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On the other hand, there is a useful emphasis in the report that China, in its turn, is not a monolith. We need to pay more attention to the Chinese provinces, and we need to make sure that there is representation for the United Kingdom and, indeed, for the European Union as a whole in the major Chinese provinces. When being briefed, I was told that Guangdong province now has an economy larger than that of Saudi Arabia, for example, with 30 other provinces to add. So far as China is concerned, the future of the EU External Action Service is very much a matter of coming to grips with a complex entity.

China is a priority for the noble Baroness, Lady Ashton. We fully support her objectives and her efforts there. She visited China at the end of April, and one notes that this is a dual relationship. President Sarkozy made a major visit. The Chancellor was in Beijing on 3 and 4 June for economic discussions and then, I remind the noble Lord, Lord Clement-Jones, went to the Shanghai Expo to visit our excellent exhibition there.

The noble Lord, Lord Anderson, asked about collocation and secondment. I remind him that the British Government have collocated a number of their missions with others-in particular, German ones-and I think in at least one case with a European Commission office. Therefore, there is no objection in general and, indeed, there is a huge advantage in doing so, often on economic grounds. The European Union External Action Service is in the process of development. We are busily training and seconding officials to it, but we will have to write to the noble Lord about the development of the structure of the EU External Action Service in China.

It may be appropriate to say a little about the new coalition Government's approach to co-operation on foreign policy within the EU. The noble and learned Lord, Lord Howe, referred to William Hague's maiden speech at the Conservative Party conference. The noble and learned Lord reminded me the other day that on the famous photograph so often reproduced of the 15 year-old William Hague, there are only three other recognisable faces, one of which is his. So a number of people go back that far with William Hague.

In the Queen's Speech debate in the Commons, the Foreign Secretary said:

"The Government will be an active and activist player in the European Union ... while working to make the European Union as a whole a success ... It is also in our interests and in the EU's general interest for the nations of the EU to make greater use of their collective weight in the world".-[Official Report, Commons, 26/5/10; cols. 187-88.]

This report is, after all, about making greater use of the EU's collective weight in its relations with China. In a couple of days' time, the Deputy Prime Minister and the Foreign Secretary will be speaking together in Berlin about Britain's European policy.

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The noble Lord, Lord Cobbold, asked whether an enhanced partnership with India, mentioned in the coalition agreement, would mean that China would be downgraded. We do not see it as one situation versus the other; we very much want to continue to build on the previous Government's approach to China and to extend their strategic dialogue as far as we can. We already have a fairly developed structure of annual summits, the economic and financial dialogue and, now, the strategic dialogue. Therefore, we are currently talking to the Chinese at many different levels.

There has been much reference in this debate to history. The noble Lord, Lord Alton, went the furthest back-150 years-reminding us that the western treatment of China, with years of humiliation, western arrogance and complacency, is still very much in their minds. That explains part of the intense sensitivity with regard to sovereignty, outside criticism of domestic affairs, including on human rights, their treatment of minorities and the management of Tibet and Xinjiang, and so on. Perhaps we also have to be a little more humble in remembering that when we were behaving in Beijing in the way that the noble Lord suggested, our treatment of our national minorities in Ireland was not entirely above criticism. Therefore, we are moving along a certain path.

The noble Lord, Lord Hannay, talked about the opening of contact with the EC in 1975. We are, after all, still struggling with a trade agreement of 1985 and are making efforts to move that forward into a more constructive partnership agreement. However, I think we all recognise that the transformation of China since then-economically above all but also to some extent socially and in some ways even in terms of human rights and the rule of law-has been remarkable. The noble Lord, Lord Alton, talked about the changes in the freedom to worship. The noble Lord, Lord Selkirk, quoted the claim-which perhaps is quite correct-that the Chinese have better human rights now than they have had over the past 5,000 years. There may be some way further to go but there are signs of movement in the right direction.

The noble Lords, Lord Clement-Jones and Lord Crickhowell, both said that it is a great mistake to preach at the Chinese. It is far better to appeal, as far as we can, to their enlightened self-interest. That is clearly true in relation to the rule of law. On my first visit to Beijing in 1981, I met Professor Gerry Cohen from Harvard, who was giving introductory lectures on international law to Chinese trade officials. They did not want to learn about that out of a sense that it was important intrinsically; they wanted to negotiate over trade-enlightened self-interest. Similarly, the Great Britain-China Centre, to which the noble and learned Lord, Lord Howe, referred, has made very important contributions to work on rule-of-law issues in China. We have to persuade the Chinese that a stronger rule of law, a stronger recognition of the importance of whistleblowers in providing for better industrial relations and better sustainable development is in their own interests and not just a question of value. That has to be the way forward. The same is true of their attitude to intellectual property, which is still a sensitive issue, to the market economy and to energy use.

