Covid-19: Vaccinations and Global Public Health

Lord Purvis of Tweed Excerpts

Thursday 9th September 2021 Lords Chamber

[Lord Purvis of Tweed (LD)]

My Lords, I am glad to follow my noble friend’s powerful contribution. I start by commending the noble Lord, Lord Boateng, on securing this debate and introducing it so comprehensively. He set the right tone of fact and passion.

We have heard from all sides of the House the depressing information and the passionate contributions to back it up. I was reflecting on one of those powerful contributions, that of my noble friend Lord Oates, and thought that I have been in the House for eight years but, long before that, it has been a common thread throughout British government policy that we are an upholder of the rules-based international order. The problem with this is that a great number of countries now say that those rules are set by countries that, especially in a time in a crisis, are less interested in an international order than they are in their own internal interest. The rules are out of date and biased towards the developed West. In the 70 years since the rules were developed, the world has never suffered a health emergency such as this pandemic. It had an opportunity to demonstrate that, in the age of sustainable development goals, the response of the richest nations, which set those rules in the first place, could be flexible enough to support the less rich nations and share the enormous burden of the pandemic. That opportunity has been missed.

The chart from Our World in Data by the University of Oxford, included in the Library briefing, showing the vaccine doses administered per 100 people across the globe, is as startling as it is shameful. The OECD tells us that high-income countries, which account for 16% of the global population, had negotiated supply agreements amounting to approximately half the world’s vaccine supply. The opportunity presented itself last year through the establishment of the COVAX scheme, as the noble Lord, Lord Boateng, indicated, for fair global access between countries, regardless of income level. However, a combination of vaccine nationalism and perhaps what some may consider an understandable desire among domestic populations in rich countries to return to normal as soon as possible and release themselves from lockdowns has meant that the negotiated purchase of rich countries to vaccinate their populations many times over has limited the capacity of the COVAX programme to get access to and then distribute those doses. I shall conclude on the most sobering consequences of those actions later.

As the combined charity briefings that we received say—and as the noble Baroness, Lady Sugg, highlighted—the hoarding of doses has only exacerbated the core source of the inequality in vaccine access. Only 1.4% of the 5 billion vaccine doses administered globally to date have gone to low-income countries. The growing number of destroyed doses in the United States is now outstripping some countries’ pulldown from the COVAX scheme. That is a shameful indictment of how we in the richest countries in the world are operating.

Buried in the rather self-congratulatory communiqué of the G7 held in Carbis Bay was an equally sobering detail in paragraph 10 on vaccine production. It stated:

“These include exports from domestic production, with at least 700 million doses exported or to be exported this year, of which almost half have gone or will go to non-G7 countries”.


So of the 700 million doses that the G7 communiqué said had been produced so far, less than half have gone to the non-richest seven countries in the world. That was, again a shocking indictment. Just this week, the relative ease with which two of the richest countries in the world, the UK and Australia, agreed a 4 million-dose swap, when compared with the relative difficulty for African Union members in drawing down already-manufactured doses available, is telling.

The UK approach seems to have been a combination of donation in cash and of surplus doses, as well as the encouragement of manufacturers to share and pool manufacturing. However, for a full year, as my noble friend Lady Brinton said, Members on our Benches have argued that the UK should have led on activating the Doha declaration and the TRIPS waiver mechanisms. We proposed Amendment 75 to the Trade Bill in 2020 so that the Government would activate that, and were supported by the noble Lord, Lord Collins, and others who took part in those discussions. It was a cross-party effort. In the Government’s response to my question about why Canada had activated the mechanisms in March 2020 but the UK chose not to, the Minister replied to me:

“The UK believes that a robust and fair intellectual property system is a key part of the innovation framework that allows economies to grow, while enabling society to benefit from knowledge and ideas.”


However, as the charities’ briefing to us highlighted, the Oxford AstraZeneca vaccine, if it had been openly licensed, as was originally intended by Oxford University, more suppliers would potentially have been producing vaccines to be distributed globally. Instead, the exclusive licence by AstraZeneca for producing the Oxford AstraZeneca vaccine at the Serum Institute of India has meant that there have been major problems with the rollout. Indeed, in some countries it has been halted altogether and others are paying much more, as has been referred to.

Let us not forget that the innovation framework which the Minister referred to in the Trade Bill processes was part-funded by overseas development assistance—so we would not have this innovation for the UK economy if it had not been for the ODA in the first place, and now, most depressingly, as we have heard, we are stripping some of that back. I hope that the Minister can update the House on our position. Are we still acting as a block on the Doha declaration and the TRIPS waiver situation? If the Government gave the reason a year ago, almost to the day, that their situation was preferable, where has been the benefit and where has been the proof that that approach has been better?

