Universal Health Coverage

David Simpson Excerpts

Wednesday 10th July 2019 Westminster Hall

[Alistair Burt]

I do, and I may say something further about vaccination in just a moment. The hon. Gentleman is absolutely right.

[David Simpson (Upper Bann) (DUP)]

Alongside the health and mental health issues of young people, there is grave concern in many countries about the trafficking of children and young people in camps and outside. Does the right hon. Gentleman agree—I am sure he will—that that also needs to be addressed?

[Alistair Burt]

Yes, the hon. Gentleman is correct. When I was in the main camp in Cox’s Bazar—colleagues will have visited it—with those who had been there a year, protected from the atrocities in Burma, I asked, “What happens next?”. I was told the biggest worries on the camp were: boredom and lack of things to do; education for the children; domestic abuse in the camp; and trafficking. That is a signal to all of us that just keeping people in a camp, protecting them from one thing but leaving them exposed to another, is a further tragedy.

Let us look at the state of the world’s health, concentrating on three areas in particular. The first is children’s health, where the picture is not all gloomy. Each day, 17,000 fewer children die than did in 1990, but more than 5 million children still die before their fifth birthday each year. Since 2000, measles vaccines have averted nearly 15.6 million deaths. Despite determined global progress, an increasing proportion of child deaths are in sub-Saharan Africa and southern Asia; four out of five deaths of children under five occur in those regions. Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.

Secondly, let us look at maternal health. Maternal mortality has fallen by 37% since 2000. In eastern Asia, northern Africa and southern Asia, it has declined by about two thirds, but the maternal mortality ratio—the proportion of mothers who do not survive childbirth—in developing regions is still 14 times that of developed regions. The need for family planning is slowly being met for more women, but demand is increasing rapidly. Again, we see that in the camps, where women who, in the countries they come from, had been excluded from reproductive health advice, perhaps for religious reasons, gain rapid access to it in the camps. That again is a lesson for the future.

Thirdly, I turn to HIV/AIDS, malaria and other diseases. In 2017, 36.9 million people globally were living with HIV, and 21.7 million people were accessing antiretroviral therapy, but 1.8 million people became newly infected with HIV and 940,000 people died from AIDS-related illnesses in that year. TB remains the leading cause of death among people living with HIV, accounting for about one in three AIDS-related deaths. Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which puts them at increased risk of acquiring HIV. It is the leading cause of death for women of reproductive age worldwide, and now the leading cause of death among adolescents in Africa, and the second most common cause of death among adolescents globally.

More than 6.2 million malaria deaths were averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global incidence of malaria has fallen by an estimated 37% and mortality by 58%.

What is DFID doing in these areas, and where are we going? The UK’s significant boost to the Global Fund, the combined effort to combat AIDS, TB and malaria, was announced by Prime Minister at the recent Japan summit. The 16% increase to our already generous contribution sets a new standard for others to follow, and I thank the Minister and all those behind him who worked on that over a long period. My friends at STOPAIDS and ONE and many others welcomed the achievement. ONE said:

“This is global Britain in action.”

There’s a phrase! It continued:

“It is fantastic to see the UK reaffirming its position as global health leader, working in partnership with other donors, countries affected by the diseases, the private sector and philanthropy to make the world a safe, and healthier place”.

However, we must ask the Minister how he plans to ensure that others follow. Will he outline any changes or developments in transition strategies, as nations take on more of their own responsibilities and work towards what, in such areas, is often a difficult process?

Let me say a few words about vaccination. Gavi, created in 2000, is a global vaccine alliance bringing together the public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. From 2016 to 2020, the UK is providing a quarter of Gavi’s funds. We are its largest donor, and have supported it since its inception. Gavi’s first replenishment conference was hosted by David Cameron in London in 2011.

As well as providing direct funding to Gavi, the UK was also instrumental in creating the international finance facility for immunisation, which raises funds for Gavi by issuing vaccine bonds on international capital markets. The UK also helped create the advanced market commitment for pneumococcal vaccines, which have helped protect millions of children in developing countries against the leading cause of pneumonia, as well as the matching fund, which encourages funding from the private and philanthropic sectors by doubling donations. That is my point about partnerships. It is always tempting to think that this work can be done by one sector or another alone. My experience is that that is not the case. Partnerships can contribute to the whole, but they need to be handled carefully.

