9 JUNE 2004

PROFESSOR ANDY HAINES, PROFESSOR IAN MAUDLIN AND MR NICK WINTERTON

  Q442 Chairman: Could I welcome you to the second half of our sessions today. We now move into the health arena and I am sure you are well versed in what the inquiry is looking into and what its intentions are. DFID is central to what we are investigating. They have made some significant changes recently and I wondered if you had anything to say about these changes, if you had noticed even, and if you think they are significant or insignificant in terms of their approaches to these problems.

  Professor Haines: We have looked at the research strategy and we think there is a lot in it that is commendable. I should say that I think health has had a very central role in DFID in the past. There has been a very strong record of health research directed at problems of development and we were concerned that that fruitful relationship continued with the academic sector. I think the research strategy, although it has taken a little time to come out, contains many good elements to it. There are a couple of issues which perhaps need more development. One is the issue of capacity strengthening in low income countries, to which certainly there is some commitment in this strategy, but I think we need to know how that is going to be undertaken. One of the problems is of course that there are very few incentives for UK-based institutions to undertake that kind of capacity building. It does not figure in the RAE; we cannot afford to send staff to spend large times in low-income country institutions so the question is how we can in practical terms strengthen the incentive system to build up research capacity in low-income countries. The other issue which needs to be dealt with head on is the impact of untying aid. Many institutions were used to competing on the international field. We have no problems with that, but it is of some concern to what extent that is a level playing field. For example, if UK institutions have to put in bids based on full economic costings, whereas institutions, say, from North America do not have to do that, then there is a concern that there might be some kind of undercutting or disadvantage to UK institutions and I think that needs to be thought through in more detail.

  Q443 Chairman: Tell me about the biggest research problems you see in the next few years in the field of international development. What are the disease problems?

  Professor Haines: The disease problems are obviously HIV/AIDS, which is a major killer: over 40 million people infected. There is a lot of work going on on AIDS vaccines. We are some way I think from any kind of vaccine that is useable. There is also a lot of work going on on microbicides, to try to prevent transmission. Again, there has been no real proven effectiveness as yet, but there are some very important trials going on. The main struggle at the moment with HIV/AIDS is to improve the update of proven effective preventive interventions, like condoms, for example, and also to implement anti-retroviral treatment in very large populations. No one has ever tried to do that before. The WHO programme, the Three by Five Programme (aiming to get three million people on ARVs by 2005) is an attempt to do that.

  Q444 Chairman: Run me through some of the other things as well.

  Professor Haines: The others obviously include malaria and TB. For malaria, again, there is some work around vaccines but not so far very fruitful. It hopefully will be in the future. There have been concerns about anti-malarial drugs because very few have been developed in recent years. There are one or two recently being developed and we need to get more in the pipeline. TB is an important area, particularly in terms of multi-drug resistant TB and the problems of trying to get people to adhere to the treatment over fairly long periods of time.

  Q445 Chairman: What about animal human interactions? SARS, as you know, scared the pants off everybody suddenly. The fear is that this is now going to be much more of a feature of health problems, not only in the developing world but in the developed world as well.

  Professor Haines: That is right. It is more than a development issue, although it can have big impacts on the economy of China and other countries where SARS may arise. But it is certainly a global issue and there is a question whether we properly configured to deal with rapidly developing global epidemics. I think the WHO again has done some good work in this, setting up a global observing system to detect very early new epidemics, but we certainly need more research.

  Q446 Chairman: Where would you rate DFID in this great perspective?

  Professor Haines: I think DFID has made some very useful contributions in the past, particularly because it funds work in the area of health systems. Health systems is a very important area of research because many of the constraints that we are coming up to now, in terms of, say, delivering anti-retrovirals, are the fact that health systems are not functioning in many countries. We need to invest money into whole systems research. How can we develop sustainable financing systems, sustainable human resource development systems, mechanisms for ensuring quality of care? DFID is one of the very few funders of this kind of applied research, which is very important, just as basic research is important. We need a whole spectrum of research.

  Q447 Chairman: Ian Maudlin, can you add to that? Nick Winterton from the MRC, where do you fit into all this stuff?

  Professor Maudlin: In the area of animal health, of course, DFID is one of the most important funders of tropical animal health research—if not the most important—certainly in the UK. It is very difficult to get money for animal health research in the tropics. Research in this country is mainly restricted to things like foot and mouth disease which of course are very important to us. The Institute of Animal Health deals with problems like that, but to get money for other sorts of research which does not directly impact on DEFRA is far more difficult and we are reliant very much on DFID and the Wellcome Trust for that sort of funding.

