Sexual and Reproductive Health and Rights: Overseas Aid

Dan Poulter Excerpts

Wednesday 12th July 2023 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Will the hon. Member give way?

[Sarah Champion]

I will, of course, give way to a former IDC member.

[Dr Poulter]

I thank the hon. Member for giving way. She is making a good speech, and I congratulate her on securing the debate. One area that the Royal College of Obstetricians and Gynaecologists has focused on in the past, and rightly so, is the high rates of maternal and new-born baby morbidity and mortality in many low and middle-income countries, particularly in Africa. Will the hon. Member address that point and make some suggestions to the Minister about how Britain can better support that agenda through its aid strategy and improve safety around pregnancy and childbirth?

[Sarah Champion]

I will indeed cover that, and also benign gynaecological conditions, which are another major killer for women. I congratulate the hon. Member on all his work on global health over the years. He continues to be an advocate in this place.

UK aid has contributed significantly and meaningfully towards ensuring that all women and girls can access their sexual and reproductive health and rights, and we should all be proud of that track record. RCOG members in Pakistan who had been providing training as part of the UK’s women’s integrated sexual health—WISH—programme reported dramatic increases in access to safe abortion care, post-abortion care and family planning by those who participated in their schemes. However, the decision to cut ODA threatens to stall or even reverse that progress around the world.

WISH is supposed to be the Government’s flagship sexual and reproductive health programme, but even that is not safe from the cuts. MSI Reproductive Choices had its funding under the WISH programme slashed by 78%. My Committee has also heard that a three-year health programme for the most marginalised communities in Bangladesh received a £1.1 million cut to its £2 million budget two years in, with no notice whatsoever. A direct grant in Ghana, which was providing safe birth, child health and psychoeducation for pregnant women and mothers through building new maternal health self-help support groups and outreach clinics, received a 25% cut.

The Government are not putting their money where their mouth is. The most recent data shows that bilateral spending on SRHR decreased by more than 50% from £515 million in 2019 to £242 million in 2021. The Minister is aware that it is not good enough, and I am aware that he is trying to change it, so I look forward to hearing more about that in his remarks.

Estimates by the Guttmacher Institute suggest that the cuts could already have resulted in 9.5 million fewer women and girls having access to modern methods of contraception, 4.3 million more unintended pregnancies, 1.4 million more unsafe abortions and, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, a possible 8,000 more avoidable maternal deaths.

Countries with the greatest need for SRHR funding and programmes have been hit the hardest by the cuts, and within those countries, the most marginalised are often the most affected. Professor Friday Okonofua, an obstetrician and gynaecologist based in Benin City, Nigeria, said in RCOG report that it is the most marginalised people who are reliant on donor-funded services. In Nigeria, where nearly 80% of health payments are out of pocket, the loss of funding from the UK Government has only widened this dire gap in services.

Making donations towards SRHR in humanitarian crises is welcome, but not enough. UK support must be in the form of sustained programming that delivers against the UK’s commitments to the UN sustainable development goals, and promoting the health of women and girls must be the backbone of international development. As RCOG recommends, will the Minister commit to restoring funding for SRHR, and spend £500 million each year for the next three years on SRHR programming and supplies?

RCOG is calling on the Government not only to restore investment in SRHR, but to strengthen their global advocacy on SRHR by investing in new and existing global partnerships and collaborations. The UK’s financial commitment to the Family Planning 2020 initiative had a significant impact on the global funding landscape for SRHR. It contributed to enabling an additional 24 million women and girls to access family planning services. I ask the Minister again to make a financial commitment to the Family Planning 2030 initiative, so that we can continue the programme’s success.

Only by linking our national actions to global goals and commitments can we hope to achieve truly universal access to SRHR for every woman and girl. As well as being one of the largest donors of support for SRHR supplies, the UK has been one of the most progressive in its advocacy. RCOG is calling on the Government to strengthen their global advocacy on SRHR by championing stigmatised issues such as abortion care. That is something I care about deeply, particularly as abortion rights are being rolled back around the world. I was proud that the UK co-led a statement at the UN General Assembly last year on the importance of respecting the bodily autonomy and SRHR of women and girls. It has also been reassuring to see the UK Government commit to prioritising safe abortion care as part of their commitment to supporting SRHR in the women and girls strategy.

Mainstreaming safe abortion services and post-abortion care is essential to reduce maternal morbidity and mortality. Unsafe abortion remains one of the world’s leading causes of maternal mortality. The risk of dying from an unsafe abortion is highest for women in Africa, where nearly half of all abortions happen in potentially dangerous circumstances. In his response, will the Minister say how the Government plan to champion safe abortion care in their programming, and in nations’ universal healthcare plans, as part of an effort to strengthen health systems?

We have seen the success of telemedicine in early abortion care in the UK. Guidance from RCOG, the World Health Organisation and other authorities on clinical standards affirms that telemedicine is a safe and effective delivery model for expanding access to abortion care. RCOG has encouraged the FCDO to invest in telemedicine and in self-management of abortion in settings where that can offer safe additional pathways to increased access. As RCOG has suggested, I would like the UK Government to champion the prioritisation of women’s and girls’ gynaecological health needs on the global health agenda.

Middle East Peace, Security and Development and UNRWA

Dan Poulter Excerpts

Wednesday 15th June 2022 Westminster Hall

[Sarah Champion]

My friend, the hon. Gentleman has wise words. I am proud to be the MP for Rotherham and to be the Chair of the Select Committee on International Development. We have done a lot of inquiries on the subject of UN practice—on sexual exploitation by its staff, on misuse of funds and on racism in the sector. In such a vast organisation, of course there will be some rotten apples, but when those failings are highlighted it is inexcusable that they are not rooted out and safety measures put in so that such issues never happen again. As the hon. Member rightly says, one rotten apple taints the whole barrel. The UN does amazing work, but it is a big organisation and some people feel emboldened to make ridiculous personal comments that damage everybody.