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We will, if we may, write to the noble Lord, Lord Alton, on the specific human rights issues that he mentioned. We raise specific cases of concern within our human rights dialogue with China. The last round of the EU human rights dialogue with China took place last November and the next round is due to take place in Madrid in June. In that dialogue, we will again focus on freedom of expression, freedom of the press, human rights defenders, the situation in Tibet and Xinjiang, and the death penalty, torture and so on. Therefore, we continue to raise these issues and slow progress is made.

Similarly, on climate change, we have some leverage because the Chinese themselves are increasingly worried about the environmental damage they are doing to their economy. Therefore, we welcomed the focus on climate change during the recent visit to Beijing by the noble Baroness, Lady Ashton. We are also engaged with the Chinese in work on carbon capture technology and on other forms of reducing the energy intensity of their economy.

We have to explain to them that, because of its special status, it is in their interests that Hong Kong continues to remain an economic and financial driver for the entire Chinese economy. In the introduction to the 2009 EU annual report on Hong Kong, just published, the noble Baroness, Lady Ashton, welcomed the EU's strong support for early and substantial progress towards the goal of universal suffrage in accordance with their Basic Law. So we are doing our best to persuade them that their enlightened self-interest goes along with the values that we ourselves wish to promote. This is more difficult in some areas than others.

Several noble Lords mentioned the arms embargo issue. It is a sensitive issue partly because it is one for both sides. Indeed, in some ways it is more symbolic than real. It was imposed because of the abuses of human rights, above all in the Tiananmen massacre. It was not originally linked to the Taiwan issue, although we are conscious of the Taiwan dimension and there is broad consensus in Europe that now is not the right time to lift the arms embargo. We need to see clear progress on those matters before the issue is raised again.

Cyber crime strategy and the whole question of what is happening is one of the most sensitive issues with which we are dealing with the Chinese and with companies such as Google operating in China. We agree that we should continue to work closely in this area with all our partners in the EU, NATO and other relevant organisations. A number of noble Lords raised the much broader question, which is in the report, of how to encourage China to become what some call a more responsible power or to shoulder a larger share in the responsibility for maintaining global order and prosperity. Again, the report notes that China is gradually becoming more engaged in all sorts of ways. It is the largest contributor to peacekeeping within the P5, although most Chinese peacekeepers I understand are still in the logistical, medical and support dimension. They do not yet have combat troops in UN peacekeeping operations, unlike India which is the largest contributor to UN peacekeeping operations at present. When I looked at how many British ships were taking part in the anti-piracy operations off Somalia, I was struck by

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the fact that there was one British ship and three Chinese. So the Chinese are beginning to take a larger role.

In Africa, too, as the noble Baroness, Lady Kinnock, said, the Chinese now find themselves moving up a learning curve on how they need to co-operate with African states to preserve their longer-term interests. Sudan is an interesting case in point, where the possibility that there might be a secession in Sudan in the next year-possibly accompanied by further conflict-must directly affect Chinese interests. We therefore have an interested basis on which to discuss with the Chinese how we help to prevent future conflict. We see ourselves as working with the Chinese on peacekeeping and peacebuilding and there is more to be done to encourage the Chinese to take full part in multilateral approaches to conflict prevention, post-conflict reconstruction, and so on. We will be ending the British bilateral aid programme to China next March and we see ourselves moving towards a strategic partnership with China in international development, which will be working with China on issues such as African development. The International Development Secretary has asked that a global partnership fund be established within DfID to provide resources to work with countries such as China on the exchange of experience and mutual learning in support of other developing countries. I hope that noble Lords think that that is a useful step forward.

We have to recognise that as we adjust to China taking a larger role in international institutions, that may in time raise some painful issues for Britain and other European countries. We are all-the Italians, French and Dutch, as well as the British and the French-conscious that we wish to retain our positions in the IMF and elsewhere. There is much to be done in terms of how we adjust.

On North Korea and Taiwan we are conscious that China is the only country that can significantly influence North Korea. China pursues a policy of economic engagement to encourage stability in North Korea and avoid the threat of a collapse, which would hit China more strongly than anywhere else except for South Korea. We have to ensure that Chinese policies do not undermine UN Security Council resolutions designed to prevent proliferation. On Taiwan, again we do all that we can to encourage China to recognise that a peaceful relationship and further development of the relationship of two countries within one state should be developed. So far, again it is clear that that is also in China's interest as well as in ours.

