Covid-19 Inquiry

Baroness Chakrabarti Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, I declare interests as the former shadow Attorney-General who attended cross-party briefings with Ministers and officials in early 2020 and as a member of your Lordships’ Committee inquiring into the operation of statutory inquiries in general.

The work of the noble and learned Baroness, Lady Hallett, and her team is to be commended for its ambition and delivery so far. The module report currently before your Lordships’ House deals with UK pandemic resilience and preparedness, which, on the evidence before it, the inquiry found significantly wanting. Its findings and recommendations in this respect are clear, compelling and, in my opinion, rather difficult to quibble with—but of course quibbles none the less come. From my own recollection, meetings in January 2020 revealed significant gaps in both preparedness and even nimble thinking. A question I remember posing about the possible need for rationing and temporary requisitioning of vital medicines, equipment and large vacant premises was met more than once with embarrassed silence.

However, this report also foreshadows other modules to follow, all of which must to some extent be interconnected. In the hope that the inquiry team will watch or at least read today’s debate with interest, and with the aim of advocating towards areas of vital detailed inquiry still to be pursued, it is on as yet unexplored areas of pandemic handling that I intend to focus my remarks. I am especially concerned with the modules dealing with vaccines and therapeutics and with the UK’s economic response to the Covid-19 pandemic. Once more, these are distinct discussions but with crucial overlap.

By way of introduction, it has long been my view that the pandemic was both a genuinely global tragedy justifying urgent and continuing international—rather than purely national, let alone, as we have heard, nationalistic—responses and a parable for every inequality and hypocrisy in our own nations and the wider world.

Here at home, health and other vital public service workers and volunteers displayed nothing short of heroism in our communities, risking their own lives—sometimes dressed in bin liners for meagre protection—to help others, even before a full understanding of the virus, let alone the advent of life-saving vaccines. They were akin to the unknown soldiers of the Great War. Some—including from minority ethnic and international communities—literally sacrificed their lives for others. By contrast, we saw some people panic-buying essential goods, corporate profiteering, corrupt firing and rehiring of staff in some service industries, so-called VIP lanes for public procurement, and a government inability or reluctance to tackle fraud in relation to Covid business support loans. That prompted the dramatic resignation of the noble Lord, Lord Agnew, from that Dispatch Box in your Lordships’ House in January 2022.

Ordinary people and small businesses gave up precious liberties, livelihoods and lives during chilling but none the less proportionate lockdowns, yet there was often an asymmetry to lockdown enforcement and support. In the public mind this will perhaps be for ever symbolised by infamous parties at No. 10 and breaches of social distancing implicating not one but two former Prime Ministers, while the elderly died, grieved alone, or were tipped out of hospitals untested, often into unsafe care homes.

However, such inequities became even more distastefully graphic and counterproductive on the international stage, where deaths reached 7 million. Crucially, when critical vaccines arrived, as a result of large-scale public and philanthropic investment, normal rules on intellectual property were not promptly and temporarily waived to allow them to be shared at scale and at genuine production costs with millions of people in the global South. It was as if big pharma refused to share the floor-plan locating emergency exits in a burning building, even though Governments, charities and altruistic scientists had collaborated to build those fire escapes in the first place.

Of course, in a pandemic, even more than in a fire, hoarding lucrative but life-saving knowledge is counter- productive to public health, as the spread of a virus and its mutations anywhere risks new infections and re-infections everywhere. Dead bodies floated down the sacred Ganges river, while subcontracted Indian manufacturers provided vaccines to be sent to the global North. If ever there was a justification for human rights principles to be applied more directly and effectively to international institutions and corporations, it was this.

Many leading voices at the WHO, in the Vatican and in the White House—at least, after President Biden took office—called for an activation of the TRIPS waiver for vaccine patents at the WTO. Gordon Brown was a leading UK proponent of this emergency measure, with so much support in the global South, where vaccination continued to be beyond the reach of too many. Shamefully, the UK Government were one of those who stubbornly blocked the measure in the interests of corporate profit. Some noble Lords opposite elegantly stonewalled on this question month after month as the death toll soared.

By way of context, after 9/11, the US faced a threat of anthrax, after samples were sent to key politicians. The US needed drugs to treat this disease but could not get supplies quickly enough, so it threatened the supplier, Bayer, with a compulsory licence, to allow the US to mass-produce the drug or obtain generic versions to treat people with anthrax. During Covid, Israel issued a compulsory licence to secure supplies of early drugs thought to be active, and Spain also changed laws to allow compulsory licensing.

There are understandable and proportionate precedents. If states believe that they are in a health emergency situation, just as they may demand social distancing and home-working for individuals and small businesses, they may issue compulsory licences in the face of corporate non-co-operation and greed. But how much more effective would it be to do this collectively at the international level, as proposed?

