Global Health Agencies and Vaccine-Preventable Deaths

Chris Law Excerpts

Thursday 9th May 2024 Westminster Hall

[Chris Law (Dundee West) (SNP)]

It is a pleasure to serve under your chairship, Sir Gary.

I thank the hon. Member for Ealing, Southall (Mr Sharma) for securing this debate; the hon. Gentleman and I spend time together on the International Development Committee, and we are equally passionate about this topic. This is a timely and important debate. The hon. Gentleman put some really good, detailed questions to the Minister, and I am looking forward to hearing his responses later.

Throughout the world, people are living longer and healthier lives because of vaccines. Over the past 200 years, vaccination has saved more lives and prevented more serious diseases than any advance in recent medical history. Indeed, every year, 2 million to 3 million lives are saved globally because of immunisation. Only clean water rivals vaccines in reducing infectious diseases and deaths. Immunisation is therefore recognised by the World Health Organisation as

“the foundation of the primary health care system and an indisputable human right.”

An indisputable human right. It is important to remember that. Vaccines are critical to the prevention and control of infectious disease outbreaks. They underpin global health security and are a vital tool in the battle against antimicrobial resistance. Quite frankly, they are one of the best health investments money can buy.

A recent major landmark study published in The Lancet has revealed the global impact of vaccines on saving lives. Over the last 50 years alone, global immunisation efforts have saved an estimated 154 million lives, which is quite astonishing; nearly two thirds of those whose lives were saved were children. Of the vaccines included in the study, the measles vaccination has had the most significant impact on reducing impact mortality, accounting for 60% of the lives saved due to immunisation. As a result of vaccination against polio, more than 20 million people are able to walk today who would otherwise have been paralysed. The world is on the verge of eradicating polio once and for all. The study found that for each life saved through immunisation, an average of 66 years of full health was gained. A hundred years ago, that would be unimaginable. Vaccines speak huge volumes in themselves.

Vaccinations against 14 diseases, including diphtheria, hepatitis B, measles, meningitis A, rubella, tetanus, tuberculosis and yellow fever have directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African region. Those gains in childhood survival highlight the importance of protecting immunisation progress in every country of the world.

In the covid pandemic, the vaccination programme was crucial in reducing deaths and in allowing us to return to a life free from lockdowns and to reduce societal restrictions. Covid demonstrated to all of us just how reliant our public health systems have become on effective vaccinations. It also taught us important lessons about how vaccines are distributed fairly—or not—during a pandemic. We must take steps at international level to avoid a repeat of richer countries stockpiling more vaccines than we could use, while poorer countries waited months on end for the first shipment to arrive.

If we cast our minds back to 2021, many of us were double or even triple-dosed with vaccines from Pfizer-BioNTech or Moderna, which have now become household names, but they supplied less than 2% of their vaccines to low-income countries. Three quarters of health workers in Africa had not received a single vaccine dose, and just 2% of people in low-income countries had received a single jab. The result, as we would imagine, was catastrophic, with avoidable loss of life. A report in The Lancet found that 600,000 people died as a result of the global failure to ensure that 40% of people in low- income countries were vaccinated in 2021. Even 40% is a low bar—we expected 100% of our citizens to have the vaccination.

The World Health Organisation is urging countries to work on concluding a new pandemic agreement, to ensure that the mistakes of the covid pandemic are not repeated. A new international, legally binding WHO instrument would strengthen pandemic prevention, preparedness and response and regulate the sharing of drugs and vaccines fairly, to avoid a repeat of covid-era failures.

Attempts by the WHO to pool intellectual property and scientific knowledge through the covid-19 technology access pool initiative were dismissed, and dismissed repeatedly in this House. Market-led redistribution through COVAX—the covid-19 vaccines global access scheme—and bilateral donations of vaccines, while highly noble, were deeply insufficient.

Dr Ghebreyesus, the director-general of WHO, said disparities in vaccine access were a “catastrophic moral failure”. He has since said that the pandemic treaty would help countries better guard against outbreaks and would be only the second time in the WHO’s 75-year history that it had agreed such a legally binding treaty—the previous one was a tobacco-control treaty in 2003. We must ensure that this treaty is a success, and I hope we hear endorsement from the Minister.

