World Immunisation Week

Philippa Whitford Excerpts

Thursday 2nd May 2019 Commons Chamber

[Rory Stewart]

Absolutely. It is grossly irresponsible and, I am afraid, profoundly and disturbingly misleading, and even ignorant, to go around doing that. It ends up stoking public paranoia and fear, and leads to the unnecessary loss of life. From the beginning, the story of immunisation—and, indeed, the story of international development—has often been about challenging public perceptions and irrational fears, and following through. There are reasons for that. The heart of what immunisation is carries within it the seeds of that challenge. The basic idea of immunisation is, of course, to make somebody sick to make them better. From the very beginning, that has involved not only challenging public fears, but something that Governments find quite difficult: taking risks and working, genuinely and collaboratively, internationally.

Although we tend to pat ourselves on the back a great deal in this country, immunisation was, of course, not a European discovery at all. It was a Chinese discovery of the early 16th century. Chinese public health officials, or their 16th century equivalents, went into villages and sneezed into people’s mouths, which rapidly reduced the mortality rate by tenfold or twentyfold. The normal mortality rate for smallpox was 20% to 30%, but remember that that reduced mortality rate under the new technique was still between 0.5% and 2%, so the procedure was very risky. Moving on with my international point, this immunisation practice arrived in Britain in about 1700.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

rose—

[Rory Stewart]

I give way to the honourable and learned doctor.

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[Dr Whitford]

I, too, welcome the Secretary of State and congratulate him on his new post. It was actually a bit more dramatic than that: variolation involved cutting into veins and putting in smallpox scabs. That did indeed make people ill, and then they were immune. However, modern vaccines do not do that—they are no longer based on making someone ill. There is a fallacy that the flu vaccine will give people flu, but it does not. Modern vaccination is no longer based on giving someone an illness to protect them from worse.

[Rory Stewart]

Moving rapidly forward, the key to this is scientific advances whereby things become safer all the time. Immunisation moved from China to Britain, and in 1799 in Britain, there was the development of vaccination—in other words, the use of cows to do this. There were then the developments of Louis Pasteur in the 1880s in France, and then of course the amazing developments in the post-war period.

Throughout all that, we see something that really matters for the Department for International Development, a Department that co-operates with other countries and puts science at its heart. This story, which in its early history links China to Britain, Britain to France and France to the United States, continues today with Gavi, the global alliance. In all this work, the same themes occur at an accelerated rate. We have, remarkably, achieved the eradication of smallpox, and we are close to a 99% success rate on wild polio. But it is on Ebola that we see most clearly today the security risks, the scientific advances, the complexity and the international co-operation.

In 2015-16, DFID, working with other international partners, began to develop—initially in Guinea, and then, through academic partnerships, in the United States and Canada—the first attempts at inoculation against Ebola. Ebola, like all such diseases, finds no borders, and that has a direct connection with justifying the international aid budget here in the United Kingdom. Perhaps the easiest way of explaining to people why we have an international development budget is to point out that had that disease taken off in Liberia and Sierra Leone, given modern transport mechanisms it would have found its way rapidly to Europe and ultimately to the United Kingdom, and people would have been dying here.

That investment, which seems quite complex, and which often—particularly in the case of diseases such as wild polio—involves spending a surprising amount of money on tracking down the last few cases, is the kind of investment that only a Government can make and only an international aid budget can provide. Why? Because this is not a normal economic case. If an individual were asked whether they wanted to spend a lot of money on inoculating themselves, they might say no, and on the basis of a traditional cost-benefit analysis, one might ask, in relation to that individual, “Why are you spending so much money?” The point is, however, that that individual is part of a community, and that community is part of a broader nation. If the disease takes off, it will begin to infect hundreds of millions of people. At that stage, significant investment in preventing someone from getting polio, for example in rural Afghanistan or Pakistan—there can be quite surprising investments, ending up with the spending of hundreds of thousands of dollars on tracking down the last few cases—is critical if it actually prevents millions of people from getting the disease.

The same applies to Ebola. The issue raised by the hon. Member for Rhondda (Chris Bryant) about how we deal with fears is central to the tragic death of a very courageous doctor, who was killed when bringing a vaccine and treatment to people in the eastern part of the Democratic Republic of the Congo. He originally came from Cameroon. Part of the same story is the killing of public health nurses on the Afghanistan-Pakistan border when they were trying to inoculate people against polio.

In the solution to this, then, is human courage, and in the driver of this is human suffering, but in the broader story are things that we have to communicate. Pharmaceutical companies, which we are often nervous about, can play an incredibly positive role if properly harnessed. Merck, which is developing some of this vaccination, has a structured contract with Gavi to deliver 350,000 vaccinations, on hold, at any one time. We have reduced the price of vital drugs from $4 to $2, which means that we have access to twice as many people. We have worked out how to use the fact that Britain is the global leader in Gavi. Britain puts in 25% of the funds for this extraordinary global programme of vaccination. The second biggest contributor is the Bill and Melinda Gates Foundation, and the third biggest is the Government of the United States.[Official Report, 7 May 2019, Vol. 659, c. 6MC.] All that makes our money go much further, and tied into it are the World Health Organisation and some of the best universities and researchers in the world.