The British Council, which recently signed a co-operation agreement with UNRWA, has granted the British Council’s international school awards to 80 UNRWA schools during the past two years, with many others having gained this recognition previously. The World Bank has confirmed that UNRWA students are on average one year ahead of their peers in public schools in the region. MOPAN—the Multilateral Organisation Performance Assessment Network—of which the UK is a member, recognises that UNRWA is a “competent, resilient and resolute” organisation.

UNRWA was created more than 70 years ago by the United Nations General Assembly. The UK voted in favour of its formation and has since approved the renewal of UNRWA’s mandate every three years. In establishing UNRWA, the UN General Assembly recognised that continued assistance for the relief of the Palestinian refugees was necessary

“to further conditions of peace and stability”.

UNRWA has carried out multitudes of positive work in the middle east in the absence of a political solution between the Israelis and the Palestinians. It has already educated more than 2 million children, and today creates significant livelihood opportunities through its construction projects throughout the middle east. UNRWA’s provision of human development services and humanitarian relief provides an anchor of stability in a troubled region.

Of the nearly 6 million Palestinian refugees living in the middle east, more than 2.6 million live in poverty. As the number of refugees falling into poverty continues to rise, UNRWA faces increased demands on its services. Refugees are increasingly reliant on UNRWA for the education of their children, their health and their livelihood.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

As the hon. Lady highlights, we on the International Development Committee have investigated these issues. She has rightly highlighted key problems in Palestine, but, more generally, some of the cuts to the aid budget, particularly to health and education, were arbitrary and have had a real impact on people’s lives. Can we urge the Minister to look again at some of those decisions?

[Sarah Champion]

I fully support my fellow Committee member and thank him for repeatedly raising his concerns about this issue. The forthcoming budget that goes alongside the development strategy is due in the next month, and it very much seems that global health will be the biggest casualty. The concerns that he raises are right. There does not seem to be a joined-up strategy on the impact of the cuts. If the Minister could outline that, it would help us all to understand the Government’s logic.

The impact of UNRWA breaking down because of donors such as the UK continuing to significantly decrease or stop its funding is unimaginable. Have the Government considered the consequences for millions of people in the middle east if the cuts cause significant reductions in UNRWA’s services? UNRWA has the expertise; it has proven effectiveness and can provide its services much cheaper than any other UN agency. Let me be frank: if people are left with no healthcare, no education and no job, what does the Minister think will happen to them?

The world already has a formidable tool to provide support to people in the form of UNRWA. Why would we want to weaken our own investment in it to the point of hundreds of thousands of people feeling they have no future? More needs to be done to work with the organisation. Of course, as we have outlined, UNRWA is not perfect—nothing is—but the Government’s cuts are threatening its capability to deliver support to a vulnerable population in the middle east. We need to maintain trusted relations with the people of Israel, Palestine, Jordan, and Lebanon. Palestinian refugees are a key constituency for peace in the region in terms of their number, socio-political relevance, and the refugees’ personal stake in the search for a lasting solution.

Without UNRWA, we risk destabilising the region further and emboldening those who do not share our belief that the best way to bring peace and stability to the region is through a political resolution to the conflict. The millions of people who access UNRWA’s services would be forced to turn elsewhere to survive. If we are to remain committed to our vision of two states, surely we should provide support to UNRWA, which has proved itself a reliable partner by which the international community can address the refugee constituency. Although it is non-political, UNRWA’s presence and role have been recognised as having significant implications for regional security and stability.

The Prime Minister has consistently highlighted that girls’ education is his top priority for UK aid. UNRWA directly supports that objective by operating one of the largest school systems in the middle east and providing primary education to over a half a million students, 50% of whom are girls. Gender parity in school enrolment was obtained in the early 1960s at UNRWA schools—long before any other country in the region. UNRWA is providing government-like services such as elementary and preparatory education, and, through that commitment to sustainable development goal 4, is playing its role as a major contributor to the 2030 SDG agenda.

It is clear that UNRWA is essential for the stability of that volatile and fragile region, so will the Minister explain the substantial cuts in UK funding to UNRWA, despite Ministers telling the House for years how excellent UNRWA’s services are? Why are the Government slashing funding to this essential and efficient organisation? Will the Government carry out an analysis of the impact of the funding cuts on UNRWA? Is there any plan to reinstate our financial support to previous levels, and what discussions has the Minister had with other potential donors to encourage them to back UNRWA? If the UK cannot or will not sufficiently support UNRWA, we have to ask: do we not have a responsibility towards these people? Is not stability in the middle east what we are aiming for, and why are we not doing all we can to achieve it?

--- Later in debate ---

[Vicky Ford]

I will take questions at the end, because there is quite a lot that I would like to say. If I have time, I will take the hon. Gentleman’s intervention later.

UNRWA’s essential work is focused not only on the Occupied Palestinian Territories; it also supports vulnerable Palestinian refugees in Lebanon and across the region with essential services, including basic education and healthcare. Some £7 million of our UNRWA contribution in the 2020-21 financial year went to UNRWA’s regional emergency appeal in Syria and Jordan, which has helped to provide humanitarian assistance to more than 450,000 vulnerable Palestinian refugees in those countries. The final status of Palestinian refugees must be agreed as part of wider peace negotiations. Until that time, I confirm that the UK remains firmly committed to supporting Palestinian refugees through UNRWA, and the other valuable work that UNRWA does in the region.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) asked how aid is being allocated post the decision to reduce official development assistance from 0.7% to 0.5%. It was a challenging decision to make, but we must recall the massive impact the global pandemic has had on the UK’s own finances. It is a temporary decision, and the Chancellor has set out the methodology by which we would return to 0.7%. I suggest my hon. Friend looks at the international development strategy that we published a few weeks ago, which brings together our key global priorities for the allocation of ODA, in particular bringing back humanitarian aid and girls’ education—both of which, as the hon. Member for Rotherham pointed out, are key for UNRWA.

[Dr Poulter]

rose—

[Gareth Thomas]

rose—

--- Later in debate ---

[Vicky Ford]

I cannot confirm that at this stage, but I can confirm that my right hon. Friend, the Minister for Asia and the Middle East, who covers this territory, is very focused on the issue.

