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11 May 2006 : Column 187WH—continued

My hon. Friend led an extraordinarily successful campaign for interim targets to meet the 2010 target. I am delighted that, despite the complexities of the issue,
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the British Government have taken up his suggestion, which was supported by the hon. Member for Walthamstow (Mr. Gerrard) and 248 others in this House. It will be put to the United Nations at the meeting at the end of May and beginning of June. If my hon. Friend is successful, he will have achieved something extraordinary for somebody who has been in the House for just over a year. He may change global policy through his personal efforts, and he should be congratulated on that.

The hon. Member for Northampton, North (Ms Keeble) has been a consistent advocate of improving the lot of HIV/AIDS sufferers, particularly children. She spoke with great knowledge. She was right to discuss paediatric formulae and the necessity of improving diagnostics, especially on the ground, and she made a good point about access to antiretrovirals.

My hon. Friend the Member for North-East Bedfordshire (Alistair Burt) was right to highlight the importance of diet, and he gave some good examples. I want to thank him for the excellent work that he does with World Vision, which tries to improve the lot of people suffering from HIV/AIDS, but I am sure that he would be the first to acknowledge that it is not the only worthwhile organisation involved in this sector.

Opposition Members recognise DFID’s contribution. We recognise that the UK is the second largest bilateral donor on AIDS and that it donates one of the highest proportions of gross national income to AIDS projects. We welcome the £1.5 billion that has been committed by the Government to tackle the disease over the next three years, and the recent additional £20 million pledged by the Prime Minister for the international AIDS vaccine initiative.

The Opposition are interested in and welcome the global steering committee on scaling up access to antiretroviral drugs, primarily because it is independent and transparent, and its monitoring systems are vital to ensuring that aid is effective. I agree with the hon. Member for Richmond Park that if it is possible to do such work and to have the regionalisation strategy that DFID has put in place in Latin America, why is it not possible to do that elsewhere in the DFID budget, which is growing, as it rightly should?

I have some questions for the Minister about how the global steering committee will work. Will there be standardisation of reporting structures so that there is a means of comparison between countries, to ensure that those that do not meet the requirements and targets are assisted by being able to identify the problems?

We acknowledge the three ones principle to create one AIDS action framework, one national AIDS authority and one monitoring and evaluation system in each country. It will be helpful if the Minister could inform us of the number of countries that have implemented that principle to date, the number that are working towards doing so and the time scale involved in those countries implementing the three ones principle. It will be interesting to know whether DFID has given any thought to how the three ones initiative will fit in with the monitoring and evaluation reference group, and how they will co-ordinate with each other to ensure the maximum impact on the ground.

The hon. Member for Walthamstow rightly mentioned the three by five initiative. While it was
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worth while in setting out the structure and architecture of the programme, sadly it did not have the impact that we all hoped it would have. Only 550,000 people were receiving antiretroviral drugs at the end of last year against a target of 3 million. I hope that DFID has learned serious lessons so that that failure will not be repeated and the 2010 target will be met, or that we get as close as possible to meeting it.

In the report, the Committee rightly stated that there were problems with the three by five initiative, particularly its highly vertical nature. I would be interested to hear the Minister elucidate—perhaps not today, but at another time—how he will ensure that that mistake will not be made again and how country strategies will fit in with donor responsibilities for ensuring that British taxpayers’ money and taxpayers’ money in other countries is spent where it is supposed to be spent, so that we get the maximum impact on the ground.

There was an interesting exchange between the hon. Member for South Ribble (Mr. Borrow), who made a thoughtful contribution, and the hon. Member for Walthamstow. They discussed the necessity of continuing the funding of antiretrovirals and other resources to combat HIV/AIDS as we go forward. We cannot have a situation in which countries, particularly in Africa, are dependent in perpetuity on developed countries giving them money. We must facilitate their economic growth to enable them to trade and build their own infrastructure so that they can pay for their health care systems. That will particularly help those countries that have significant and large rural populations, which are difficult to access in the normal course of events. We support the Government in their current difficult discussions to try to resolve the Doha round of trade talks, which could play a major role in facilitating at least the start of that process.