In telling the story of immunisation, we are telling the story of international development, and in telling the story of international development, we are telling the story of international co-operation: the fact that researchers from China and Europe can come together; the fact that brave health workers on the ground in eastern DRC risk their lives delivering vaccines; and the fact that a single child in eastern DRC who was saved from death, with their family saved from the horror that they would have experienced, can be traced back to money spent by British taxpayers, alongside people from other countries. It has meant bringing in the private sector, the best academics in the world and, above all, brutal, bruising practicality: how do we make sure that the refrigeration is right in eastern DRC so that the vaccines survive in transport; how do we get the electricity to ensure that the vaccination works; how do we deal with communities, politics and conflict to get to the front line; and how do we understand the political and economic structures on the ground so that we can make sure that the local mullah or village chief in Afghanistan will not block the arrival of the polio vaccine in that community?

Get all those things right and we protect Britain from dying from Ebola. Get all those things right in the world of climate change and we can potentially save the planet. Get all those things right and we can show how our international aid budget can touch everyone in this country, re-energise a younger generation, and prove that if we can sometimes do less than we hope, we can do much more than we fear.

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[Alistair Burt]

Absolutely, and I think that that is the model to take forward for the development of healthcare systems. We need to bear in mind the nature of that relationship, because it will be absolutely key.

I am proud of the United Kingdom’s support for Gavi. We are its largest donor, and we are

“currently responsible for 25% of its budget. The UK has committed £1.44 billion to Gavi from 2016 to 2020, including funding to its innovative finance mechanisms. This investment fully delivers on the UK commitment to immunise 76 million children and save 1.4 million lives by 2020.”

I am grateful to the team for the briefing it gave me for the meeting with the all-party group, which I have kept. Credit where it is due: that was a quote from the Department’s own briefing. The replenishment conference is coming up. There was very little I could say about that when I was a Minister, but speaking from the Back Benches, I can say to the Secretary of State that I am sure we will sort it out and I hope he will be really, really generous. He can be absolutely sure that I will be on his tail if we do not make a serious commitment to Gavi, because it really delivers. Seth Berkley delivers for us, and the visit to Bognor Regis in the past few months when he saw the work being done here was really important. I hope the Secretary of State will bear that in mind.

Vaccination does more than the obvious function of preventing diseases in children. Its background, not only in the health system but in the development of countries, is fundamental. A healthy child goes to school, is able to learn, and grows into a productive adult. Unless that basis for immunisation is clear, so much development work is stymied right at the beginning. Immunisation is part of a sustainable, integrated health system. The reckoning is that the overall impact is that every £1 spent on immunisation leads to a £16 saving in terms of subsequent health care bills and people’s inability to interact effectively in the community.

Before I deal with the threats, I want to remind the House of what this is all about, and I will talk briefly about measles, because measles outbreaks have suddenly returned in recent times. The tendency in the United Kingdom is to accept measles as a rudimentary childhood suffering that is easy to go through, so the misery of measles is forgotten. A recent piece in Forbes Magazine talked about the problems of anti-vaccination and included a quote from Roald Dahl. His oldest daughter, Olivia, died of measles in 1962 at the age of seven, and the article quotes his words:

“one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. ‘Are you feeling all right?’ I asked her. ‘I feel all sleepy,’ she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.”

That is how real it is. When we talk about vaccination and take on those who are concerned about it, that is the reason.

Measles has largely died out in the United Kingdom, but it is coming back in different places, and it will come back here unless we challenge it. The United States declared measles eliminated in 2000, but there have been 695 cases this year, mostly concentrated in three outbreaks and mostly concentrated in small tightly knit communities. The rise in measles cases in both the developing world and the developed world is really frightening, and it must be challenged.

When I was first made aware of the rising figures, I had a discussion with my ministerial team about how to deal with it. I have to say that I was pretty gung-ho and thought, “We’ve really got to take this on aggressively.” The team, to their credit, tried to scale me down from that, saying, “There are different reasons for the threat to vaccination, and you need to handle them differently.” That was good advice, and my sense is that the challenges are as follows. The first is the straightforward matter of incomplete coverage—the millions of children who do not currently get vaccinated. Gavi needs to look at where it is developing its resources, but it is committed to go to the poorest areas, and we need to keep that up. We need to deal with the areas where coverage is not great, but there are other threats, too.

We can divide anti-vaccination into several categories. First, there are religious reasons. I am unaware of any tenet in any major religion that suggests that vaccination is inherently wrong. It is quite the reverse. As a practising Christian, I believe that one of the revelations of God has been to give us the skills to discern what harms us and what helps us. That is where science and medicine come in, and vaccination is part of that. We have been given the skills to be able to help our God-given children and keep them healthy.