Unsurprisingly, and in response to the Covid-19 experience, there is currently legislation pending in the European Parliament in relation to EU-wide emergency compulsory licensing. Unlike the last Government, our new Government are internationalist in outlook and pro-human rights in their values. Will they learn lessons from the bitter fruit of nationalism, whether in racist public disorder on our streets or the disproportionate loss of life in health crises?

There are currently remarkable new drugs, such as lenacapavir, which prevents HIV infections. There are currently 1.3 million of these new infections in the world every year. The drug is sold in high-income countries for $40,000 per patient per year, despite a potential annual production cost of just $40. Without voluntary or compulsory licensing, this drug will be beyond the reach of millions of people in low and middle-income countries, meaning many unnecessary infections and deaths, with no hope of ending the epidemic. Often the poorest countries get better deals than middle-income ones, which are frequently left out of voluntary licence agreements. Further, the general problem of drug and vaccine inequity is surely a huge issue for pandemic prevention and response, now and in the future.

It is a marvel of human resilience that so many people have adjusted to life after the Covid-19 pandemic as if it were but a bad dream. However, we know that for a great many others its ramifications will be felt for decades to come. In some ways, it is not unlike a world war in the scale of the existential threat that was posed and its human and economic costs. After World War II, statesmen across the political aisle and around the world came together to try to prevent reoccurrence by way of shared values and a machinery for co-operation. May we not do that again?

Pandemic Preparedness

Baroness Chakrabarti Excerpts

Monday 15th April 2024 Lords Chamber

[The Lord Bishop of Leeds]

My Lords—

[Baroness Chakrabarti (Lab)]

My Lords, why did we block the TRIPS waiver?

[The Lord Privy Seal (Lord True) (Con)]

The noble Baroness knows better than to shout at another Member when other Members before her are also trying to get in to ask a question.

[Lord Markham (Con)]

That is all a part of what I referred to as having a toolkit for a flexible response. The problem always in these things is that you tend to fight the next war on what happened in the last one. We have to be careful in what we do and that we are not trying to fight the next pandemic on the last one, because inevitably it will be different. Having a flexible and scalable response, including communications, is vital.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister says that we have a—

[Lord Turnberg (Lab)]

My Lords—

Black and Minority Ethnic Babies: Mortality Rates

Baroness Chakrabarti Excerpts

Wednesday 15th November 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. One main reason for that is that in London there is generally a more ethnically representative mix of staff, who are better placed to understand and work in that way. Clearly, we need to increase training as well as recruitment across the rest of the country to make sure that they achieve the same levels.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister will know how highly regarded he is in this place as one of the most caring members of the Government, but what does he say to the comments of the president of the Royal College of Paediatrics and Child Health about how troubling these figures are in a wealthy nation such as ours and about child poverty in this country being a driver of child mortality? What will the Government do about that?

[Lord Markham (Con)]

That is specifically what the Best Start for Life programme is all about. It is a joint Department of Health and DfE £300 million initiative focused on the 75 most deprived areas and local authorities. As the noble Baroness might be aware, the whole reason Andrea Leadsom wanted to come back as a Minister—I was talking to her about this yesterday—was to drive this programme, which she is passionately behind. That work is being done through family hubs, making sure that the whole family is involved and bringing in the dads. That sort of action is very much focused on making sure we tackle this.

Menopause

Baroness Chakrabarti Excerpts

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

I again agree with the point. Helpfully, the noble Baroness, Lady Thornton, pointed me towards the excellent Fawcett Society report this morning, for which I am grateful. It makes for a very interesting read. As I mentioned earlier, the statistic that 10% of women during the menopause end up leaving employment is a telling one. That is what the appointment of health ambassador for the employers is all about. I hope that noble Lords will see the seriousness with which I take this subject, because it is vital not only to women but to the economy and business as a whole. This time next year—if I am still here—I commit to doing a stocktake report on the progress that we have made on this over the year, because I think it is vital.

[Baroness Chakrabarti (Lab)]

My Lords, I am grateful to the Minister for the very serious tone of his response to this Question. I declare an interest which is not in the register but is self-evident from my date of birth, which is public information. Will he readdress that part of my noble friend’s question that was about the EHRC and whether that public body has a role in setting out guidance for employers? Will he, in the light of his commitment on this subject, suggest that the Equality Act needs to be at the very least enforced and possibly beefed up in this regard?

[Lord Markham (Con)]

I apologise if I have not answered the point on the EHRC satisfactorily and it is best that I follow it up in writing to make sure that I do so.

On the Equality Act, as I am sure everyone is aware, menopause should be covered as a protected characteristic within the terms of discrimination, be it on grounds of sex or age, and I believe there are cases where it has been shown to be used correctly in that regard, so the capability is there. However, if there is not adequate reason for redress under the Equality Act, that would obviously need to be looked at in the future.

Skills for Care Report

Baroness Chakrabarti Excerpts

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.

