|
HIV/AIDS (International Development)
(15/05/07)
Dr. Gavin Strang (Edinburgh, East)
(Lab): We are all aware of the tragedy of HIV/AIDS and the impact of
that pandemic throughout the world. The damage being done is particularly
serious in a number of developing countries. We are looking forward to the
launch of the Government’s consultation on a new strategy for HIV/AIDS
later this week. The Minister will not be able to anticipate the content
of that document, but I hope that he will see the debate as an opportunity
to set out the Government’s assessment of the problem.
Some 40 million people now live with HIV.
Last year alone, 3 million people died of AIDS and more than 4 million
were newly infected. Two thirds of people with HIV live in sub-Saharan
Africa and three quarters of all AIDS deaths occur in that region. In
recent years, the most dramatic increases in the spread of HIV have been
elsewhere. In east Asia, the number of people living with HIV rose by 17
per cent. in the last three years. In eastern Europe and central Asia, the
number of new infections rose by almost 70 per cent. in the last two
years.
HIV/AIDS in the developing world is
predominantly a young person’s disease. The leading causes of death in the
UK tend to affect people as they get older; HIV/AIDS tends to strike young
people. Life expectancies in many countries have plummeted and many of the
people killed by AIDS are at an age when they would contribute most to the
development of the country that they live in. So it is that in many
developing countries, HIV/AIDS corrodes the economies, the services and
the infrastructure. Vital sectors—health, education and agriculture—are
put under intolerable strain as the work force are removed by AIDS.
The world has responded to the pandemic,
but slowly. The $10 billion estimated to be available for HIV in low and
middle-income countries this year is a significant increase on the $8.9
billion provided last year. However, that $10 billion is just over half of
what is needed. Estimates of global resource needs for this year stand at
$18 billion, and $22 billion will be needed next year.
One landmark development in the effort to
combat HIV/AIDS has been the establishment of the Global Fund to Fight
AIDS, Tuberculosis and Malaria, which has approved a total of $7 billion
for more than450 grants in 136 countries. A report on the first five years
of the work of the global fund was published in February, and the fund has
made a good start.
The focus has rightly been on expanding
access to treatment. Until a few years ago, to become infected with HIV
was in practice a death sentence. The question was not whether one would
die of an AIDS-related condition, but when. That is no longer the case
thanks to the development of antiretroviral drugs. With access to proper
treatment and care, people with HIV can now live fairly normal lives.
However, millions of people have died of AIDS despite the emergence of
antiretroviral treatment because those drugs have been unavailable to much
of the developing world.
In recent years, the international
community has accepted the principle of universal access: as far as
possible, everybody who needs antiretroviral drugs should receive them.
Under the presidency of the UK in 2005, the G8 agreed the aim of universal
access by 2010, which was taken up in the political declaration by the
world’s Governments at the UN last June.
There have been improvements in access to
antiretroviral drugs. UNAIDS—the Joint UN Programme on HIV/AIDS—estimates
that since 2002, some 2 million life years have been gained through
expanded access to antiretroviral treatment. In December 2006, the number
of people on treatment in low and middle-income countries was 54 per cent.
higher than in the previous year.
Treatment still reaches only a small
proportion of the people in need. The World Health Organisation estimates
that just over a quarter of people in low and middle-income countries who
need treatment receive it. There is a particular problem with children.
Despitea 50 per cent. increase in the number of children receiving
treatment in the past year, still only 15 per cent. of those in need get
access to HIV treatment. The World Health Organisation and UNAIDS have
called for urgent action to develop appropriate diagnostics and paediatric
drugs.
A report published last month by the World
Health Organisation, UNAIDS and UNICEF made it clear that universal access
by 2010 will require a steep increase in the number of people who receive
treatment each year. The UN Secretary-General has reported that many
countries are struggling to scale up their work sufficiently to be on
course for the 2010 commitment. If we continue at this pace, the UN
estimates that less than half of those in urgent need of treatment will
receive it by 2010. My hon. Friend the Minister will be aware of the
campaign calling for a G8 funding plan to be put in place to achieve
universal access, and I would be grateful for his thoughts on that.
Will my hon. Friend set out what is being
done to enable developing countries to find their way through the legal
complexities of TRIPS—the agreement on trade-related aspects of
intellectual property? There are particular concerns about access to newer
drugs, including second and third-line treatments. Since 2003, the price
of most first-line antiretroviral treatments has decreased by at least 50
per cent. in low and middle-income countries. However, the World Health
Organisation has found that the prices paid for second-line treatment tend
to be unaffordably high in countries that lack generic alternatives.
In the years to come, more people will need
access to second and third-line therapies as the first-line treatments
will cease to be effective. UNITAID, the international drug purchasing
facility of which the UK Government is a sponsor, is working to lower
prices of second-line medicines and I was pleased to see the price
reductions that the Clinton Foundation was able to announce last week.