No major religion contradicts that, but sects in various religious denominations are against it. When we do get an outbreak, such as in an Orthodox Jewish community in New York, it runs around quickly. The United States has seen recent outbreaks in the Orthodox Jewish community, among Slavic migrants, in the Amish community in Ohio and the Somali community in Minnesota, because measles spreads quickly in a small, closed group and then it affects anyone else they come into contact with outside who has not been immunised. The United Kingdom should urgently work with religious leaders worldwide and say, “Please make a declaration to ensure that none of your leaders—none of those who promote a faith under your auspices—are in any way in any doubt about the value and importance of vaccination and say that there is no religious tenet against it.”

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is the right hon. Gentleman aware of the terrible measles outbreak in Israel? Many rabbis, including those in Orthodox communities, have come forward to point out that the Torah talks about the preservation of one’s own life and the lives of others. They are trying to counter what has almost become a habit, rather than something that is based on holy writings.

[Alistair Burt]

The hon. Lady is absolutely right. I have not been able to discern whether a poor El Al flight attendant who fell seriously ill in the past couple of weeks has recovered, but I am aware of that outbreak. Religious leaders, rather than Government figures or civil spokespeople, need to make the case. We can deal with the religious factor by understanding the fears and trying to descale them so that no one can go to a religious group and find some reason to campaign against vaccination.

A second reason might be conspiracy, which has certainly been an issue in Pakistan and Afghanistan, where those trying to disrupt the vaccination movement say that it is western influenced and designed to harm. All that can be done in response to that is more and more information and transparency, and Governments do have a responsibility there. It must be made absolutely clear that health workers are not to be used for any other purpose, so that there is no risk of any political contamination. We are aware that it has happened, but it must not happen again. If health workers are not to be targets, they must purely be health workers.

Thirdly, there are medical reasons why a vaccination may not be appropriate for a particular child. These are exceptionally rare, and there is scientific evidence to back that up and it must be handled purely through the medical profession. We have been asked this past fortnight to listen to the science. Whether on climate change or anything else, we should listen to the science. When it comes to medical reasons why vaccination may not be right, listen to the science and recognise how incredibly rare those reasons are. Someone is much more likely to protect their child by vaccination and immunisation than not.

The last reason is misinformation, which is really scary. This is part of the phenomenon of people trying to pull down authoritative sources of information—the mainstream media, experts or whatever. If someone wants to disregard something to try and minimise its impact, it is becoming popular and easy to claim that their own personal experience or anecdotal experience somehow trumps what people are being told by those from scientific backgrounds who are making a serious case. We are seeing an awful lot of that.

The issue follows from the false, discredited and debunked information about the MMR vaccine that came from a doctor in the United Kingdom some years ago, which is used by so many. The issue seems to be extremely prevalent in the United States, where picking up ideas that have little foundation but can be used to inflame people seems to be almost a way of life for some. It is seriously dangerous and anti-expert. It is based on a false dilemma between liberty and the state, which we can see creeping into arguments here on social media. It is all highly dangerous.

Now, there may be other ways of combating the other problems that I have mentioned, but I am afraid that we do have to be aggressive on misinformation. We have to be vigorous and gung-ho. It is nonsense, and we must be clear about taking it on. False information and those who provide it must be exposed, and those who have fallen victim to it must be understood and given as much information as possible.

I recently saw a good piece on the “Victoria Derbyshire” programme in which a couple who were uncertain about vaccinating their child were given the opportunity to question people about it and, in the end, they came to a different conclusion. It shows how worried people are, and we should understand that, but there are answers to their worries and we should not be afraid of making sure people have those answers. We must be clear about those who are deliberately spreading misinformation, who are connected to arguments that have no basis or who are trying to bring together issues of liberty and public health, which is particularly prevalent in the United States, where almost anything provided by the state is somehow suspect—a view I do not hold, as most in this House know. Public health programmes are good, and those who say it is all the state trying to control people are just wrong. That has to be challenged by every means possible.

Immunisation is good. It works and it has proved itself. It is one of the building blocks of world strength and world health and we lose it at our peril. Recent years have taught us that, just because we think something has become part of mainstream culture and is accepted by everyone, it does not mean that the argument does not have to be made over and again. We have lost valuable things in recent years by not vigorously making the argument for them because we thought everyone understood the argument—I will not go into detail—but we are not going to lose the argument on health and immunisation. If we do so, we would put ourselves at risk. We know it is safe and we know it is good, so let us not leave it to others to make the argument. Let us make the argument ourselves. I know that I can completely count on the Secretary of State and the Minister of State to do that job, and I know that I can rely on this House to do the same.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome this debate in Government time on such an important topic as World Immunisation Week. It is just a wee bit tragic that it has been scheduled today, clashing with local government elections, and that therefore the Chamber is so empty when I am sure that many Members would have liked to have taken part.

This topic is of particular interest to me, and I am glad to see in the Chamber other members of the all-party group on vaccinations for all, which I chair. As the Secretary of State mentioned, the history of vaccines goes back long before Jenner to the Chinese empire. Indeed, it was common practice to carry out variolation in the Ottoman empire, too. There is documentation from travellers and the East India Company going back 100 years before Jenner.