[Baroness Chakrabarti (Lab)]

My Lords, I, too, welcome the Minister to his place. I congratulate him on the tone of his responses so far. I agree with him that the workforce is key. Another feature of the report is that a quarter of the adult social care workforce are on zero-hours contracts and get paid £1 an hour less than healthcare assistants on average. Given the projection in the report that, if we are to keep up with our ageing population, we will need the best part of 500,000 more of these workers by 2035, we must address their low pay, must we not?

[Lord Markham (Con)]

The noble Baroness is correct that a number of people are on zero-hours contracts. As I am sure she is aware, their employment is through a number of agencies and local authorities, but it is an issue in a number of places and goes to the wider conversation about how we make this sector an attractive place to work. Earlier, my colleague mentioned the Skills for Care working group, which found that a significant proportion of all employers—around 20%—have a turnover rate of only around 10% versus the 29% average. So, clearly there are areas where certain employers do a fantastic job of not only recruiting but retaining, and making the sector an attractive place to work. I believe that the whole emphasis of the conversation we are having now is exactly about how to make this sector an attractive place to work because, as we all know, it is a vital part of our care and health system.

Health and Care Bill

Baroness Chakrabarti Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

Moved by

[Baroness Chakrabarti]

174: After Clause 164, insert the following new Clause—
“Global health emergency international cooperation
In the event of the World Health Organisation declaring a public health emergency of international concern (“PHEIC”), the Secretary of State must within three months—(a) initiate or otherwise support and implement proposals temporarily to waive elements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS”) at the World Trade Organisation to assist wider global manufacturing of and access to health technologies;(b) waive such UK-registered patents, industrial designs, other intellectual property rights, and protections concerning undisclosed information relating to—(i) vaccines,(ii) medicines,(iii) diagnostics and their associated technologies, and(iv) materials,as necessary for combatting the emergency internationally; and(c) issue relevant emergency compulsory directions to enable the domestic manufacturing of generic and biosimilar products.”Member’s explanatory statement
In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.

[Baroness Chakrabarti (Lab)]

My Lords, the aim of Amendment 174 is to learn from mistakes made during this pandemic and ensure that, in the event of a public health emergency of international concern, our Government share and support others to share critical knowledge, data, research and intellectual property relating to vaccines, tests, treatments and their associated materials. By sharing this information and intellectual property we can scale up and, crucially, diversify the manufacturing of pandemic tools to ensure equitable access around the world, expediting our ability to end the emergency for all by winning the race against new variants.

Less than 10% of people in low-income countries have been double vaccinated. Lower-income countries are not prioritised. The status quo pharmaceutical model of supplying to the highest bidder means that low-income countries have to rely on the good will of high-income countries and companies to provide donations. Evidently, this has not proven effective in achieving global equitable access. Many low and middle-income countries therefore want to manufacture their own vaccines, tests and treatments so that they can have greater oversight of supply volumes, timelines for dispensing products and prices now and for the future. However, pharmaceutical companies have widely refused to share their technology openly. In addition, the United Kingdom, the EU and Switzerland have continuously blocked South Africa and India in their proposal to temporarily waive certain provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement—the TRIPS agreement—on all Covid-19 tools, vaccines, tests and treatments.

Amendment 174 seeks to remedy this. It calls for the Secretary of State to support or initiate a temporary global waiver of the TRIPS agreement within three months of a pandemic being declared at the WHO. This three-month period is there to give pharmaceutical companies the opportunity and the push to make plans for how they will voluntarily openly license their products and engage in transferring their know-how to companies with established manufacturing capacity. This time period is in step with the recommendations of the Independent Panel for Pandemic Preparedness and Response.

The pharmaceutical industry is an immensely powerful machine, and we need to work with it. But as history has taught us, through the HIV crisis, pricing for cancer treatments, and now with Covid-19, it does not always do the right thing. As we speak the WHO’s mRNA hub in South Africa based at a biotech company called Afrigen has managed to reverse engineer Moderna’s vaccine. As Moderna made a pledge not to enforce patents during the pandemic, Afrigen are doing well in its development. The project has been significantly slowed down by Moderna and BioNTech’s refusal to share their knowledge with the hub. This is just one example. There are over 100 potential mRNA producers across Africa, Asia and Latin America who could be producing vaccines now, if only they had access to the know-how and data, and were not restricted by the fear of patent infringement.

Amendment 174 is about encouraging the industry to do the right thing and the Government to take action to protect global health and live up to the slogan “global Britain”. It is not just political rhetoric but epidemiological fact that none of us are safe until we are all safe. If viruses are left unchecked, they will mutate and this pandemic is far from over; cases have risen hugely in South Korea, China and here in the UK of late. Talk of Covid-19 becoming endemic does not that mean it has disappeared. Malaria is endemic in many parts of the world, but it continues to kill hundreds of thousands of people every year.

