Vaccinations: Developing Countries

Alistair Burt Excerpts

Wednesday 13th June 2018 Westminster Hall

[The Minister of State, Department for International Development (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Evans, and I thank all colleagues for taking part in today’s debate and for the way it has been handled.

I thank my right hon. Friend the Member for Preseli Pembrokeshire (Stephen Crabb) for the way he introduced this debate—indeed, others have mentioned the passion with which he spoke. Such passion is appropriate for the leader of Project Umubano, and for a number of years he has played an integral part in the Conservative party’s social action programme in Rwanda and Sierra Leone. He spoke about the non-partisan nature of this debate, and that was emphasised by contributions from the hon. Members for Dundee West (Chris Law) and for Birmingham, Edgbaston (Preet Kaur Gill). There is no issue between colleagues in the House on this subject, and we are rightly proud of successive Administrations of all shapes and colours, and the work that has been done in making the United Kingdom a global leader in vaccination.

My right hon. Friend drew attention to the history of vaccination and the United Kingdom’s involvement in it. He mentioned our position in contemporary medicine, research and development, and spoke about looking forward to the next stage. As the long title of the debate suggests, he then moved from that historical perspective to the wider economic benefits of vaccination, and emphasised a link that is not made often enough.

The hon. Member for Strangford (Jim Shannon) spoke, as he always does, with passion, commitment and great wonder about the success of these programmes. Sometimes there is immense concentration in the press and media of everything that is wrong, but in the world of medicine, lives have been saved by finding opportunities to invest in things that have led to a reduction in diseases that were once all too common, including in our own childhoods, let alone 50 or 100 years ago. Medicine has made a remarkable contribution, and the hon. Gentleman was right to mention that. He encouraged us all to keep going on the eradication of polio, and he can be sure that we will.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) linked access to our success and the importance of research, and he spoke with pride about his involvement with Rotary. I, too, am a Rotarian—I am an honorary member of the Rotary club of Sandy in Bedfordshire. I recently met Judith Diment, who is chair of the polio advocacy taskforce. Rotary has done remarkable work on that issue, and we pay tribute to everything it has done over the years.

My hon. Friend the Member for Stafford (Jeremy Lefroy) contributes a remarkable amount to this House through his work on malaria and in east Africa, and he related the importance of vaccine research in those areas. The hon. Members for Dundee West and for Birmingham, Edgbaston had some questions, and if I may, I will return to those at the end of my contribution—on this occasion I actually have some time, so I will be able to answer one or two of the questions, although not all of them.

Let me bring this back to basics and the practice of vaccination. My dad is a doctor, and I am old enough to have needed injections for polio when I was very young, as that was before the wonderful man developed his oral vaccine on a sugar cube. My dad had to give me my polio injections, and I hid under every available table in the surgery because as a small boy I was terrified of needles. He will be tickled pink to know that I am responding to a debate on vaccination today, bearing in mind the struggle he had to get near me with a needle. I am eternally grateful that he did, because those vaccinations protected me—as they did many others—from the ravages of polio. My dad is still with us, so he will be able to get a copy of this debate and realise that all those days from long ago are still remembered fondly by his son. This issue is that personal. The hon. Member for Strangford referred to the moment of pain caused by a mother when a child gets vaccinated, although she knows that it will do so much good in future, and today we are remarking on the remarkable good that is done.

The number of children dying each year almost halved between 1990 and 2012—a significant achievement. Nevertheless, around 375,000 children still die every year from diseases that could be easily prevented by vaccines. As we all agree, the challenge is most acute in the developing world, where nearly 1 million children die every year from pneumonia. In 2016, 7 million people were affected by measles, resulting in nearly 90,000 deaths. It is therefore right that the UK works through organisations such as GAVI, the Vaccine Alliance, the Global Polio Eradication Initiative and the World Health Organisation to tackle vaccine-preventable diseases.