The Committee was right to highlight the position of, and the difficulties with, vulnerable groups, and much has been said about that. I want to make one or two points about children and orphans. There is no doubt that very few companies so far have shown an interest in developing accurate, simple and affordable tests for diagnosing HIV/AIDS in children. Much greater interest and attention needs to be given to paediatric treatment.

Packaging antiretrovirals in doses suitable for children is another point that my hon. Friend the Member for South-West Surrey made. We must focus on reducing the cost of paediatric antiretrovirals, which are currently six times more expensive than standard antiretrovirals for adults. DFID needs to work with the international community to ensure that children are included in the international and national treatment targets. As children grow, their development necessitates a change in their treatment. What is DFID’s strategy for HIV prevention and treatment specifically for children, especially as malnutrition hinders effective antiretroviral treatment?

The hon. Member for Edinburgh, West (John Barrett) made a good point—we have debated it before, so I shall not repeat it—about the coterminosity between HIV and TB, and the necessity of ensuring that those with HIV are tested for TB and vice versa. We must ensure that those whose tests are positive
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receive all the drugs they require, and not just those for one of the diseases that they have.

The Committee made an interesting point about coherence. I would like to know how the Minister is implementing “Taking Action”, which is an attempt to tackle the problems of coherence, and what steps DFID is taking to ensure co-ordination and coherence between the different programmes through the non-governmental, multilateral and bilateral organisations that it funds.

All hon. Members, not just members of the Select Committee, want to ensure that the maximum amount of antiretroviral drugs reaches the maximum number of people as fast as possible, and DFID needs to address three things quickly. The first is resistance to drugs, about which the hon. Member for East Dunbartonshire (Jo Swinson) was absolutely right. It is important, because of the cost, that there is a swift and effective transition from the provision of first-line to second-line and, subsequently, to third-line and fourth-line antiretroviral drugs.

The second point involves delivery on the ground. As well as provision of the drugs, there must be strategies to ensure that there are effective methods of transportation, refrigeration, delivery on the ground and monitoring of treatments. The third point concerns generic drugs and the TRIPS agreement. Like the hon. Member for Richmond Park, I was slightly surprised by the Government response to the report. TRIPS is important and has been relatively successful at creating a new programme, but there needs to be flexibility, increased capacity, assistance on the ground and capacity-building in Governments to purchase generic drugs.

Fairly recently, the former director of the World Health Organisation’s HIV/AIDS programme suggested the designation of a “humanitarian corridor” within which leading drugs manufacturers would allow rivals to produce drugs at low prices for modest royalties, with the purpose of allowing people in developing countries to benefit as fast as practically possible. That is a good idea.

To meet millennium development goal 6, which is to have halted and begun to reverse the spread of HIV by 2015, strong strategies are needed for prevention as well as treatment. If the Government go down that route, Opposition Members will be very supportive.

Sir Nicholas Winterton (in the Chair): I call the Minister to wind up what has been an excellent debate.

5.12 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): I agree with your characterisation of the debate as excellent, Sir Nicholas. That is largely due to the quality of the work done by the Select Committee. I pay tribute to the contributions of members of the Committee and particularly to the leadership of the Committee by the hon. Member for Gordon (Malcolm Bruce). I am not sure that I would go as far as the hon. Member for Boston and Skegness (Mark Simmonds) in hoping that the Committee continues to be so powerfully led all the time. Nevertheless, I welcome the interest and the commitment of the Committee and particularly of the hon. Member for Gordon to reviewing annually our work on HIV and AIDS.


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The debate demonstrates powerfully the commitment of hon. Members on both sides of the House to addressing this issue. It also reflects the passion among many of our constituents, who want to see progress. In that respect, I pay tribute to the advocacy work and the direct services that many organisations based in the UK provide in sub-Saharan Africa in particular and in the developing world more generally. The hon. Member for North-East Bedfordshire (Alistair Burt) mentioned World Vision. Others mentioned Save the Children, UNICEF and many other NGOs with which we are familiar.

The report that we are debating was published in late November 2005 for world AIDS day and much has changed in the time since then. The hon. Member for Boston and Skegness rightly drew attention to the announcement by my right hon. Friend the Prime Minister on world AIDS day of a further £20 million to help to accelerate progress towards vaccines, which the hon. Member for South-West Surrey (Mr. Hunt) mentioned.

