The Battle of the Surcharge – won

Finally, last Friday, the Government announced it was going to remove the surcharge that overseas NHS staff have to pay for using the service they themselves work for. This follows two years of campaigning by unions such as Unison and Unite, which between them represent over 600,000 nurses, student nurses, midwives, doctors, health visitors, healthcare assistants, paramedics, cleaners, porters, catering staff, medical secretaries, clerical and admin staff and scientific and technical staff, who are either employed by the NHS or by other organisations which provide NHS services.

Only last Wednesday at Prime Minister’s Question Time Johnson told MPs that the extra raised £900m needed for the NHS. This has been challenged by the Institute of Fiscal Studies which put the sum at a tenth of that – £90 million. But that is irrelevant to this argument, which is that none of the overseas staff should ever have had to pay to use the NHS. The Government could focus instead on making all the big multinationals pay the taxes they avoid, just for a start.

Unite national officer for health Colenzo Jarrett-Thorpe said: “Of all people, Boris Johnson should appreciate the wonderful and dedicated work of NHS health and social care professions, including the two non-UK nurses he singled out for particular praise in his fight for survival against coronavirus.

Who is Dominic Cummings?

He is not actually the Prime Minister, but appears to many to play the role of ventriloquist. He is not an MP or an elected representative of any kind. His official title is Senior Advisor to the Prime Minister, with an office in Downing Street. But he has succeeded in getting the British Public angry, which neither Boris Johnson, nor Matt Hancock, nor indeed any other member of the Government, has managed to do on anything like the same scale.

What he has done was to behave as though the Government’s lockdown rules (which he proposed in the first place) did not apply to him, when many of us have not seen children, grandchildren and other loved ones for weeks, and too many have not even been able to say goodbye to those who were dying. And he is still refusing to admit to any wrong doing: “I think I behaved reasonably”. Up and down the country people are calling on him to resign – including more than 20 Tory MPs by Wednesday, 44 by Thursday morning with 61 criticising him. The numbers are still growing – and one Government minister has resigned over it.

Cummings was responsible for the Brexit slogans “Get Brexit Done” and “Take Back Control”; for the campaign bus that said “We pay £350 million to the EU. Vote Leave and give it to the NHS instead” (which many of us knew was never going to happen, but some people were taken in by); for the offensive, enormous posters that said Turkey (population 75 million) was going to join the EU (implying 75 million Turkish people would be moving to Britain); and broke electoral law over spending limits, for which the campaign was fined £70,000. But not till the voting was over. The BBC website this week pointed out that Cummings was also held in contempt of Parliament for not responding to a summons to appear before, and give evidence to, the Culture, Media and Sport Select Committee. He also managed Johnson’s election campaign 2019, and is obviously very useful to the man who became Prime MInister, coming up with catchy slogans, launching a campaign against the Labour “heartlands” and advising Johnson how to handle public relations. David Cameron, a previous Tory PM, is widely quoted on twitter as saying Cummings was a “career sociopath”, while others have called him a narcissist on social media. As I am not a qualified psychiatrist I couldn’t possibly comment.

Meanwhile a man called Craig Murray is a career diplomat, whose last job was as British Ambassador to Uzbekistan. He stood as an Independent in Blackburn in the 2005 General Election, opposing Jack Straw, then Foreign Secretary. And now he writes a blog in which he has drawn attention to Cummings’s presence in Castle Barnard on 12th April (allegedly testing his eyesight) which just so happens to be where the pharmaceutical giant, GlaxoSmithKline (GSK), has one of its 18 UK premises: an important research and manufacturing site. (See  https://www.craigmurray.org.uk/archves/2020/05/why-barnard-castle/ 24.05.20).

