Covid-19: Vaccinations and Global Public Health

Lord Browne of Ladyton Excerpts

Thursday 9th September 2021 Lords Chamber

[Lord Browne of Ladyton (Lab)]

My Lords, I too congratulate my noble friend Lord Boateng on securing this debate. He made an excellent speech in introducing it. From the quality of the contributions thus far, he also appears to have exposed a rich seam of knowledge, wisdom and humanity in your Lordships’ House; we owe him a debt for that.

On 15 October 2020, I asked a supplementary question about vaccine equity. Referring to expert warnings—there were many then—that the COVAX initiative offered no guarantee that Covid-19 vaccines would reach the world’s poor, I asked the then Minister for Overseas Territories and Sustainable Development at the FCDO, the noble Baroness, Lady Sugg, whether she was aware that a team of global experts led by Ezekiel J Emanuel, a world-class, distinguished medical ethicist, had proposed a new model ethical framework for global vaccine allocation, dubbed the “fair priority model”, and if so what was the Government’s assessment of it.

In the experts’ words, this framework

“is the best embodiment of the ethical values of limiting harms, benefiting the disadvantaged, and recognizing equal concern … Ultimately, the model offers governments, international organizations, and vaccine producers a practical way to fulfill their pledges to distribute vaccine fairly and equitably”.

Graciously, the noble Baroness restated her belief that

“the right way forward is for the world to come together through the COVAX commitment”.—[Official Report, 15/10/20; col. 1186.]

She offered to look at the fair priority model and come back to me in writing. I am afraid I am still waiting for the promised letter, but there may be a simple explanation for that omission. On 25 November, the noble Baroness, a Minister of ability and admirable integrity, quit after Rishi Sunak announced that foreign aid expenditure would be cut from 0.7% to 0.5% of national income. Interestingly, her former post still exists with all its responsibilities, but is vacant; she is indeed irreplaceable.

I expect that the response to this debate will be that COVAX will deliver, but the truth of the matter is that it is not. We have a situation now in which only 1.9% of people in low-income countries have received at least one dose. Today, CNN reports that only

“330 million doses have been released for delivery to underserved countries through COVAX”,

while the ambition for this year was 1 billion. In August only 12.6 million of the 4.46 billion doses administered globally were in low-income countries. On 4 August, the WHO director-general had to issue a plea for a moratorium on third-dose boosters in high-income countries. These facts prompted the Lancet, for a second time, to add its voice to growing demand for equitable access to vaccines.

As we have heard, the mantra for the Covid pandemic is:

“No one is safe until everyone is safe”—


and with good reason. Unmitigated transmission means rampant viral replication and the likely emergence of new, more transmissible variants that could overcome natural or vaccine-induced immunity. In the words of the Lancet editorial:

“A perverse social experiment would be to allow the virus to continue ripping through low-income and lower-middle-income countries … where people tend to live in close proximity and infection prevention strategies are difficult to implement … while seeing how quickly”


high-income countries

“can redesign vaccines to counter yet another variant that has emerged”

from low and middle-income countries.

“Beyond the moral argument, this approach would make no economic sense”.

Rich countries

“rely on raw materials and intermediate goods”

from low and middle-income countries, and if they

“cannot provide these materials because their populations are dying from COVID-19 or are prevented from working because of lockdowns”

how long do we think we can keep our own economies running?

On 1 September, for similar reasons, Professor Emanuel re-entered the fray too, this time in the company of 80 other leading world figures, who published a letter in the FT. He urged world leaders to convene a global summit during this year’s UNGA to boost vaccine availability. They wrote that

“inequitable access to high-quality vaccines and capacity to administer them is prolonging the pandemic and destabilising economies and societies around the world.”

The briefings we all received for this debate are excellent. They are redolent with evidence of rampant injustice. My noble friend Lord Boateng asked for specific steps to remedy this injustice, as did others. I support them all, but I am struck in my reading by the constant theme from experts that a global pandemic needs a global plan of attack—why did we not think of that ourselves? To boot, it needs one that is developed within an ethical framework, to secure the commitments and actions needed to close the vaccine supply and capacity gaps, to increase countries’ distribution and delivery capabilities and to strengthen health systems and, importantly, our preparedness for the next pandemic.

It appears that not only do we no longer have a specific Minister who holds the responsibilities that the noble Baroness had but we have no comprehensive plan of response to this challenge either. I invite the Minister to urge the Prime Minister to join the call for a global summit during the UNGA and, in the meantime, to study the fair priority model framework, consult its authors and assess its merits and, if he can find the time to do so, to write the letter that I have now been waiting for for coming on a year.