Covid-19: Vaccine Availability

Lord Bourne of Aberystwyth Excerpts

Tuesday 14th July 2020 Lords Chamber

[Baroness Sugg]

My Lords, we are working closely with all manufacturers to ensure that we have full, affordable access to all vaccines.

[Lord Bourne of Aberystwyth (Con) [V]]

My Lords, I thank my noble friend for her efforts. Will she urge her ministerial colleagues, and indeed the Prime Minister, to provide continued world leadership on vaccine sharing, particularly backing Gavi and Bill and Melinda Gates’s initiative, for all to benefit from vaccine research and progress?

[Baroness Sugg]

My Lords, our record shows that we are taking a leading role in this. The Prime Minister has consistently called on world leaders to work together to rapidly develop a vaccine and make it available to all, including at the Coronavirus Global Response pledging conference, which the UK co-led, and at the recent Global Citizen summit. The UK also hosted the Gavi summit, which raised over £6.9 billion for Gavi to sustain its immunisation coverage and bolster the primary healthcare systems needed to tackle Covid-19. We will continue to play this leading international role.

International Development (Official Development Assistance Target) Bill

Lord Bourne of Aberystwyth Excerpts

Friday 27th February 2015 Lords Chamber

[Lord Lawson of Blaby]

If my noble friend will allow me—

[Lord Bourne of Aberystwyth (Con)]

Perhaps I could say that, after the Minister has spoken, only short questions of elucidation to the Minister are permitted on Report.

[Lord Purvis of Tweed]

Ordinarily, I would give way but on the basis of that guidance and a reflection on the Companion, I regret that I will not.

But as my noble friend has drawn me, let me address his amendment. He was referring to whether it would be virtuous to establish a separate organisation to carry out this function. In Committee, I was very clear in citing from the Official Report when my right honourable friend Michael Moore lodged his proposal. I quoted that and need not do so now, but he lodged his proposal and consulted upon it. The Government put forward their reasoned argument with regard to effective independent evaluation. My right honourable friend accepted that argument and the Bill was sufficiently amended. I am therefore satisfied that the Bill as it stands is robust in that regard and does not require the creation of a wholly new and separate quango. We have a structure in place under the Bill that I believe calls for the points that the noble Lord, Lord Hollick, called for. On that basis—and, hopefully, clarification—I hope that he will withdraw his amendment.

Developing World: Maternal and Neonatal Mortality

Lord Bourne of Aberystwyth Excerpts

Thursday 15th January 2015 Lords Chamber

[Baroness Hayman (CB)]

My Lords, I am grateful for the opportunity to introduce this debate, and delighted that noble Lords from all Benches of your Lordships’ House are planning to contribute on this important issue. I declare my interests in health and development, particularly my chairmanship of the external advisory group of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine.

It was in this role that last year I visited Zimbabwe and saw for myself the power of the Making it Happen programme run by the centre in 11 countries, supported by DfID. I saw UK volunteers, an obstetrician and a midwife, together with Zimbabwean master trainers who had been through the course before, supported by the country’s Ministry of Health, running the course for Zimbabwean health workers, giving them the skills to save the lives of mothers and babies and to pass on those skills to their colleagues to ensure sustainability and improved services countrywide.

I will step back from the specific to address the scale of the problem. The statistics are chilling. Some 300,000 women die every year; 800 women die every day in pregnancy and childbirth; 50 will die in the course of this short debate. There are an estimated 2.6 million stillbirths and 3 million neonatal deaths every year; half of those neonatal deaths occur in the first 24 hours of life. A child dies somewhere in the world every five seconds, overwhelmingly of preventable causes.

These maternal and neonatal deaths are not evenly distributed. The maternal mortality ratio shows the highest discrepancy: the greatest gap between high and low income settings of all international health indicators. In the UK, the maternal mortality ratio is eight per 100,000. In Sierra Leone, it is 110 per 100,000. That is the last figure that we have; I hate to think what the figure will be for the last 12 months when the ravages of Ebola have put into abeyance the most basic health services that were available in the past. The average for neonatal mortality in developed countries is 3.7 per 1,000 live births; in southern Africa and south-east Asia it is 10 times that; 99% of all maternal deaths and 98% of all neonatal deaths occur in low or middle-income countries.