Let me mention polio. As we know, it has decreased by over 99% since 1988, but transmission has never stopped in three countries: Pakistan, Afghanistan and Nigeria. There remains a risk of failure. We must thank the development and health workers who are responsible for vaccination. In particular, we recognise that in some countries they face genuine physical threats and loss of life.

In other countries, vaccination faces a threat from anti-vaccination campaigns, which are run for all sorts of reasons. It is essential that anti-science is combated by evidence of science and evidence of success. As far as I am aware, vaccination is about Edward Jenner and smallpox in the United Kingdom, and about Pasteur and others worldwide. It is not about big pharma trying to sell vaccines; it is a proven method of saving countless millions of lives. As we have learned to our cost, we might find a good argument lost for want of it not being made regularly. Let that not happen with vaccination.

Finally on polio, I must mention rotary. I am an honorary member of the Sandy rotary club—my father has been a member of the Bedford rotary club and Bury rotary club for many years—and we recognise that rotary has helped vaccinate 2.5 billion people in 122 different countries and given more than £1.8 billion over 30 years. I have met Judith Diment, the national representative, a number of times. We thank those in rotary up and down the country and abroad for their efforts and voluntary work.

Finally, on behalf of Save the Children and others who have written to me on this issue, I turn briefly to the high-level meeting. The first ever high-level meeting on universal health coverage will take place in September at the UN General Assembly. It is a critical opportunity to galvanise global momentum behind healthcare.

“The theme…is ‘Universal Health Coverage: Moving Together to Build a Healthier World.’ This…will be the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC, and sustain health investments in a harmonised manner.”

I am shamefully reading out the briefing from Save the Children. I am not pretending to claim authorship of this; I am acknowledging the support we get from our remarkable partners. The high-level meeting has the potential to be a transformational moment for children everywhere, but countries need to step up their efforts to tackle the biggest challenges in global health today, from ending the scourge of preventable diseases to reigniting action on stalled global immunisation rates, for the reasons I mentioned.

I know the Minister will have been presented with a series of challenges for the high-level meeting. Perhaps I could outline them. We hope that the Secretary of State will attend the high-level meeting. The UK should champion free-at-the-point-of-use health and nutrition provision, helping to deliver on the “leave no one behind” agenda and to ensure that we reach those furthest behind; it should signal its support for domestic resource mobilisation, which is essential for encouraging more countries to work on strengthening their systems; it should champion the full integration of nutrition and immunisation into national universal health coverage plans; and it should fund UHC2030 as the main institution that can make a difference in driving the UHC agenda and on accountability, with a focus on meaningful civil society participation.

I could mention much more. Sexual and reproductive health is vital. At the 2017 summit, we announced £250 million of support over the next four years. Access to sexual and reproductive health services is under increasing threat from some developed nations that ought to know better. It is essential that the United Kingdom follows its independent path, and is not browbeaten by any of its larger partners or friends into offering restrictive reproductive health facilities just because somebody else does not like them, for questionable reasons.

We must continue the work on neglected tropical diseases. We are protecting some 200 million people from 2017 to 2022 with support of £360 million. I have not mentioned anti-microbial resistance and the work of Sally Davies. She moves on from her post relatively soon, and we should thank her warmly for all the vital work she has been able to do. Ultimately, it will protect us all; if we cannot find answers, that threatens us all. I thank those involved in the collaborative work that we now do internationally with the Department of Health and Social Care, and I hope the Minister will be able to take that work further.

I could mention the contribution of water sanitation and hygiene—the foundation for good health. I have seen remarkable projects that the United Kingdom is doing around the world on that. There is no point having a global health system or a national health system if there is no effective sanitation. It makes a particular difference to young women at important stages in their lives. It is absolutely essential. Nutrition, one of my favourite subjects in the Department, is much underrated. It is really vital to ensure that nutrition is correctly promoted. There is a difference between feeding people and feeding them nutritiously, as I learned in my first week in DFID.