Examination of Witnesses (Questions 442-459)|
9 JUNE 2004
Q442 Chairman: Could I welcome you to
the second half of our sessions today. We now move into the health
arena and I am sure you are well versed in what the inquiry is
looking into and what its intentions are. DFID is central to what
we are investigating. They have made some significant changes
recently and I wondered if you had anything to say about these
changes, if you had noticed even, and if you think they are significant
or insignificant in terms of their approaches to these problems.
Professor Haines: We have looked
at the research strategy and we think there is a lot in it that
is commendable. I should say that I think health has had a very
central role in DFID in the past. There has been a very strong
record of health research directed at problems of development
and we were concerned that that fruitful relationship continued
with the academic sector. I think the research strategy, although
it has taken a little time to come out, contains many good elements
to it. There are a couple of issues which perhaps need more development.
One is the issue of capacity strengthening in low income countries,
to which certainly there is some commitment in this strategy,
but I think we need to know how that is going to be undertaken.
One of the problems is of course that there are very few incentives
for UK-based institutions to undertake that kind of capacity building.
It does not figure in the RAE; we cannot afford to send staff
to spend large times in low-income country institutions so the
question is how we can in practical terms strengthen the incentive
system to build up research capacity in low-income countries.
The other issue which needs to be dealt with head on is the impact
of untying aid. Many institutions were used to competing on the
international field. We have no problems with that, but it is
of some concern to what extent that is a level playing field.
For example, if UK institutions have to put in bids based on full
economic costings, whereas institutions, say, from North America
do not have to do that, then there is a concern that there might
be some kind of undercutting or disadvantage to UK institutions
and I think that needs to be thought through in more detail.
Q443 Chairman: Tell me about the biggest
research problems you see in the next few years in the field of
international development. What are the disease problems?
Professor Haines: The disease
problems are obviously HIV/AIDS, which is a major killer: over
40 million people infected. There is a lot of work going on on
AIDS vaccines. We are some way I think from any kind of vaccine
that is useable. There is also a lot of work going on on microbicides,
to try to prevent transmission. Again, there has been no real
proven effectiveness as yet, but there are some very important
trials going on. The main struggle at the moment with HIV/AIDS
is to improve the update of proven effective preventive interventions,
like condoms, for example, and also to implement anti-retroviral
treatment in very large populations. No one has ever tried to
do that before. The WHO programme, the Three by Five Programme
(aiming to get three million people on ARVs by 2005) is an attempt
to do that.
Q444 Chairman: Run me through some of
the other things as well.
Professor Haines: The others obviously
include malaria and TB. For malaria, again, there is some work
around vaccines but not so far very fruitful. It hopefully will
be in the future. There have been concerns about anti-malarial
drugs because very few have been developed in recent years. There
are one or two recently being developed and we need to get more
in the pipeline. TB is an important area, particularly in terms
of multi-drug resistant TB and the problems of trying to get people
to adhere to the treatment over fairly long periods of time.
Q445 Chairman: What about animal human
interactions? SARS, as you know, scared the pants off everybody
suddenly. The fear is that this is now going to be much more of
a feature of health problems, not only in the developing world
but in the developed world as well.
Professor Haines: That is right.
It is more than a development issue, although it can have big
impacts on the economy of China and other countries where SARS
may arise. But it is certainly a global issue and there is a question
whether we properly configured to deal with rapidly developing
global epidemics. I think the WHO again has done some good work
in this, setting up a global observing system to detect very early
new epidemics, but we certainly need more research.
Q446 Chairman: Where would you rate DFID
in this great perspective?
Professor Haines: I think DFID
has made some very useful contributions in the past, particularly
because it funds work in the area of health systems. Health systems
is a very important area of research because many of the constraints
that we are coming up to now, in terms of, say, delivering anti-retrovirals,
are the fact that health systems are not functioning in many countries.
We need to invest money into whole systems research. How can we
develop sustainable financing systems, sustainable human resource
development systems, mechanisms for ensuring quality of care?
DFID is one of the very few funders of this kind of applied research,
which is very important, just as basic research is important.
We need a whole spectrum of research.
Q447 Chairman: Ian Maudlin, can you add
to that? Nick Winterton from the MRC, where do you fit into all
Professor Maudlin: In the area
of animal health, of course, DFID is one of the most important
funders of tropical animal health researchif not the
most importantcertainly in the UK. It is very difficult
to get money for animal health research in the tropics. Research
in this country is mainly restricted to things like foot and mouth
disease which of course are very important to us. The Institute
of Animal Health deals with problems like that, but to get money
for other sorts of research which does not directly impact on
DEFRA is far more difficult and we are reliant very much on DFID
and the Wellcome Trust for that sort of funding.
