Mike Freer is MP for Finchley and Golders Green.
The science isn’t in doubt, the costs are plain and simple, and the scale of the impact it could have in reducing HIV rates across the UK would represent the biggest breakthrough in a generation.
Of course I am talking about PrEP (pre-exposure prohylaxis) – A drug which when taken has been proven to reduce the transmission of HIV by over 90 per cent.
The debate over this controversial drug has been ongoing for many months. NHS England had agreed to fund medical trials into PrEP here in the UK, to mirror those undertaken by clinicians in the United States and Canada. Campaigners were confident therefore that NHS England were likely to fund the drug, predicting the trials would reveal similar results already confirmed in drug trials in the US.
However, in May this year NHS bosses made a shock announcement stating PrEP was a preventative drug. That meant it would be the responsibility of local authorities to commission funding for PrEP.
Last week, NHS England’s decision to leave it to councils, and therefore risk a potentially unbalanced approach to PrEP nationally, was challenged by the High Court. Mr Justice Green ruled that NHS England could fund the drug.
However, with a way open for an appeal, NHS England have vowed to challenge the ruling, holding to their belief the drug is preventative and not a cure. This is correct: it’s not a cure and nor is it a vaccine, but it is a significant part of a toolkit to reduce HIV infection rates, which continue to rise.
The response from NHS England following the decision was callous and unprofessional. They argued the ruling could put funding for other life-changing drugs on the line, including a new drug which is expected to improve the health of children suffering from Cystic Fibrosis. Meanwhile the line taken by some tabloid newspapers has been reminiscent of stories published when AIDS first struck in the 1980s.
The argument goes that being diagnosed with HIV and AIDS comes down to a lifestyle choice. In some cases this will be true – but the NHS funds to cure and treat illnesses which are diagnosed from certain life choices all the time.
For one, the contraceptive pill which is as preventative as PrEP; then there is treating life-long smokers from lung cancer, as well as performing gastric band surgery on those struggling from health problems because they are overweight.
If the issue behind funding PrEP is cost, it shouldn’t be. The mind-set is the same as that behind treating obesity and helping smokers pack in smoking through health kits; and to repeat, the funding given to prevent childbirth. At the end of the day, we are all human. We can encourage those who do not use the advice and tools given to them to prevent them from taking decisions that put their health at risk, but does that make someone less deserving?
Not only that but early intervention can prevent further health complications, which in the long-run could end up costing the taxpayer even more to treat. The cost of PrEP is currently £400 per person per month, around £10-20 million per year. This is set to come down when the drug’s patent expires in 2018. Moreover, NHS England has been negotiating with Gilead – the pharmaceutical company responsible for making PrEP – to improve its price.
If you compare that with the lifetime costs of treating someone with HIV, you are looking at an estimated £200,000 to over £350,000. So, as I said at the beginning of this article the costs are just plain and simple.
What has been made clear during this entire episode is funding for PrEP is more controversial than it would have been had this been about a drug not linked with sex. And that’s because there is a stigma attached to contracting HIV; something inherited from the 1980s. But also because this affects gay men more than it does heterosexual men. This stigma needs to end.
NHS England – stirred up by tabloids – proceeded to put one set of patients up against another. They used a hypothetical situation of a child suffering from Cystic Fibrosis, diagnosed with a terrible disease by no fault of their own, with a gay man who contracted HIV because he could not be responsible enough to use a condom.
But if we can fund the contraceptive pill, we can fund PrEP. Funding for drugs should only ever be based on clinical evaluation, cost effectiveness and the impact on society more widely. Each one of those criteria have been met in my mind, and for this reason NHS England should move in the direction of funding PrEP.