This amendment will also initiate a great deal of cost saving for the NHS during pandemics. We are paying the highest recorded price for the Pfizer vaccine at £22 per shot. This amendment reaffirms our commitment to using in these emergency situations compulsory licences, one of the public safeguards in the TRIPS agreement to enable the domestic manufacturing of generic and biosimilar products, which would mean that any company within the UK with manufacturing potential could be making these vital medical tools.

Just today we heard that a draft copy of the waiver has been leaked, although it has been significantly watered down and reduced in scope. None the less it shows there is a global consensus that intellectual property monopolies are a barrier to accessing Covid-19 vaccines, tests and treatments. We need the Government to use this moment finally to do the right thing and support a waiver on all intellectual property covering vaccines, tests and treatments that can be utilised by all countries in the negotiations to come.

I also urge Her Majesty’s Government to use their influence as a faithful customer of Pfizer and Moderna to push them to share their technology with the WHO’s mRNA hubs and revoke the patents they filed on Covid-19 technologies. This amendment is about improving access to affordable life-saving health technologies for our NHS and worldwide during public emergencies. We can bolster pandemic preparedness and expedite our response to Covid-19 and future pandemics. I beg to move.

[The Deputy Speaker (Lord Lexden) (Con)]

I invite the noble Baroness, Lady Brinton, who is taking part remotely, to speak now.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank all noble Lords who have taken part in this debate for the passion they have shown. I think we are all concerned by vaccine inequity—as noble Lords have rightly said, we are getting our third or fourth vaccines while some people have not had their first yet—but we also have to be clear how we get to this stage. It is easy to say, “We spent this much money on public research and that led to the vaccines”, but it is not as simple as that. It may have led to the research but that does not lead to the production of millions of vaccines that can be distributed worldwide. There is a clear difference between pure research and turning that into actual vaccines and, once they are produced, getting them into people’s arms. You can certainly deliver them to countries but they do not always reach the arms. We have heard stories of vaccines being thrown away because of a lack of distribution in particular countries.

The sharing of knowledge has played and will continue to play an important role in the rapid scale-up of Covid vaccine production. The UK Government are very committed to addressing vaccine equity on every front. As the son of people who came from outside the EU—not white, privileged Europe—I believe very strongly in global Britain.

The experience of the pandemic has shown that it is voluntary collaboration that has made real, positive impacts on vaccine delivery. The scale-up of vaccine production at record pace has been driven by more than 300 voluntary partnerships. This unprecedented collaboration around the world has meant that global Covid vaccine production now stands at nearly 1.5 billion doses per month. Voluntary partnerships such as AstraZeneca and the Serum Institute of India, and Pfizer-BioNTech and Biovac in South Africa, show what is possible if you work together.

The intellectual property framework has been crucial in facilitating this knowledge sharing. Indeed, the legal certainty it produces cannot be overstated. It gives innovators the confidence to form partnerships and continue investing in the innovative health products and technologies that have contributed so positively to our global pandemic response. The intellectual property framework similarly supports the production and dissemination of vaccines and other products across the world.

Yes, 97% of the investment in research is public funding, but research is not vaccines. There needs to be a whole chain from that pure research to scaling up and distribution, and universities cannot do that. Waiving intellectual property rights would dismantle the very framework that has facilitated this collaboration. It would undermine not only the knowledge sharing that has helped to develop and produce Covid-19 vaccines at the pace and scale now seen but the framework needed to support the development of new vaccines and treatments, should these be needed in future.

It should also be noted that the least-developed countries are exempt from implementing the Trade-Related Aspects of Intellectual Property Rights—or TRIPS—Agreement, meaning that they already have a de facto TRIPS waiver. In addition, the TRIPS Agreement already provides flexibilities to enable countries to achieve their public health objectives, and we fully support the right of these countries to use these where needed—but you have to build the capacity. Low and middle-income countries can access medicines in times of emergency through flexibilities that allow them to manufacture or import without the consent of the patent holder.

For these reasons, the UK does not consider intellectual property rights a barrier to supplying and improving access to Covid-19 goods. The noble Lord, Lord Russell, can put another £10 in the Christmas bag. Instead, we shall continue to be a visible champion of those elements of the intellectual property framework that support effective knowledge sharing.

The noble Baroness will be aware that we have contributed vaccines through the COVAX scheme—a partnership of the Coalition for Epidemic Preparedness Innovations, Gavi, the Vaccine Alliance, UNICEF and the World Health Organization—but we know that is not enough. As noble Lords have rightly said, we have to learn from what we have done during this pandemic. One part of my ministerial portfolio that I am very proud of is international relations and health diplomacy. A constant theme in my G20 and G7 Health Ministers’ meetings is how we tackle these vaccine inequities and learn the lessons that many noble Lords have rightly raised.

