Examination of Witnesses (Questions 500
- 504)
MONDAY 31 MARCH 2008
Dr Sylvia Meek, Mr Alastair Burtt, Mr Paul Sommerfeld
and Ms Tina Harrison
Q500 Chairman:
It is the WHO and Interpol that you would see working together
better on this?
Dr Meek: I think they should be working together
more on it. They are both very keen to do so but, again on the
WHO side, it is probably relatively limited resources. They are
open to any opportunities to do more and Interpol seems to be
enthusiastic about it as well.
Mr Sommerfeld: The picture for tuberculosis
is very similar to that for malaria as far as prequalification
is concerned. The real block is the WHO's ability to handle the
requirements of a number of cases coming forward. That is becoming
increasingly important for us in TB because we have new diagnostics
coming on board. We are beginning to see new drugs or new formulations,
and new vaccines are coming closer to a trial, so there are new
developments where the whole issue of prequalification will be
more important. The only way we have so far got round it is exactly
the same as in the malaria world. We have managed to try and find
some money from somewhere to give a bit of extra money to the
central WHO operation to do the prequalification. That is not
a very satisfactory way. It is a bit of horse trading and it is
likely to lead to unfairness between diseases. A general remark
would be to strengthen the funding available to the WHO to have
a large enough prequalification team.
Dr Meek: From what I hear, that is working now.
Mr Sommerfeld: And there have been improvements
in the past two years. On the false drugs, again it can be an
issue in tuberculosis but crucially for us has been the strength
of the Global Drug Facility, which is the purchasing agent of
the Stop TB Partnership, either given free or at a very low price
to major, high burden countries. The fact that a very high proportion
of TB drugs come through the Global Drug Facility means that they
are properly controlled and checked. False drugs are an issue.
You can go into any chemist in many countries of the world which
are high burden TB countries and you can buy all sorts of things
that claim to be Rifampin and Isoniazid and so on, but largely
in the public sector that itself is not an issue. It is notable
that the Global Drug Facility is one of the success stories of
the Stop TB Partnership, and DFID just over 18 months ago agreed
to fund through the Global Drug Facility and is paying for all
of the TB drugs of the Indian National Programme, which means
potentially a third of the world's TB sufferers.
Q501 Lord Avebury:
I was wondering, on the funding, why there has been no corresponding
mechanism to pneumo-aid as you have with pneumoococcal disease
and funding of new vaccines, so that payment can be made in advance
to manufacturers to produce larger quantities and therefore bring
the price down. That seems to be a mechanism that is working very
well in pneumococcal disease. As far as I know, it has not been
applied to any other disease group. Can you explain that?
Dr Meek: At present there is not a malaria vaccine
yet.
Q502 Lord Avebury:
Or medications generally?
Dr Meek: They are just about to introduce a
mechanism like that but a slightly different one, which is promoting
access in the private sector. This is the Affordable Medicines
Facility. We have a report on it and I can leave you a copy. It
gives quite a lot of detail about how it would work but it is
the same kind of idea and it does seem that some of those barriers
are overcome.
Q503 Lord Avebury:
What about TB?
Mr Sommerfeld: It is a question of how close
is something potentially to market. At the moment there are debates
going on. It is a strange body. I have never yet managed to pin
down quite the international committee that is the legal agency.
It has gone through one particular drug and we are beginning to
talk about what will be its next one. We had a debate in the Coordinating
Board of the Stop TB Partnership as to whether or not we should
be pushing for a TB drug to be the feature of an advance market
commitment. We suspect in a way that we are not quite at the point
or that it would be an appropriate mechanism, but we should be
rather soon. I believe there are issues which are worth exploring
about what is the nature of the advance market commitment international
agreements because they seem to be controlled by a slightly amorphous
body. When this came up at the Coordinating Board of the Stop
TB Partnership, I said, "Can somebody tell me exactly what
is this committee? What is it an agency of?" Nobody seemed
to be able to answer me.
Chairman: Can I thank you very much your evidence,
both written and verbal? If you feel that anything has been missed
out, please write to the Clerk. You have already been in contact
with him. Please send those comments in. You will get your transcript
to look at before it goes out in public form.
Baroness Eccles of Moulton: Could we possibly
ask Mr Sommerfeld if he could let us know a bit more about integrating
the HIV and TB programmes?
Lord Desai: I thought we had talked about that.
Q504 Chairman:
If you feel there was anything that was not covered on that, perhaps
you could send it in.
Mr Sommerfeld: I think it was dealt with in
the evidence of the people before us.
Chairman: I agree it was covered to some extent
but, if there is anything you want to add to that, please send
it in.
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