also on an extremely clear and cogent speech about what is literally a matter of life and death.

The hon. Member for East Devon asked the right question: why have we not made more progress, given that AIDS is—I agree with him completely on this—the single biggest threat to development? That is certainly true in sub-Saharan Africa, not only because of what
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AIDS is doing, but because it is the part of the world where we are making least progress towards achieving the millennium development goals. Doing something about AIDS in Africa is essential to enabling that continent to progress.

I do not agree with the hon. Gentleman that a lack of progress calls into question everything that we have done until now, because many of the things that we have done hold true. He is right to say that we must ask ourselves what more we can do and how we can do it better. That is why I welcome the debate, which is a chance for us collectively to explore the nature of the challenges that we face and the most effective measures to take, while acknowledging that the problem is complex and requires action on several fronts.

That is the framework within which I want to set my replies. If it were a question merely of doing one thing, as if development as a whole were just a question of aid, the problem would be very easy to fix if one could raise the cash. It is not just a question doing that; it is about action on a number of fronts.

Like other hon. Members, I do not propose to go over the statistics on the scale of the challenge, because we did so fully in the debate in the main Chamber not that long ago. I begin by reminding Members of the steps that the   Government have taken. On World Aids Day—1 December last year—we published the "Call for Action on HIV/AIDS", a deliberate call to us and to others to do more, and an invitation to people who are interested in the subject to send us their views and comments on what we should do.

When we published the UK strategy in July, with its commitment to spend £1.5 billion on the fight against AIDS over the next three years, one commitment was to set aside £150 million to support orphans and vulnerable children. I advance that as an example of the Government listening, because one point that came across very clearly from the consultation was that people did not think that enough was being done for orphans and vulnerable children. I hope that that illustrates the willingness of the Department and myself to listen and to respond.

The hon. Member for Rutland and Melton rightly made a point about our G8 presidency. The UK cannot make Africa one of the two centrepieces of its G8 presidency without putting AIDS at the heart of that effort. We are talking about a human tragedy and the impact on the economy of a whole productive generation being in the process of dying. With the older generation looking after the younger generation, they are deprived twice over.

It is a huge task getting the increased effort, energy, money and willingness from the international community to work together in the way that is most effective. I see that as the biggest single challenge that we have, not just for the G8 presidency, but in the context of what will come out of the Sachs report, the Commission for Africa report and the UN millennium summit, and it will form the main opportunity for making 2005 a development year.

No one will argue with the fact that AIDS is a global emergency that requires an emergency response. At the same time, we have to ensure that our schemes to support developing countries themselves in tackling the epidemic are efficient and sustainable over the long
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term, and that they manage to combine the effort, interest, enthusiasm and money of the international community with building the structures to make the schemes work. That is why we bat on endlessly about harmonisation. We must find the most effective way of bringing all the effort together, which is why the UK has been such a strong supporter of the "three ones"—one plan, one body with responsibility in any country and one way of monitoring progress.

We offer, and will offer in future, substantial support to the fight against AIDS in Africa, and I now turn specifically to anti-retrovirals. We are committed to increasing access to medicines for people in poor countries. One change that I made shortly after becoming Secretary of State for International Development was to make it absolutely clear that DFID was a strong supporter of treatment. We should acknowledge that there has always been debate about the fact that, although there must be treatment, there must also be a mechanism for delivering it. One will not work without the other, and we must make progress on both fronts.

We have been working with pharmaceutical companies and others to try to make medicines more affordable and accessible. At the end of June, we published our paper, "Increasing Access to Essential Medicines in the Developing World: UK Government Policy and Plans", which hon. Members will no doubt have seen. Several hon. Members have referred to the decisions taken through TRIPS, and in particular the agreement last August to allow countries with no capacity or insufficient capacity in their own pharmaceutical industry to import copies of patented medicines. The European Union has now published the draft regulation needed to take that forward. The TRIPS agreements are important in saying that there should not be an intellectual property bar on enabling countries that have their own production capacity and those that do not—this is what the second agreement was about—to import from elsewhere to deal with this public health emergency.

We have seen some progress on the price of drugs, and I agree with the figures given by the hon. Member for Rutland and Melton. I was going to give a figure of about $300 for generic drugs, and he gave a figure of between $200 and $400. That is the average cost that we are talking about for generic medicines, but the cost remains higher for patented medicines: more like $700. However, we still see only a very small number of people having treatment, and I acknowledge the figures that the hon. Member for East Devon gave in that regard.