Clearly there is a strong moral case for the UK and its international partners to support developing countries to tackle the scourge of vaccine-preventable disease—the contributions to the debate have shown that we all understand that. However, the economic case for vaccination—a subject that my right hon. Friend the Member for Preseli Pembrokeshire homed in on—is also unquestionable. Vaccinating against childhood diseases is one of the most cost-effective health interventions. As colleagues have said, for every £1 spent on immunisation, there is a direct saving of £16. Those savings include healthcare costs, lost wages and lost productivity due to illness. Vaccination is a key driver towards reducing childhood mortality globally, and vaccines administered in 41 of the world’s poorest countries between 2016 and 2030 will prevent 36 million deaths.

Vaccination provides economic benefits many times beyond the direct costs of vaccinating children, which is why it is such a high impact investment. As the hon. Member for Dundee West reminded us, if we take into account broader economic and social benefits, the return on investment rises from £16 to £44 for every £1 invested. The wider economic benefits of vaccination are vast.

By preventing illness, whole families are freed from crippling medical costs, which in turn can have a substantial effect on poverty reduction. Unexpected healthcare expenses push about 100 million people into poverty every year, making medical impoverishment one of the main factors that force families below the World Bank’s poverty line. A vaccinated child is more likely to be healthier, live longer and have fewer and less serious illnesses. Healthier and more productive populations trigger a virtuous cycle that results in enormous economic gains. Vaccinated populations therefore form a more productive labour force, resulting in higher household incomes and economic growth.

There is a clear positive relationship between immunisation and education. Vaccines support cognitive development, so children learn more and have more opportunities. In the Philippines, for example, routine immunisation was found to raise average test scores among students. When translated into earning gains for adults, the return on investment was shown to be as high as 21%. In Bangladesh, measles vaccination was found to increase school enrolment of boys by 9%.

There is also an effect on the next generation. Children of educated parents are more likely to be vaccinated and healthier. In Indonesia, for example, child vaccination rates are just 19% when mothers have no education, but increase to 68% when mothers have at least a secondary school education.

Additionally, the decrease in child mortality as a result of routine immunisation can have a significant impact on a country’s economy by reducing fertility rates. Since more children are expected to survive, families have fewer children. A lower birth rate has significant effects on child and maternal health, as well as a broader economic impact, not least in the role that it might play in the development of women’s opportunities in their societies. Up to 50% of Asia’s economic growth from 1965 to 1990 is attributed to reductions in child mortality and fertility rates. Overall, the savings that come from the need to pay for fewer medical interventions, combined with a healthier, more productive labour force and demographic dividends, create more economically stable individuals, communities and countries.

Let me turn to some of the questions asked by hon. Members. First, we are very proud to be the largest investor in GAVI, the Vaccine Alliance. The UK recognises the strong and convincing economic arguments for vaccines as being a clear development best buy. That is why we, through the Department, have supported GAVI since its inception in 2000.

Since then, our investment has supported the immunisation of 640 million children and has contributed to the prevention of 9 million deaths from vaccine-preventable diseases. Those are remarkable figures that, as my right hon. Friend the Member for Preseli Pembrokeshire said at the start of the debate, and as we have all said, we do not talk about nearly enough. If someone is looking for a demonstration to put to the people of the positive advantage not just of UK aid, but of any country’s development budget, and of why they are useful, vaccination is possibly the single most obvious example that they can give.

Between 2016 and 2020, the UK’s support to GAVI will directly enable 76 million children to be vaccinated and will save 1.4 million lives. Investment through GAVI represents a particularly high rate of return. The £16 direct return for every £1 invested, which I mentioned earlier, rises to £18 in the 73 developing countries that GAVI supports. Overall, between 2001 and 2020, in GAVI-supported countries, the long-term gains associated with a more productive workforce are expected to add up to £260 billion. Every year, as a result of vaccinations, each of those 73 countries will avoid more than £3.5 million in treatment costs.