What was also important about world AIDS day was the review of the state of the AIDS epidemic. Many of the contributions in this debate rightly focused on the severity of the epidemic in sub-Saharan Africa, but as my hon. Friend the Member for Walthamstow (Mr. Gerrard) made clear, we cannot afford to take our eye off the growing epidemics in eastern Europe and central and east Asia. The UNAIDS report referred to that point, and highlighted the increasing epidemics in China, Papua New Guinea and Vietnam.

My hon. Friend also mentioned India. We are seeing signs that serious epidemics might be about to start in Pakistan and Indonesia. As my hon. Friend the Member for South Ribble (Mr. Borrow) said, there is a significant difference between the way in which the epidemic is being driven in Asia and in sub-Saharan Africa. In Asia, it is driven particularly by marginalised groups, whereas the driving factor in sub-Saharan Africa tends to be heterosexual sex. We must recognise those differences, and nuance our responses accordingly.

Another change to the landscape since the Committee published its report is the launch of round 6 of the global fund. My right hon. Friend the Member for Edinburgh, East (Dr. Strang) and the hon. Member for Richmond Park (Susan Kramer) drew attention to the serious lack of funding in the global fund’s finances for round 6—it has just $46 million, I believe. We know that Spain has just made a commitment and that a further sum is due from the European Commission now that its budget headline figures have been resolved. Obviously, we will use our leverage to try to secure as large a sum as possible for the global fund from the European Commission.

My right hon. Friend the Prime Minister has already written to G8 Heads of State to draw their attention to the need to commit more resources to the global fund for round 6, and similarly, he hopes to speak to the business community soon to encourage it to make contributions. We are also lobbying oil-rich states that have not yet made significant contributions into the global fund. I hope that, in that way, further resources can be made available.


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The hon. Member for South-West Surrey rightly drew attention to the broader estimates of funding gaps for spend on HIV/AIDS—broader than the issues of global fund financing. If we are to address those long-term gaps, we have to make sure that G8 and other nations follow through on their pledges of assistance that were delivered at Gleneagles and confirmed at the millennium review summit. We must also recognise that even those resources will not be enough on their own. That is why it is so important to get innovative sources of financing up and running; why we are working with the French on their idea for a ticket levy; and why we continue to pursue the international finance facility. The excellent progress made by the international finance facility for immunisation is a powerful demonstration of the IFF concept. We continue to make the case that people should support the major IFF.

The G8 presidencies of our Russian friends and our German friends next year will provide further opportunities to focus on financing for AIDS. In that respect, I welcome the fact that President Putin has prioritised infectious diseases as one of the development issues on which he wants to focus.

The points made by my hon. Friend the Member for Northampton, North (Ms Keeble) about the need to ensure that both future and current financing get to community organisations is extremely well made. Other hon. Members asked about coherence across government. The Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), and I went to Malawi and Zambia last year, and looked at issues such as health workers—an issue to which I shall return—and blockages to resources from the global fund, World Bank and other bilateral donors. As a result of pressure from her and the experience in Malawi and Zambia, that issue was discussed at the global partners forum in February. The experience gained there will help us to continue to unblock access to those funding streams.

Obviously, in countries whose Governments are committed to reducing poverty and addressing HIV/AIDS epidemics, we will be able to make faster progress in getting more resources to the grass-roots level. Indeed, in Malawi, there were encouraging signs that funding was getting through to many community organisations, although more still needed to be done. In countries such as Zimbabwe and Burma, where we have to set up systems completely outside and outwith the Government because of corruption and other problems, it can take longer to ensure that community organisations get access to financing. We take the issue extremely seriously and we are busy working on it.

As the hon. Member for Boston and Skegness made clear, through our joint chairmanship with UNAIDS of the global steering committee, we have been following through on the commitments made at the G8 and the millennium review summit on universal access to try to come up with a plan that can be adopted by the international community at the UN General Assembly special session in June. My right hon. Friend the Secretary of State will lead the delegation, again demonstrating the coherent approach across Government to the issue. The Minister of State, Department of Health, my hon. Friend the Member
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for Don Valley (Caroline Flint), who has responsibility for public health, will also be part of that delegation.