At that time, smallpox epidemics were common and a third of people who caught it died. It is hard to get our heads around those numbers. Smallpox left survivors very scarred and damaged, and Jenner followed up the observation that milkmaids were noted for having beautiful skin. Of course there was the fallacy that milkmaids bathed in milk, and there is all the imagery of Cleopatra having bathed in milk, but it is simply that milkmaids tended to catch cowpox, which protected them from smallpox. The word “vaccine” comes from the Latin for “cow.”

Smallpox was declared eradicated across the world in 1980, and we are within touching distance of eradicating polio. Eradicating a disease from the world is an incredible achievement and could not be done using any tool other than vaccination.

The vaccinations for polio came in after five huge epidemics, which were visible here in the UK, between 1945 and 1960. Instead of about 500 or 600 young children a year being affected by polio, the figure went up to 5,000 or 6,000, with about 750 deaths. We got the Salk vaccine, the injectable vaccine described by the right hon. Member for North East Bedfordshire (Alistair Burt). I was not quite born when that vaccine came in, and I was lucky enough to get the Sabin oral sugar cube version. The oral vaccine had the huge advantage of being able to vaccinate large numbers of children very quickly and, because it was excreted in faeces, it spread protection within communities—it was an accelerated way of carrying out vaccination.

The Global Polio Eradication Initiative was established in 1988 and, as has been mentioned, the Rotary Club played a huge part in the UK. At that time, there were still 35,000 cases worldwide every year. Some 2.5 billion children were vaccinated under the programme, and at least 10 million cases of paralysis have been prevented.

Last year, there were 35 cases, and as we have heard, they were predominantly in difficult areas on the border between Afghanistan and Pakistan, where a friend of mine worked for UNICEF for several years—the area is very challenging. The other area where we are not sure what is happening is northern Nigeria, because it is difficult to get data. There has always been this problem of warzones, of extreme poverty and even of communities that we hardly know exist.

The last case of wild polio in the UK was in 1984, and at that time we changed back from the oral vaccine to the injectable vaccine because it uses a dead strain that is not attenuated or weakened and cannot induce polio. As has been said, the UK can be proud of being the lead contributor to Gavi, the Vaccine Alliance, and to the global health fund—the UK is a big supporter of many of these programmes.

The last 10 years, which are being called the decade of vaccines, have seen at least 20 million lives saved, and vaccination is the single most successful health intervention ever. People will say that that is clean water, a civil engineering intervention that does bring health, but if we look at the returns and the lives saved, vaccination is even more successful.

The problem is that uptake is falling. We are lucky in Scotland to have managed to keep the uptake of childhood vaccinations above the World Health Organisation’s recommended level of 95%, which is critical to creating community protection for children who are very young, for babies who are only a few months old and are not yet vaccinated, and for those who are vulnerable for various reasons and cannot be vaccinated.

Unfortunately, the uptake of many childhood vaccines has dropped below 95% in England because of what is described as “vaccine hesitancy”. As has been mentioned, the UNICEF report refers to about half a million children in the UK being unvaccinated. That is a dangerously large pool of children and, now, of young people and perhaps even middle-aged adults who are exposed to catching these diseases.

People often put that down to the anti-vax campaign but, actually, Public Health England’s research suggests that the situation is much more complicated. When it surveyed parents, it found that only quite a small percentage had a strong anti-vaccination feeling. There are also issues of complacency and of access, which we need to tackle so that we shrink it down, as well as the need to tackle head on the fake news we see on social media.

There is complacency simply because vaccines are a victim of their own success. People do not see the awful impact of these conditions. As the right hon. Member for North East Bedfordshire mentioned, people think of measles as trivial, like a 24-hour flu—they have forgotten what it means. People do not see many cases of polio, but I remember it from my childhood. I was lucky enough to visit vaccination projects in Ethiopia with Results UK. When we pulled in to get petrol, we saw a young man, aged about 30, with obvious flaccid paralysis from polio, and it hit me between the eyes that that is something that we do not see. If people saw the results of polio, they would never think of withholding the vaccine from their children.

We think that there are not great risks from infectious diseases and that antibiotics will treat them, but air travel brings the risk of pandemics. The Secretary of State mentioned Ebola, and when we had a huge Ebola outbreak a few years ago, work was started on a vaccine that has been used to prevent recent outbreaks from reaching the levels we saw in Sierra Leone five or six years ago.

It is important that we realise that antibiotics are not a solution. They do not work on viruses. The only option to prevent dangerous viruses is to use vaccines, and there is also increasing antibiotic resistance.

On access, as the shadow Secretary of State mentioned, across the world we are patting ourselves on the back for the fact that in poorer countries 85% of children are getting the basic vaccines. However, we have stalled—the figure is not climbing and has been at that level for a long time. When the all-party group produced its report on vaccination for all in the developing world, I was shocked to find that only 7% of children in such countries are given the full WHO 11 vaccines.