What has compounded this—and has also been raised in this debate—has been that at the same time that the UK has not been leading from the front in those areas, it has actively cut development assistance for health systems across many countries. Part of the awful consequences of the unlawful cut of 0.7% to 0.5% has been the reduction in support for health systems to distribute the vaccine, even if those countries were able to get it. Can the Minister confirm that reductions for health system support in developing countries will not be cut next year, as it has been cut this year?

Finally, on the consequences of this, as I highlighted, we have been warning that, without a different approach, there would be consequences. What are some of those consequences? On Wednesday of this week, COVAX slashed its forecast for doses available in 2021 by roughly a quarter. The assumption that was made during the UK hosting of the G7 was “the two billion”. We all saw the Prime Minister talking about “the two billion”. The 1.9 billion has now been reduced to 1.4 billion for the release in 2021, as a consequence of hoarding. The World Health Organization has formally asked for developed countries to delay booster shots as a way of lifting vaccinations to lower-income populations to 40%. Do the Government agree with the WHO’s position? Dr Tedros, Director-General of the WHO, said:

“I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers.”


However, most shockingly in today’s debate, we have heard that in June, the UK actually drew down 539,000 doses from the COVAX facility itself. Reportedly—I would like the Minister to confirm this—it has options for a further 27 million doses to be drawn down from COVAX. Can the Minister do one thing in response today: confirm that the Government will not do it? It is a clear signal that shows the international rules-based order is working for developed countries. The statistic that Africa as a continent so far has received 100 million doses in its entirety, and we have an option from COVAX just for our country for a drawdown of a quarter of that, surely cannot be acceptable. I hope that the Minister in his response will say that we will not do this.

--- Later in debate ---

[Lord Parkinson of Whitley Bay (Con)]

My Lords, I thank the noble Lord, Lord Boateng, for tabling this debate and all the noble Lords who have taken part. It has been urgent and passionate, but focused. As the noble Lord, Lord Browne, put it, it has demonstrated the

“rich seam of knowledge, wisdom and humanity in your Lordships’ House”.

It has been almost 19 months since the first cases of Covid-19 were reported, and nine months since widespread international vaccination programmes began. Yet, as noble Lords have rightly said today, too many people remain unvaccinated, particularly in the global south.

The rapid spread of the delta variant illustrates what we have known from the very beginning, and what the noble Baroness, Lady Lawrence, and others echoed today: nobody is safe until everyone is safe. Worldwide vaccination is essential to beat the pandemic, and UK science and diplomacy have been pivotal to the progress made so far. From the outset, Her Majesty’s Government have advocated rapid and equitable access to vaccines, and we have helped to drive the global response including, as noble Lords noted, by hosting the Global Vaccine Summit and through our presidencies of the G7 and the UN Security Council. We have been a champion for global action in this important area.

We have worked closely with our partners to design, fund and implement the COVAX Facility, which is an unprecedented initiative led by the World Health Organization, Gavi, or the global vaccine alliance, and the Coalition for Epidemic Preparedness Innovations, or CEPI. COVAX has brought together 191 countries to fund, develop, manufacture and deliver Covid vaccines, particularly to the global south. Its advanced market commitment is focused on providing safe and effective vaccines to up to 92 low-income and middle-income countries. From Benin to Zambia, from Bangladesh to Timor-Leste, it is delivering vaccines across the world.

It was launched at the Global Vaccine Summit that we hosted in June last year. The UK was among its founding donors and our total commitment of £548 million is among the largest from any donor. Thanks to our leadership at the UN General Assembly and our match-funding campaign, we helped to mobilise an additional $1 billion for COVAX from other donors by the end of 2021. The noble Lord, Lord Boateng, rightly talked about resources that have been made available—our work has helped to mobilise the resources that have been made available so far. By leading this early funding drive, we gave COVAX the purchasing power it needed to secure its first deals with manufacturers, which locked in the supply of internationally approved vaccines.

The first COVAX shots—vaccines from the University of Oxford and AstraZeneca—were delivered to Cote d’Ivoire and Ghana in March this year, just four months after the first vaccination in the UK: an historically unprecedented speed. From a standing start in June last year, COVAX has now delivered more than 230 million vaccine doses to 139 countries and territories, including 87 low and middle-income countries.

Manufacturing vaccines at scale is difficult, even for experienced companies. Delays in production have slowed progress, a frustrating fact that has rightly been echoed throughout today’s debate. However, the COVAX vaccine rollout is now poised to accelerate, with new funding, supply agreements and donation commitments in place which will provide 1.8 billion vaccines to low-and middle-income countries for early 2022. This will protect millions of front-line healthcare workers and other vulnerable people.