Several noble Lords mentioned the question of the considerable attention to China from within the United Kingdom and the extension of British and other European students studying in China. More young people are being encouraged to study Mandarin elsewhere. Again, these are encouraging signs. The last time I was in Beijing I was lecturing on a joint London School of Economic's graduate degree course in China made up of half British and European students and half Chinese. The University of Nottingham is doing much more than that, so there are a number of initiatives under way, not all of which are government-led, helping to encourage that. I know that a number of independent schools, in particular, are encouraging more people to study Mandarin.

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In conclusion, the Government are happy to accept many aspects of this report's analysis. We see that a more coherent and effective EU-China relationship should be a priority for the EU High Representative for Foreign Affairs and for the European External Action Service, supported by a more consistent approach to China from the different member states. Constructive engagement with China can deliver huge opportunities for the people of Europe across our international, bilateral and trade priorities. I thank the EU Committee for this excellent report and look forward to the next one on this subject.

7.06 pm

Lord Teverson: My Lords, I thank the Minister for his response and also for his undertaking to come back to us with a full Government response. We have had a response already from the previous Government and I want to thank the now Opposition for their positive response to our report when they were in government.

I particularly thank non-Sub-Committee C members for contributing to the debate. Their contributions were as excellent as those from members. Two noble Lords talked about the importance of the parallel role of EU and member states. That is absolutely right but most importantly, both understand what each other's roles are. They are consistent on that and it is not all about the way in which it is written in a legal treaty-Lisbon or whatever. It is around making that work in practice.

I take the point made by the noble Lord, Lord Faulkner of Worcester, about the death penalty in China. That should have been covered far more strongly. We did not cover Taiwan because this report was broad enough as it was, but the plain fact is that Europe has no effect on the strategic relationship and the risk of that conflict between Taiwan and China. That is an entirely Chinese-United States issue and, regret it or not, the EU has no leverage in any defence way over it.

I shall respond briefly to the noble Baroness, Lady Kinnock. I take her point about the European Parliament. I am not absolutely sure that we did not ask for help when we went to Brussels and asked for an interview. I may be incorrect. She is absolutely right about all these reports.

I was interested in the idea, which I take particularly from our history, that we might have a paternalistic attitude towards China. What concerned us most as a committee was the opposite of that-as if Europe in many ways has already said, "Game over. China is the future; Europe and the West is the past". It was that fatalism about the future that concerned us. We wanted to see Europe as a major player in the future. Various development issues are important and in many ways we were positive about China's future role there.

Finally, I join many fellow committee members in thanking our committee clerk, Kathryn Colvin, and Oliver Fox and Bina Sudra who gave us a huge amount of positive clerical and organisational assistance. In particular, I thank our special adviser, David Kerr, who gave us superb assistance during this assignment. I commend the Motion.

Motion agreed.

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Genomic Medicine: S&T Committee Report

Genomic Medicine

Motion to Take Note

7.10 pm

Moved By Lord Patel

Lord Patel: My Lords, the sequencing of the human genome in 2000, and the technological advances that made that possible, brought with them the possibility that these advances could benefit healthcare. The Government of the day recognised this by the publication of the White Paper, Our Inheritance, Our Future, in 2003. The investment that followed resulted in the provision of services mainly for the treatment of single gene disorders.

Several further advances have resulted in the development of molecular and genetic tests, both for identifying risk of disease and treatment. As genome sequencing technologies improve and more genetic tests become available, new models of service delivery will have to be considered. We are familiar with the association of diseases such as cystic fibrosis, Huntingdon's disease, sickle cell and others with defects in single genes. The sequencing of the human genome in 2000 affords scientists the opportunity to explore the association of gene mutations in more common diseases such as diabetes, heart disease, cancers, Parkinson's disease, mental health and many others. The development of genetic tests has made it possible to target treatment to patients most likely to benefit, identifying patients sensitive to certain drugs such as Warfarin-an anticoagulant-and retroviral drugs for the treatment of HIV and many others.

In the world of competing priorities and cost savings, how are the advances in genetics and clinical genetics going to be translated into clinical practice? We should be certain of one thing: that scientific advances will lead to the identification of newer drugs, allowing for the treatment of more diseases and the identification of patients most likely to benefit from treatment. Without the planned introduction of validated tests, the effective treatments available across the whole of the NHS will not occur. A postcode lottery in the provision of care will develop, as it already has in relation to the use of currently available genetic tests for single gene diseases.

The purpose of our inquiry was to explore the current state of genomic science and its implications on healthcare. We also briefly explored the ethical and legal implications of genetic information. The report is presented in seven chapters, each focusing on different issues. It is based on the written evidence given in response to our call for evidence, and oral evidence from some 140 individuals representing nearly 110 organisations. We make 54 recommendations. All the evidence is presented in part 2 of the report, running to nearly 360 pages. We also carried out a visit to the National Institutes of Health in Bethesda, Maryland, to get evidence from the USA. It was presented to us in 34 sessions over three days.