Q448 Chairman: MRC, where do you fit
into all this?
Mr Winterton: Would it be helpful
if I said a little bit about what the MRC does in terms of funding
research overseas and in relation to the needs of developing countries?
Q449 Chairman: Yes.
Mr Winterton: We spend about £40
million per annum on research relevant to the developing world.
A very large proportion of that is research in the field of infections.
In relation to more applied research, of interest particularly
to DFID, the figure is about £23 million, and I think that
reflects very much the kind of priorities that Andy has described.
If you look at where the bulk of that money is being spent, it
essentially is on HIV/AIDS; it is on malaria, it is on TB; there
is quite a bit on maternal and child healthso an interest
in child mortality and, relevant to that, quite a lot of support
for vaccine trials in the developing world. As you probably know,
we fund two quite large units in Africa, one in the Gambia and
one in Uganda: the Ugandan one focusing very much on HIV/AIDS;
the Gambian with a broader remit in the general area of infections
of importance in the developing world. So, if you like, our own
investmentand that is a pattern that has been established
for a good many years nowI think does reflect those priority
needs. DFID makes and has made historically a significant contribution,
currently of the order of £4 million, to the MRC's work and
portfolio of research in the developing world.
Mr Key: What are your views on what DFID
is doing in allocating money to other research funding bodies,
for example, giving £4 million to the MRC; £20 million
to the Consultative Group on International Agricultural Research;
£14 million to the International AIDS Vaccine Initiative?
Is DFID getting value for money from the various investments or
would the money be better spent by directly funding research elsewhere?
Q450 Chairman: That is individual researchers,
rather than giving it to bodies.
Mr Winterton: In relation to the
MRC, essentially of course that is money that is then fed through
to individual researchers. The process is that the MRC makes the
decisions in relation to the research that is funded. There was
a review conducted by the Swiss Tropical Institute of how successful
the MRC's concordat with DFID was. I think the conclusion of thatand
this is before we negotiated the renewal of the contractwas
that it represented very good value for money as far as DFID was
concerned. It was a cost-effective mechanism for delivering research
of very direct relevance to DFID's agenda.
Q451 Mr Key: Each of you, do you apply
to DFID for research grants or do they approach you and say, "Please
could you do some work for us"?
Professor Haines: It is a mixture
of both really. In terms of the Knowledge Programmes, they have
been strategic programmes. These are the 15 programmes that DFID
has funded over the years on a range of health issues. The school
houses seven of those programmes and they are largely driven by
DFID's perceived needs but obviously our researchers play an important
role in deciding what the detailed research questions might be
within those broad strategic projects. You also asked earlier
on about the investment of DFID into these international initiatives.
I would say that I think it is very important for the UK to be
at the table in some of these very big international initiatives
around AIDS vaccines and so on. Certainly the amount of money
we are putting in is a relatively small proportion of the total
but it does give the UK a seat at the table to see how these important
initiatives are developing. The general point I would make is
that I think the proposed modest increases in health research
may not reflect the requirement, given the overall uplift in DFID
funding. I would like to see obviously a greater investment in
health research, given the importance of the problems.
Q452 Mr Key: What is your own experience
of dealing with the European Union when it comes to getting money
Professor Haines: Like earlier
respondents, we have had quite difficult experiences with the
EU. It is quite bureaucratic. Setting up the networks is quite
time-consuming. A point that came out earlier on was the fact
that the UK Government does not provide any incentive, so that
there can be a negative impact on the institution from taking
on the coordination function for a large and complex grant (particularly
when you are actually responsible for many of the partner institutions
who may or may not actually keep appropriate financial records
and so therefore it is a major responsibility to take on). I feel
that if the UK Government wants us to be big players in the EU,
they need to create a more supportive funding structureas
some other European countries actually have. There is a new development
in the EU, the European and Developing Country Clinical Trials
Platform, which I think is worthy of noting. I think it is quite
an important development. It does have the potential to put more
direct funding into low income countries, in collaboration with
northern partners, actually to test out some of the potentially
effective interventions. That is a development to be welcomed.
Q453 Mr Key: Could I probe a little bit
further on the process and mechanism of getting money out of Europe.
Do you think the deficiency lies in the fact that the Government
does not have somebody sitting out there in Brussels to guide
you as an applicant through the processes, or is it DFID who have
neglected this and have not encouraged you and others in this
particular area of development?