It is right to draw attention—as the noble Lord, Lord Boateng, and others have—to the discrepancy between the number of vaccines available in the UK and elsewhere in the world. The first duty of the Government, just as it is for all Governments around the world, is to ensure that we have sufficient vaccine supply for our own domestic rollout. I am sure that noble Lords would not disagree with that. We are ensuring that we have sufficient future supply for the UK’s needs alongside meeting our G7 commitments.

Alongside this, as noble Lords have said today, making vaccines available globally not only helps address the coronavirus pandemic in developing countries and is the morally right thing to do, but it will also reduce the threat posed by vaccine-resistant variants which are emerging and could pose a threat to us all. As my noble friend Lady Sugg put it, it is in our enlightened self-interest as a force for good in the world. Through our participation in COVAX and by sharing vaccines bilaterally, the UK is therefore also championing the need for access for all countries.

At the G7 leaders’ summit in Cornwall, the UK committed to sharing 100 million Covid-19 vaccine doses within 12 months, including 30 million by the end of this year. Of these, 80% will go to COVAX to accelerate support to countries in need. My noble friend Lady Sugg and others asked how many had been delivered so far. To date, the UK has delivered over 9 million doses—ahead of our target for the end of September—of which half are helping to meet the urgent need for vaccines in countries across Africa, south-east Asia and the Caribbean. UK donations are already helping to immunise health workers and those most vulnerable to serious illness from Covid, and to protect health systems. Our 100 million doses are part of the broader G7 promise to finance and donate a billion safe and effective vaccines worldwide by June next year.

My noble friend Lady Sugg and many others asked about the taking of vaccines from COVAX for UK use. As well as being one of the largest donors to COVAX, the UK was one of the earliest. That is pertinent here, because the UK opted into procuring the Pfizer vaccine through COVAX at a time when that was the only vaccine demonstrated to be effective and approved by the UK regulator. COVAX subsequently decided, after consulting those participating, to procure only a small amount of the Pfizer vaccine because it is, as noble Lords will know, difficult for many countries deploy, given the challenge of establishing the very cold temperatures at which it needs to be stored in the delivery chain. Our early funding to COVAX gave it the purchasing power it needed to secure deals with manufacturers to supply internationally approved vaccines for low and middle-income countries.

These practical points lead to questions posed by the noble Baroness, Lady Lawrence, and others, about donating vaccines with short shelf lives. We agree that adequate shelf life is important for all vaccines supplied to all countries. We are aiming for all donated and dose-shared vaccines to have a minimum of two months of shelf life, in line with Gavi and COVAX guidance. The partner Governments are free to refuse donations if they are concerned about expiry dates. They are working to ensure the rapid rollout of shared doses to priority groups, including people who need a second dose, and to prevent wastage. The WHO EUL vaccines are approved with a six-month expiry date at present, which may be reviewed by the WHO depending on emerging stability data.

The noble Baroness also asked what we are doing to speed up vaccine access and to tackle the problem of sell-by dates. We are working through the governing boards to ensure that Gavi and World Bank funding is available for in-country delivery and that it is approved and dispersed in a timely manner. We are also supporting COVAX to become less reliant on India-based manufacturers and to diversify its portfolio to manage risk.

The noble Baroness, Lady Brinton, asked another practical question about new variants that may evade vaccine immunity. If such a variant emerges, it should be possible for manufacturers to update vaccines to protect against it, but this means scaling up vaccine manufacturing and rolling out vaccines as quickly and widely as possible. In addition, as more people get vaccinated, we expect virus circulation to decrease. This will lead to fewer mutations, but of course we must track those mutations and variants closely to detect them, and that means carrying out genomic sequencing globally and sharing data.

The noble Baroness, Lady Bennett of Manor Castle, referred to the UK’s role in the development of the AstraZeneca vaccine. So much of what we have been debating today would not have been possible without the extraordinary work of our scientists. The UK’s scientific excellence and co-operation has enhanced collective knowledge about the virus and led to pivotal breakthroughs. The Government’s role in supporting AstraZeneca is well known and we are proud of the helping hand that we gave. The advance there has become an extraordinary gift to global vaccination efforts. More than 1 billion doses have already been delivered at cost, with no profit, with around two-thirds of them going to lower-income and middle-income countries. That has saved countless lives across the globe.

We also supported wider international collaboration to develop vaccines. In March last year the Prime Minister announced £250 million of funding for CEPI to accelerate vaccine development against global threats including Covid-19. CEPI has supported 11 vaccine candidates, including the approved Moderna vaccine, as well as Novavax, which has showed positive results in clinical trials. The UK will host a replenishment conference to raise funds for CEPI’s crucial work on vaccine development in March next year, helping it to realise the aim of making vaccines against new health threats, including new Covid variants, in just 100 days.