Within developing countries there are wide variations, with the poorest, the youngest, the least educated, and rural women most at risk. The deaths are not the end of the story. For every woman who dies in childbirth, it is estimated that 20 to 30 live but suffer lifelong morbidity such as fistula. The health and survival of babies is dependent on the health and survival of mothers, not only in the quality of antenatal, intra-partum and post-partum care, but evidenced by the fact—I have lost the reference for this statistic, but I am sure someone will tell me—that a motherless child is 10 times more likely to die in the first two years of its life than a child who has a mother to care for them.

It was the recognition of this tsunami of suffering and the obstacle to development that the figures represent—because we all know how crucial women are to development—that led to the introduction of millennium development goals 4 and 5, of reducing child deaths by two-thirds and maternal deaths by 75% by 2015. When the Minister comes to answer the question posed in the title of this debate, I am certain that she will outline the considerable progress that has been made since 1990.

I pay tribute to the work that has been done in developing countries by DfID and other international agencies in just about halving those deaths. The figures have been helped of course by the progress in other MDGs, for example in relation to HIV/AIDS and malaria, and perhaps point us again, looking forward, to the importance of joined-up healthcare and healthcare for all.

However, it is disappointing that the progress that has been made has, again, not been evenly distributed, and that some of the countries that have the worst figures, and which need the greatest improvements, are ones that have seen the least change in their statistics. I ask the Minister to address the issue of how, post-2015, we attend to the unfinished business in the millennium development goals and ensure that we do not take our eye off the ball in these hugely important areas where we need to make sustained efforts in order to continue with the progress made so far.

I have not said a lot so far about the causes of maternal and newborn mortality, and how this terrible toll of death and suffering can be reduced. That is partly because when I asked a local expert for help in preparing for this debate and what she thought I ought to stress and what ought to be said, she shrugged her shoulders and said, “There is nothing new to say. We know what the issues are and we know how they can be addressed. What are needed are the resources and the political will to do it”.

You can go through the list of causes of maternal and newborn death: poor nutrition, existing medical conditions—which are often the diseases of the poor, such as malaria—unsafe abortions, infections, eclampsia, haemorrhage and obstruction in labour. The last three of these can be addressed by specific programmes of maternity care, but the first are much wider issues relating to water and sanitation, education for girls, an end to child marriage, immunisation programmes, and access to family planning and antenatal intra-partum and post-partum care from trained and skilled birth attendants. That is where programmes such as Making a Difference can have profound effects: in the first phase of those programmes, maternal death rates in areas where they had been implemented reduced by as much as 50%. The decision we have to make globally is about the priority that we give to the quality of women’s lives and the numbers of women’s deaths.

In the early 17th century, Joseph Hall, who was then Bishop of Exeter, wrote:

“Death borders upon our birth, and our cradle stands in the grave”.

That is no longer true in this country. It need no longer be true in the developing world. But to stop it being the reality for millions in that world, we have to put the resources and the priority into work to reduce maternal and neonatal deaths.

[Lord Bourne of Aberystwyth (Con)]

As the debate gets under way, I respectfully remind noble Lords that this is a time-limited debate.

Ebola

Lord Bourne of Aberystwyth Excerpts

Thursday 8th January 2015 Lords Chamber

[Baroness Kinnock of Holyhead (Lab)]

My Lords, I thank the noble Lord, Lord Fowler, for initiating this debate and for his extremely thoughtful introduction to the subject, which made many of us think of the complexity of the issue.

After more than a year, the current outbreak of Ebola continues to destroy lives, livelihoods and communities. It impairs national economies and has damaged already fragile basic services. Ebola is a frequently recurring and fatal disease. Since its discovery in 1976, there have been several separate outbreaks with casualty rates as high as 90%. As Kofi Annan has said, it was only when the disease got to Europe and America that the international community really woke up to the crisis. This judgment was echoed by Dr Margaret Chan, the director-general of the World Health Organization. Speaking on the reason for the failure to produce a vaccine or a cure after 40 years, she said:

“Because Ebola has been, historically, geographically confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay”.

