My Lords, I metaphorically rise to move Amendment 19, which is in my name and that of my noble friends Lady Jolly and Lord Sharkey and the noble Lord, Lord Alton, whose support is always very welcome. I look forward to the contributions from other noble Lords who have signalled their intention to speak. It is a matter of deep frustration that a number of noble Lords who wished to contribute to this debate are instead committed to the equally important debate on the internal markets Bill, which is pitted directly against this Bill.
Amendment 19 has been tabled simply to ensure that fair access to medicines is a core aim of the Bill. It would root the Bill in the International Covenant on Economic, Social and Cultural Rights of 1966, which is a binding international human rights treaty that we in the UK ratified in 1976. The amendment would put into the Bill the fundamental right of every citizen
“to access medicines as part of the right to the highest attainable standard of physical and mental health.”
Fair access to medicines is an issue at the forefront of concerns expressed by patients’ groups. There are regular reports in the media about price gouging by pharmaceutical companies. Furthermore, one of the key calls in the collated briefing of the Royal College of Physicians, the Faculty of Pharmaceutical Medicine and the British Association of Dermatologists is that:
“The Bill must include provisions which allow for review of processes for issuing sole manufacturing licenses and consider the use of price control mechanisms in relation to costs of production, to increase access to medicines at fair prices.”
Yet this issue was not brought up during the Bill’s passage through the other place, nor does it feature directly in any other amendment before the Committee. So I hope that your Lordships will forgive what will be a rather full presentation of the important issues raised in the amendment.
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Badly governed international property rights have resulted in price gouging, unethical practices to perpetuate monopolistic markets, and the blocking of open and innovative science. That last point is important, because it is often cited as a strong defence of the current regime. However, patents are no longer being awarded predominantly for real innovations and cutting-edge therapies.
For example, a recent analysis of new medicine approvals in Europe between 2000 and 2014 revealed that 51% of newly approved medicines were modified versions of existing therapies. The granting of overly broad patents and the evergreening of patents extend monopolies and delay access to lower-priced products. Demanding to extend a patent for turning a powder into a pill is deplorably unethical.
Data exclusivity, which the noble Lord, Lord Patel, spoke of so compellingly in Committee on the Trade Bill, is another ploy with far-reaching consequences. There are many other nefarious practices. I will not go into all of them, but during my research I came across an article in a 2017 edition of the Harvard Business Review, called “How Pharma Companies Game the System to Keep Drugs Expensive”, and I recommend anyone interested in this issue to have a look at it.
The NHS’s spiralling drugs bill led even the Health Secretary, Matt Hancock, to recognise that pharmaceutical companies are trying to “rip off taxpayers”. In an interview in the Times in 2018, with reference to the NHS’s negotiations with Vertex over its drug Orkambi, for sufferers from cystic fibrosis, he condemned “profiteering” on products that rely on government-funded research and NHS patient data. Those are his words.
High prices have put pressure on national health budgets and led to the rationing of treatments—for example, on breakthrough medicines for hepatitis C and cancer. In a Guardian report in 2015, Dr Andrew Hill, from Liverpool University, the lead author of a cancer drug cost analysis, said:
“Some of the drugs which have recently been removed from the cancer drugs fund are actually very cheap to manufacture, and are being sold in other countries at prices much lower than the UK.”
The second part of Amendment 19 was drafted in response to the fact that pharmaceutical companies’ national patent rights are too often given much greater force than human rights in trade deals. This part of the amendment reaffirms countries’ rights, among others, to grant compulsory licences and determine their own regime for when a patent holder’s rights have been exhausted, and parallel importing and exporting can occur. We saw in the case of Orkambi that just the threat of a compulsory licence had a major effect on Vertex’s decision to reduce the price to a more affordable one.
As we start to sign our own free trade deals across the world, we must take great care that our citizens’ rights to the highest attainable standard of care are protected. There is a great deal of unease about the way the Trade Bill is structured, with little meaningful parliamentary scrutiny. ISDS, the investor-state dispute resolution mechanism, is causing grave concern. Under that mechanism, investors can sue countries for discriminatory practices, as when Australia was sued by Philip Morris International for introducing plain packaging for cigarettes—but I will leave that there, as there was a comprehensive discussion of ISDS, and concerns were expressed about it, in Committee on the Trade Bill.
What determines the price of a medicine? The answer is: “it’s complicated”. I believe the amendment’s overarching approach is the right one to offer British citizens some protection from unreasonably priced medicines and other countries’ interference in our right to determine our own principles and values regarding fair access to medicines and medical devices. I hope those who advocated taking back control will at least agree that much.
I end with the very topical and urgent issue of Covid-19, which is causing so much economic and emotional hardship. The world awaits with a great
deal of uncertainty a vaccine for Covid-19. It is clear that as soon as one is given the go-ahead there will be a stampede to get hold of doses. Vaccine nationalism is already rife, with billions of dollars committed up front to secure doses of the most promising vaccine candidates.
To its credit, the WHO acted with speed to set up the access to Covid-19 tools accelerator—the ACT accelerator—the COVAX facility and the COVAX advanced market commitment to oversee global collaboration of the rapid development, regulatory approval and fair and equitable distribution of any new safe and effective vaccines, in recognition of the clear evidence that no one is safe until everyone is safe. However, there is a fly in the ointment. The barriers of intellectual property rights, vaccine know-how and deep data sharing must be overcome if we are to be ready to hit the start button once a safe and effective vaccine gets the go-ahead.
The WHO and partners have offered a solution through setting up C-TAP—the Covid-19 technology access pool—to do just that, so that when a vaccine is given the go-ahead the world will immediately be ready to scale up manufacturing. I ask the Minister: why are our Government dragging their feet in committing to play their part in this essential plank for an equitable and organised global response to the pandemic?
At a recent meeting of the TRIPS council, in frustration the Indian and South African Governments asked the WTO to waive parts of the TRIPS Agreement to allow all countries to choose neither to grant nor to enforce patents and other intellectual property rights related to Covid-19 drugs, vaccines, diagnostics and other technologies for the duration of the pandemic. This would allow as many suppliers as possible to manufacture Covid-19 technologies, maximising global supply and enabling all countries, including ours, to access affordable Covid-19 health products. The proposal is gaining some traction. Will the Minister tell us what the Government’s view of this waiver is? If they are not in support, what is their proposal to move this issue forward?
Can the Minister also confirm that the Government’s position on getting access to Covid-19 vaccines is to rely on pharma companies voluntarily sharing IP and issuing non-exclusive voluntary licences to announce generic manufacturing? If that is the case, the question that must be put is: does the track record of the pharmaceutical industry warrant such trust? Is reliance on the good will of pharmaceutical companies too complacent to protect the British people from Covid-19? The recent example of Gilead’s remdesivir should serve as a salutary reminder of how much we are at the mercy of the decisions of pharmaceutical companies. Earlier this year, the US bought up all the available supplies of the drug, such that rationing had to be put in place in the NHS.
I would like to end by saying thank you to STOPAIDS and its coalition partners for their tireless work on this issue, no doubt driven by their bitter experience during the HIV/AIDS pandemic—or global epidemic, whichever term you prefer. However you look at it, they more than most understand the urgency of putting safeguards on to the face of the only Bill we will see for some time
on medicines and medical devices. No one in Britain should die needlessly while the NHS is held to ransom by unscrupulous pharmaceutical companies. I beg to move.