Critically, GAVI not only delivers vaccines on an impressively large scale, but works to bring down the cost of vaccines to make them more affordable for the world’s poorest countries. Since 2011, GAVI has enabled a 43% reduction in the cost of immunising a child, from $33 to $19. That price cut means that UK taxpayers’ money goes much further and delivers a much greater impact, and brings those products within the reach of poorer countries’ Governments, which was a key point made by the hon. Members for Birmingham, Edgbaston and for Dundee West. Our support for GAVI is explicitly designed to ensure that Governments in developing countries gradually increase their contributions until they eventual transition away from aid, which the price cut also helps with.

In response to the point made by the hon. Member for Dundee West about bilateral funding, some time ago the United Kingdom made a decision to put its support for vaccination into GAVI, because it has a wider reach than our bilateral funding programmes. That is why the contribution to GAVI has been so strong: it allows us to reach more children. We continue to offer bilateral support to health systems to make them more sustainable. Of course, GAVI will work in some of the areas where the UK is also working directly through the Department.

On the need to ensure that vaccinations support equity, the financial benefits of vaccines are mostly accrued by poorer households, which are more susceptible to financial shocks from unexpected healthcare expenses. Immunisation programmes reduce the proportion of households facing catastrophic out-of-pocket health expenses. GAVI ensures that the right people are reached through the three equity measures in its monitoring framework, which track vaccination coverage by geography, poverty status and the mother’s education. We work with GAVI to ensure that the vaccinations are reaching the poorest, as my right hon. Friend the Member for Preseli Pembrokeshire said in his opening remarks. GAVI is designed to do so, and we will continue to work with it on that.

[Stephen Crabb]

Will the Minister address the question asked by several hon. Members about why the levels of inoculation seem to have plateaued internationally? Is that correct and, if so, what might be the underlying causes? I hope he will forgive me if he had planned to come on to that in the next few moments.

[Alistair Burt]

I cannot give my right hon. Friend the figures, but let me say two things. First, in some areas, there has been a reaction against vaccination. Earlier this year, two vaccinators in Pakistan, a mother and a daughter, were killed. The Pakistani Government have worked with others to try to change the nature of the programmes, but that is a reminder of how brave some health workers have to be. In some cases there is a supposed religious objection to vaccination, and in others it can be more direct.

Secondly, yesterday, in another context, I mentioned in the House the issues that are being faced in Yemen due to the de facto Houthi authorities in the north of Yemen, which have refused permission to transport vaccines into Sana’a. That has meant that 860,000 people in the north have not received vaccines, while hundreds of thousands of people in the south have benefited from the campaign. The Department is working closely with the World Health Organisation and through diplomatic channels to help unblock the use of vaccines in Yemen, particularly in Houthi-controlled areas.

In some areas, the cause is conflict; in others, it is an ideological response or a false fear that has been spread. In some areas, vaccinators are somehow seen as being connected to the west, and it is easy for false stories to spread. All those things need to be combated, and perhaps one way to do that is to ensure that there are more local programmes, because it is essential that the effort of vaccination continues, as all hon. Members have said.

In particular, we cannot afford to lose the chance to eradicate polio, and we have to be very careful. The rise in measles may be connected to some false stories about vaccines. There appears to be a market for people who want to spread those false stories, not only in developing countries but in places such as the United States. Fake news has to be combated. The outstanding research in this area makes it very clear that the benefits of vaccination far outweigh any potential medical consequences, of which there are some from time to time, but in a very tiny proportion of people. It is essential that the public grasp that.

Let me return to other remarks by hon. Members. We have talked about how we can ensure that future research is done in areas where the economic benefits of a vaccine may be questionable and about what help we can give. That is not an easy issue to tackle or to be absolutely certain about, because the specific diseases market is highly variable and pharmaceutical companies need to know that they will make a sufficient profit for a new market initiative to be possible.