Last week, the British Government hosted the Global Pandemic Preparedness Summit to learn those lessons: to make sure that we brought together all our experiences as countries, learned from those and asked what we could do next time. I was very privileged to host a working lunch with several overseas Health Ministers, as well as Dr Richard Hatchett, CEO of CEPI; Dr Seth Berkley, the Gavi CEO; and Dr Tedros, the director-general of the World Health Organization, sitting next to me. One of the issues that came up in our discussions was, rather than developing and less-developed countries relying on donations via COVAX, how we ensure that, first, there is more local and regional manufacturing of vaccines through public-private partnerships and, secondly, that vaccines get into people’s arms as quickly as possible once they are manufactured or are imported into a country. We need to avoid those situations where vaccines were wasted because they were not stored or transported properly, or where there was difficulty distributing them once inside a country.

With international partners, we are looking at a whole range of issues and new technologies, such as new distribution methods. Some noble Lords may well have read about drones being used to deliver vaccines to certain remote areas. Before using these drones, it is all very well having all these vaccines in the capital, but how do you get them into people’s arms? We have to look at that area. Intellectual property rights are irrelevant here. The fact is that the vaccines are there but you have to get them into people’s arms. We have to train more vaccinators and we need better transport.

We agree that the vaccine supply must be matched by the capacity of health systems to deliver them, and we have been working to strengthen health systems around the world. Our recently launched health systems strengthening position paper sets out this Government’s determination to do more to build overall capacity, from policy through to delivery.

But there are other issues. Just as there are the vaccine-hesitant in this country, there are many vaccine-hesitant people in other countries. Our African vaccine confidence campaign is working with experts in countries such as Botswana, Ghana and Uganda to reinforce communities’ trust and build demand from the ground up. Once again, you can get the vaccines there but you have to get them into people’s arms. We have also been working to minimise constraints on supply chains, such as tariffs. This has been demonstrated by our sponsorship and promotion of the trade and health initiative as well as the unilateral measures we have taken, including tariff suspensions.

We have also provided support for the development of regional manufacturing capabilities. This includes technical support to develop business cases for the manufacture of vaccines in South Africa, Senegal and Morocco. We are working with the COVAX supply chain and manufacturing task force to champion other practical efforts to scale up capacity. We believe that we are doing lots of things with our global partners—with Gavi, CEPI and the World Health Organization.

To be honest, I am incredibly inspired by some of the work that I see going on. This is about building real capacity. It is about transferring knowledge and technology and making sure that we have that capacity. It is about making sure that we live up to global Britain, in which I firmly believe given my own family history—not from white Europe, but from a global perspective. I believe very strongly in that. I believe that waiving intellectual property rights will not help overcome these challenges. I may be passionate about this but I feel very strongly about it. I feel strongly about global Britain. I feel very strongly about my distant relatives who come from developed countries and about my own history, my own heritage. I feel much more strongly about this than noble Lords may well feel.

This is the right approach. I am hugely encouraged by this international co-operation and the potential of new technologies to help. I would be very happy to continue to engage with the noble Baroness. I think we probably share the same passion for making sure that this happens. Given that, I hope she will consider withdrawing her amendment.

[Baroness Chakrabarti (Lab)]

I am grateful to all noble Lords who spoke at this late hour, including the Minister. With respect, however, the numbers just do not stack up. I am so glad that the Government have now donated over 30 million shots, but these have almost all been AstraZeneca, which has lower efficacy against the now-dominant omicron variant. Moderna belatedly allocated a mere 110 million shots for a continent—Africa—with an estimated population of 1.3 billion people. Pfizer has allocated only 2% of its global supply to COVAX. We are just not getting enough shots to enough people, and so the variants develop.

I am grateful to everyone and I would happily keep speaking to the Minister, who is always courteous in his responses, but I really do think that it is time to test the opinion of the House.

Health and Care Bill

Baroness Chakrabarti Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

Moved by

[Baroness Chakrabarti]

292: After Clause 148, insert the following new Clause—
“Public health condition for investment in research into vaccines and other health technologies
(1) Any relevant research or development funded or part-funded by public finances is subject to the public health condition.(2) The Secretary of State, UK Research and Innovation, the National Institute for Health and Care Excellence, the Intellectual Property Office and all public authorities must ensure that the public health condition is fulfilled in respect of such research or development and any material benefit derived from it.(3) The public health condition is that—(a) a proportionate share of any intellectual property resulting from the public funding (including intellectual property in all research, pre-clinical and clinical data, safety and efficacy information and manufacturing capability) is subject to Crown ownership and openly licensed,(b) a proportionate share of any private profit resulting from the public funding is re-invested in further public health-related research, and(c) any proportion of public funding is published and taken into account in relation to the setting of reasonable prices for the public procurement of medicines domestically and internationally.(4) In addition, the Secretary of State must utilise, and actively support other countries to utilise, the full range of flexibilities within the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS”) for the purposes of public health. (5) In the event of the World Health Organization declaring a pandemic, the Secretary of State must immediately—(a) waive UK-registered patents, industrial designs, other intellectual property rights, and protections relating to undisclosed information relating to—(i) vaccines,(ii) medicines,(iii) diagnostics and their associated technologies, and(iv) materials,necessary for combatting a pandemic internationally, (b) issue relevant emergency compulsory directions to enable the domestic manufacturing of generic and biosimilar products, and(c) support and implement any proposal to temporarily waive elements of the TRIPS Agreement at the World Trade Organization to assist wider global manufacturing of and access to health technologies.”Member’s explanatory statement
This new Clause ensures public benefits in exchange for public financing of research and development. It would require the Secretary of State to support public health flexibilities under the TRIPS Agreement and, in the event of a pandemic, domestic and international knowledge-sharing to combat the emergency.

