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11 May 2006 : Column 154WH—continued
Dr. Gavin Strang (Edinburgh, East) (Lab): I am grateful for the opportunity to follow the hon. Member
for Gordon (Malcolm Bruce). I pay tribute to his chairmanship and to the Committee for its report, the first of the Session and on an important subject.
I do not intend to speak for too long but, on average, for every minute that I do, nine people in the world will become infected with HIV and six will die from AIDS. At least one of the newly infected people will be a child and so will one of those who dies. I sometimes wonder whether the shock-horror statistics—40 million people living with HIV, five million new infections, three million deaths a year—might be too much or difficult to comprehend. There is a danger that people might become overwhelmed by the scale of the crisis and conclude that the battle is lost.
It is important to remember that progress is possible and in some areas has been made. The global response to AIDS has improved significantly since the world’s leaders agreed the 2001 UN General Assembly special session’s “Declaration of Commitment on HIV/AIDS”. The special session’s declaration followed the millennium declaration and set targets for prevention, treatment, care and support. The “Declaration of Commitment on HIV/AIDS” will be reviewed at the UN high-level meeting in New York at the end of this month.
Total funds available for HIV work in the developing world have more than quadrupled since 2001 and are in the target range set by the special session. Progress on the ground can be seen in some areas. Prevention work has reduced the spread of HIV in some countries, including Uganda, Senegal, Thailand and Brazil. With respect to treatment, the “3 by 5” campaign was launched by UNAIDS and the World Health Organisation, with the target of giving 3 million people access to drugs by the end of 2005. That target was missed. The number of people getting HIV drugs in the developing world nearly doubled last year to 1.3 million. It is clear that far more needs to be done. For every five people in the developing world who need HIV drugs, only one gets them. Last year the G8, led by the UK, made a commitment to getting as close as possible to universal access to HIV treatment by 2010. I join the Select Committee in commending the work of the Department for International Development in securing that commitment, which was adopted by world leaders at the UN.
Nobody in this Chamber needs to be reminded that if we are to meet the 2010 commitment, catching up with the epidemic will require a huge increase in the scale of the effort. For every one person in the developing world who received antiretrovirals last year, eight people were newly infected.
There has been an increase in funding, but the resources available at present to address HIV/AIDS still do not match the scale of the crisis. As cited by DFID in its written evidence to the Select Committee, it is estimated that $15 billion is required this year to meet prevention, treatment and care objectives, yet only $9 billion is available. The UN Secretary-General has warned that the rate of increase in HIV funding appears to be slowing, yet $22 billion will be needed for 2008.
I am sure that my hon. Friend the Minister will remind us that the UK has increased the money that it
makes available: at least £1.5 billion will be spent in the current three-year spending round, including £100 million each year for the global fund to fight AIDS, tuberculosis and malaria.
I had the privilege of initiating a debate on the global health fund a year or so ago. At that time, the drive was to get round 5 launched. I was pleased that last month’s board meeting agreed to launch round 6, and that the UK was given much of the credit for the decision. However, I understand that no money is yet available for round 6, as all existing finances are required to cover the costs of previous rounds. Of course, that means that new pledges are needed from donors. I would be grateful for an indication from my hon. Friend the Minister as to how he sees that developing and how we can get an adequate response from donors. I welcome the acknowledgement of the Chairman of the Select Committee about the contribution that the Government have made in this area. Indeed, this country is a world leader.
Access to drugs was the centre-piece of the Select Committee’s excellent report. One strand in the effort to get drugs to those who need them has dealt with prices. There have been moves to reduce the cost of antiretrovirals in poorer countries through differential pricing and the availability of generic drugs. Such steps have had a noticeable effect on the prices of first-line drugs. However, as resistance becomes more prevalent, there will be more need for second and third-line treatments, whose prices remain high. In his report to next month’s high-level meeting, the UN Secretary-General has called on donors to work with their pharmaceutical industries to reduce the prices of second and third-line drugs, and I would be grateful if the Minister could outline where discussions on the matter are in the UK.
Bearing in mind that pharmaceutical companies need an income to finance research, I would be grateful for an insight from my hon. Friend the Minister into how well we are doing at ensuring that lower-priced drugs remain in the developing countries for which they are intended. DFID noted in its framework for good practice in the pharmaceutical industry how important it is to “avoid leakage and diversion”. I believe that there is broad consensus in this Parliament that we must enable drug companies to make profits if they are to develop new drugs.
The hon. Member for Gordon referred to trade-related aspects of intellectual property rights. As we know from the Government’s response, they do not share the Select Committee’s view that they should lobby for a review of TRIPS at this time. However, I wonder whether my hon. Friend the Minister could indicate whether he is of the widely held view that the TRIPS safeguards are too onerous and too complicated for developing countries seeking to get access to vital drugs.
On the affordability of treatment, the Select Committee considered the effect of user fees and concluded that it had heard no evidence that such fees improve adherence to drug regimes. I would be interested to hear the Minister’s assessment of the reliability of the data on that point, and his response to the call by the Select Committee to work with the WHO and UNAIDS to issue a statement supporting the removal of user fees.