  Q448 Chairman: MRC, where do you fit into all this?

  Mr Winterton: Would it be helpful if I said a little bit about what the MRC does in terms of funding research overseas and in relation to the needs of developing countries?

  Q449 Chairman: Yes.

  Mr Winterton: We spend about £40 million per annum on research relevant to the developing world. A very large proportion of that is research in the field of infections. In relation to more applied research, of interest particularly to DFID, the figure is about £23 million, and I think that reflects very much the kind of priorities that Andy has described. If you look at where the bulk of that money is being spent, it essentially is on HIV/AIDS; it is on malaria, it is on TB; there is quite a bit on maternal and child health—so an interest in child mortality and, relevant to that, quite a lot of support for vaccine trials in the developing world. As you probably know, we fund two quite large units in Africa, one in the Gambia and one in Uganda: the Ugandan one focusing very much on HIV/AIDS; the Gambian with a broader remit in the general area of infections of importance in the developing world. So, if you like, our own investment—and that is a pattern that has been established for a good many years now—I think does reflect those priority needs. DFID makes and has made historically a significant contribution, currently of the order of £4 million, to the MRC's work and portfolio of research in the developing world.

  Mr Key: What are your views on what DFID is doing in allocating money to other research funding bodies, for example, giving £4 million to the MRC; £20 million to the Consultative Group on International Agricultural Research; £14 million to the International AIDS Vaccine Initiative? Is DFID getting value for money from the various investments or would the money be better spent by directly funding research elsewhere?

  Q450 Chairman: That is individual researchers, rather than giving it to bodies.

  Mr Winterton: In relation to the MRC, essentially of course that is money that is then fed through to individual researchers. The process is that the MRC makes the decisions in relation to the research that is funded. There was a review conducted by the Swiss Tropical Institute of how successful the MRC's concordat with DFID was. I think the conclusion of that—and this is before we negotiated the renewal of the contract—was that it represented very good value for money as far as DFID was concerned. It was a cost-effective mechanism for delivering research of very direct relevance to DFID's agenda.

  Q451 Mr Key: Each of you, do you apply to DFID for research grants or do they approach you and say, "Please could you do some work for us"?

  Professor Haines: It is a mixture of both really. In terms of the Knowledge Programmes, they have been strategic programmes. These are the 15 programmes that DFID has funded over the years on a range of health issues. The school houses seven of those programmes and they are largely driven by DFID's perceived needs but obviously our researchers play an important role in deciding what the detailed research questions might be within those broad strategic projects. You also asked earlier on about the investment of DFID into these international initiatives. I would say that I think it is very important for the UK to be at the table in some of these very big international initiatives around AIDS vaccines and so on. Certainly the amount of money we are putting in is a relatively small proportion of the total but it does give the UK a seat at the table to see how these important initiatives are developing. The general point I would make is that I think the proposed modest increases in health research may not reflect the requirement, given the overall uplift in DFID funding. I would like to see obviously a greater investment in health research, given the importance of the problems.

  Q452 Mr Key: What is your own experience of dealing with the European Union when it comes to getting money for research?

  Professor Haines: Like earlier respondents, we have had quite difficult experiences with the EU. It is quite bureaucratic. Setting up the networks is quite time-consuming. A point that came out earlier on was the fact that the UK Government does not provide any incentive, so that there can be a negative impact on the institution from taking on the coordination function for a large and complex grant (particularly when you are actually responsible for many of the partner institutions who may or may not actually keep appropriate financial records and so therefore it is a major responsibility to take on). I feel that if the UK Government wants us to be big players in the EU, they need to create a more supportive funding structure—as some other European countries actually have. There is a new development in the EU, the European and Developing Country Clinical Trials Platform, which I think is worthy of noting. I think it is quite an important development. It does have the potential to put more direct funding into low income countries, in collaboration with northern partners, actually to test out some of the potentially effective interventions. That is a development to be welcomed.

  Q453 Mr Key: Could I probe a little bit further on the process and mechanism of getting money out of Europe. Do you think the deficiency lies in the fact that the Government does not have somebody sitting out there in Brussels to guide you as an applicant through the processes, or is it DFID who have neglected this and have not encouraged you and others in this particular area of development?

  Professor Haines: I do not think it is a particular problem of DFID, I think it is a general problem of EU funding. We do have the UK Research Office in Brussels which does give guidance about how to apply. So I do not think you can say there is a lack of guidance. I think it is more a question of policy: Does the UK Government want to encourage the UK to be major players in European research or not? The UK in general has been pretty good at getting EU funding, but it comes with a price.