[Dr Poulter]

I thank the Minister for giving way. I think we all accept the challenges the pandemic has caused for finances in this country and more generally. The Committee recently heard from the Foreign Secretary and some of the permanent secretaries, who were unable to provide details on reductions to in-year funding. It would be helpful if the Minister could confirm that education and healthcare funding will be prioritised.

Elections Bill

Dan Poulter Excerpts

Report stage
Monday 17th January 2022 Commons Chamber

[Mr Carmichael]

I am grateful to you, Madam Deputy Speaker, for the opportunity to take part in this important debate. Let me say briefly at the outset that the fact that the House has less than two and a half hours in which to debate such a Bill on Report is nothing short of an outrage. When the Government brought forward their motion of instruction, they should have recognised at that stage that they had turned this into a constitutional Bill, and the Committee stage, never mind the Report stage, should have been on the Floor of the House. This is an unacceptable and contemptible way for the Government to be treating Parliament.

I rise to speak to new clause 13, which stands in my name, and the names of my hon. and right hon. Friends, and a number of others, including Members of the Labour party, the Green party and the Alliance party. I would very much like to test the opinion of the House in relation to this new clause.

We have seen just this weekend, with the Government’s announcements in relation to the BBC, the dangers and just what is possible when we have an electoral system that puts total power into the hands of a party on a minority vote at a general election. These are the arguments that we often rehearse in relation to proportional representation. I will not rehearse them tonight because time is short, but I want to talk a little bit about what proportional representation would mean for Parliament and for this House and how it could lead to a restoration of the standing of the House in public life.

Madam Deputy Speaker, I think you know how I feel about being a Member here. It has been the privilege of my life to be a Member of Parliament and to have the opportunity to do things for my community and for the individuals who live there. To have a role at the heart of the nation’s politics is the greatest privilege that any of us can hope for.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

As the right hon. Gentleman knows, I am sympathetic to electoral reform. He makes the point about being privileged to represent his constituency, as indeed I am and all of us in this House are. I wonder whether he can reassure me on one concern. I would like to support his new clause this evening, but it breaks the constituency link, or at least an element of local representation, as part of a more proportional system. Can he reassure me that if I were to vote for his new clause this evening, some level of local representation would be maintained?

[Mr Carmichael]

I can give the hon. Gentleman that reassurance. I can assure him that, if anything, the link would be strengthened. I live in a local authority ward that is elected by single transferable vote. I elect four councillors. Each of them has a link to the constituents and, between them, they are able to represent the views of just about everybody in their community, not just those who have voted for them and those who agree with them. In that way, using the single transferable vote, the link between the elected and the elector is, in fact, strengthened.

I was just saying that it has been the privilege of my life to be a Member of Parliament, but, believe me, I am by no means blind to the multiple faults of this House. It would not take an awful lot to make it so much better. We have heard an awful lot of talk in the last week or two about cultures, and about the culture at the heart of this Government in No. 10 Downing Street, but let us also accept that the culture of Parliament has to change.

Time and again over the years, the culture of deference and entitlement has led us into difficulty, as in 2009 with the scandal over MPs’ expenses. I thought that perhaps we would have learned our lesson after that, but last year, with the Owen Paterson affair and all the stories about MPs with second, third and fourth jobs—and the amount of time they gave to them and the amount of money they earned—it became perfectly apparent that the sense of entitlement continues. Unless we can change that sense of entitlement—the culture in this House—we will not change the standing in which we are held by the public.

Why do we find ourselves in this situation? Why do we keep coming back to this place, time and again, where we become our own worst enemies? I can answer that question in two words: safe seats. The existence of areas where parties can depend on the return of a Member of Parliament with a majority of tens of thousands without making any real effort creates that sense of entitlement.

Someone offering themselves for re-election should never be a formality, but for many people elected to this House it is exactly that. Follow the money and look at the expenses returns: in marginal seats the expenses are right up to the limit, and in the so-called safe seats the party makes the smallest possible expenditure. We talk about having a national election, but in truth we campaign only in an ever-reducing base of marginal constituencies.

Palestinian School Curriculum: Radicalisation

Dan Poulter Excerpts

Tuesday 10th March 2020 Westminster Hall

[James Cleverly]

I recognise the hon. Member’s point. We absolutely recognise that this is an imperfect situation, but we are working with the Palestinian Authority, as we will continue to do, to reinforce and support moves to improve textbooks. My hon. Friend the Member for Bury South (Christian Wakeford) pointed out that Jordan has significantly improved the content of its textbooks. There is a pattern, and that is something on which we will engage with the Palestinian Authority.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I apologise for not being here at the start of the debate; I too was at a Select Committee hearing. Given that this has been an issue for 19 years, what faith does the Minister genuinely have that the Palestinian Authority will investigate the matter properly?

[Sir Charles Walker (in the Chair)]

Minister, you have a minute and a half left.

World War Two: Polish Contribution

Dan Poulter Excerpts

Tuesday 2nd July 2019 Westminster Hall

[Daniel Kawczynski]

I have a little section on that later in my speech.

In Operation Market Garden, when the allies tried to shorten the war by landing in the Netherlands, Polish paratroopers took part in unprecedented numbers with their British counterparts. Again, I have had the opportunity to visit the Polish and British cemeteries in the Netherlands, and to see the same recurring theme: the sheer youth of those young men who together gave up their lives so that we might have freedom.

My hon. Friend the Member for Henley (John Howell) mentioned Bletchley Park. He is absolutely right, because Polish mathematicians and code breakers came over from Poland. Sir Dermot Turing, a relative of Alan Turing, in his book, “The Real Story of How Enigma Was Broken”, highlighted the unique, outstanding and overwhelming contribution of Polish mathematicians and cryptographers to breaking the Enigma codes. I cannot begin to explain how important that was. It gave us the opportunity to understand where German positions and movements would be forthcoming, allowing us to shorten the war by, some suggest, at least two years—my hon. Friend alluded to this—and potentially saving hundreds of thousands, if not millions, of lives. I will put three gentlemen on the record: Marian Rejewski, Jerzy Różycki and Henryk Zygalski. For someone born in Poland, even I have difficulty pronouncing those surnames —I dread to think what the people in Hansard will do with them, so I hope that I pronounced them correctly.

