This blog has been written by Matt Oliver, Health Advocacy Officer for TB and Policy Adviser to the All Party Parliamentary Group on Global TB.
Last Tuesday (8th July), the All Party Parliamentary Group on Global TB launched its report entitled “Dying for a Cure: Research and Development for Global Health” through a debate in Westminster Hall.
The launch marks the culmination of a six month process collating evidence and researching the report. The group published a call for evidence in February, followed by three oral evidence sessions, conducted dozens of interviews and reviewed over 200 articles to provide the backbone of the report.
The final document is focused on two major issues: 1) exploring why and how the traditional commercial model of development has failed diseases of poverty such as TB and 2) what reforms could be made to incentivise increased investment in R&D and help to bring through new products such as TB drugs or an HIV vaccine.
Although often perceived as quite a dry subject, R&D is absolutely central to efforts to improve global health and eradicate poverty. Whilst great progress has been made with existing interventions against HIV, TB, malaria and other diseases, without new interventions, there is little chance of moving beyond ‘control’ of these diseases and towards ‘elimination’.
Unfortunately, we cannot rely on the wit and ingenuity of private sector pharmaceutical companies to come to the rescue. Researching and developing vaccines can take decades, the recent rotavirus vaccine took 33 years to develop; few private sector companies would devote such a period of time to development. In regards to drugs, a single new product costing in the region of $1bn to develop (and sometimes much more), making the decision to embark on the R&D process for such a new drug extremely risky, particularly because global markets for drugs for diseases like TB, malaria, and paediatric HIV are simply not big enough to offer the consistent, long-term financial return to incentivise commercial sector investment.
So, public and philanthropic sources of finance must fill the gap.
However, as the co-chairmen of the APPG highlight in their foreword to the report, the objective of a 21st century aid agency cannot be to fix the world’s problems. Diseases such as TB are global and require a globally coordinated response that no single aid agency could manage. A modern aid agency should devote its resources to finding solutions to some of the world’s biggest problems, giving developing countries the weaponry to win their own battles against the major diseases, and supporting them in doing so.
Simply listening to the Secretary of State reveals that DFID makes the case for aid spending through a pure value for money approach, and investing in interventions that reach enormous numbers of people. This, in itself, is no bad thing, but the challenge must be to strike the right balance between operations and long-term research and development investment.
As a single example, the UK currently spends nearly £300m a year helping other countries tackle HIV, and over £630m a year treating HIV in the UK, yet DFID spends just £1 million a year developing an HIV vaccine. If there is a balance between R&D spend and operations, that balance is not quite right.
The recommendations in the report, if implemented, will not make a difference overnight. R&D timelines are long and we may not see benefits for decades. Nonetheless, new drugs for TB were needed decades ago, there is no time to spare. These recommendations must be implemented, and R&D made a greater priority of DFID spending if we are to ever develop products like HIV vaccines that are simply not commercially viable. To accelerate our progress against these diseases, to drive them towards elimination, and to safeguard the health and well-being of millions of people around the world, we need to transform our approach to R&D for global health. Hopefully, the APPG TB report marks a first step towards such a transformation.
The views in this blog are those of the author and not necessarily of RESULTS UK. A transcript of the Westminster Hall debate can be accessed here.