  Q454 Mr McWalter: You have said two things which give me cause for concern. You have pointed out there is a need for a policy change really in relation to those EU funded projects. The second thing you said way back was that you were concerned about policy changes within DFID that mean you may well be contracting for work which actually is taken away from you because of the rules, because of DFID's change of policy in effectively having a free-for-all about tenders. You correctly pointed out the United States tenderer might have some level of subsidy for their infrastructural costs or whatever but we might not have and we might hence lose it. The combination of those two things might suggest we end up in a situation where we lack the capacity to support other people's capacity building. Would you agree?

  Professor Haines: That is a theoretical possibility. I have enough faith in the UK Government and DFID to hope that that will not happen, but I think it needs to be very carefully considered and mechanisms put in place to guard against that. Certainly there has been rather a tendency in DFID not to see the support of UK capacity as a core part of its mission—and one can understand its mission is international development. However, I think it is very important to say that the UK does have major capacity—it is not necessarily very large but I think it is high quality capacity, certainly in health research and no doubt in other fields as well—and I believe that if the UK wants to play a major role in international development, which it patently does, then it is very important to maintain and strengthen and develop that capacity in health research because it is very much looked up to around the world.

  Q455 Mr McWalter: You would like our report to emphasise that fact.

  Professor Haines: I think it would be a very important point to emphasise.

  Q456 Dr Iddon: Could I direct some questions to the MRC, please. How doe the MRC balance its research finances between diseases that predominantly affect the developing countries against those that predominantly affect the developed countries?

  Mr Winterton: Not an easy question to answer. There is a mix. Part of it is essentially a response to scientific opportunity. In a sense, part of MRC's investment will reflect what kind of proposals are coming forward, the quality of those proposals, and therefore it will reflect in part the research interests of the UK research community. The balance, as it were, between work that is directly relevant to the developing world and work that is, as it were, only really of direct relevance to the developed world, that balance will change over time in part as a reflection of that. Then there is, if you like, an overlay on that, which is that the MRC has made a conscious decision that we have a responsibility to make a contribution to the health needs of the developing world, hence the decision to maintain really quite significant investments overseas ourselves in the Gambia and Uganda. Therefore, that, if you like, is a strategic decision that there must be a certain minimum level of investment that we need to make in part to retain infrastructure overseas to enable us to play our own part to a degree in capacity building overseas. So I would say that the total sum is a mix of that strategic decision and, in a sense and in part, our responsiveness to the research community in the UK. But I think, probably fairly consistently, about 5% of our budget is being spent on work that, if you like, is almost exclusively of relevance to the developing world and probably about 10% of our budget is broadly supportive of that, and that has not changed historically very much.

  Q457 Dr Iddon: Do you think £4 million is a significant contribution by DFID in the concordat that you have developed out of a total of £23 million?

  Mr Winterton: We would obviously welcome more. It is particularly important in two respects. One is that it enables us, and quite explicitly, to support health services research overseas which we would not see normally as part of the MRC's mission. This money enables us to broaden that. Obviously it is also a very important part of sustaining that decision, that strategic decision, to maintain a certain level of investment in relation to infrastructure and capacity building. It is more than symbolic—that is important—but also it does make a significant contribution to that. We obviously could spend more, there is no question about it. There are more good research opportunities out there that we are not exploiting, and we obviously could spend more money, both from MRC's own resources and if we had more money from DFID.

  Q458 Dr Iddon: The UK overseas aid budget is increasing. We would like to get 0.7% of GDP obviously. Do you think some of the money you spend on your work overseas should come from the aid budget?

  Mr Winterton: Yes, I think there is a very good argument for that. Clearly part of it is essentially aid, there is no question, and no one can argue that that is a very major issue in relation to playing our part in tackling poverty, particularly in sub-Saharan Africa. There are real improvements that can be made in health terms and that will have huge spin-off in terms of poverty.

  Q459 Dr Iddon: Are you aware that any of the UK aid money does go in the direction of disease? If not, have there been any discussions, with the increase in the aid budget for the future, hopefully, in putting some of that money into disease?

  Mr Winterton: Within DFID, of course, the spend in relation to health is very substantially more than the money that is channelled through the MRC. On the Knowledge Programmes to which Andy referred, the spend is of the order of £11 million or £12 million a year. And we do play our part in some of those programmes as well. For example, in the Virucide Project the MRC is very active. Our units play a part in participating in managing some of these other programmes.