Memorandum submitted by the Parliamentary
Office of Science and Technology (POST)
The White Paper was published in December 2000
and the House of Commons Select Committee on International Development
is to hold a short inquiry into the document, seeking oral evidence
from the Secretary of State at the end of January 2001. The Parliamentary
Office of Science and Technology (POST) has been asked by the
Committee to provide comments and questions related to scientific
and technological issues raised in the White Paper.
The issues arising can be divided into four
information and communications technology
(ICT)for example, provision of telephony and internet services
to developing countries;
health and poor peopleespecially
improving access to existing essential drugs and vaccines and
research into the development of new ones;
intellectual property regimesfor
example, their impact on, access to, and cost of medicines; and
environmentin particular addressing
the vulnerability of poor countries to global environmental change.
Distance learningthe White Paper
discusses distance learning in Chapter 3, Paragraph 112 and Box
5. In particular, the Prime Minister's initiative on technology
in teacher training (known as `Imfundo') is detailed. This is
a public/private partnership to employ ICTs to support teacher
training and development, particularly in sub-Saharan Africa.
While distance learning can allow a wider geographical spread
of students to take advantage of teaching resources and tutors,
it requires a long term guaranteed investment to buy and maintain
expensive equipment, which may be inappropriate in very remote
communities and raises issues concerning continuity of funding.
Indeed, the Imfundo website states that "education-only projects
are unlikely to be sustainable," and suggests that projects
should provide commercial as well as education facilities.How
does DFID intend to balance the educational and commercial aspects
of this initiative and ensure the long term future of its projects?
The digital divideParagraphs 116
to 126 of the White Paper consider the development of communications
infrastructure and the use of ICTs. The expanding use of these
technologies raises concerns that developing countries may be
disadvantaged, although this may seem less urgent compared with
priorities in health and education. A number of general recommendations
are made in the White Paper, but few specific initiatives are
detailed. Some of the issues raised are considered below.
There is seen to be a lack of legal and regulatory
frameworks for telecommunications in developing countries.
The White Paper suggests that telecommunications regimes need
to be reformed, moving from state run monopolies to competitive
markets. There are two requirements for the development of telecommunications:
lowering costs and expansion of the network to cover all areas.
If a widespread telecommunications network is seen as a necessity
for developing countries, to what extent should regulation to
ensure universal access supplement market mechanisms? How does
DFID intend to encourage this balance?
Universal access. There is concern over
a digital divide within developing countries. The inadequacy of
telecommunications infrastructure in many areas rules out use
of the telephone, fax or internet (indeed, even electricity may
be lacking in some areas). Access is likely to be particularly
difficult for those outside cities. For example, more than two
thirds of China's population lives in rural areas, but eighty
per cent of internet users live in cities. Internet users are
also likely to be young and male. Internet use presumes basic
literacy (in the developing world, one adult in four is illiterate).
It also requires information in local languages. For many in the
developing world, residential telecommunications are not affordable,
so community access schemes are necessary. What steps is DFID
taking to ensure that communal access programmes are available
to all, including older people, women and those in rural areas?
How is DFID encouraging the development of local information sites
in local languages and training so that local people can use them?
International telecommunications and standards
bodies. In the White Paper, the role played by organisations
such as the International Telecommunications Union and World Trade
Organisation in regulating ICT policy is considered. It is recognised
that developing countries need a greater say on these bodies.
What specific steps is DFID taking to encourage this?
(Paragraphs 97-103 and 138-141, Chapter 3).
These parts of the White Paper identify a number
of global health problems affecting developing countries, including
HIV/AIDS, malaria, TB, meningitis, pneumonia and diarrhoea. The
White Paper reinforces the Government's intention to strengthen
international efforts to combat such diseases by:
ensuring that affordable drugs and
vaccines are available and establishing the basic health systems
needed to distribute medicines in an effective way; and
encouraging the development of new
drugs and vaccines (particularly for communicable diseases).
Improving access to essential drugslittle
further detail is given in the White Paper as to how DFID intends
to improve access to drugs. Effective medicines already exist
for many of the conditions of most concern. The challenge faced
by DFID and other funders is to facilitate access to them; for
instance, by assisting in their procurement and helping to fund
the basic health infrastructures needed to dispense them effectively.
The WHO estimates that one-third of the world population (and
up to 50 per cent of the population in sub-Saharan Africa) do
not have regular access to essential drugs. It is not clear from
the White Paper how the UK will address these problems.
The WHO has a medicines strategy which encourages
each country to develop a national drugs policy. This involves
setting up a list of essential medicines and developing strategies
and systems to ensure that people have access to them. It has
identified improving access to anti-malarial and anti-HIV treatments
as being major priorities. A major focus of the White Paper is
the issue of affordability. One approach here is to involve pharmaceutical
companies in drug donation schemes. Other options mentioned in
the White Paper (see Section on "Pro-Poor Research",
paragraphs 135-141) include public purchase funds, differential
pricing, use of tax credits and extending patent periods, although
such measures are primarily seen as ways of encouraging the development
of new products (see below). Other issues identified by the WHO
(but on which the White Paper is largely silent) include:
implementing national drug policiesco-ordination
of action by all stakeholders to ensure rational use of drugs
by health professionals and consumers;
other aspects of accessibility(ie
apart from affordability) such as security of supply;
quality and safety issuesdrugs
available to developing countries have often been associated with
quality control problems;
guidelines for donated drugs stipulate that they should have useful
shelf-lives of at least 12 months (although there are some exceptions
to this rule); and
disposal of unwanted drugs(eg
Researchthe White Paper identifies
a need for "pro-poor research" to encourage the development
of new drugs and vaccines. Specific priorities identified for
such research include communicable diseases, especially HIV/AIDS,
malaria and TB. One of the main issues raised by such research
is that of commercial incentives. While governments can fund fundamental
research, it is commercial companies that have the manufacturing
and marketing skills needed to turn such research into new products.