However, as patenting restrictions are tighter on newer drugs, a lot needs
to be done before we can expect to see adequate reductions for second and
third-line treatments.
On 30 August 2003, a decision was taken
with the aim of allowing certain countries to import generic drugs.
However, my hon. Friend is probably aware of the conclusions of Médecins
sans Frontières that the mechanism is unworkable. The Government have made
clear their support for the right of developing countries to use TRIPS
flexibilities to ensure affordable access to drugs, including the use of
compulsory licensing provisions. My right hon. Friend the Secretary of
State and his G8 counterparts agreed at their meeting in March that more
needs to be done to help to lower the cost of some drugs
“including the
use of TRIPS flexibilities to the fullest extent”.
My hon. Friend will be well aware of the
calls from non-governmental organisations in the field for the G8 urgently
to review the effectiveness of the TRIPS flexibilities and to identify and
resolve all obstacles to their use. I would be most grateful for his
perspective on the progress that has been made.
Perhaps my hon. Friend can also take the
opportunity to update us on the new independent advisory body that was
announced by his Department last month to help get more drugs to the
world’s poorest people. The Secretary of State has also expressed an
interest in patent pooling, and I should be grateful if my hon. Friend
would tell me the Government’s thinking on that point.
In order for antiretroviral treatment to be
successful there must be a medical infrastructure in the country that
ensures that people have regular access to their medication, and are
properly instructed and supported in adhering to their regime. The UN
Secretary-General has remarked that we must move from an emergency footing
to a longer-term effort, laying the groundwork for sustainable progress
and strengthening health and social service systems. Far greater
investment is required in the infrastructure of health systems.
When we talk about getting drugs to people,
there is a tendency to assume that Governments and Government services
alone can deliver, but in many countries projects run by employers or the
voluntary sector are equally important. Professor Richard Feachem, the
previous executive director of the global fund, and the Secretary of State
himself have singled out faith groups as being particularly important
because of the work that they do in that area.
It is right that we focus tremendous effort
on expanding access to treatment. It is a matter of international shame
that so many have died and continue to die of a treatable disease. At the
same time, we must dramatically step up our efforts to prevent the spread
of HIV/AIDS. Work on a vaccine continues, and it seems that every few
years we are told that a vaccine is 10 years away. I know that that work
is supported by the UK Government. A vaccine would of course be a huge
breakthrough, but in the meantime we need to improve prevention efforts
dramatically. If we do not, meeting the commitments to universal access to
treatment will be well-nigh impossible.
The rate of new infections far outstrips
the expansion of HIV treatment. While 700,000 additional people got on to
treatment last year, 4 million became infected with HIV. Treatment and
prevention services must be scaled up in parallel. The World Health
Organisation has called urgently for far more effective outreach work with
at-risk populations and for prevention work to be done with people living
with HIV/AIDS.
UNAIDS has identified three main problems
with the current prevention effort: insufficient funding, inadequate
access for populations with higher rates and risks of infection, and a
lack of action against the social, economic and cultural factors that
drive the spread of HIV, such as stigma, poverty and gender inequality.
Access to prevention services for at-risk populations in low and
middle-income countries remains generally very low. In 2005 it was less
than 20 per cent.
Still only about 11 per cent. of pregnant
women with HIV are given treatment to prevent mother-to-child
transmission. That is a particularly depressing statistic when one bears
in mind the fact that the treatment available for pregnant women with HIV
is so effective that it virtually eliminates the possibility of the child
being born with HIV. I presume that it is very different if no treatment
is provided. I would have thought that most reasonable people would see it
as a priority to get a lot more pregnant women on the treatment so that
their children are not born HIV-positive. Just last year my hon. Friend’s
Department cited an estimate thata comprehensive HIV prevention package
costing $4.2 billion annually could avert 29 million of the 45 million new
infections expected by 2010.
I cannot end my consideration of prevention
work without mention of a recent development relating to male
circumcision. As colleagues may well be aware, the World Health
Organisation and UNAIDS have stated:
“Male
circumcision services should be recognized as an important intervention to
reduce the risk of HIV infection”.
That followed clinical trial data that
demonstrated a significant reduction in the risk of heterosexually
acquired HIV infection among circumcised men.
This summer marks the halfway point in the
work to achieve the millennium development goals. As one of those goals,
the international community made a commitment to have halted and begun to
reverse the spread of HIV/AIDS by 2015. A massively increased prevention
programme is required if we are to meet that commitment. We must also
consider the important role that diagnostic testing must play, as the
availability of testing is vital for progress in prevention and access to
treatment. The global coverage of HIV testing and counselling remains low.
Available information is limited, but surveys done in a small number of
countries in sub-Saharan Africa indicate that at most one quarter of
people living with HIV were aware of their status. Late diagnosis not only
impedes prevention work that can be done with people living with HIV but
means that treatment for an individual is less likely to be successful.