As global players prepare their next strategies and funding plans, and with the eradication of polio on the horizon, this is a time to step back and think about how we are going to help, across the world, to eliminate more of these diseases. We need to aim for the fully immunised child. We need to come up with strategies to deal with remote areas and warzones, and research is a crucial part of that. It is brilliant to read that the trial of a new malaria vaccine is beginning in Malawi. It is expected to be only 40% successful, which is quite weak for a vaccine. However, malaria is so widespread that it causes more than 400,000 deaths a year, so making 40% of children immune to it will, along with the other manoeuvres and actions being undertaken, such as the use of nets and anti-mosquito treatments, help to bring that number of deaths down.

We face access issues here in the UK. A busy parent may have several children and although the first baby may get all its immunisations, the second and third might not. That can be an issue in some of the religious communities that tend to have large families. Someone who is having their seventh, eighth or ninth baby may struggle to look after the others and get the new baby to its vaccinations. These people need easy access to their GP, nurse or health visitor, and those people need to have time to answer parents’ concerns. We are talking about one of the first big decisions a parent will make about their child and they are seeing all this swilling anti-vaccine rhetoric on social media. They need to be able to ask questions, and then not to be patronised or dismissed, but to have their questions answered.

Although uptake in Scotland is high, at above 95%, when we drill down into the situation, we also see variations in areas of deprivation and in religious and cultural communities. We are therefore not complacent, and Scotland is embarking on a vaccination transformation programme, because keeping the rate high, and indeed improving it, will require concerted action. Sometimes this is about policy decisions. When the meningitis ACWY vaccine was introduced for 14-year-olds at school, Scotland carried out a four-year catch-up, immunising 14 to 18-year-olds, whereas Wales did a two-year catch-up. Sadly, the advice in England was that teenagers, young adults and university students could go to see their GP. At a recent event, it was reported to me that uptake was only 40%—after all, how often are teenagers at their GP? This is not a concerted way to proceed. I do not know whether the decision was based on cost, but analysis of the cost-effectiveness of vaccines shows that they are so cost-effective as to justify any process that will actually raise uptake, even home visits to try to help a busy mother to get her babies vaccinated.

The third thing to mention is the anti-vax campaigns. As I say, Public Health England surveys suggest that we are talking about a relatively small proportion of people, and the situation does seem largely to stem from the MMR—measles, mumps and rubella—vaccine. The vaccine is 97% effective, but uptake fell dramatically after Andrew Wakefield’s paper in 1998. He has since been struck off the medical register and his research was completely discredited, yet he is being given a platform in the US again as President Trump is promoting this in America. While uptake has improved, a cohort of teenagers were not given the MMR vaccine when they were babies and they are particularly vulnerable.

As Members have heard, people think that measles is trivial, like a 24-hour flu, yet 2.5 million people died from it in 1980. The figure came down to 73,000, its lowest point, in 2014, but last year the number of worldwide deaths from measles had increased to 110,000. Sadly this year, by only 2 May, 112,000 young people worldwide have lost their lives to measles. It is literally the most contagious disease, and if there is a local outbreak, 90% of unvaccinated people will get infected—it is unavoidable. People are incredibly infectious before there is a rash and the disease is spread simply in the air. During a recent outbreak in America, it was found that patient zero had infected more than 40 people before he even knew he had measles. Last year, we saw 82,000 cases in Europe and 72 deaths. There will a similar number of encephalitis cases, as was mentioned by the former Minister, the right hon. Member for North East Bedfordshire. The disease leaves children with brain damage, and it can leave them blind and deaf. Those are not minor sequelae, but life-threatening things.

In England, thankfully, there have not been any recent deaths due to the disease, but whereas in 2017 there were 259 cases, that had increased nearly fourfold to almost 1,000 last year. In Scotland, we had only two cases, and they involved people who had been travelling outwith the UK. That did not start an outbreak, because we had 97% uptake of the vaccine, so community protection was in place and there was no opportunity for the disease to spread. Community protection is crucial. I know that people use the term “herd immunity”, which sounds awful, because it sounds like animals, but we are talking about community protection that allows us to protect our babies under one year old and our most vulnerable.

Even the uptake of the meningitis vaccine, something parents were campaigning for in this House just two years ago, is now only at 92.5% in England. Parents have an image of meningitis. They may know people who have had it and they will certainly have seen the appalling photographs of a child who is dying of meningitis and meningitis sepsis. In Scotland, the uptake is still at almost 96%, but we face the same issues of anti-vax sentiment; for many vaccines, we also see a drifting down of a few points every year. We cannot allow that to become critical, so we need open dialogue with parents. We must not push their concerns under the carpet, as that simply breeds a greater sense of conspiracy and leaves them open to these terrible social media campaigns.

Just two years ago, the O’Neill report on antibiotic resistance highlighted how crucial antibiotics will be in the future in fighting antibiotic resistance. At the moment, antibiotic resistance causes 700,000 a year, but it is estimated that we will have 10 million a year if we reach a truly post-antibiotic world. As a surgeon, I can tell the House that many procedures simply cannot be carried out if we do not have the ability to protect with antibiotics.