Recently, a book was donated to the House of Commons Library, and only two weeks ago we had an exhibition here in the House of Commons, about a lady called Krystyna Skarbek—or Granville. According to legend, she was Winston Churchill’s favourite spy. She was a young Polish lady who was dropped behind enemy lines on many occasions. She was instrumental in reconnaissance and in helping to ensure that sabotage against German forces was co-ordinated effectively.

Despite all such extraordinary contributions—my hon. Friends and other hon. Members will acknowledge that Poland made them—the Clement Attlee Government refused to allow Polish soldiers to take part in the victory parade on 8 June 1946, for fear of offending Joseph Stalin. By that stage, that dictator had already managed to impose a brutal, tyrannical communist puppet regime in Poland, but for fear of upsetting him we in this country decided to exclude the Polish forces from the victory parade.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate and on his tremendous speech. In Suffolk, we are aware of the contribution made from Norfolk and Suffolk by the Polish air force in support of the war effort. On that point—a good one about the failure of the Attlee Government to recognise the contribution of the Polish community, army and air force in the war—next year, 75 years on from VE-day, we could help to put right that wrong by better recognising the Polish contribution to the war effort?

[Daniel Kawczynski]

I am extremely grateful to my hon. Friend for raising that point. I want to take this opportunity to say that, as a fluent Polish speaker—or attempting to be fluent; it is a very difficult language—when I go to Poland and speak to people in English, what they say is quite different from what they say when I talk to them in Polish. They are very friendly to the British—they love them and want to work with them—but that is still a source of real pain for the Poles. He touches on a very important issue: how do we repair what happened in 1946? How do we engage and work with the Polish diaspora here in the United Kingdom to create a new monument, or do something to ensure that their unique contribution is highlighted? We have a Polish war memorial in Northolt, but in the run-up to many anniversaries can we do something in addition, yet again to celebrate the contribution of Poles and educate the younger generations about their unique contribution?

World TB Day

Dan Poulter Excerpts

Wednesday 27th March 2019 Westminster Hall

[Nick Herbert (Arundel and South Downs) (Con)]

I beg to move,

That this House has considered World TB Day and the efforts to end tuberculosis globally.

I am delighted to be able to introduce this debate. It was World TB Day on Sunday, but this is not an anniversary that we should be having to mark at all. It is wrong and extraordinary that we still have to debate the toll from death and suffering of a disease that has been curable for well over half a century, since the discovery of antibiotics by Fleming in 1928. It is unnecessary that so many people die from tuberculosis.

Imagine if the World Health Organisation announced tomorrow that a new disease had been discovered that was highly infectious, airborne and susceptible to drug-resistance, and that next year 10 million people would fall sick, of whom 1.6 million people would die. Imagine the global response to that news. That is in fact a description of the reality of tuberculosis. TB kills more people every year than HIV/AIDS and malaria combined —1.6 million people last year. Of course, there is overlap between HIV/AIDS and TB, because the AIDS epidemic in the 1980s drove the resurgence of tuberculosis. A disease that the world thought it had beaten has come back with a vengeance.

TB was first declared a global health emergency 25 years ago, in 1993. Since then, 50 million people have died. Just consider that. A disease is declared a global health emergency and subsequently 50 million people die, yet that disease is treatable and curable. That represents nothing less than a catastrophic failure on the part of the world’s Governments to deal with a disease that we should deal with more effectively.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My right hon. Friend is making some good points and I congratulate him on securing the debate. He mentions the failure of world Governments. There is clearly a need for greater urgency in the approach taken by the international community in dealing with this issue, but what about the behaviour of pharmaceutical companies, which rarely invest in drugs that will help people in low and middle-income countries in the way that they would do in lucrative medications that they can sell in higher income countries, such as Great Britain?

[Nick Herbert]

My hon. Friend makes a good point, but I do not blame pharmaceutical companies, because I think this is a clear case of market failure. The fact is that the demand for better TB drugs, which we need, falls largely in low and middle-income countries, so there is no commercial case for sufficient investment in these new drugs. It can therefore proceed only on a public-private partnership basis. Some pharmaceutical companies have a pro bono programme for the drugs that do exist, such as Johnson & Johnson, where there is a drug to deal with drug-resistant TB. However, that is still insufficient.

This market failure is a striking contrast with what happened with AIDS. There was a serious response to the AIDS epidemic from pharmaceutical companies, not only from publicly funded programmes, but from commercially funded investment. As a consequence we have had extraordinary innovation, and new drugs that can prevent HIV and ensure that it is not a death sentence are available. What is the difference between the two? AIDS was a disease that was killing people in the west and TB is a disease that kills the poor. That is the fundamental difference. That is why we have not had the same level of investment in tuberculosis. Another fundamental difference is that TB was already curable with antibiotics. It is just that these antibiotics were not being delivered, TB patients were not being identified and we did not have the health systems to do it.

[Dr Poulter]

I am a little more sceptical about the operation of some pharmaceutical companies than my right hon. Friend. In fact, one reason that the global community was able to so effectively deal with HIV—he is right to identify TB as an AIDS-defining disease—was that international Governments brought pressure to bear on pharmaceutical companies to drop the price of the medications, and push medications out in low and middle-income countries. That has not happened with TB. Unless there is a concerted effort from global Governments to encourage pharmaceutical companies to behave with greater global awareness and corporate responsibility, I am not sure we will see much change in the situation that he is describing, and change is badly needed.

[Nick Herbert]

This is an interesting debate, but I disagree with my hon. Friend. The drugs are not in the pipeline, because the return on investment for these companies is insufficient in the first place. I do not think that they are sitting on drugs that are available for wealthier people, which, if pressed, they could simply roll out to poorer people. There is an insufficient quantum of investment in research and development. I will come on to that point. I do not think that the need can be met by the private sector alone.

I believe that there are three key reasons why we need to take more action against this disease: humanitarian reasons, economic reasons and reasons of global public health. The humanitarian reason is that so many people are dying needlessly from this disease and falling sick. The figures speak for themselves.