I turn now to local production of ARVs. Let us be straight: I welcome any steps to increase production of ARVs from all sources, including domestic companies in Africa. As has been said, competition will help to bring down the price of ARVs further, and together with others in the international community, we will then be better placed to work with developing countries to ensure that there is enough financing to support countries in buying medicines. It might be helpful for me to draw hon. Members' attention to some of the activities that are already under way or being planned, although I recognise that the process is quite complex. I shall come to that point when I talk about the specific proposal that we have received from African AIDS Action, to which the hon. Members for Carshalton and Wallington and for Rutland and Melton referred.
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In South Africa, Aspen Pharmacare is already producing under voluntary licences from GlaxoSmithKline and Bristol Myers Squibb. In Ethiopia, Bethlehem Pharmaceuticals is preparing production under licence, working with an African NGO, the Initiative for Pharmaceutical Technology Transfer. The current state of play is that it has submitted all the necessary applications and is awaiting    authorisations. Another company, Addis Pharmaceuticals, is trying to do the same in Ethiopia. In Kenya, the company Cosmos now has a voluntary licence and is looking to produce, and there are other examples in countries such as Tanzania and Nigeria. In the Democratic Republic of the Congo, there is a public-private partnership between Pharmakina, a German-French company, and the German technical development agency GTZ. In Ghana, Zimbabwe and   Zambia, there is a partnership with the Thai Government pharmaceutical organisation, to which reference has been made. I understand that in the case of      Zambia, it is hoping eventually to sell to 13 neighbouring countries.

There are also the partnerships with the Brazilian Government to which the hon. Member for Carshalton and Wallington referred. My understanding is that Brazil is giving $100,000 in technology transfer grants to countries in Africa to help them to develop that generic capacity. It is important to acknowledge that there are several examples on the stocks of people trying to do exactly what the hon. Member for East Devon asked for when raising these issues for debate. Reference has also been made to the substantial generic production taking place in other parts of the world. India and Brazil were mentioned, and there are also China and Thailand. In   some of those cases, work is being done with pharmaceutical companies based in Europe, the United States and Japan to try to make sure that the medicines have greater availability worldwide.

On the African AIDS Action proposal, I congratulate the organisation on its enthusiasm and ambition, but as I said in my letter to the hon. Member for Carshalton and Wallington, ambition needs to be achievable and practical. My first point, which is very frank, is that DFID is not in the business of pharmaceutical manufacture. Although we have done our best with our expertise and with what we have been able to call upon to offer an opinion to AAA about the proposals that it has put forward, this is not a field of particular speciality.

I make that point before I refer to what needs to happen, because we have reservations about the credibility of the proposal that has been made. Any proposal has to have a credible business plan, and pharmaceutical production is a complex business that takes quite some time. It has been suggested that the proposal can take place very quickly, and I raise this question: is it achievable in the time suggested? How quickly could production be up and running, given all the other projects that are in train, involving organisations that are trying to achieve exactly the same objectives of increasing production, helping to increase competition and helping to bring down the price to ensure that ARVs are made available much more widely than currently?
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We have pointed out that there are several other sources of funding for a credible plan that is likely to work. They include national Governments. To what extent has AAA been able to talk to national Governments and to some of the big pharmaceutical and generic producers? There are also social investors,    the European Community's accelerated action programme on AIDS, tuberculosis and malaria, the World Bank, the African Development Bank and the Initiative for Pharmaceutical Technology Transfer, which is an African-owned initiative under the New Partnership for Africa's Development. Our officials have asked African AIDS Action about those potential alternative sources of finance.

Mr. Alan Duncan : On the crucial point of the concept that is being proposed, what would happen if we were to set ourselves the objective, unrealistic though it may be at the moment, of getting treatment to every sufferer of HIV who needs it? Is the global problem at the moment a limit on the productive capacity of the pharmaceutical companies or the absence of funding to pay for people to get the drugs, or both?

Hilary Benn : The hon. Gentleman asks an important question. It anticipates neatly the question that I was coming to: what are the obstacles to making further progress on treatment? In part, they are the two things to which he alluded in his question. I shall put them in the following order, which is not an order of priority.

First, we need more nurses, more doctors and more of a health care service that has the capacity to administer the drugs. As part of that, we need testing. That point was acknowledged earlier. Unless there is testing and people know their HIV status, we will not be in a position to make an effective decision about whether they need treatment. Treatment must also be available. If it is available, people are more likely to come forward to be tested, because there is the possibility of getting something as a result, as opposed to knowing that they are HIV-positive but not being able to do much about it. That is not a great incentive to come forward.