[Baroness Chakrabarti (Lab)]

My Lords, Amendment 292 is in my name and that of my noble friends Lady Lawrence of Clarendon and Lord Boateng, and the noble Baroness, Lady Bennett of Manor Castle. I thank noble Lords from across the Committee and the People’s Vaccine Alliance—Saoirse Fitzpatrick of STOPAIDS, in particular—for their advice.

Last year, the Prime Minister lauded the successes of the UK’s vaccination programme as a result of “greed and capitalism”, but the virus-busting vaccines, treatments and tests were in no small part funded by taxpayers, supporting the work of scientists at universities, research institutions and small-scale biotech companies across the world. Over €93 billion of public money has gone into developing vaccines and therapeutics. The AstraZeneca vaccine developed at Oxford University was over 97% publicly funded.

Public investment at the beginning of the research process assumes the biggest risk at the point when there is no certainty that a product will be successful. It is only when effectiveness is clearer that big pharma swoops in and uses exclusive intellectual property rights to hold a monopoly over that product in the market. The risk is socialised but rewards are privatised and, crucially, monopolised. The NHS is paying twice for medicines: once for research and again through procurement.

Some estimates show the public paying for up to two-thirds of drug development, including research and clinical trials. Drugs are getting only more expensive, with estimates that the NHS procurement bill increased by nearly 10% over the last couple of years, to £20.9 billion. Yet there is still no guarantee of production at the volumes required to meet demand or that patients will be able to access health technologies at affordable prices, nor that scientists will be able to make use of the data, knowledge and technologies generated in the research process to develop improved follow-on products. Due to the opaqueness of the pharmaceutical industry, it is very difficult to track public funding. The terms of agreement, actual costs and prices charged—all these are kept behind closed doors.

The amendment seeks to change that for health technologies developed with public funding, as well as to define emergency procedures to expedite a sharing of research, data and intellectual property in the case of a pandemic. By adhering to the “public health condition”, the Secretary of State and all public authorities would ensure that

“a proportionate share of any intellectual property resulting from the public funding … is subject to Crown ownership and openly licensed … a proportionate share of any private profit from public funding is re-invested in further public health-related research, and … public funding is published and taken into account in … the setting of reasonable prices for the public procurement of medicines domestically and internationally.”

Open licensing would allow production in a competitive generic market, bringing down the price of medicines. A study published in the BMJ showed how the price of oncology drugs could decrease by between 75% and 90%. We saw this with ARVs for HIV/AIDS, and how crucial that was in fighting that pandemic by reducing costs from over $10,000 per person per year to under $100. Reinvesting a proportion of profits could ensure that they go towards health priorities rather than financialised practices or the development of me-too drugs—sufficiently different to obtain patent protection but without added therapeutic value, compared with existing products.

There is recent precedent for more transparency and conditionality around public funding in Italy and France, while the European Union is looking at how to track public funding and measure societal impact. Even our Government are beginning to think about public interest conditions for future pandemic tools to ensure access in low- and middle-income countries. This is a recommendation of the UK’s pandemic preparedness partnership’s 100 Days Mission report, published during the UK’s G7 presidency.

There are also circumstances where there has been no public funding but the price or volume restrictions of a product are preventing widespread access. In that case, the amendment calls for a recommitment to the use of pre-existing public health safeguards within the Trade-Related Aspects of Intellectual Property Rights—TRIPS—Agreement. These flexibilities include the use of compulsory licences when intellectual property monopolies prevent access to a medicine. They enable a Government to license another manufacturer to produce a generic or biosimilar version of a patented health technology at a much lower price. These can be used at any time by any WTO member; they have already been implemented more than 100 times between 2011 and 2016.

The need to use flexibilities has never been greater, with ever more drugs coming to market with a price tag of over £1 million per dose. For example, the NHS is currently paying a list price of £1.795 million for a single dose of Zolgensma to treat spinal muscular atrophy—SMA. It is the most expensive drug in the world, despite public and philanthropic funding. A Crown-use licence would permit the Government to allow a third-party manufacturer to make a biosimilar version at a discounted price.