Mary Wakefield, Cummings’s wife, who is editor of The Spectator,  published an article on 23rd April describing how ill Dominic had been for 10 days, with high fever, muscle spasms and difficult, shallow breathing. But on 5th April he was seen in his Father’s garden in Durham. On 12th April they were seen at Barnard Castle. On 14th April Cummings was back at work in London. On 14th April GlaxoSmithKline and Sanofi announced their collaborative agreement. On 19th April he was spotted again in Durham, though he has denied that he was there then. The former chancellor Sajid Javid was quoted in The Guardian (28.05.20) as saying the journey was not “necessary or justified”.

Returning to Craig Murray, he further points out that GSK have been fined on more than one occasion for illegal behaviour eg fined £37.6 million in 2016 for bribing firms not to produce generic drugs. As a result the NHS would have had to pay more for these drugs, as generic drugs are cheaper than branded ones.

GSK currently has 37 new medicines and 15 vaccines in development, according to its website. Its global HQ is in Brentford, Middlesex – you pass it if you drive into London on the M40, just before the turn-off for Kew. So a bit more handy for Cummings to get to from his own home, but also a bit more public. (GSK has 18 facilities in Britain and many more worldwide – offices, research labs and production facilities).

On 14th April, 2 days after Dominic Cummings was seen in Barnard Castle, it was announced by GSK and the French firm Sanofi, which also makes vaccines, that they had signed a deal to develop and manufacture a Covid-19 vaccine. We all want that, don’t we? The long term solution to Covid-19 is a vaccine, just as measles, another viral illness that in the USA was serious enough for 48,000 people to need hospital treatment, resulted in 4-500 deaths and 1000 people developing encephalitis per year before the vaccination programme started in 1963.

So why was Dominic Cummings not shouting about this development from the rooftops? It would, of course be illegal to use insider knowledge to buy up shares in the firms before their value on the stock market went up with the announcement of a potential vaccine for coronavirus. And indeed it might be a complete coincidence that he was nearby shortly before the announcement.

Sanofi has developed an antigen based on recombinant DNA technology[1], which allows it to make a genetic match to proteins that occur on the surface of the coronavirus. They have called this the Spike (S) protein COVID-19 antigen[2]. The DNA sequence which encodes this antigen has been combined into the DNA of the baculovirus expression platform[3]. Sanofi has received some funding and collaboration from the US Biomedical Advanced Research and Development Authority (BARDA[4]).

GSK will contribute its pandemic adjuvant (auxiliary) technology to the collaboration, so more vaccine doses can be produced. An adjuvant is used with the vaccine to stimulate the immune system, so that the vaccine is more efficient and longer lasting, and less of it is needed for each dose. This is an advantage when making enough vaccines to treat a pandemic.

The firms have entered a Material Transfer Agreement to enable them to start working together immediately, with details to be firmed up in the following few weeks.

BARDA’s website says its “mission is accomplished through successful public-private partnerships with industry to share risk, improve efficiency and accelerate development all while sustaining a marketplace that guarantees continued access to countermeasures vital to our national security.” “Our” here refers to the USA. It is not clear what advantage the USA intends to gain over the collaborative work of a British and a French firm, or whether Britain, France or indeed any other country with a serious outbreak of Covid-19, will be sharing in this.

Cummings listed his goals as “Get Brexit done then Arpa” in a whatsapp profile mentioned on the BBC website on Monday. ARPA is the Advanced Research Projects Agency set up by the USA in 1958, which led to Silicon Valley. It is not clear what Cummings meant by this. It is clearly not a UK version of Silicon Valley – which has already been tried with variable longer term success eg in the science based firms around Cambridge, and in Silicon Glen in Scotland. But he might have in mind something like the US Cooperative Research and Development Agreement (CRADA), which was established in 1984 to encourage collaboration between firms and public sector research organisations or state agencies, and which has enabled firms to make money out of public sector research.