Professor Haines: I do not think
it is a particular problem of DFID, I think it is a general problem
of EU funding. We do have the UK Research Office in Brussels which
does give guidance about how to apply. So I do not think you can
say there is a lack of guidance. I think it is more a question
of policy: Does the UK Government want to encourage the UK to
be major players in European research or not? The UK in general
has been pretty good at getting EU funding, but it comes with
Q454 Mr McWalter: You have said two things
which give me cause for concern. You have pointed out there is
a need for a policy change really in relation to those EU funded
projects. The second thing you said way back was that you were
concerned about policy changes within DFID that mean you may well
be contracting for work which actually is taken away from you
because of the rules, because of DFID's change of policy in effectively
having a free-for-all about tenders. You correctly pointed out
the United States tenderer might have some level of subsidy for
their infrastructural costs or whatever but we might not have
and we might hence lose it. The combination of those two things
might suggest we end up in a situation where we lack the capacity
to support other people's capacity building. Would you agree?
Professor Haines: That is a theoretical
possibility. I have enough faith in the UK Government and DFID
to hope that that will not happen, but I think it needs to be
very carefully considered and mechanisms put in place to guard
against that. Certainly there has been rather a tendency in DFID
not to see the support of UK capacity as a core part of its missionand
one can understand its mission is international development. However,
I think it is very important to say that the UK does have major
capacityit is not necessarily very large but I think it
is high quality capacity, certainly in health research and no
doubt in other fields as welland I believe that if the
UK wants to play a major role in international development, which
it patently does, then it is very important to maintain and strengthen
and develop that capacity in health research because it is very
much looked up to around the world.
Q455 Mr McWalter: You would like our
report to emphasise that fact.
Professor Haines: I think it would
be a very important point to emphasise.
Q456 Dr Iddon: Could I direct some questions
to the MRC, please. How doe the MRC balance its research finances
between diseases that predominantly affect the developing countries
against those that predominantly affect the developed countries?
Mr Winterton: Not an easy question
to answer. There is a mix. Part of it is essentially a response
to scientific opportunity. In a sense, part of MRC's investment
will reflect what kind of proposals are coming forward, the quality
of those proposals, and therefore it will reflect in part the
research interests of the UK research community. The balance,
as it were, between work that is directly relevant to the developing
world and work that is, as it were, only really of direct relevance
to the developed world, that balance will change over time in
part as a reflection of that. Then there is, if you like, an overlay
on that, which is that the MRC has made a conscious decision that
we have a responsibility to make a contribution to the health
needs of the developing world, hence the decision to maintain
really quite significant investments overseas ourselves in the
Gambia and Uganda. Therefore, that, if you like, is a strategic
decision that there must be a certain minimum level of investment
that we need to make in part to retain infrastructure overseas
to enable us to play our own part to a degree in capacity building
overseas. So I would say that the total sum is a mix of that strategic
decision and, in a sense and in part, our responsiveness to the
research community in the UK. But I think, probably fairly consistently,
about 5% of our budget is being spent on work that, if you like,
is almost exclusively of relevance to the developing world and
probably about 10% of our budget is broadly supportive of that,
and that has not changed historically very much.
Q457 Dr Iddon: Do you think £4 million
is a significant contribution by DFID in the concordat that you
have developed out of a total of £23 million?
Mr Winterton: We would obviously
welcome more. It is particularly important in two respects. One
is that it enables us, and quite explicitly, to support health
services research overseas which we would not see normally as
part of the MRC's mission. This money enables us to broaden that.
Obviously it is also a very important part of sustaining that
decision, that strategic decision, to maintain a certain level
of investment in relation to infrastructure and capacity building.
It is more than symbolicthat is importantbut also
it does make a significant contribution to that. We obviously
could spend more, there is no question about it. There are more
good research opportunities out there that we are not exploiting,
and we obviously could spend more money, both from MRC's own resources
and if we had more money from DFID.
Q458 Dr Iddon: The UK overseas aid budget
is increasing. We would like to get 0.7% of GDP obviously. Do
you think some of the money you spend on your work overseas should
come from the aid budget?
Mr Winterton: Yes, I think there
is a very good argument for that. Clearly part of it is essentially
aid, there is no question, and no one can argue that that is a
very major issue in relation to playing our part in tackling poverty,
particularly in sub-Saharan Africa. There are real improvements
that can be made in health terms and that will have huge spin-off
in terms of poverty.
Q459 Dr Iddon: Are you aware that any
of the UK aid money does go in the direction of disease? If not,
have there been any discussions, with the increase in the aid
budget for the future, hopefully, in putting some of that money
Mr Winterton: Within DFID, of
course, the spend in relation to health is very substantially
more than the money that is channelled through the MRC. On the
Knowledge Programmes to which Andy referred, the spend is of the
order of £11 million or £12 million a year. And we do
play our part in some of those programmes as well. For example,
in the Virucide Project the MRC is very active. Our units play
a part in participating in managing some of these other programmes.