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The previous Government responded to our report, accepting some of the recommendations. However, in general the response was poor and failed to recognise the reasons for some of our recommendations. The coalition Government now have an opportunity to scrutinise the report and, I hope, produce a more studied response over the coming months. I hope, though, that by the end of today's debate the Minister will commit the Government to taking forward some of the key recommendations, particularly those related to the White Paper on genetics and the new Institute of Bioinformatics.

Let me briefly allude to some of the advances in genomic science with implications for healthcare, and refer to some of the dramatic advances reported since the publication of the report in July 2009. Watson and Crick described the structure of DNA in 1953, working in Cambridge. Fred Sanger, also from Cambridge, reported on the methodology of sequencing the human genome in 1977. The mapping of the complete human genome was reported in 2000 and cost around $3 billion. The mapping of the second human genome cost around $180 million. The third mapping-that of James Watson-cost around $1.3 million. The pace of the sequencing technology is such that both the speed of doing the sequencing and the cost is coming down by the month. The most recent report suggests the cost to be in the region of $10,000, with the prediction that within one to two years it will be down to $1,000 or even lower.

Moore's law that applied to developments in microprocessing may well apply to the sequencing of the genome-some say to the point that regular and repeated sequencing of an individual patient's genome will be routine practice in clinical medicine. High-throughput sequencing technologies open up myriad opportunities: the identification of rare variants of DNA that have a large effect in an individual's risk of developing disease; gene mutation in cancers; de novo mutations in a range of diseases; monitoring the progress of disease; and effective treatment. Costs may even be less if targeted sequencing is used. Protein encoding axons of the 23,000 or so human genes comprise 1 per cent of the genome but contain 90 per cent of the mutations that cause disease. Of course, more scientific work is still necessary to increase the accuracy and relevance of the vast amount of information.

The United Kingdom will need adequate capacity for fast sequencing. Currently, only a few companies worldwide provide this. One of them, Oxford Nanopore Technologies is based in the United Kingdom, but China is building this capacity fast. Recent reports in the Lancet, New England Journal of Medicine and New York Times reported the identification of rare mutations of single-gene diseases such as Clarcot-Marie-Tooth disease, Miller syndrome and ciliary dyskinesia. These suggest that the identification of rare mutations of common multigene diseases, such as diabetes, heart disease, cancer, Alzheimer's and others, using whole genome sequences, will be possible-and soon.

The scope of our report did not allow exploration of the role of environment in DNA modifications and disease without genome alteration in the science of epigenetics. Clearly, though, the ability to map the epigenome is crucial, as key elements in the development

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of disease are controlled by the epigenome-the chemical modifications not encoded in DNA that control how and when genes are expressed.

Pacific Biosciences, a company based in Menlo Park, California, which I visited last year, reported two weeks ago on an integrated system it has developed that simultaneously reads a genome sequence and detects an important epigenetic marker called DNA methylation, which reduces gene expression and is linked to disease development in many types of cancers. With the further refinement of technology, we might be heading towards a full-scale methylation map at a cost of hundreds of thousands of dollars. It will change our understanding of the behaviour and functionality of cells with identical genomes, and their association with disease development. While companies like Oxford Nanopore Technologies in the UK are developing such technologies, bigger investment is needed if the UK is to maintain its lead.

A recent report in the Lancetillustrates further benefits of rapid sequencing. Investigators were looking for novel mutations-rare variants in DNA-that could modulate a response to drugs. A 40 year-old healthy male with a family history of premature coronary heart disease, aortic aneurism and sudden death had his genomal sequence analysed. The report identified 63 known pharmacogenetic variants that could affect the person's response to commonly used drugs, such as statins, Warfarin and Clopidogrel.

That brings me to pharmacogenetics-the way in which genetic variations across the genome affect drug metabolism. The right drug at the right dose for the right patient is the way to go for medication in future. Current estimates suggest that 400,000 patients a year in the NHS suffer severe drug reaction, with 15,000 to 20,000 resulting in fatal outcomes. We also make recommendations about the stratified use of medicines, an area of potential UK leadership if the right investment is made now. An increasing range of cancer drugs, such as Herceptin, Iressa and Erbitux, are effective in patients only if they have specific mutations in P13 kinase and other pathways. Breast cancer patients with HER2 receptors respond to the drug Herceptin. Similarly, patients with non-small cell lung cancer with EGF receptors respond to the drug Iressa. Further developments in molecular and genetic tests will lead to more patients being treated in a similar way.

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