In September 2022, I travelled to Cape Town in South Africa to visit the mRNA vaccine technology transfer hub. In response to being left at the back of the vaccine queue and being locked out of innovative new medicines by giant businesses that put profit ahead of equitable distribution, scientists there have reverse-engineered Moderna’s mRNA vaccine. The mRNA technology is based on decades of public research, and the Moderna vaccine was almost entirely publicly funded, yet Moderna was the greatest and most private beneficiary from covid vaccinations. The model of drug development in which Governments pick up the tab for research and development, but pharma companies assume monopolies of drugs to guarantee profit, cannot continue. It is abhorrent and leads to continued global health inequity and preventable death.

Prior to arrival at the research and production facilities, I had expected a vast chemical and industrial plant. Instead, I found a tiny boutique company, working 24 hours, around the clock, but that in no way inhibits the impact its work can have. The shocking bit was that I was told that as little as 5 litres of vaccine—we know how big that is in a container—can supply up to 100 million doses. Having expected this huge industrial chemical plant, I found myself instead in a little room with what looked like a little pot still—I would say that, of course, coming from Scotland, with its whisky, but it was similar in scale to a pot still.

Equipped with the knowledge of how this technology works and is made, staff at the hub have the vision and ability to reproduce this vaccine to ensure equitable access for low and middle-income countries. The plan is for this to be scaled outwards, with small manufacturing plants spread throughout the world to provide for local and regional production of mRNA vaccines, turning on its head the narrative that pharmaceutical production must be high-cost and high-scale.

Crucially, this work has been shared with other scientists throughout the world. Indeed, there are 14 spokes— I love the imagery of the hub and spokes—in the rest of the world, which have become partners in creating an ecosystem in which knowledge is freely shared, production and access are more equal across the world, and a more resilient healthcare system, based on need, not greed, is built. That is a public health necessity, and it has the power to transform the way we provide medicines throughout the world.

As Charles Gore, the executive director of the Medicines Patent Pool, told me,

“this is the single most exciting health programme—no longer about dependency or donation, but about empowerment.”

The mRNA hub has huge potential, not only to act against covid vaccine inequity, but to manufacture treatments for a range of diseases, including diabetes, cancer, HIV, malaria and tuberculosis. It is therefore vital that we reaffirm our commitment to vaccination programmes for preventable diseases and to the global health agencies that provide them in the aftermath of the covid pandemic, which had a significant impact on the distribution of vaccinations.

In 2022, the WHO and UNICEF reported that there had been the largest sustained decline in childhood vaccinations in approximately 30 years, which all of us should be seriously worried about. In 2021, there were 12.4 million zero-dose children—an increase of 3 million from 2019. UNICEF’s immunisation road map to 2030 is being designed to address the setbacks in childhood immunisation programmes due to the covid-19 pandemic. The WHO’s “Immunisation Agenda 2030” is a global health plan focused on improving access to vaccines for all; it is looking to achieve 90% coverage for essential vaccines given in childhood and adolescence and to halve the number of children completely missing out on vaccines. Gavi’s 5.0 strategy includes the vision of

“Leaving no one behind with immunisation”

by 2030 and has a core focus on reaching zero-dose children and missed communities.

A large proportion of UK Government contributions to vaccination programmes are provided through global health initiatives such as the Global Fund, Gavi, the Vaccine Alliance and the WHO. However, the decision— I keep having to repeat this—to cut UK official development assistance spending from 0.7% to 0.5% of gross national income has had a massive impact. The Minister will speak about the Government’s £1 million pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria. That is welcome, but the fact remains that it is a cut of almost 30% from their 2019 pledge. STOPAIDS has said:

“This is a disastrous decision that risks 1.54 million potential lives lost and over 34.5 million new transmissions across the three diseases, setting back years of progress.”

In recent years, a new malaria vaccine has reached nearly 2 million children, yet evidence to the International Development Committee from the malaria campaign organisations Malaria No More UK and Medicines for Malaria Venture stated that the aid reductions put the UK’s strategy at risk. They also said that cuts to broader health programmes would have significant knock-on impacts for malaria. While I have the opportunity, I would like to put on record my thanks to the drug discovery unit at the University of Dundee, in my constituency, which is world-leading in work on a single-dose treatment for malaria, in terms of both preventing it spreading and protecting people from getting it.

Support for global health agencies and for vaccines is vital in stopping preventable deaths, but that must be part of a well-funded, coherent global health strategy. The UK Government must therefore reverse their death sentence cuts to ensure that children throughout the world have access to vaccines that increase their prospects, as well as to public health systems that will be there for them during the rest of their lives.