Secondly, the capacity to monitor people's CD4 status is also needed. There are two ways of approaching that issue. In making this point, I hasten to point out that I am not a medical expert. I understand that syndromic management means looking at the patient and saying, "You look pretty ill. We think this is what you've got, but we'll give you some anti-retrovirals." There is also management based on CD4 monitoring, which makes a medical assessment of whether somebody is at the point in their illness where ARVs would be appropriate. That looks at the effective operation or otherwise of the immune system. The danger of the first approach is that it may involve giving drugs to people at a point when they do not need them. There is also always concern about drug resistance developing. In other words, even if we had all the drugs that we needed tomorrow, we would need doctors, nurses, testing and monitoring to make sure that those drugs were used effectively to manage the disease in individuals. There is a need to ensure that people adhere to the drug regime.

Much progress has been made in producing combined therapies. There has been real progress on that front to make things easier for people. One combined pill that
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people take once a day is much better than many different pills that they must take at different times of day, which was the treatment regime when anti-retroviral treatment was first developed. We have come a long way in that respect.

Mr. Swire : The Secretary of State cites the example of people not being in a regime in which they take the drug every day as part of their treatment. Is he not also concerned at reports that some people who have been put on a course of drugs suddenly have them withdrawn because the drugs simply do not exist?

Hilary Benn : Of course I am concerned about that problem, which undermines the purpose of identifying that people have a need and of ensuring continuity of supply. A break in supply recently occurred in Nigeria, for example. Such a problem is extremely dangerous and damaging. That is why there has been movement in bringing prices down. I congratulate those who have worked hard to make that happen, including those in the pharmaceutical companies who have given a lead—we encourage as many others to follow that lead as    possible—and the Global Fund, the Clinton Foundation, the Gates Foundation and others.

We need a system to ensure that, even if all the drugs were available, they could go to people where they live, at the time that they need them, with continuity of supply. That is the very point that the hon. Member for East Devon made. A system must be in place to make that work. Otherwise, drugs might sit in a warehouse, people might pinch them from the warehouse or other practical difficulties might arise. That is the difficulty that we face.

I want to deal with two other points. First, I agree completely with the point that the hon. Gentleman made about local culture in the conclusion of his speech. That is an important point. It is the reason why we are and should collectively be strong advocates of the development of policies and approaches that countries and communities themselves design for dealing with the situation. To use the terrible jargon, I am talking about country ownership. But what is country ownership about? I try hard to avoid terrible jargon wherever possible, and I am sure that the Opposition spokespeople who are present will make common cause with me on that subject, because the problem is to explain these issues in ways that people can understand.

When we say that we want to support developing countries in developing their own plans it is precisely because that is one of the ways in which we can respond to the point that the hon. Gentleman made—the fact that, in the end, the countries themselves have to deal with the epidemic. They have to design their solutions, and we have a responsibility to support them.
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The first African country that I ever visited was Malawi; I did so in 2001, when I was first a junior Minister in DFID. Malawi was a desperately poor country and Justin Malewezi, the then vice-president, who had responsibility for dealing with the AIDS crisis, was debating with his advisers at that point how they might use anti-retrovirals to keep some of their population alive. Those involved were faced with an impossible choice: to whom would they give the anti-retrovirals if they did not have enough drugs and enough capacity in the system to provide them to everyone? That experience had a profound effect on me, and it is why I changed and made clear DFID's approach to treatment. It seemed odd that there was a perception that, in dealing with the crisis, we were somehow behind developing countries in Africa themselves. It is now clear that we support prevention, treatment and care in those circumstances.

My final point is that we must continue to support African countries in finding solutions and to work with them. We are giving substantial funding to the Global Fund, as well as through our own bilateral programmes. We are the second largest provider of funding over a    period of long-term commitment: the figure is £250   million up to 2008. We are supporting national Governments in building capacity so that they can scale up the treatment that they are offering, for example in Ethiopia and Malawi. We will continue to work with pharmaceutical supply and distribution companies on the issues that have been raised in this extremely important debate. We will increase our AIDS spending, as we have committed ourselves to do, and we will continue to support the Global Fund and to work to ensure that the new TRIPS agreement is effectively implemented.

I give one other assurance: we will continue to reflect on what we do and how we do it, because we have one common interest in this debate. We need to ensure that the resources, effort, capacity and will of this country are put to best effect in fighting the AIDS crisis, and we have a moral obligation across the world to ensure that the collective will, money, resources and effort are used to best effect to help the largest number of people in tackling this dreadful epidemic.

Mr. Deputy Speaker : I am sure that the House thanks the Secretary of State for that very considered and full reply. I congratulate all those who have contributed to this excellent debate, and particularly its initiator, on what has been a positive and helpful contribution to a world problem.

3.24 pm

Sitting suspended.
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