Most antibiotics have a lifespan from development to resistance of less than 10 years—the longest have a lifespan of less than 20 years before we see resistance—yet we are using vaccines that are 70 or 90 years old and do not have resistance. It is crucial that we tackle this anti-vax idea if we are ever to tackle antibiotic resistance. This is particularly the case for respiratory infections, because that is where the greatest use of antibiotics is. There are three ways in which vaccines will help us on this. The first is simply by preventing a drug-resistant infection in the first place. Secondly, they will also prevent the secondary infections from viruses and other conditions, where, again, we are using antibiotics. Thirdly, they will help in respect of viruses, where antibiotics are not going to work in the first place. It is important to realise that vaccines are absolutely central to that battle.

We now see vaccines preventing cancer. A study in Scotland looked at the effect of HPV, partly because we had such good uptake of the HPV bivalent vaccine, and also because our cervical screening started at 20. That study has shown an 85% reduction in precancerous changes on the cervix, which means we are on the road to seeing a really dramatic fall in cervical cancer. Having watched one of my friends lose her daughter to cervical cancer at 28 just a few years ago, I know that eliminating that disease is worth it in its own right.

We will be moving on to directing vaccines against cancer itself, and there is huge potential in vaccines to be realised as we tackle other diseases and scourges, such as multi-drug-resistant TB, but we will realise that potential only if we can tackle the anti-vaccination campaign and re-establish real confidence among parents, not just here but around the world.

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[Thangam Debbonaire (Bristol West) (Lab)]

It is truly a pleasure to follow not only my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), but the right hon. Member for North East Bedfordshire (Alistair Burt) and all the Front-Bench speakers, and I am sure that the summing up speeches will also be a pleasure to hear. It is truly a pleasure—a constructive pleasure—to be able to say during a debate in this place that there have been excellent contributions from everyone in the House. We have already come to various points of consensus and agreement. We can all point to things that need to be done, as well as to places that we can learn from and successes that we can celebrate. I will try to confine my remarks to areas that have not been covered by others—I always try really hard not to repeat things that other people have already said. I will focus mostly on antimicrobial resistance and the relationship with immunisation.

In the 1970s, when I was nine, I went to India for the very first time. Just like the right hon. Member for North East Bedfordshire, who described his experience with his dad, I can still remember the pain and discomfort of the vaccinations. I can also remember much more clearly the impact of seeing someone with elephantiasis when I reached India, and of meeting a relative who had been affected by one of the deadly diseases, which she had survived but which had left her permanently disabled, that I had been vaccinated against. It was a really visceral experience of the connection between the discomfort and pain of the vaccination and the consequences of not having access to that vaccination. It was also a real-life experience of inequality—the fact that I had received that vaccination because I was a UK citizen, and the people whom I met in India at that time were not getting those vaccinations. The experience transformed me and my understanding of what vaccinations did. Obviously, I was a child, so I was transformed from being a child without information to being a child with a really strong sense of the importance of vaccination. As an adult, I have been left with a real passion about the value of vaccinations, particularly in the way that they eradicate inequality as well as disease.

I am glad that this debate falls under the Department for International Development rather than the Department for Health and Social Care; it is an interesting place from which to be discussing this matter. Others have already provided examples of diseases, such as smallpox, and also polio, with its permanent debilitating effects. Polio is a good example of a disease that has been virtually eliminated in most countries through widespread vaccination, but still circulates partly because the symptoms are not easily recognised in certain parts of the world. The value of vaccination is so crucial in those diseases where early signs are not necessarily clear or where infection can be transmitted before there are early signs, such as in the case of measles, as the hon. Member for Central Ayrshire (Dr Whitford) mentioned.

While I cut out from my speech things that others have already said, I will also add something about the decision not to vaccinate a child. The hon. Lady was absolutely right: we must not patronise parents. If they have valid questions, they must be heard, and if they have worries, they must be understood. The right hon. Member for North East Bedfordshire mentioned certain specific examples of why we have to listen to people. Obviously, we can be gung-ho in our attitude, but not in our interactions. I apologise for being personal about this, but it occurred to me that if someone said to me right now that there was someone in the Lobby who could vaccinate me against ever having cancer again, I would not be seen for dust. We would all rush. We would have no question. We probably would not even stop to ask what the side effects would be. We would be out there immediately. It occurs to me that in our lived memory, we have lost the understanding of the fact that measles is also a deadly disease. Hearing the right hon. Gentleman read out that account from Roald Dahl was really moving and served, perhaps, as a reminder of the issues, or even as new information to many parents who are fortunate enough to live in a world where measles is no longer in front of us—in this country certainly—causing those deaths.

[Dr Whitford]

rose—

[Thangam Debbonaire]

The hon. Lady, who is about to intervene on me, gave us examples of how it still is an issue in some parts of the world.

[Dr Whitford]

I thank the hon. Lady for giving way. As I said at the end of my speech, there are researchers who are actually working on the ability to vaccinate against cancerous cells. This is something that we will hopefully be seeing in our lifetime. Is it not then surprising that, in England, even the uptake of the meningitis vaccine, a disease that parents are terrified of, has fallen down to just 92.5%, which means that the community protection is not there.

