I thank the witnesses for coming before the committee, for giving of their time and for all they do, particularly Mr. Lawlor.
It is very important that patients are out there advocating for others.
To follow on from the comments of my colleague, Deputy Durkan, on the EU, I have to agree that the solution here is the EU market and its 500 million people. We are being played off against each other when it comes to drug pricing. Deputy Brassil mentioned Spinraza, which I believe has gone through the BeNeLuxA agreement. We are given a price and then told it is not the real price, because the list price and the actual price are different. We are told information is commercially sensitive, etc. Transparency is clearly a big issue here. We seem to spend so much time dancing around and protecting pharmaceutical companies' confidentiality when people are suffering daily due to lack of access to drugs, as I am sure the medics are aware.
I am very supportive of centralising assessment through the EU. We are a body of people with essentially the same rules, so I cannot understand why each country is running this through its national equivalent of the National Centre for Pharmacoeconomics. That is the way we have to move.
When a company proposes a drug, it already knows its market. It already knows how many people have human immunodeficiency virus, HIV, hepatitis, or a rare condition such as cystic fibrosis. I am a pharmacist, but I think we should be very conscious that the responsibility of pharmaceutical companies is to their shareholders and not to public health. As legislators, that is where our concern arises. Over the last few years in this committee, I have seen that drugs can be available to those who get a good PR company, tell a good story and promote the right victims. We end up in a situation which I am sure is very concerning to our witnesses as medics, where those who shout the loudest often get the most. It is a huge injustice. Suppose that two children have debilitating physical illnesses. A drug comes out to treat one disease but not the other. By the power of the pharmaceutical industry, the child for whom the drug has been developed might get €500,000 a year in drug treatment. The child for whom no drug has been developed gets nothing. That is a huge inequality, and as a medical professional and a legislator, I find it very difficult. That injustice is probably why our witnesses are here today.
In regard to how we move forward on this, a lot of people speak about ring-fencing budgets. The witnesses can tell me if I am wrong, but I always find that if funding is ring-fenced it is a target rather than a bill. Let us suppose that an arbitrary figure of €100 is to be given to biosimilars or to orphan drugs. We always end up at €11. I am concerned about ring-fencing, because if the money is gone in March companies will ramp up their production of drugs to come onto the market in January. The drug released in June will never see the light of day and the patients will suffer. I am concerned about the ring-fencing model.
The opening statement referenced generic substitution and reference pricing. I have lived through that phase as a pharmacist. Biosimilars promise similar opportunities to those promised by generic drugs 15 years ago. I understand that legislation was brought in to allow pharmacists to generically substitute. There is huge pushback against biosimilar substitution from the usual suspects. Perhaps one of the doctors could give their opinion on this, or any data that might be available. Are there any costings of the savings we would make if we substituted the top ten rare disease drugs or high-tech drugs with biosimilars? Every time we provide a branded high-tech product while a biosimilar sits on the shelf, somebody is not getting a treatment as a result.
I am aware that these are used all the time in the Netherlands. I met with a pharmacist in the Netherlands the other night. We seem to be behind the curve here. Is there a reason for this delay? Is it cynical to think that the position of big pharma in Ireland might have something to do with our slow progress in this regard?
Returning to the issue of the market, there is definitely a move in the pharmaceutical industry to pick the illnesses affecting a massive population, such as cholesterol, and not the very rare conditions. Firms pick a proper market. They do the sums and note there are, say, 3,000 children or adults with a certain condition. They multiply the numbers, determine their top price and cut off 40% to find the lowest point they can go to. To some extent this is all a game, but the game is costing lives and leaving people without medication. It is high time we stood up to these companies. They want to sell drugs and we want to buy drugs, but we are in a position where we have limited and finite resources.
I am quite interested in the issue of access to medication in the developing world where it affects vaccination, HIV control and hepatitis C eradication. I recently saw data saying that in Ireland and Europe, when we are exposed to fake news or incorrect information on vaccination, many people are able to look at the information, realise it is not as it seems and make their own informed decision. This reflects our belief in our public health system. I have seen evidence that in developing countries people may use the Internet as their only source of medical information. They may not have the benefit of an education system that develops critical thought and a public health system in which patients believe the GP and meet the hospital doctor. They may not hear about things on the news. Someone whose only source of news with regard to vaccinations, hepatitis C or HIV is social media can be a really good target for people trying to affect global vaccination rates, whatever their reason for doing so. If the witnesses have any information on that sort of bias, the challenges it poses to the developing world and how we protect those people I would be interested to hear it. Funding public vaccination programmes is absolutely pointless if herd immunity is not reached. It is a complete waste of time.
Dr. Harkin's comments on antibiotic resistance were very interesting. I had never even considered it before. There is no money in antibiotics. There is no money in developing a drug that doctors do not want or whose usage they want to restrict. I would be interested to hear any more information Dr. Harkin may have on that. Perhaps he could send it to me after the committee meeting. I am quite concerned about this. We can have all the vaccinations and HIV eradication programmes in the world, but if a super-resistant bug appears that is the end of us all anyway. There is no point in the rest. Perhaps Dr. Harkin could elaborate on that.
I read one of the documents on antibiotic resistance. There is now a movement called One Health that combines a view of antibiotic use's effects on the human population, the animal population and the environment. If I take an antibiotic and excrete a certain amount of it, it enters the water supply. Farmers put antibiotic bulk powder into pig and chicken feed. That is totally unrestricted. The Government does not charge any value added tax, VAT, on it either, but that is another day's work. Overuse of antibiotics in the animal world and the veterinary field combined with restrictions in the human world affect the environment, which is what we are all talking about right now. If Dr. Harkin has any research on that or a view he would like to share, I think it would be of value.