We must also stand with other countries in the face of huge and unconscionable pressure from big pharma when TRIPS flexibilities are used. In 2007, we supported the Thai Government when they applied for a compulsory licence to produce a more affordable antiretroviral drug to treat HIV and were met with a threat from the pharmaceutical company AbbVie that they would lose access to all its other products. We could show leadership and solidarity again. Multinational corporations, whether tech, pharma or other corporations that noble Lords have considered in your Lordships’ House in recent times, warrant international democratic governance, regulation and restraint. Hence the last part of the amendment.

In future pandemics, we must not remake the continuing mistakes of this one. Monopolies which profiteer from poverty and sickness are bad enough at the best of times. But in a global emergency, when so many ordinary citizens, health workers and ethical businesses have sacrificed so much by way of livelihoods, liberties and lives, such conduct is totally amoral. Pharmaceutical companies’ refusal to share manufacturing know-how has led to grotesque vaccine inequity. Only 10% of people in low-income countries have received a single jab. So the amendment stipulates immediate action as soon as the World Health Organization declares a pandemic. The temporary—I stress, temporary —waiver of UK registered patents, industrial designs and other intellectual property rights relating to undisclosed information necessary for combating a pandemic, and emergency compulsory directions to enable domestic manufacturing, would mean that any company within the UK with the capacity could be making these products. It would allow products to be shipped internationally and allow companies across the world access to the critical data and rights to produce pandemic tools at scale for their own people.

The Indian and South African proposal to temporarily waive the TRIPS agreement is supported by more than 100 countries. It is only opposed by the European Union, Switzerland and our own Government. The waiver could allow the 100-plus potential mRNA producers across Latin America, Asia and Africa access to critical clinical data and manufacturing know-how required to make mRNA vaccines, without fear of litigation in the worldwide race to beat variants of the virus.

New treatments are in high demand, and high-income countries have already brought up the lion’s share. We will be facing a treatment apartheid on top of a vaccine one if the United Kingdom and others do not shift their position urgently. Just last week, it was reported that the director-general of the WTO, Ngozi Okonjo-Iweala, was hopeful of a breakthrough in the long-standing waiver discussions. However, it is incredibly important that any compromise is not overly restrictive geographically or in terms of products or types of intellectual property.

The UK Government must stop saying that a waiver will take too long to implement while simultaneously blocking its agreement. They should end their group hug with the EU, Switzerland and big pharma and start embracing and empowering the global south and wider world. The line that temporarily waiving TRIPS will stifle future innovation ignores the public money that funded the riskiest parts of developing vaccines and treatments, and how innovation works. Sharing research data and clinical trials results with great minds around the world creates the conditions for competitive collaboration, vying to have the best results but also sharing lessons learned and supporting each other. This is how we have made great leaps in the past, as with the human genome project, where public funding supported a global collaboration which has changed modern science.

This is about improving access to affordable, life-saving health technologies for our NHS and the world to combat pandemics and improve health. It is about ensuring that we get the best from our biomedical innovation, especially when we are investing so much money and expertise and putting human beings through clinical trials. In a global health emergency, not sharing life-saving knowledge is as wicked as blocking access to emergency exits from a crowded building in a raging fire. I beg to move.

[The Deputy Chairman of Committees (Lord Brougham and Vaux) (Con)]

My Lords, I call the noble Baroness, Lady Brinton, who is taking part remotely.

Health and Care Bill

Baroness Chakrabarti Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

I have stood before your Lordships many times and said that we must take action in calling out and ending the atrocities in Xinjiang. I have always maintained that our condemnation should not be words alone. This amendment puts those words into action. I hope that the Minister will do all he can to persuade his department to support it.

[Baroness Chakrabarti (Lab)]

My Lords, I congratulate the noble Lord, Lord Blencathra, the supporters of his amendment and everyone who has spoken in this debate. I am sure that the Minister will reflect before he replies on the significance of an amendment to a major piece of government legislation that has garnered such disparate support from across the House.

I am conscious that the NHS is something that everyone in the United Kingdom is very proud of. It is a source of genuine patriotism—and a patriotism that is neither militaristic nor xenophobic. We have sometimes fierce arguments about how it should be organised but fewer arguments about it being a wonderful thing. It is perhaps the greatest experiment in solidarity and collaboration in human history. It even has “national” in its title, which is good for patriotism yet it is more than national because, in truth, its proud history is one of a service built on the contributions of people who came to this country from all over the world. It is a model of healthcare admired by people from all over the world.

As I heard noble Lords from across the Chamber speaking in recent minutes, I was reminded of the contrast between the London Olympics and the Beijing Olympics. The latter was a great display of military strength, while the other was something a little more novel. I was proud to take part in the opening ceremony, and remember the nurses bouncing on NHS beds. It drew huge amusement from parts of the press but was a reminder of the example that Britain can offer the world.