The hon. Member for Boston and Skegness alluded to the fact that interim targets have been incorporated in the country plans that we have encouraged countries to adopt. I take issue with the point raised by the hon. Member for Buckingham (John Bercow) that we should set targets ourselves as a donor. I understand the initial attraction of such a concept as a way to track how our funding is being used, but if we want to make faster progress in a developing country, we need targets to be owned and accepted by that country’s Government. Indeed, all donors, not just the British Government, need to get behind such targets. That is why the lengthy consultation process undertaken by the global steering committee—UNAIDS deserves praise for the way in which it has gone about its work in drawing up plans—offers substantial encouragement that we will get as close as we can to universal access by 2010.

I do not accept the doom and gloom about the three by five initiative, although I recognise that only about 1.3 million out of the 6 million people in developing countries who need access to antiretrovirals are gaining access to those drugs. I do not accept it precisely for the reason given by my hon. Friend the Member for Walthamstow: the initiative has galvanised attention on what must be done to address the issues.

That is where the point about broader health systems comes in. We need to recognise that it is not possible to solve the problem of HIV/AIDS in a vacuum. It is necessary to develop much stronger health systems, and not only to provide drugs at affordable prices, but to continue training health workers so that they can support people not just in towns and cities, where it is often easier to get access to a health worker, but in rural areas. I and the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central, saw a programme in Malawi, which the Department is funding, that will increase the number of nurses and doctors over the next six years. Part of that programme involves ensuring through VSO that trainers are training future trainers in Malawi so that the process is sustainable in the longer term, as the hon. Member for Boston and Skegness and others have made clear.

Ms Keeble: Does my hon. Friend accept that networks of health visitors are in place, run by community-based and faith-based organisations, but there is no funding going downstream, so they are not getting access to things? They exist, they are trained and they know what to do, but they do not have any resources.

Mr. Thomas: My hon. Friend draws attention to two problems: the broader problem of funding, on which I have recognised that more money must be made available, and the issue of co-ordination. We need to ensure that all those contributing to the fight against AIDS in a developing country, whether they are small NGOs or major donors, are working through the three ones process to one national plan, with one national monitoring and evaluation framework, under the
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leadership of one national AIDS commission. Where those three processes are effective, the types of problem to which my hon. Friend alluded can be more effectively addressed. The last thing we need is donors having different plans about how they will operate in a country. In such situations, plans often overlap and donors do not think through how each is working in different ways.

Several hon. Members have mentioned the relationship that we have with our friends across the Atlantic. I pay tribute to the work of Randall Tobias, the US global AIDS co-ordinator, who has worked extremely closely with us within the mandate given to him by Congress. We work closely in several sub-Saharan African countries. Along with other donors, we examine what each of us is doing, where there are gaps in the response that is necessary and which of us can deal with them.

As my right hon. Friend the Secretary of State made clear at questions yesterday, and as both of us have made clear before, we take a different view from the Americans on abstinence and on issues such as our support to drug-users who inject. We continue to have debates on such matters with them. The hon. Member for Edinburgh, West (John Barrett) alluded to the fact that we had such debates last year on the prevention policy of UNAIDS. We are having them in the run-up to the UN General Assembly special session, and it is important that we continue to have them. We have a strong view. I welcome the fact that our view and approach are endorsed by the vast majority of Members of the House; I wish there was 100 per cent. endorsement, but there is not. We will continue to advance our position.

Several hon. Members raised the issue of the relationship with the IMF and the concerns that a number of NGOs have expressed about its adverse influence on public health investment. I am sure that hon. Members will be pleased to know that in his note for the high-level meeting, the Secretary-General made it clear that he expects the IMF and the World Bank to initiate a much more transparent process to ensure the necessary fiscal space for AIDS spending. Members who have followed the issue will be aware of problems that arose in Zambia, and they will be pleased to know that the issues appear to have been resolved.

My hon. Friends the Members for Calder Valley (Chris McCafferty) and for Walthamstow rightly pointed out the need to focus not only on antiretrovirals, but on the much broader response to the epidemic that is needed, with the broader focus on sexual and reproductive health rights that must be part of the prevention response.


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