Drugs and vaccines aimed specifically at conditions affecting
developing countries are often commercially unattractive; mechanisms
thus need to be found to provide incentives for companies to develop
such products. The White Paper acknowledges this and notes a number
of different approaches including:
public purchase funds, where governments
guarantee to buy vaccines for developing countries at a fixed
price from any company that develops an effective new product.
This raises the question of how DFID will encourage strict
criteria to be agreed regarding the safety/efficacy of any new
differential pricing, where drugs/vaccines
are sold more cheaply in developing than in developed countries.
How will DFID ensure that such schemes are not subject to profiteering?
extending the period of patent protection
to allow companies to make profits on drugs and vaccines targeted
at developing markets over a longer time period. A potential
issue here that is not discussed in the White Paper is defining
which products should qualify for this treatment.
Other areas relevant to research but which are
not covered in the White Paper include:
clinical trials in developing
countries. There is a perception that clinical trials conducted
in developing countries do not always match the ethical standards
required in developed countries;
identification of emerging diseases
(eg Ebola)this is particularly relevant given the time-scale
required (10-15 years) to develop and market new drugs and vaccines;
One of the biggest practical obstacles
in using current vaccines and drugs is the need to keep many of
them refrigerated; this makes their use particularly difficult
in (for instance) sub-Saharan Africa. There may be scope for
more research into improving existing drug and vaccine formulations
to make them more robust for use in developing countries.
(Paragraphs 142-149, Chapter 3)
The White Paper identifies a number of concerns
that developing countries have voiced over the WTO Agreement on
Trade-Related Aspects of Intellectual Property Rights (TRIPs).
A particular concern is that patenting regimes may restrict access
to/increase the cost of essential drugs (eg if they do not permit
the import of the cheapest legitimate source of a product, such
as a generic drug). Another is that the TRIPs Agreement does not
cover traditional knowledge or access to indigenous genetic resources.
DFID proposes the establishment of a UK Commission on Intellectual
Property Rights to consider such issues and report back to the
Secretary of State for International Development. More details
of the workings of the Commission could be requested, such as
its membership, who and how it will consult and when it will report.
The WHO has also expressed concern that trade
agreements might restrict access to essential medicines. It is
concerned that drugs should not be treated merely as yet another
commodity, and that access to them is part of a broader right
to health care. When setting up IPR systems, a balance must thus
be struck between protecting the interests of the patent holder
and protecting public health. To this end, the WHO are monitoring
the impact of the WTO TRIPS Agreement on drug prices, technology
transfer, and levels of resources available for research and development
into tropical diseases. It is not clear from the White Paper
how the proposed UK Commission will interact with the WHO monitoring.
Clean technologyChapter 6 of the
White Paper refers to the need to promote the development and
uptake of cleaner technology. The question arises whether DFID
sees this in terms solely of reducing the release of pollutants
to the environment from production processes. The discussion in
Paras 261-263 appears to suggest this. However, this topic can
be viewed more broadly, in terms of increasing the productivity
of resources, and ensuring that products are designed to be inherently
less damaging throughout their lifecycle (the cradle to grave
approach). POST published a report on this topic in April 2000,
and further information is available on request. The White
Paper does not make clear how DFID intends to promote life cycle
thinking in cleaner technology, rather than just cleaner process
Value of the EnvironmentParagraphs
258-259 refer to the environment as having value to people only
in terms of benefits to humans (eg protecting people from ultraviolet
rays, purifying air and water, and providing resources). While
these ecosystem services are real, the environment is of value
to people all over the world for a variety of other non-instrumental
reasons. Cultures, expressed through religion and ethics, for
instance, place a less materialistic value on the environment.
Similarly, the environment is of value to science in providing
understanding of the workings of the earth. Finally, the 1981
UN Charter on Wildlife expressly recognises that "all life
warrants respect regardless of its usefulness to Man". To
what extent does DFID acknowledge the non-instrumental value of
the environment, and what actions does it intend to take to recognise
this alongside the instrumental values?
Global Environmental ChangeThe
White Paper states that developing countries are the most vulnerable
to global environmental change, but does not address the means
by which such vulnerability could be reduced. Research has pointed
to a number of features of developing countries that make them
especially vulnerable to global environmental change. In particular
vulnerability increases as the capacity to adapt to the changes
("resilience") decreases. This relates to the extent
to which countries have access to technology, robust institutional
arrangements for emergency response, and financing and insurance.
The differences in the scale of the consequences of the impacts
of Hurricane Mitch on Central America and the southern USA in
March 1998 illustrated the extent to which vulnerability and resilience
are related to socio-economic conditions. How far does DFID
recognise these issues, and what action will it take to address
the issue of reducing vulnerability (ie increasing the capacity
to adapt) to global environmental change?
Parliamentary Office of Science and Technology