The poor old noble Lord, Lord Ahmad of Wimbledon, often has to address this human rights-interested Chamber on difficult issues of international relations when they rub up against the instinct to protect human rights. It is a difficult equation for successive Governments of either stripe. However, here there is an opportunity, because the NHS is such a big customer. This Bill is about being an ethical provider of health services to our people. In parts, it is about being an ethical employer. Now we might aspire to be an ethical customer on the world stage as well.

Noble Lords have done better than I can to explain the morality behind this concern about the Uighurs, but my noble friend Lord Rooker offered the practical element to go alongside the moral arguments.

In closing, I say to the Minister before he answers that, if there are some technical concerns from those who advise him about the precise drafting of the amendment, these can no doubt be resolved. I feel sure that the noble Lord, Lord Blencathra, and his supporters—and those who support them—would no doubt work with the Minister to ensure that something that does the trick comes forward on Report. What a golden opportunity this is to set an example on how one can walk this tightrope between realism and human rights protection, and what a great thing it would be for this Committee to be able to achieve.

Social Care Sector: Private Equity

Baroness Chakrabarti Excerpts

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

We value the role of independent and third sector care homes. It is important that we have that right mix. Some private companies will include private equity, and it is important not to tar all private equity with the same brush. Private equity plays a role in many companies in turning them around and retaining jobs. The important thing for us is that, if any companies are potentially in financial trouble, we have the market oversight scheme to ensure that, if they go bust, there is an ability to transfer patients elsewhere.

[Baroness Chakrabarti (Lab)]

My Lords, front-line carers often get paid around £9 or £10 an hour, and it is hard to survive on that. Yet last year, Barchester Healthcare’s CEO collected 120 times more than his care staff. What proposals does the Minister have to ensure that public moneys paid to private care homes are used to improve care and staff welfare and not siphoned off to fat cat executives?

[Lord Kamall (Con)]

The CQC has a role in making sure that the care provided to care home residents is of satisfactory quality. As I said, 84% of care providers are rated good or outstanding. The market oversight scheme examines companies that could potentially be in trouble and keeps a close eye on them. There are six stages in the market oversight scheme to make sure that we manage that.

Health and Care Bill

Baroness Chakrabarti Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, I join the welcome to the noble Lord, Lord Stevens of Birmingham.

The pandemic has been a magnifier of every single inequality on the planet. I hope we can all agree on our enormous good fortune to live in the land of the NHS, arguably the greatest experiment in compassionate collaboration in the history of the world. It is cause for genuine patriotism without the slightest risk of xenophobia because this service is not just envied the world over, it was built by the hard work, endeavour and innovation of people from all over the globe as well. It even has “National” in its title and mission.

While some noble Lords have spoken eloquently about the need for local flexibility and responsiveness, I fear the Minister will have to do more to convince your Lordships’ House—let alone those watching anxiously outside it—that this Bill will address widening inequalities in health, care and other outcomes, rather than baking in fragmentation and privatisation, notwithstanding his welcome opening remarks about the founding mission of a service which should be cradle to grave support, available to all and free at the point of use.

I join my noble friend Lady Bakewell in seeking greater safeguards to prevent private companies taking representation in NHS governance structures in a clear and institutional conflict of interest, inevitably necessitated by a profit motive, that will always threaten the principle of universal provision where there is limited supply and limitless demand. Similarly, public health and care professionals should be the default providers of these vital services that have proved as vital to the safety of the nation as the police and military over the last couple of years.

The complexity of this reorganisation has already been remarked upon at length, but I fear that it conceals rights of direction without corresponding overarching legal responsibility upon the Secretary of State. I would like to hear the Minister’s specific explanation of provisions to the contrary. Statutory powers and functions should not be capable of delegation to non-statutory bodies. All those working in health and care should be protected, not just with warm words and applause, but with statutory recognition of terms, conditions, pensions and collective bargaining alongside appropriate management and regulation in the public interest.

As others have said, it is high time for a national care service to dovetail with our National Health Service, giving cradle to grave security for those in need of it and a parity of respect and protection to those working within it. Likewise, lifting mental health provision from its current Cinderella status and investing in such services as lifestyle and preventive care would save billions from being wasted on substance abuse and criminal incarceration, and provide rewarding careers for young professionals in an otherwise increasingly automated world.

Finally, I will say a word on the vaccinations, to which perhaps nearly all of us in your Lordships’ House owe our lives. Those who peddle non-science about vaccines are just as dangerous and irresponsible towards their neighbours here and around the world as those who deny global warming. They of course have a right to express their views, but I suggest we have a duty to do more to correct their falsehoods.

Given that most of the initial investment in the world’s major vaccines, including here in the UK, came from public and philanthropic sources, not to allow a narrow and time-limited vaccine patent waiver at the WTO so that the poorer nations of the global south can speed up vaccination and defeat variants, is as incomprehensible a decision as any I can think of. Future generations will have little forgiveness for it, let alone respect.