In addition to our support for vaccines, the UK is a world leader in viral genomic sequencing, which will be important for the reasons I outlined in response to the question from the noble Baroness, Lady Brinton. This has proved crucial in identifying the emergence of new variants and will be essential to ensuring that the vaccines remain effective. Public Health England is already working with seven countries and the Africa Centres for Disease Control to build their capacity in genomic sequencing.

A number of noble Lords raised the issue of manufacturing. The rollout of vaccines has raised important questions about TRIPS, the agreement on trade-related aspects of intellectual property rights, which the noble Baroness, Lady Chakrabarti, and others focused on in particular. We have engaged in discussions on intellectual property and a possible TRIPS waiver at the WTO and we will continue to engage constructively with the US and other WTO members, as the noble Lord, Lord Boateng, and others urged. We have not yet, however, seen conclusive evidence indicating that the removal of intellectual property protections would lead to the scaling up of production or the improvement of the supply of Covid-19 products, including vaccines. At this point we remain unconvinced on how beneficial a waiver would be.

As a practical point, any negotiations at the WTO on a waiver would need unanimous support, which could take a long time. While we will continue to engage in IP discussions and review the merits of any proposals submitted to the TRIPS council, we must also continue to push ahead with pragmatic action now, including voluntary licensing and technology transfer agreements for vaccines, support for COVAX, as I outlined, and solutions to production bottlenecks and supply chain issues. The UK is also co-sponsoring the Ottawa group’s trade and health initiative. This aims to increase co-operation among WTO members, keep medical supply chains open and lower trade barriers, getting vital supplies, including vaccines, to those who need them most.

The voluntary licensing approach taken by the team at Oxford and AstraZeneca has had our full support, as has their collaboration with the Serum Institute of India to scale up manufacturing for global supply. We welcome the work of the new Partnerships for African Vaccine Manufacturing, which is developing its road map to manufacture vaccines in Africa and engaging to identify opportunities for partnerships. We have provided technical support to Biovac, a vaccine company in South Africa, to develop an investment case, which helped secure financing to produce Covid vaccines there. We are giving similar support to the Institut Pasteur in Dakar, to companies in Senegal and to the Government of Morocco.

Noble Lords also focused on questions of distribution, and we recognise that distribution, particularly in hard-to-reach locations, is a critical challenge in many countries. Investment in delivery is vital in getting jabs into people’s arms. Multilateral development banks are playing a central role in funding health systems to deliver vaccines, treatment and testing while maintaining other essential services, and the UK has led engagement with multilateral banks to strengthen co-ordination with COVAX and speed up the processes for applications and release of funds. The FCDO is also working with UNICEF and other humanitarian partners to ensure that planning and finance are in place to address the challenges of distribution in difficult environments.

It is extremely difficult for charities and healthcare workers safely to provide jabs to people living in conflict zones, so the UK used its presidency of the UN Security Council in February to secure unanimous support for a resolution calling for ceasefires in conflict zones to enable vaccine delivery. We continue to work with our international partners to monitor and support the implementation of that important resolution.

[Lord Purvis of Tweed (LD)]

I am not sure whether the Minister will be coming back to the UK and COVAX. He has been asked very specific questions: to confirm whether in fact the UK drew down 539,000 doses in June and whether we have in fact negotiated options for a further 27 million doses. He was asked whether the Government will confirm that they will not draw down those 27 million doses.

[Lord Parkinson of Whitley Bay (Con)]

I cannot confirm that number, but I outlined that we drew down some of the Pfizer vaccine for the practical reasons that I gave—the difficulty of distributing and using those doses—with the agreement of those taking part. I fear I cannot give the commitment that the noble Lord asked for today, but I will certainly take his questions and those from other noble Lords back to the Vaccine Taskforce and will ensure that all noble Lords who have taken part in the debate get the answer to that.

The goal to which we and our G7 partners have committed—to vaccinate the world in 2022—is a monumental one. Much has been achieved already but, as today’s debate has powerfully underlined, we know that there is much more to do. The points noble Lords have raised today, particularly on manufacturing and distribution, are significant issues, which the UK is working with our partners to tackle.

International collaboration remains the key to ending this global pandemic, and we will continue to work with our international partners through the autumn, including at UNGA, the G7 and the G20, to support the G7 commitment to vaccinate the world in 2022. The international community must work together to get vaccines to those who need them around the world, and Her Majesty’s Government are determined to do all we can to ensure that that happens.