I note that the UNAIDS paper “Towards Universal Access”, published at the end of March, set a target date of June next year for countries to reduce or eliminate user fees for AIDS-related services including treatment. I wonder whether we can anticipate progress in the direction hoped for by the Select Committee. Again, what is the Government’s view?
Meeting the 2010 target—the target for universal access—will require action from many agencies at international, regional and national level. The global steering committee, which is co-chaired by the UK, has called for an integrated approach through implementation partnerships involving not only the Government but other key leaders in society, including private sector employers.
I shall say a few words about the need for the private sector to meet its obligations. The World Economic Forum warns that businesses are doing too little, too late, in the battle against HIV/AIDS. The organisation conducted a survey of businesses worldwide and found that some firms have responded to the needs of their work force. Globally, 17 per cent. of responding firms provide antiretroviral drugs. That rises to 38 per cent. in the countries that are hit hardest by HIV. The private sector delivers antiretrovirals to 60,000 people in South Africa. However, the response is still inadequate. Kofi Annan described the level of provision as lamentable. I should be grateful if my hon. Friend the Minister would outline what is being done to secure a strengthening of the private sector’s response.
Getting antiretrovirals to everyone who needs them is not merely a matter of securing adequate quantities of affordable drugs. For a start, health workers can treat only those people who have tested positive for HIV. Access to testing and counselling services more than quadrupled between 2001 and 2005 in more than 70 countries surveyed, but UNAIDS reports that only a fraction of the 40.3 million people who are currently living with HIV are aware of their infection. Yet the health infrastructure in many countries has been weakened. Many health workers have been lost to AIDS. In some countries pay for health care and other key infrastructure staff is below subsistence levels. Added to that is the pull of richer countries that rely on health care workers from the developing world.
The broader health infrastructure of many countries that have been hit by the epidemic will need to be strengthened if the world is to meet the 2010 commitment.
Joan Ruddock: Does my right hon. Friend agree that there may be real scope for the international community to give much more support to health workers in relation to financial assistance, social payments or some means to enable them to remain in their own countries to provide the services that are required? In Africa we saw that it is, as my right hon. Friend says, not just the availability of drugs that matters, but systematic testing and monitoring of the people receiving the drugs. That requires an enormous input from health workers. If there are not sufficient health workers—as is true of all the countries in question—we need a way to assist them in acquiring greater numbers, perhaps by training but certainly by support.
Dr. Strang: My hon. Friend raises an important and topical point, because as hon. Members are probably aware, a change in the regulations on medical staff means that people training in the medical field from outwith the European Union will find it difficult to get employment; everything is now swinging in favour of doctors trained in eastern Europe. On Sunday, I spoke to the Bangladeshi postgraduate association in Edinburgh, and although we were not, in particular, pursuing the present subject, we discussed the question of how to provide the correct incentives. What should our attitude be to the doctors and nurses who come to work in our health service?
The answer is that we live in a global world, and that they must have the opportunity, if they want it, to work in this country. However, as my hon. Friend says, we should surely try to provide incentives and encouragement to them to go back, even if only for five years, to make a contribution, having been trained to a high standard in this country. I think, also, that we must be prepared to employ them. We cannot just train them and tell them to go home immediately.
John Bercow: Of course, substantial subvention by the Department for International Development of key cadres of health service staff is taking place to the great advantage of Malawi—a fact that we discovered on a recent visit. Further, however, in response to the intervention of the hon. Member for Lewisham, Deptford (Joan Ruddock), does the right hon. Gentleman agree that on the assumption that we cannot finance staff or anything else for ever, it is incredibly important that we accept the need not only to finance staff now but to train the future trainers of staff?
Dr. Strang: Again, I am grateful for the intervention; it is a complex area and perhaps the Minister will throw some light on it. Certainly we are all aware of the objectives. We want, as the hon. Member for Gordon said, to reverse the process that is going on to an extent in some countries of an implosion of the health infrastructure, for which there are several reasons, not least of which is HIV itself.
I congratulate the Select Committee on addressing prevention in its report on the treatment target. As I have said, last year an extra 630,000 people in the developing world received HIV drugs, but there were also almost 5 million new infections in that year. Without improving prevention work, we do not have a hope of reaching the 2010 commitment.
Many of the people most at risk are not being reached by the HIV prevention programmes. Throughout the world, less than one person in five has access to basic HIV prevention services. Less than a third of young people in the developing world can correctly identify ways of preventing HIV transmission, as against the 90 per cent. target set by the special session. The United Nations population fund estimates the gap between the supply and the demand of condoms to be 50 per cent. It is also important to reduce maternal transmission of HIV. Only 9 per cent. of HIV-positive pregnant women receive antiretroviral drugs; that is still very low. The failure to provide treatment to pregnant women is one of the factors leading to 1,800 infants becoming
infected with HIV every day. The Department for International Development’s written evidence to the Select Committee cites estimates that a comprehensive HIV prevention package costing $4.2 billion annually by 2007 could avert 29 million of the 45 million new infections expected by 2010. I urge my hon. Friend the Minister to do all in his power to secure additional funding for the world’s prevention efforts.