The Government are playing an important
role in the councils of the world. They have ensured that HIV/AIDS is on
the agenda at the UN, the EU and the G8. They are also putting their money
where their mouths are by increasing the amount that Britain spends on
overseas aid. Will my hon. Friend give us his view of the prospects for
progress at the G8? The Finance Ministers meet this Friday and the G8
summit is just more than three weeks away. I am sure that we all hope for
progress.
I am pleased that we have had the
opportunity to have this debate in the week when my hon. Friend the
Minister will be launching a consultation on a new strategy along with the
interim evaluation of the current strategy. I look forward to hearing his
comments.
The Parliamentary Under-Secretary of
State for International Development (Mr. Gareth Thomas): I begin by
saying, and particularly this time genuinely meaning, that I am grateful
to my right hon. Friend the Member for Edinburgh, East (Dr. Strang) for
persuading Mr. Speaker to allow us to debate this topic. As he said, the
debate is timely, not least because of the launch on Thursday of a
consultation on how we can step up our work on HIV/AIDS as a country and
particularly as a Department, but also because we are a matter of weeks
away from the G8. There will be considerable international attention on
what else the G8 can do to focus attention on the terrifying growth in the
incidence of HIV/AIDS across the world. I shall not repeat the statistics
that he rightly reminded the House of.
My right hon. Friend ended his comments by
drawing attention to the lead that the Government have taken on HIV and
AIDS. It is perhaps worth noting that, in 2005, when we held the G8 and EU
presidencies, we took the opportunity to use them to secure important
commitments to universal access to HIV treatment and prevention. As he and
the House will know, through the UN General Assembly we managed to secure
a commitment to a broader definition of universal access, including
prevention, treatment, care and support. I know that he supports that.
A year earlier, in July 2004, we attempted
to prepare the ground for such a discussion at the UN by setting out an
ambitious and, I hope the House will agree, progressive UK policy on
tackling AIDS in the developing world in the document that we published
called “Taking Action”. We shall have a chance to discuss on Thursday a
review of that document and an assessment of where we have got to in
implementing the commitments that we made in it. It set, for the first
time, a spending target for funding through my Department of some £1.5
billion to support our response to AIDS, making us the world’s second
largest bilateral donor. It took a strong stance on the importance of
meeting the needs of vulnerable groups, including by committing to spend
some £150 million on support for children affected by AIDS.
My right hon. Friend rightly sought to
remind the UK and the international community of the need to follow
through on the commitments made at that G8 summit and the UN millennium
review summit. That is why we have sought to do our part by commissioning
an independent interim evaluation of the “Taking Action” document to
enable us to assess our performance at the midway point in the drive to
make progress towards universal access, and to enable us to take any
corrective action needed. Again, Thursday will offer the opportunity to
review in more detail where we have got to.
It is also why we pushed to set ambitious
targets in-country, led by the developing countries themselves, including
interim targets for 2008, in the UN General Assembly’s political
declaration on AIDS in June 2006 to help us to review progress towards the
goal of universal access. It is also why we pressed the G8 at St.
Petersburg—and will press again at the summit in just a matter of weeks—to
report against the AIDS commitments that were made at Gleneagles.
On progress, it is clear from the UN and
from civil society reports that there are areas where the AIDS response
has progressed. We can be proud of that response, but it is also true, as
my right hon. Friend said, that there is a considerable amount that we
still need to do if we want to achieve our ambition of an AIDS-free
generation.
On treatment, there have been huge
increases in the number of people taking antiretroviral drugs, as my right
hon. Friend said. According to UNAIDS, the World Health Organisation and
UNICEF, more than 2 million people were receiving treatment at the end of
2006, a 54 per cent. increase in just one year. Of that number, more than
1.3 million people in sub-Saharan Africa were receiving treatment in
December 2006, compared with just 100,000 in 2003.
However, the sad truth of those impressive
statistics is that only 28 per cent. of those who need treatment actually
have access to the drugs that they need. We must do more to boost access
to treatment and diagnostics, in particular for children. We must take
steps to reduce the cost of second-line AIDS drugs, which, as my right
hon. Friend clearly knows, can cost as much as 10 times more than other
treatments, and we must take more steps to tackle the stigma and
discrimination that block people’s access to services, including
treatment.
I am delighted that the UK played its part
in tackling those issues by helping to set up UNITAID, the new
international drug purchase facility. It has already approved, among other
things, programmes of nearly $62 million for treatments for children and
nearly $70 million for those second-line therapies that cost so much.