The economic reason is that this awful loss of life and this illness are a drag on economic success in the poorest countries, hindering their development. There will also be a serious economic impact if we fail to tackle the disease. By 2030, it is estimated that if the current trajectory of TB continues, that will cost the world’s economies $1 trillion. Some 60% of that cost will be concentrated in the G20, and it will be caused by the 28 million deaths over that period. That is a terrible statistic, because that is the period over which tuberculosis is meant to be beaten according to the sustainable development goals. The United Nations set those goals four years ago, and said that the major epidemics—AIDS, malaria and TB—would be beaten in 15 years’ time. We have just 11 years to go. On the current trajectory, TB will not be beaten for well over 100 years. There will be a further 28 million deaths during that period alone, as well as huge economic costs.

The global public health reason is the susceptibility of tuberculosis to drug resistance, because of the old-fashioned drugs that are used to treat tuberculosis. People who take the drugs do not continue with their treatment and it is a very serious fact that there are well over 500,000 cases of drug-resistant TB in the world. The highest burden is actually in the European region. Only one in four people who have drug-resistant TB can access treatment.

We know that there are 3.5 million missing cases of TB every year that are simply undiagnosed, accounting for one in three sufferers. The proportion is much higher for drug-resistant TB, where 71% of people are missing. This constitutes not only a humanitarian issue, but a serious risk to global public health, because this is an airborne, highly infectious disease.

Vaccinations: Developing Countries

Dan Poulter Excerpts

Wednesday 13th June 2018 Westminster Hall

[Stephen Crabb]

I have heard that said, and I will go on to refer to the importance of reaching the hard-to-reach groups. There is evidence that that is the way to get, to put it crudely, more bang for our buck on the vaccinations spend, because the threat of outbreaks of killer diseases is higher for some of those isolated communities and families than for those elsewhere. My hon. Friend makes a useful point early in the debate.

For the last decade and more, there has been a political consensus that we should spend 0.7% of our GDP on international aid and assistance. At times in recent years, it has felt as though that consensus is being tested; certainly, the all-out assault on our aid budget in some sections of the popular press has had a corrosive effect, at least among some members of the general public. The discussion in the popular press is overwhelmingly dominated by questions over the headline funding commitment and the suggestion, repeated over and over again, that aid money could be better spent on domestic priorities.

While those of us who support Britain’s role as a leader in effective overseas development should never tire of restating the basic case for aid, we should also do more to draw attention to specific examples where UK aid has helped to achieve profound economic and social improvements in some of the poorest countries on earth. One area of British leadership and expertise that has received too little attention is the funding, development and distribution of vaccines against killer diseases, and I will use this short debate to highlight that. Diseases are not just an unpleasant inconvenience for a country; they ravage a nation’s economy, directly affect its ability to grow and hold back economic development. Diseases keep poor countries poor.

It was a British doctor, Edward Jenner, who pioneered the first vaccine at the end of the 18th century, when he used pus drawn from a cowpox boil to inoculate a boy against the killer smallpox—a story that many of us will have learned about in our schooldays. More than 200 years on, British science and medical research still lead the world in improving the health of people living in extreme poverty. The eradication of smallpox was one of the great achievements of immunology in the 20th century. Smallpox was once one of the world’s most feared and deadliest diseases. Just 60 years ago, it was endemic in dozens of countries containing around 60% of the world’s population. By 1980, it had been eradicated, following a concerted international effort.

More recently, polio, once epidemic, has almost been eradicated too, due to concerted vaccination efforts worldwide. It has been reduced by 99% globally and the number of polio-endemic countries has decreased from 125 in 1983 to just three today. That is the culmination of a remarkable international effort that brought together Governments, NGOs and many private individuals. Rotary clubs around the world, for example, took this up as a campaign and raised enormous sums toward the effort through community-led fundraising. Full eradication of the disease is within reach, showing again what can be achieved when we harness political will, public support, large-scale resources and world-class science. I believe that that formula is the key to so many of the interventions that will make the world a better place in the years ahead.

British medical and scientific research remain world leaders in the fight against vaccine-preventable diseases. We are part of numerous initiatives and alliances, recognising that multilateral co-ordination and use of public resources to leverage in private sector funding provide a strong platform for this work at a global level. I am sure the Minister will update us on some of those initiatives in his winding-up speech.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my right hon. Friend on securing the debate and on the speech he is making. On the issue of private company and pharmaceutical involvement in the development of vaccines, there has been a challenge, as we saw with the Ebola outbreak, in that this is not an area of great profit for pharmaceuticals; it is difficult for them to recoup their investment from lower-middle income countries. The pharmaceutical model needs more encouragement of pharmaceuticals to invest in development of vaccines such as Ebola. What would he say to encourage that?

[Stephen Crabb]

My hon. Friend, who knows an enormous amount about this field, makes an important point. We are essentially dealing here with a case of market failure, where markets in the purest sense do not work in bringing through vaccine development and distribution in some of the poorest countries. I will talk about that later. I am about to talk about GAVI, the Vaccine Alliance; the model on which it operates is based on tackling exactly that problem, where there is not sufficient market demand in a poor country to create the financial incentive or pull for pharmaceutical companies to invest there profitably.

GAVI was created in 2000 and it brings together the public and private sectors with the shared aim of creating equal access to vaccines for children living in the world’s poorest countries. Britain was one of its original donors, and today we provide around 25% of its funding. There is also the global health fund, which was created to accelerate the end of HIV/AIDS, tuberculosis and malaria as epidemics, and for which UK funding averages around £360 million a year. Last year, the global health fund partnered with GAVI and Unitaid to provide around $50 million to pilot the world’s first malaria vaccine for young children in Ghana, Kenya and Malawi. That vaccine has been 30 years in the making in fighting a disease that still claims thousands of lives each year.

Back in 2015, the former Prime Minister, David Cameron, announced a plan to tackle the risk of global health pandemics that included the establishment of a UK vaccines research and development network. The network’s focus is to bring together experts from industry, academia, philanthropy and Government to invest in projects on vaccines and vaccine technology to combat diseases with epidemic potential, such as Ebola and Zika, in low and middle-income countries. Britain has led from the front in the global fight against killer diseases.