[Thangam Debbonaire]

The hon. Lady is absolutely right, and I do find that baffling, but that does reinforce the point that she and the right hon. Gentleman made about listening to people’s worries and concerns. We will not get very far if we barge through them saying that they are wrong—they are wrong, but we need to listen to where those concerns come from and to try to address them.

Take the influenza vaccination, for example. I declare an interest, in that one of my sisters has to have this vaccination every year because of problems with her immune system. Influenza is a disease about which many of us nowadays would think, “I’ll take a few days off work, take some pills, have a bit of a lie down and sweat it out, and I’ll be back to work, as right as rain.” But of course, not only does influenza still kill people today in other parts of the world; it can kill people today in this country, if their immune system is depleted or for other reasons. Influenza is a really good example of a microbe that is mutating, so new vaccines will have to be developed. As the hon. Member for Central Ayrshire said, some vaccinations are the same as the ones that we were being given 10, 20, 30, 40 or 50 years ago, but others will need to be developed. The job is not done on vaccinations. We still need to respect the developing science.

The diseases that we could eradicate forever include elephantiasis, which I mentioned earlier, as well as polio, measles, mumps and rubella. The MMR vaccination has attracted particular attention, partly because of the discredited research by that dreadful person who I do not feel like naming because I feel so angry with him. I just think that these diseases are horrible, and the irresponsibility he showed at that time was quite extraordinary.

What really struck me while I was having cancer treatment was the sheer volume of unqualified, non-medical people willing to give pseudo-medical advice online, when it would not be allowed offline. The Front Benchers here are not quite from the right Departments to address this specific issue, but I ask them to pass on my message to their colleagues in the relevant Departments. I would like to see work done in the Department for Digital, Culture, Media and Sport to ensure that there are equivalent levels of regulation for online medical, pseudo-medical and pseudo-scientific advice as there are in the offline world, because the harm done is the same. I would not expect to go to anywhere on the high street and be given pseudo, incorrect, dangerous, non-scientific advice face to face. It would not be legal; there are laws against it. But in the online world, not so much.

I return to antimicrobial resistance. As I am sure the House is aware, if left unchecked antimicrobial resistance will lead to 10 million deaths a year by 2050, as the Scottish National party spokesperson, the hon. Member for Central Ayrshire, has said. Immunisation is a vital intervention against AMR. AMR happens when microbes adapt to become resistant to antimicrobial drugs. Once resistance occurs in pathogens—the microbes capable of causing disease—treatment options become very limited and lives are then put at risk. There are already about 700,000 deaths a year caused by infections that are resistant to treatment.

I urge all Members to read or to read a precis of—certainly to absorb the messages of—the brilliant O’Neill review on AMR of 2016, which concluded that vaccines have been overlooked as a tool to reduce AMR and that there should be a much greater focus on and investment in them. Immunisation helps to reduce the increase of AMR in two critical ways. First, it prevents infections in general and drug resistant infections, thereby preventing the disease and deaths. That then negates the need for ever more complex drugs to be used, which are often much more expensive and are therefore probably not available in poorer countries, to treat those resistant infections. Secondly, by preventing infection and the need for treatment at all, the use of antimicrobial drugs overall is reduced in both humans and animals.

Vaccines offer sustained long-term and, in some cases, lifelong—although that depends on the pathogen—protection from infection. Antibiotics do not. Far too many people have in their heads the idea that when they get sick, they will get an antibiotic and that is all that needs to happen. Many vaccines still effective today were introduced many years ago, but the same cannot be said for antibiotics. If there are high rates of mutation, we will need new vaccines. We therefore need to think about the money and investment that we put into developing vaccinations, as well as into maintaining the use of proven ones. The O’Neill review also identified some really clear contexts in which immunisation can reduce AMR, including vaccinating against hospital-acquired infections, and discussed the importance of investment in research for the early stages, when commercial viability may be some years or decades off. The effects of vaccines on AMR are, preventing disease and death; reducing progression and the severity of disease; reducing transmission; and reducing antibiotic use, and therefore the pressure of resistance.

Vaccines work. They save lives, halt the spread of disease, reduce the impact of antimicrobial resistance and prevent rare infections and illnesses. So why do we need a debate at all? Well, we need a debate partly to celebrate the achievement and the impact of vaccination, but also to reiterate the case for it. Sadly, there has been a decline in the use and take-up of vaccinations, with consequent increases in illnesses and infections. The case has to be restated to prompt parents just to check. As the hon. Member for Central Ayrshire said, there are parents in countries across the world who are busy for all sorts of reasons. They may get to their third or fourth child, and getting them vaccinated is either not practically easy or it slips their mind. Just check—I am asking all parents out there, with absolutely no judgment whatever, to use this week as an opportunity just to check whether their children are up to date with their vaccinations.

As people who travel to different countries, it also behoves us all to ensure that we are not being complacent when we travel. I know how easy that is. I have relatives in India who I like to visit on a fairly regular basis, and it is important for us adults to make a little note-to-self to check that our vaccinations are up to date.

