Global Vaccine Access

Philippa Whitford Excerpts

Thursday 13th January 2022 Westminster Hall

[Theo Clarke (Stafford) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I congratulate the hon. Member for North East Fife (Wendy Chamberlain) on securing this important debate on global vaccine access.

I start by thanking the healthcare workers, NHS staff and volunteers who have helped Britain to have one of the most successful coronavirus vaccination programmes in the world. I also pay tribute to our scientists who have worked to develop coronavirus vaccines, and thank the Government for funding this vaccine development. I was grateful to receive my vaccines at the Kingston Centre and St George’s Hospital in Stafford, and I was delighted to hear that over 2.5 million vaccines were given in the west midlands in December alone. Seeing the vaccine roll-out in my own Stafford constituency has made me passionate about the need for global vaccine access.

Britain has always been at the forefront of global healthcare. The efforts of consecutive British Governments and the generosity of the British public has helped to eliminate many diseases globally. Britain was a founding member of GAVI, the Vaccine Alliance, and this Government are continuing to champion access to vaccines.

As Chair of the International Development Sub-Committee, I welcomed the Independent Commission for Aid Impact’s recent information note on GAVI that highlighted the need to establish worldwide vaccination programmes for dangerous diseases, such as polio, as well as rolling out coronavirus vaccinations. In September, I met with GAVI at its headquarters in Geneva, to discuss the coronavirus vaccine roll-out, and to ensure that the poorest and most marginalised communities in the world are not left behind.

I welcome that Britain is one of the most generous donors to GAVI, pledging £1.65 billion from 2020 to 2025. During the height of the pandemic in June 2020, Britain led the hosting of the GAVI replenishment conference, and I was pleased that fundraising target the was exceeded, with world leaders pledging $8.8 billion. That was a crucial step in tackling the coronavirus pandemic, which, as we know from experience, shows that vaccines do work in protecting us from infectious illnesses.

Polio provides another example of how vaccines can be used to tackle terrible diseases. In 1988, over 70 million people worldwide were infected with polio, and more than 350,000 people developed paralytic polio. The Government’s generous financial support for the Global Polio Eradication Initiative meant that 2018 saw only 33 cases of polio worldwide. That represents millions of people being saved from the perils of polio by one simple vaccine. That is a real example of how vaccination programmes do work, and why we must follow this model and continue to provide global access to vaccines in order to end the coronavirus pandemic.

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

Will the hon. Member give way?

[Theo Clarke]

I will not take interventions at the moment. As vice-chair of the all-party parliamentary group for Africa, and having visited numerous health programmes across eastern, southern and western Africa, I have seen at first hand the devasting impact that diseases can have on people already living in challenging circumstances. I welcome the recent breakthrough with the malaria vaccine which, like the coronavirus vaccine, has the potential to make a real difference throughout the developing world.

I repeatedly raised the importance of COVAX with the then Foreign Secretary, my right hon. Friend the Member for Esher and Walton (Dominic Raab), and have done so again with other Foreign Office Ministers, including raising the issue in the Chamber and in International Development Committee evidence sessions. I welcome that Britain took the lead regarding COVAX when hosting the G7 last summer, committing the UK to providing 80 million vaccine doses and helping to secure commitments to COVAX of nearly $10 billion from other developed countries. The Government should be commended for meeting their ambitious target to donate 30 million vaccines to COVAX by the end of 2021.

On my visits to Kenya, as trade envoy, I have seen at first hand the difference these COVAX vaccines have made. On my most recent visit in November, I went to the Kenyatta University Hospital and met with Kenyan doctors and healthcare professionals. This hospital in Nairobi works in partnership with the University of Manchester in order to improve healthcare treatments and tackle infectious diseases. The British also developed the Oxford AstraZeneca vaccine, which has helped to save lives and improve the life chances of people living in Kenya; I am pleased this has been replicated across the Commonwealth, with over 2.5 billion doses being used in over 170 countries. At the G7 the Prime Minister said that we need a plan to vaccinate the world. If we want a definitive end to this pandemic, then I agree with him.

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

Thank you very much, Mrs Murray. I pay tribute to the hon. Member for North East Fife (Wendy Chamberlain) for securing the debate. I declare an interest as chair of the all-party parliamentary group on vaccinations for all and vice-chair of the all-party parliamentary group on coronavirus, which has been taking evidence every fortnight since July 2020, including hearing from Health Ministers across sub-Saharan Africa and other places who emphasise what we have been hearing today—the difficulties they have in accessing supply and the poor quality of supply they actually get.

It is certainly true that all of us have gained from the researchers who have developed new vaccines, and I pay tribute to the staff of the four national health services across the UK for the speed and skill with which they have delivered them. We have vaccinated almost 80% of adults with a third—or booster—shot, whereas access to even one shot in low-income countries is well below 10%. That simply highlights the inadequate access and inequity across the globe. High-income countries have literally hoovered up the vaccines as they were developed over the last year. That is indefensible. It is very reminiscent of AIDs, when people in Africa who were suffering from HIV or AIDs could not access the treatments that were available in the richer countries.