Vaccines are widely recognised as an important mechanism for controlling infectious disease outbreaks, although they are by no means the only mechanism. In fact, the supply of clean water, for example, is even more important in reducing the burden of infectious diseases. However, it is right that the international effort to develop and distribute vaccines against deadly diseases, of which Britain is a key part, is a strategic priority for our overseas aid policies, and it needs to remain so.

At the heart of that challenge is the market failure referred to by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Outbreaks of some of the world’s deadliest diseases occur only intermittently, and often in the world’s poorest countries, meaning that there might not be a strong market incentive for the pharmaceutical industry to develop vaccines for such diseases.

The UK Government are taking concerted and co-ordinated action to address that market failure. For example, the UK has committed to invest £120 million between 2016 and 2021 in the development of new vaccines for diseases with epidemic potential, in line with the expert advice provided by the UK Vaccine Network. The UK is also helping to build laboratory capacity, surveillance networks and response capacity in low and middle-income countries to deal with the threat of antimicrobial resistance, which militates against the efficacy of drugs in treating diseases.

Some of the health impacts of vaccinations are widely known. For example, between 2010 and 2016, 109 million children were given the pneumococcal vaccine to protect against the main cause of pneumonia, saving an estimated 760,000 lives. In 2017, nearly 1 million people were vaccinated against cholera when an epidemic threatened South Sudan. Only 400 people lost their lives, thanks to an integrated approach that also incorporated surveillance, investigation of and response to cases by rapid response teams, the provision of clean water and the promotion of good hygiene practices. We could cite many other examples.

However, the wider economic benefit of vaccination programmes to the poorest nations has not been fully explored. More research and data are needed to help us to tell the full story of how and why investing in vaccinations helps to alleviate poverty and create stronger foundations for economic success. We certainly know that high out-of-pocket expenditures contribute to poverty, and healthcare can be one of the most significant such expenses for those living in poor countries. In 2010, the World Health Organisation reported that the cost of healthcare prevented many poor people from seeking treatment while simultaneously pushing 150 million care seekers into poverty each year. Put simply, poor people getting sick is likely to make them even poorer and to wreck their future earning potential. When that picture is repeated across families and communities, the consequences can be dire.

At economy level, we have evidence of the ravages that killer diseases can cause. For example, the 2014 Ebola crisis in west Africa disrupted international trade and travel, cost at least $2.8 billion in lost growth and killed more than 11,000 people in the three countries worst affected by the outbreak—Sierra Leone, Liberia and Guinea. It had a severe developmental impact in those counties, placing already weak health systems under extreme pressure, and had a negative impact on employment and school attendance rates.

In February, Health Affairs published a study, jointly authored by researchers at Harvard University and GAVI, that looked at the health and economic benefits of vaccinations, which it showed have a poverty-alleviating benefit, especially for the poorest people. Although the study raised some specific questions about the delivery of vaccination programmes, distributional impacts and the transition away from aid-funded programmes as countries move across the poverty eligibility threshold, it nevertheless helped to strengthen the case for continued investment in vaccinations and helped to give us a fuller picture of how good aid spent well does exactly what we claim it does—saves lives and reduces extreme poverty.

[Dr Poulter]

My right hon. Friend makes an important point. Aid initiatives are far too often evaluated purely on what they cost the Department or organisation giving the money, but cost-benefit analyses that look at the wider economic and long-term healthcare benefits are how we should evaluate aid spending in the future. Will he join me in urging the Department for International Development to look at using those more effectively in the future when looking at how it spends its money?

[Stephen Crabb]

My hon. Friend makes an excellent point and I absolutely agree with him. That is exactly the kind of research and evidence that the Department and other bodies need to provide as those who believe in and support our overseas aid spending seek to make and restate the case for it over and over again. It is a powerful message with which to challenge sceptics and cynics.

In 2016, Johns Hopkins Bloomberg School of Public Health examined the projected return on investment in vaccinations between 2011 and 2020 in 94 low and middle-income countries. Looking only at the direct costs associated with illness, such as treatment and lost productivity, it found that the return for every £1 spent on vaccines was £16. When it expanded its analysis to look at the broader economic impact of illness, it found that the return was around £44 for every £1 spent. Such studies point to investment in vaccinations being an important means of improving health equity and reducing poverty, and to vaccinations providing value for money.

There is another aspect to this: investment in vaccinations in the poorest countries is also an investment in our own national security and resilience. I am always wary of the self-interest argument when it comes to defending overseas aid, and I think people generally see through those arguments, but polling evidence indicates that the general public understand that killer diseases such as Ebola do not respect borders and shows greater support for aid that focuses resources on tackling those diseases.

I will wrap up in a few moments, but I will close with several recommendations and observations, which the Minister will perhaps respond to today or follow up in writing at a later date. What efforts is Britain making, through its international partnerships and on its own, to improve vaccine coverage rates among the very poorest, ensuring that aid is spent on those who need it most and for whom it has the biggest benefit?

Distributional impacts should be taken into account when decisions are made about introducing or expanding vaccination programmes, and programmes accruing greater benefits to the poor should be prioritised over vaccines with less equity impact. Hard-to-reach families and people in isolated areas should be priority targets, as investment among those people significantly reduces the likelihood of disease outbreaks, which are more costly in lives and the money needed to respond.

Despite significant progress since 2000, today, nearly one infant in 10—that is, around 30 million children—does not receive any vaccinations, and more than 1.5 million children under the age of five die from vaccine-preventable diseases every year. Pneumococcal conjugate vaccines immunise against the most common cause of pneumonia, but they remain inaccessible to millions largely due to high prices, thus leaving behind the poorest and most marginalised children.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 28th March 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Alok Sharma)]

The new Chief Executive, Carrie Lam, was elected by the Election Committee, and of course we respect the decision. However, we have consistently taken the view that the best way to secure the future of one country, two systems is through a transition to universal suffrage, which meets the aspirations of the people of Hong Kong, within the parameters of the Basic Law.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

T5. The Under-Secretary of State for Foreign and Commonwealth Affairs, my right hon. Friend the Member for Bournemouth East (Mr Ellwood), has made clear his concerns about Iranian state-sponsored terrorism destabilising the state of Israel and the whole middle east. As a consequence, will he please confirm that ensuring it recognises the right of the state of Israel to exist is first and foremost in future engagement with Iran?