This week, UNITAID and the Clinton
Foundation announced a major cut in the price of 16 AIDS treatments that
will be available to 66 developing countries. That clearly is positive
progress and an endorsement of the approach that mechanisms such as
UNITAID allow. I am pleased, and I hope that my right hon. Friend is as
well, that through the Medicines Transparency Alliance we can begin to
tackle some of the fraud and other inefficiencies that can on occasion
lead to a 300 per cent. mark-up in the price of medicines in developing
countries.
My right hon. Friend drew attention to
funding, and rightly said that we need to do more to ensure that the
necessary resources are available to finance universal access. He said
that an estimated $10 billion will be available in 2007 for HIV-related
programmes in low and middle-income countries. As he said, that is a huge
increase, but, as he also said, it is just over half of the $18 billion
that UNAIDS estimates is needed in 2007, so the international community
needs to do more work together to meet that funding gap.
We are committed to playing our part, not
least through the Global Fund. I take this opportunity to put on the
record my appreciation of the considerable effort made by Richard Feachem,
the first head of the fund, and of the excellent job that he has done. We
have pledged some £359 million to date to support the fund, making us the
fifth largest donor, and we recently supported the decision to triple the
size of the fund so that it has the potential to reach $6 billion to $8
billion in 2010.
I touched on UNITAID. We pledged some $20
million for UNITAID as part of a 20-year commitment potentially increasing
to some $60 million by 2010, subject to the performance of the
organisation. We also pushed hard at the UN General Assembly in June to
ensure that the international community in general made a commitment that
no credible, costed national AIDS plan should go unfunded. That important
commitment should play a central role in helping to get all donors working
on the goal of achieving universal access in each developing country.
The AIDS response must support and
strengthen health systems—we must not undermine them. In short, that is
the only way to achieve universal access and better all-round health
outcomes. We must do more collectively to strengthen health systems, not
least because of the need to address the global shortage of 4.3 million
health care workers, as estimated by the Global Health Workforce Alliance.
People are not likely to stay on antiretroviral drugs without health care
workers to support them as they take the drugs, and, potentially, the
virus could become more resistant to drugs. I have no doubt that that
issue will be of particular importance in the discussions that will take
place at the G8 coming soon.
The UK is playing its part on that issue.
In Malawi, for example, we are helping with a £100 million emergency
programme over six years that seeks to double the number of nurses and to
treble the number of doctors. The programme helps to do that by increasing
salaries by some 50 per cent. We are considering options to extend that
approach to other countries, and we are seeking to have discussions with
other donors about how we can better pool our funding to make that happen
more effectively in developing countries. I personally have had
discussions with key people in the US Government about how we could do
that.
My right hon. Friend touched on the
importance of prevention. We are supporting ongoing research to develop
new microbicides, which potentially offer the most appropriate technology
most quickly to help women to protect themselves from HIV infection. We
continue to put money into the international AIDS vaccines initiative to
help to make progress there.
I know that my right hon. Friend shares our
concerns about stigma and discrimination. I hope that he will be able to
attend the launch tonight with England and West Indies cricketers of a
stigma unit to promote our work in the Caribbean, which has the second
fastest rising epidemic rates in the world. Discrimination is the single
biggest blockage to making progress on that issue.
My right hon. Friend also asked about our
position on trade-related aspects of intellectual property rights. We
remain a strong supporter of the right of developing countries, including
Thailand and Brazil, to implement the TRIPS agreement, as is appropriate
for their circumstances. We understand the concerns of Médecins sans
Frontières and several others about the complexity of the agreement, which
is why we are working in Kenya and Botswana to fund legal research and
assistance that will help those countries to implement the flexibilities
that are available under the TRIPS process.
We initiated an access to medicines
conference just a matter of weeks ago because of concerns about TRIPS,
about whether enough diagnostics are available, about whether we need new
treatments and about how tocut through some of the other blockages to
making drugs available to fight HIV/AIDS. The conference brought together
experts in health systems and drug programmes from developing countries,
people from the non-governmental organisation world, international
pharmaceutical companies and generic drug companies. From those who came
to that meeting, we are seeking to establish a small group to work with
us, on a continuing basis, on the key blockages internationally to making
progress on delivering more HIV/AIDS drugs and more drugs to help to fight
other developing-country diseases.
I am grateful for the considerable effort
that was put in by the many different stakeholders who turned up at the
conference. As my right hon. Friend will know, access to medicines is
often a politically contentious issue, but the constructive nature of the
dialogue at that conference offers hope that we will be able to make
faster progress. I know that he will be pleased in particular by the
announcement by UNITAID and the Clinton Foundation.
Again, I welcome the opportunity for this
debate. It is timely, with the G8 approaching so soon, with our launch on
Thursday of a consultation on what we can do next about HIV/AIDS and with
the launch of the stigma unit tonight. My right hon. Friend takes a
considerable interest in the issue and has done so for a long time. I hope
that he will continue to pursue that interest and to put pressure on us to
do more.
|
ALL-PARTY
PARLIAMENTARY 