Last spring—well, actually, the spring before: 2020; I keep forgetting it is a new year—we heard lots of warm words about a global response to a global crisis. That is simply not what we have seen. We have seen that COVAX was established, and that the UK Government gave more than £500 million to it, but they did not give any vaccines until quite late last year. COVAX was meant to procure directly from companies. That never happened. Therefore, COVAX has ended up completely dependent on getting donated doses from wealthy countries that simply did advance procurements. That is the reason COVAX has delivered less than half of the 2 billion doses it was aspiring to deliver last year.

The UK Government promised 100 million doses in June 2021 at the G7—80 million to COVAX, and 20 million bilaterally. Less than a quarter of that has actually been delivered to COVAX. We are at the beginning of 2022. The 100 million is meant to be delivered by this coming June, which means 9.1 million per month to COVAX and a total of 11.5 million if we include any bilateral donations. The UK needs to radically step up donations of doses. That is the acute response, because that can be done in the short term. The UK has enough excess that it could carry out its third doses—and for many vulnerable patients, fourth doses, which I have had myself, as an immunocompromised person—and still accelerate the donation of doses to more than meet its target by June.

The problem is that wealthy countries think they can protect their own populations purely by vaccinating them. Omicron shows that that simply is not true. When we have large parts of the world, particularly in the global south, with low access to vaccines, that will generate high spread, and therefore more mutations—eventually, there will be new variants. Some of those variants may be as infectious as omicron—as transmissible and as good at escaping either natural immunity or previous vaccination—but may turn out to be much more severe. The fairy story that, inevitably, a virus is committed to becoming milder, is something that we are not in a position to count on.

We still, right now, two years into this crisis, need a global response. I therefore call on the Government to accelerate their donations, using the excess that we have. However, those must be predictable and in collaboration with the low-income countries that are receiving them. They also must have a decent shelf life.

We heard of Ministers having to visit their ports, every day, in case something had arrived. They had to keep stopping their own programmes because, suddenly, they got a delivery with a few weeks left on it. That is disrespectful to countries that do not have the health infrastructure that we have across the UK. It is critical to include consumables such as syringes and needles. It is also important to try to support the wider covid-19 responses.

Anyone looking at the WHO data will notice the incredibly low levels of covid—supposedly—in Africa. Africa does not have low levels; it has low levels of access to tests which means that cases are not being registered. We should not be using the doses as part of the already-reduced ODA budget, and certainly not charging more than the UK Government have paid for them.

That is the short-term approach, but the medium-term approach is to massively increase global production. The problem is that the TRIPS waiver has been being discussed for basically over a year. We would be in a totally different position if that had been moved on at the beginning. The UK is one of a dwindling number of countries that is blocking it. Over 130 countries now support it.

It is important to recognise that most of the leading covid-19 vaccines have been developed with public funding, either from university settings, which are largely publicly funded, or through the huge injection of funding made by the UK, US and EU Governments, and others. We touched on polio. The fact is that Salk did not patent his vaccine, Alexander Fleming did not patent penicillin and Röntgen did not patent X-rays, because they saw them as part of the global good.

As well as getting rid of the blockage of intellectual property rights and patents, it is important that there is proper sharing of data and technology transfer. Médecins Sans Frontières has identified 100 companies across Africa, Asia and Latin America that are certified by the European Medicines Agency, the United States Food and Drug Administration or the WHO for good manufacturing practice. To imply that it is not possible to produce vaccines to high qualities in the global south is frankly insulting.

The technology of messenger RNA vaccines holds hope for action against many tropical diseases in the future, such as TB, malaria and others. Sharing that technology now is not just about dealing with covid-19. It opens up the ability to tackle the scourges of infectious diseases that many countries face.

The UK should be increasing production of vaccines, to become a net exporter, instead of an importer. It is inexplicable why the UK Government pulled funding from the Valneva production site in Livingstone, when the trial data was about to be published. That vaccine was successfully developed using a traditional whole-virus approach, and people who were unwilling to take the messenger RNA vaccines may have been willing to receive the Valneva vaccine. It has not yet been trialled, but because it uses a whole-virus approach, it may provide a broader reaction that remains viable even when other variants arrive.

In comparison to delta, which had four mutations on the spike protein, omicron has 32 mutations. It is a totally different shape. Therefore, sadly with the AstraZeneca vaccine, the key no longer fits the lock. Pfizer does, but it wanes. We need to have broader vaccines so that we might be a bit more resistant to variants in the future.

The Government must maintain their support for routine vaccination. That means honouring the replenishment commitments to GAVI, because routine vaccinations have suffered due to the disruption of the pandemic. The UK has always been a leading funder of vaccination, and it must not pull back now. We must also think about future pandemics. The replenishment of the Coalition for Epidemic Preparedness Innovations is coming up this year. The UK needs to commit to that.