[The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Mr Tobias Ellwood)]

My hon. Friend is absolutely right that this is an opportunity for Iran to re-engage following the nuclear deal and to show that it is meeting 21st-century standards. I am pleased we have had the Airbus deal, which is an example of how we can work together commercially, but we also need to work together on governance and on recognising the boundaries of states.

Iran’s Influence in the Middle East

Dan Poulter Excerpts

Wednesday 22nd March 2017 Westminster Hall

[Dr Offord]

I will do; if I can get to my speech, I hope I will be able to elucidate some comments about the places that the hon. Gentleman mentions.

The Iranian leadership has cited Syria as being Iran’s 35th province, with President Assad’s Alawite minority-led regime being a crucial buffer between the influence of Saudi Arabia and the United States, so it can be of no surprise to any of us that Iran has chosen to involve itself in the conflict in Syria.

The response of the Syrian regime to the Arab spring was a brutal one. Since 2011, thousands of civilians and armed militia have been killed by Government forces in Syria. Such action has prompted many Syrian army officers to join the opposition movement and form the Free Syrian Army. With the armed resistance increasing and looking ever more likely to topple the Assad regime, the clerical regime in Iran began deploying its military capability in the country. The senior commander of the Rasoulallah division of the Islamic Revolutionary Guard Corps, Hossein Hamadani, was dispatched to Syria. That man was responsible for operations in the Iran-Iraq war, as well as for suppressing the 2009 uprising in Iran. He decided that the forces sent by Iran to Syria were primarily to be at command level, as evidenced by the capture of 48 IRGC commanders two months later. That meant that infantry were needed, and the creation of Daesh occurred as a result.

Former US Secretary of State John Kerry is on the record as saying:

“ISIS was created by Assad releasing 1,500 prisoners from jail and Maliki releasing 1,000 people in Iraq who were put together as a force of terror types.”

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend has brought forward an important and timely subject for consideration today. He mentions the US—does he agree that many of us were disappointed with the Iran nuclear deal? It dealt with Iran’s nuclear capacity, but there was a missed opportunity to tackle some of the state-sponsored terrorism and other underlying causes of instability in the middle east. That is something that we will look to America to do now with a new President.

[Dr Offord]

I hope to come on to that point, but I completely agree with my hon. Friend’s assertion. I believe that the Iranian nuclear deal was a missed opportunity. Not only did it not address issues surrounding terrorism, it also failed to consider human rights in Iran—something that is very important not only to myself and other hon. Members, but also to many of my constituents, some of whom are in the Public Gallery today.

The Iranian regime made use of its experience in suppression and control by working with the Syrian regime to achieve two objectives. The first was called the infiltration project, which was designed to instil division and dissent in the opposition; the second was the knapsack project, which was designed to bring about armed clashes between the groups and the tribes.

Although the IRGC’s Quds force remains the primary extraterritorial fighting force, and the primary force in Syria, IRGC ground forces, as well as those of the regular Iranian army, have also been employed in the conflict. In addition to those troops, more than 70,000 non-Iranian and Iranian forces have been deployed by the IRGC to fight in Syria. According to IRGC reports, that exceeds the 50,000 Syrian forces. That activity required money that became available at the right time—as my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, through the nuclear deal.

One of my principal concerns about the Iranian nuclear deal was that it unfroze huge resources that allowed terror to be funded in the middle east region. It appears that that is what is occurring. Over the last five years, Tehran has budgeted about $100 billion for the conflict, under cover from Khamenei’s office. That money has been spent on the purchase of military weaponry and on Syria’s own military expenses—$1 billion is spent solely on the salaries of the forces affiliated with the IRGC, including military forces, militias and Shi’ite networks.

Turning to another area of conflict in the middle east, we can also see the influence of Iran in Yemen.

UK-West Africa Relations

Dan Poulter Excerpts

Wednesday 25th January 2017 Westminster Hall

[James Duddridge]

The point is well made. I had the privilege of being alongside David Cameron when he held the corruption summit with the recently elected President Buhari of Nigeria and others. Tackling corruption right from the top is very effective, but I think more of the Africa of opportunities rather than the Africa of downsides. Corruption is not an African issue—it is a global issue—but it does flair up more in specific countries.

There is a massive opportunity in Nigeria. I cannot remember whether Lagos is referred to as little London or Nigerians in London refer to London as little Lagos, but there is a strong connection, a strong diaspora connection and a massive opportunity. By 2050 a quarter of the world’s population will be in Africa, and a quarter of them in Nigeria. Clearly it would be foolish to ignore such a massive opportunity.

I commend the work of PricewaterhouseCoopers in Nigeria, in Lagos with the governor, on improving the ease of doing business, which is a catalyst for getting more money into the system. I also praise President Buhari for taking the tough decision to float the naira, which will be a catalyst for greater investment in the longer term and which removes a previous deterrent to investment.

Francophone Africa is anchored in west Africa. As a result, with the Commonwealth countries, we think more of southern and east Africa rather than west Africa as our natural bedfellows, but we should not do so. We can do more in west Africa. I have worked in Ivory Coast and travelled to places such as Senegal. We need a bespoke operation in francophone west Africa. The Foreign Office and the Department for International Trade need to co-ordinate to get people whose first language is French, or who are properly bilingual, and to have them travelling to Accra and Abidjan, rather than on a traditional trade mission that might have a stop in Ghana and then a francophone country. We need to be using that sort of bloc of people—the City is pretty full of very competent French bankers who are attracted to the United Kingdom and some of our values. Using some of those French bankers or City workers on transactions in French west Africa would be a good idea.

I mentioned that I used to work in Ivory Coast, which is a beacon of opportunity and growth in west Africa. President Ouattara is forward-thinking. I am particularly impressed that, despite the tendency to extend presidential terms that so blights Africa, he has said he will step down in 2020. Since I worked in Ivory Coast, there has been a long civil war, a recovery and a subsequent significant increase in GDP per capita.