All Members present are aware that reaching a consensus on prevention work presents challenges, most notably in respect of the use of condoms. I was interested to read the evidence given to the Committee in support of the ABC approach—abstinence, be faithful and use condoms. However, I share the Committee’s concern about an over-emphasis on abstinence; the Chairman, the hon. Member for Gordon, referred to that. If ABC is to work, the three strands must work together. We must not allow the moral attractions of A or B to lead us to exclude from HIV prevention work the very people who need to be reached.
In that context, Members will have seen reports that the Catholic Church may be prepared to consider whether the use of a condom is a lesser evil than the transmission of AIDS. According to the media coverage, the specific circumstances currently being considered involve the use of condoms by a married couple when one of them is HIV-positive. I am sure that we all look forward to seeing these deliberations proceed.
At the end of this month, a high-level meeting will review achievements against the targets set five years ago in the declaration of commitment on HIV/AIDS. As I suggested at the beginning of my remarks, despondency is as much our enemy as complacency. Behind the missed targets and depressingly high infection rates lie grounds for hope for the 2010 commitment to universal access. To miss the “3 by 5” target was desperately disappointing, but the progress made in response to the initiative showed that antiretrovirals can be administered in deprived areas, that adherence is good, and that the necessary public health policies can be put in place.
I shall conclude by quoting directly from Kofi Annan’s report to the forthcoming high-level meeting:
“Although the epidemic and its toll continue to outstrip the worst predictions, the foundation for an extraordinarily stronger and sustained response is largely in place. For the first time ever, the will and means needed to make real headway have been secured.”
We can be proud of the British Government’s contribution, and I am glad that my hon. Friend the Minister will be in place in the next few crucial years. I am sure that he has the experience to continue to contribute to ensuring that we progress.
Sir Nicholas Winterton (in the Chair): Order. Before I call the next speaker, I remind Members that we have to conclude the debate by half-past 5. Quite a large number of Members wish to speak, including some who have not given notice to the Speaker’s Office, and I would like to allow as many Members as possible to contribute to this important debate—if not all of them who wish to do so.
3.9 pm
Mr. Jeremy Hunt (South-West Surrey) (Con): It is a great pleasure to follow the right hon. Member for Edinburgh, East (Dr. Strang). He followed me in a disability debate last week in the main Chamber and said that my tone was very much in line with the new leadership of the Conservative party. I have been trying to work out whether he considered that to be a compliment. In any case, it is a pleasure to follow him again.
It is also a pleasure to follow the Chairman of the Select Committee, the hon. Member for Gordon (Malcolm Bruce), who made an excellent contribution. Under his chairmanship, the Committee has not fallen into the trap of thinking that we have solved the HIV/AIDS problem with the Gleneagles declaration. It has remained a high priority on the Committee’s agenda, which I welcome and thank him for.
I also commend the hon. Member for Walthamstow (Mr. Gerrard) on the work that he does as chair of the all-party group on AIDS. I worked closely with him on the successful early-day motion on interim targets which was signed by 250 Members. As a new Member, I reflected on whether the secret to success was to form an alliance between old left and new right, although I suspect that such an approach would not find favour in either of our parties.
Last month, in Nairobi, I attended the funeral of Christobel Wanju, an HIV-positive orphan. She was 13 years old, and I met her a couple of years ago on a visit to Kenya. She was a delightful girl, and was apparently healthy, although she was HIV-positive. She had an undetectable viral load; her CD4 count was perfectly adequate. Five weeks ago, she had severe headaches and was rushed to hospital. Tragically, on 4 April, she died. The reality is, unfortunately, that antiretroviral drugs alone are not the answer. From time to time, even children such as Christobel, who was in the controlled environment of an orphanage and was getting all the care and medicine that she needed, are cruelly snatched away just because the virus makes them weak. That is particularly the case for orphaned children, who do not receive the care that they need in their early years, although they might receive it later.
The slow-burn effect of HIV/AIDS means that it is not like a famine or tsunami, so it usually does not hit the headlines in the same way. When these children keep dying, we must remember the figure put out by UNAIDS: one child dies every minute. Last year, 570,000 children died from HIV/AIDS. Let us compare that with the tsunami which occurred at the turn of that year. We are talking about two tsunamis’ worth of deaths from HIV/AIDS of children alone. Let us add the relevant figure for adult deaths, and we are talking about eight tsunamis’ worth of deaths from HIV/AIDS, not as a one-off event, but every year.
The tragedy of the epidemic is that it is getting worse. For every child who dies from HIV/AIDS, 1.3 children are being born with it. We have almost managed to eliminate mother-to-child transmission in the developed world, but in many African countries the relevant figure for it is still more than 35 per cent.
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