An example of the CRADA was the anticancer drug taxol, or Taxol®[5], which has been very successful in treatment of ovarian, breast and other cancers, but for which patients must pay twice: first through their taxes which paid for the research supported by the National Cancer Institute and other public bodies, and second in the high prices charged for the drug, since the firm producing it (Bristol Myers Squibb, BMS) was allowed to charge a similar price to that of other anticancer drugs, which had not necessarily received public funding. Remember that in the USA patients will have to pay the cost of the drugs themselves or – if they have insurance – their insurance companies will; while the NHS will have to pay those prices for taxol imported here. There were three Congressional Hearings on this and related issues, but they did not lead to any difference in the legal status of the product or the property rights of the firm.

Collaborative alliances have been a phenomenon in high tech industry, especially IT and biotechnology, since the early 1980s. Despite the risks of opportunistic behaviour by partners, the number of technologies and specialist fields in which firms need to keep up to date in order to innovate, has encouraged such relationships, though these have often ended in merger or acquisition, followed by new alliances in new specialisms.

If a vaccine is successfully developed and prevents further outbreaks of flu-like conditions from this or other coronaviruses, and is available at an affordable price, then governments will consider any collaboration to have been a success. We have yet to see how the research will progress, and exactly what relationship the US government – which has contributed to the cost – or the UK or French governments – in whose countries GSK and Sanofi have their headquarters – will have to the firms in the collaborative alliance, let alone what benefit will accrue to people in other countries.

From Vivien Walsh (Greater Manchester)

[1] Recombinant DNA is what you get when segments of DNA from different sources are joined together. Recombinant technology = genetic engineering, which can be used to make eg human insulin, used to treat diabetes instead of the earlier treatment with insulin from cattle and pigs.

[2] An antigen is a substance that can stimulate an immune response, ie activate the body’s infection-fighting white blood cells (lymphocytes).

[3] A baculovirus is an insect virus. Recombinant baculoviruses can accommodate multiple “foreign” genes or large segments of “foreign” DNA. The baculovirus expression platform is used to generate recombinant proteins in insect cells at high production levels.

[4] BARDA was established in the USA in 2006 during George W Bush’s Presidency. It is part of the Health and Human Services Office of the US Assistant Secretary for Preparedness and Response, which in turn was created the same year by the Pandemic and All Hazards Preparedness Act in the wake of Hurricane Katrina, to aid the USA in responding to chemical, biological, radiological and nuclear (CBRN) threats, to pandemic influenza (PI) and to emerging infectious diseases (EID). BARDA supports the transition of vaccines, drugs, and diagnostics from research to advanced development and consideration for approval by the Food and Drug Administration (FDA) and inclusion into the Strategic National Stockpile. BARDA’s support includes funding, technical assistance and core sevices, ranging from a clinical research organisation network to Centres for Innovation in Advanced Development and Manufacturing, and a fill-finish manufacturing network. To date, BARDA has supported 42 FDA approvals for products for products addressing CBRN, PI and EID threats. (From the various websites of the organisations mentioned)

[5] Taxol was a natural product, extracted from the bark of taxus brevifolia, the Pacific Yew, which at the time could not be patented. It was developed by a huge network of researchers in the public sector and funded by US taxes plus the firm Bristol Myers Squibb, which manufactured and marketed it. To secure the intellectual property, BMS was allowed to trademark the name taxol in 1992, a name first given to the molecule by the chemist Monroe Wall in 1967, who first discovered its activity against cancer at the Research Triangle Institute in North Carolina.

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3 Comments

  1. The battle against the surcharge has not been won when non-NHS migrant workers still have to pay it, and when charging at 1.5x cost of non-working migrants is still going on, excluding often the most needy people from the health care system, or threatening them with debt bondage.

  2. Vivien Walsh says:

    You are quite right; I agree. I was only talking about NHS staff in the blog.

  3. Edith Dyas says:

    I think it is long past time that this heartless Tory Government learned to respect and value the contribution that hard working people make to the welfare of everyone in this Country. They deserve a fair and decent standard of life. For far too long the Workers of Britain have been exploited and undervalued.

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