However, things can be done to assist with that. GAVI’s advance market commitment, which the hon. Member for Birmingham, Edgbaston mentioned, has done significantly well, and we have provided finance to support it. It now produces 150 million doses of the pneumococcal conjugate vaccine annually at a price of $2.95, which is significantly lower than market price. GAVI also provided £390 million as an advance purchase commitment for the Ebola vaccine, which enabled Merck to make 300,000 doses available. In the Democratic Republic of the Congo, that vaccine was implemented 13 days after the Ebola outbreak was announced.

There are ways in which the international community can help to ensure that some of the costs are borne collectively, but that is not always an easy process, so there will always be issues about how to develop the vaccine and how to pay for it. The Government are well engaged in dealing with those.

I will conclude and offer my right hon. Friend the Member for Preseli Pembrokeshire a chance to respond. As well as the support for GAVI, the UK invests in vaccines in developing countries in a range of ways. We are a leading supporter of eradicating polio, as has been mentioned. That investment brings economic returns of many times the magnitude, and a stronger global economy that will benefit us all.

Hon. Members also mentioned Ebola. The handling of the recent outbreak contrasts with that of the previous one. The WHO and the Department supported the development of two Ebola candidate vaccines during the 2014 outbreak that have been brought through into the most recent one. These are some examples of how we—through DFID, GAVI and bilateral programmes to strengthen and sustain health systems—have been able to put vaccination at the very top of the agenda, as the most cost-effective way of dealing with health problems.

I conclude by acknowledging the dedication and hard work of all the health workers around the world, who often put their lives at risk to deliver vaccines to children, even in the hardest-to-reach places; by saying that I am very proud of the United Kingdom’s investment in vaccines in developing countries, and I say that on behalf of us all as this is a non-party issue; and by saying that saving the lives of children and improving the lives of families in some of the world’s poorest countries is simply the right thing to do.

Finally, I will say that the exchange between the hon. Member for Strangford and my right hon. Friend the Member for Preseli Pembrokeshire about the inspiration that can be gathered for this work and the promotion of it through schools, so that people are more aware of what we can do, is the way that we should finish today. Sometimes this place has to deal with difficult subjects that occasionally colleagues fall out over—not this one. This is something we can agree on and we can all use our own influence to ensure that a new generation of young scientists, young doctors and young health professionals are inspired to work, not only in this country but throughout the world, knowing how important vaccination will continue to be.

[Stephen Crabb]

Thank you, Mr Evans, for calling me to speak again.

By way of wrapping up, I will just thank the Front Benchers. I thank my right hon. Friend the Minister for that very useful update he has given at the end of this debate. I also thank the other Front-Bench spokespeople, the hon. Members for Dundee West (Chris Law) and for Birmingham, Edgbaston (Preet Kaur Gill).

This has been a very useful debate; I have certainly learned a tremendous amount. I am grateful to all the colleagues who have spoken or made interventions, and for the spirit in which they did so. As my right hon. Friend the Minister said, this is an issue on which there should be no differences at all between the parties. It can bring this House together as something to unite behind, not to be self-congratulatory, but to recognise the remarkable progress that successive British Governments have helped to achieve internationally, in partnership with so many other international bodies and other Governments.

I will finish by asking the Minister to urge his team at the Department to keep briefing us and updating us on these developments. Do not keep Members in the dark—not that he does at all. However, there is a powerful story that we all want to tell in our constituencies about this issue, and it would be incredibly helpful if he and the NGOs that his Department works with provided us with as much information as possible.

[Alistair Burt]

Perhaps I might make an immediate commitment. I will write to all colleagues here, on the back of this debate, to set out some of the facts that have been raised by us all and, as it were, do it in the form of a factsheet, which they will then have available to give to constituents. I am very grateful to my right hon. Friend for the suggestion.

[Stephen Crabb]

I am grateful to my right hon. Friend the Minister for that response.

Finally, Mr Evans, I thank you. As ever, you have chaired this afternoon wonderfully. Diolch yn fawr.