She made that sombre statement in a world in which 38% of the population do not have access to essential medicines and 50,000 people die each day from largely avoidable causes. Governments and industries should by now have recognised the need for co-ordinated efforts to make registered medicines available at low cost or no cost. Surely Ebola has reminded everyone that, wherever a health crisis occurs, it affects us all. Professor Peter Piot, who first identified Ebola, has said that it would not have been difficult to contain the outbreak if those on the ground had acted quickly but he said that tragically,

“something that is easy to control got completely out of hand”.

Investments in healthcare as well as in drugs are essential everywhere. The unimaginable suffering endured in poor countries by poor people urgently needs and deserves a response. Liberia has 51 doctors to serve a country of 4.2 million people. Sierra Leone has 136 doctors for a population of more than 6 million, an average of 0.2 doctors per 10,000 people. There are too many similarly pitiful shortages. Clearly, the reason we do not have a vaccine against Ebola is that the likely victims of the disease are not wealthy enough to pay for the full cost of treatments and medicines.

The BBC reported this morning that the current epidemic has taken more than 8,000 lives in the three west African countries most affected. The mortality rate is estimated to be 70%. Around 75% of the sufferers in Liberia, for instance, are women who, obviously, are the primary carers and the ones with the responsibility for caring for sick and dying relatives. All three countries lack functioning health systems and access to clean water. They have poor hygiene practices and, generally, an absence of sanitation. According to the NGO WaterAid, such is the enormity of the current challenge that the costs of the emergency response to this crisis will amount to more than the total health and water and sanitation aid committed to Liberia and Sierra Leone over the past five years. That gives us an idea of the nature of the crisis. Lessons must be learnt from the fact that the effects of the response in Nigeria and Senegal have clearly shown that the virus can be contained with a functioning healthcare system and a rapid administrative response.

There are now signs of some progress, but the epidemic is far from over and experts are urging caution. Infection rates, they advise, could oscillate and reinfection could occur. The WHO assistant director-general has warned against claiming that this very dangerous disease is under control. He said that a few mishandled burials could,

“start a whole new set of transmission chains”,

and the incidence of the disease could increase again.

A report published in last week’s Lancet Global Health by three specialist professors from leading British universities made it clear that IMF conditionalities have required Governments receiving aid to adopt policies that prioritise,

“short-term economic objectives over investment in health and education”.

Using IMF archive detail, they came to a view on the effects on the health systems in Sierra Leone, Guinea and Liberia. IMF economic reform programmes,

“required reductions in government spending, prioritisation of debt service, and bolstering of foreign exchange reserves. Such policies have often been extremely strict, absorbing funds that could be directed to meeting pressing health challenges”,

with the result that all the countries “failed to meet” the very modest IMF “targets for social spending”, and,

“to keep government spending low, the IMF often requires caps on the public-sector wage bill—and … funds to … adequately remunerate doctors, nurses and other health professionals … ‘often … without consideration of the impact on priority areas’”.

Such caps,

“have been linked to emigration of health personnel”,

and massive reductions in community health workers.

The article states that,

“the IMF has long advocated decentralisation of health-care systems”,

which,

“in practice … can make it difficult to mobilise coordinated, central responses to disease outbreaks”,

and led to a deterioration in the quality of health service delivery. The professors concluded that:

“All these effects are cumulative, contributing to the lack of preparedness of health systems to cope with infectious disease outbreaks and other emergencies … Although Lagarde’s comment on prioritising public health instead of fiscal discipline is welcome, similar comments have been made by her predecessors. Will the result be different this time?”.

That is a fundamental question, a matter of life and death. The UK Chancellor and Secretary of State for International Development have governor status in the IMF.

[Lord Bourne of Aberystwyth (Con)]

I remind Members that this is a time-limited debate.

[Baroness Kinnock of Holyhead]

I must ask the Minister, therefore: what is Her Majesty’s Government’s answer to this problem?