The country is not without its problems. Only a few weeks ago there were what we might euphemistically describe as some problems—the head of the police and of the army were summarily sacked as a result—but stability was restored. Generally Ivory Coast is a beacon for growth in the area and shows what can be done. I have had the privilege of returning to Grand Bassam, where I used to go for a Sunday beer and lunch and where that terrible incident of tourists and Ivorians being killed coming in off the beach was. It was good to show solidarity and I encourage people to return to Grand Bassam and not to let terrorists get us down. People should go back there as a tourist and a business area.

In Guinea-Conakry, one of the biggest private sector investments, Simandou, was proposed, but almost immediately we found ourselves fighting Ebola, which I will come to later. I am interested in any update from the Minister on the project and, in particular, on Chinese involvement. My hon. Friend the Member for Windsor has a degree of knowledge about that and, off the back of his work as the Prime Minister’s trade envoy to Ghana, the President of Guinea was keen on him playing a similar role in his country, but I will leave it to my hon. Friend to update us—I am not sure where that ended.

Continuing our tour of countries, I very much commend the counter-terrorism and counter-narcotics works in Senegal. I also commend to British business the opportunities as the airport moves out of the capital—that big tract of prime land is available for development, commercialisation and businesses to generate tax that will grow the country out of poverty.

In a bizarre segue from Senegal, I will talk briefly about the soft power of the United Kingdom. Go anywhere and people are very interested in, first, the Queen, then premiership football and, tailing off, lots of other things depending on their view of the United Kingdom. There is a battle for influence in Africa and, interestingly, it is not only French and English but, for example, American—the National Basketball Association has just set up a college in Senegal. All those things are soft power, and I encourage the Minister to look even more than we have done previously with the British Council and the premier league at how we project British values, whether through football, the monarchy or business. Other countries including America are certainly doing those things.

I am interested in the role of the Economic Community of West African States and in an update on its activities. I have always found that the region is a stronger building block than the African Union as a whole, but it will be interesting to see what happens in the next couple of days at the African Union meeting, presumably in Addis, where I very hope that Amina Mohamed, who was the Kenyan Foreign Minister, will get elected. I am sure Her Majesty’s Government would not want to take a proactive position and will work with whomever replaces Madam Dlamini-Zuma, but if Amina Mohamed wins the election, it would be very positive for the African Union building out and going forward.

We need to do much more business. Only yesterday I was with a group of African businessmen and an excellent prospective Foreign Office prosperity team. The question was asked: how well are the British Government doing at connecting with business? I was quite self-critical and said that we were doing about four out of 10. Of the others, most people were around six or seven out of 10, but I said—I will use this language, although I am not sure whether it is orderly—that our performance historically had been pretty crap. Compared with other countries and their interaction, I feel that we are not very good. In summarising, one ex-Foreign Office official—bless him—said that he appreciated my comments, and that I was “much less crap” than many of the other Ministers. I am sure he was not referring to the Minister present today, but was making an historical reference. I was hoping for something more complimentary from former colleagues, but there we go. We take praise where we can find it.

Understanding the Brexit deal for Africa and looking at a post-Brexit economic partnership arena, Brexit might be an opportunity to look towards a continental free trade agreement in the African continent. I was positive about and pushed EPAs, or economic partnership agreements, as a liberalisation of trade in Africa and with the European Union, but Carlos Lopes previously of the United Nations and now of the AU was critical of my position, because he felt, rather as we felt that Britain should not just look towards the European Union, that Africa should not be focused on dividing itself into four blocs that refer back to the European Union, which is a relatively stagnant body for future trade.

I am interested in what we can do to leverage bilateral negotiations with African countries to allow them to buy into trading with one another. I do not know whether it is even possible under World Trade Organisation rules for lesser developed countries to trade quite freely. There are some significant middle-income countries, but I am not quite sure whether we can get one deal that fits all or how things would happen.

I am fascinated to find out more about the Commonwealth Trade Ministers meeting in February or March, which could be really good for building blocs for Brexit. We need a Commonwealth strategy, a non-Commonwealth strategy and a strategy for the Department for International Development and the countries in which it operates.

I said I would mention Ebola. I do not want Ebola to fall off the table, as it were. I compliment HMG on what they did in Sierra Leone. One of my proudest moments in the Foreign Office was handing out Ebola medals, including to a lady who works in my private office, Rachel Chetham. She had gone to Sierra Leone and put herself in harm’s way to help those people. I was very proud of what she did specifically and what the Foreign Office and HMG did overall.

Looking back on the Ebola crisis, we should learn some lessons. In that one year of crisis alone the international community spent 15 times more than had been spent in all three of the Ebola countries of Guinea, Liberia and Sierra Leone in the previous 15 years. If we can invest early in the resilience of the health system, that would be incredibly positive. That point was made to me by Results UK about Ebola.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate. He makes a good point about what lessons can be learned. We should all be proud of how the Foreign Office, the Government and the national health service responded to the Ebola crisis and the support they provided. In that context, does he believe that there are opportunities to forge stronger links between the NHS, and indeed our universities and medical schools, and many west African countries?

[James Duddridge]

I have great respect for my hon. Friend’s views on health, and he hits the nail on the head. It is ludicrous for DFID to promote health when there is vast expertise in the Department of Health that we should leverage. The same goes for the Department for Education. We can do a lot more. We must also support parliamentarians. I recently met the Sierra Leonean Select Committee on health through the good offices of the Commonwealth Parliamentary Association. It was clear that it was not getting the leverage in its Parliament to move things forward and propose changes.

I have recently started engaging on tuberculosis, which I had really associated only with being a by-product of HIV. The World Health Organisation estimates that more than 800,000 people in west Africa fell ill with TB in 2015, and nearly 300,000 people died. The mortality rate in west Africa for TB is around 36%, which is double the global average. I am keen to work with the Global TB Caucus, and I encourage other hon. Members to do so. Parliamentarians can play a great part in dealing with TB, and that caucus mobilises parliamentarians from across Africa. Will the Minister see whether his good offices in west Africa—ambassadors and high commissioners—can be used alongside the Global TB Caucus to encourage parliamentarians of those nation states to get more involved and collectively work with us to deal with this issue?