I will refer briefly to social media because although the Library research paper—I thank the Library researchers and the Parliamentary Office of Science and Technology for providing briefings for our debates—reassures us that most parents say that the information they have seen about vaccination is supportive; unfortunately, 4% said they had seen anti-vaccination information, most of which had come from the internet or social media. We need to tackle that issue.

This debate has been located in the context of international development, so it would be remiss of me not to say how much I value the work of the Department for International Development, across Governments of different political persuasions and over many years. This Department has a high reputation. Of course, that also goes for right hon. and hon. Members who have served in it over many years, so I thank the Department. By way of triangulation, I recently visited the Bill and Melinda Gates Foundation in Seattle—I declare an interest, as my brother-in-law works there—where I was really impressed not only by the thoughtful way in which the organisation contributes to vaccination across the world, but by the high regard in which it holds DFID, and for good reason.

I would, however, like there to be a greater focus on the spread of information via social media and the internet in our international work, because disease knows no boundaries, poverty knows no boundaries and the internet knows no boundaries. Perhaps there needs to be a tie-up between the work done with social media companies, the Department for Digital, Culture, Media and Sport, the Department of Health and Social Care and the Department for International Development. Forgive me—that may already be happening, and I applaud officials if it is.

I reiterate that any right hon. and hon. Members in the Chamber who have not read the O’Neill report of 2016 on antimicrobial resistance need to read it. We have talked a lot this week about the climate emergency, and it is definitely an emergency, but so too is AMR. I am going to say this again because it is so shocking: if we stay where we are, by 2050, 10 million people a year will be dead because of antimicrobial resistance.

--- Later in debate ---

[The Minister of State, Department for International Development (Harriett Baldwin)]

It is great pleasure and honour for me to be able to respond to this incredibly important debate in World Immunisation Week. It has been exceptional to see the quality rather than the quantity of the contributions that we have had. We started with my new boss, my right hon. Friend the Secretary of State, who leapt into action on his first day in the job to come to the Dispatch Box and speak without notes, giving a sweeping review of not only the history of vaccination but DFID’s important work in it as of today. I think that Members across the House have been able to be reassured by his passion and commitment to this incredibly important work.

I was also pleased to hear contributions from a range of other Members. The hon. Member for Liverpool, Walton (Dan Carden) spoke very movingly about the lessons he learned from his own grandfather. The stories that we heard throughout the debate of the personal experiences that we have had ourselves or in our families really stood out, because we have been part of a generation —an era—that has made a dramatic difference in this area. We have all pledged ourselves this afternoon to continue to be part of that difference.

The hon. Gentleman asked about replenishment, as did a number of other Members. We are in a period from 2016 to 2020 when we are contributing £1.44 billion to this important work, delivered primarily through Gavi. As a Government, we are very much looking forward to being able to host the Gavi replenishment in 2020. I can announce today that we will of course continue to be a leading contributor to the Gavi replenishment. Obviously, we will hold our horses in terms of announcing to the House exactly how much we will be contributing to that replenishment in due course.

The hon. Gentleman raised a number of other important points, including the issue of vaccine hesitancy. We must, as we did this afternoon, send a united message on behalf us of all here in the UK against that taking hold here in the UK, but also on how important it is to work on this around the world. We heard a range of contributions about social media, in terms of fake news, being part of the medium for these unhelpful messages. That is clearly an online harm. I would encourage all hon. Members to engage with the Department for Digital, Culture, Media and Sport on the online harms consultation.

The hon. Gentleman also raised the important issue of middle-income countries. Of course, DFID’s work prioritises the poorest countries. To reach the sustainable development goals, it is important that we contribute overseas development assistance, and we are proud that the UK is the first country to put into statute the 0.7% contribution. But we must also—this is where there is an element of political difference between the hon. Gentleman and me—crowd in the extra $2.5 trillion that is needed every year to reach those goals. That will necessarily come from outside the public sector. Members have raised the importance of pharmaceutical companies in this research and the role of the Bill and Melinda Gates Foundation. I need hardly say that if it were not for a successful capitalist system, they would not have been able to donate that money to their foundation.

[Dr Whitford]

At the moment, the transition begins when a country reaches a certain level of gross national income, which is a relatively crude measure. We are seeing a greater number of unvaccinated children, often in middle-income countries, and multiple countries requiring post-transition support. Obviously, Gavi is rethinking that strategy, and I ask the Government to encourage it to look at something a bit more multifactorial than a number on a piece of paper.

[Harriett Baldwin]

The hon. Lady is right to emphasise that point. We all hope that low-income countries will become middle-income countries and graduate from being supported by Gavi. In 2015 and 2016, for which we have the most recent data, countries that graduated from the Gavi programme maintained the levels of vaccination, but this needs to inform the next period in terms of replenishment, because we cannot afford to lose the community benefit of the level of vaccination.

I was deeply moved by the speech of my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who I enjoyed having as a colleague for so many months, and I pay tribute to the work he did to champion this cause. I hope his father is still watching television—hello, Mr Burt.