We are all talking about the humanitarian and the moral need to support people in poorer countries to have the access we have had, but on top of the lives lost and the huge, multi-trillion economic hit to the world, it is important that we recognise that this was a global challenge. The international community has failed, so far. If we cannot get our act together now in facing this, that does not give great hope for that other challenge—the climate crisis.

Nazanin Zaghari-Ratcliffe

Philippa Whitford Excerpts

Tuesday 16th November 2021 Westminster Hall

[Jeremy Wright (Kenilworth and Southam) (Con)]

It is a pleasure to serve under your chairmanship, Sir Charles. I join the tributes to Richard Ratcliffe—it is great to see that he is able to join us—and to his entire family, some of whom live in my constituency, whose resilience and bravery have been truly remarkable during this long period. I also join the tributes to the hon. Member for Hampstead and Kilburn (Tulip Siddiq), whose campaigning has been exemplary; many of us have been delighted to assist her in that.

I will make two points in the time available to me about the linkage of debt repayment to the detention of UK nationals and about the sanctions regime. First, I understand entirely and agree with the Government’s rejection of any suggestion by Iran that there is a connection between the repayment of a decades-old commercial debt and the release of UK citizens. However, I urge the Minister and his colleagues not to be hamstrung by what I might call the mirror image problem. Failing to repay a debt that would otherwise be repayable for fear of it being linked to the release of UK detainees is, in itself, to make a linkage that the Government have been at pains to say does not exist. If the debt should be repaid—and it seems clear that it should, subject to the remaining legal proceedings—then it should be repaid.

The UK’s adherence to standards of behaviour that states should maintain—standards which we argue Iran is not maintaining—demands that the debt be repaid promptly. How such a repayment is perceived should not, as a matter of principle, prevent us from making it.

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

Does the right hon. and learned Gentleman agree that the failure to pay an acknowledged debt creates a fig leaf for the Iranian Government to hide behind? It is not a matter of it being connected; it is an obstruction to things moving forward.

[Jeremy Wright]

I understand entirely the point made by the hon. Lady. However, as I say, I do not think it is necessary to accept any linkage—positive or negative, by the Iranians or by the UK—to justify the decision to repay a debt that is legally repayable. We should do that for its own reasons and for its own sake, regardless of what else may be happening.

That brings me to the issue of the sanctions regime as an obstacle to repayment. It seems that we require more ingenuity and more innovation. Certainly, in so far as my right hon. Friend the Minister and his colleagues are concerned, I accept that a huge amount of personal effort has been put into this case. However, as others have said, something is still missing, and that may be the innovation that we need to find.

The debt predates the sanctions regime that we see as an obstacle to making the repayment. The purpose of that sanctions regime is to prevent the enrichment of Iran during the course of the sanctions period, but it does not seem to me that this repayment would do that. The repayment of the debt would, in effect, put Iran in the position it would have been in if the obligation had been fulfilled when it should have been—well prior to the beginning of the sanctions regime.

I know better than many that the Minister has access to some exceptionally good lawyers in government. I hope that he is instructing those lawyers to use their best imagination and innovation to find ways of resolving this legal problem, because that is what we will require to break this deadlock. I know he will do his best, but I hope that he will give instructions to apply innovation and ingenuity to the case, as well as simply effort.

Israel and Gaza: Ceasefire

Philippa Whitford Excerpts

Wednesday 19th May 2021 Commons Chamber

[James Cleverly]

I thank my predecessor and good friend for the point that he raised. I have already said that the UK encourages Iran to be a more thoughtful and less disruptive regional player and to stop arming and supporting terrorist militia groups in the region. We will continue to work towards a two-state solution with the framework that has been explained from this Dispatch Box many times, and I pay tribute to the work that he did in this role to try to make that a reality.

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

Gaza has been under a suffocating blockade for almost 15 years, which already undermines the delivery of healthcare. Having been involved in breast cancer projects in Gaza for many years, I am aware from colleagues that 14 Government hospitals and clinics, including the covid laboratory, have been bombed, along with those run by international charities. We have been in this situation before, so once a ceasefire is finally agreed, what is the Government’s plan to achieve a long-term, yet just solution for both the Palestinians and the Israelis?

[James Cleverly]

I pay tribute to the hon. Lady’s work in this area and more broadly in the provision of health services to communities around the world. We are aware of the reports and, indeed, footage of medical facilities that have been damaged or destroyed, but we are also deeply concerned about the continued use by Hamas of civilian infrastructure for its military operations. Ultimately, we seek to bring about an end to the conflict so that humanitarian support can get to the people who need it. We remain one of the most generous humanitarian donors in the world and we are working hard to keep those humanitarian access routes open so that our support and the support of others in the international community gets to the people it needs to.

Government Support for India

Philippa Whitford Excerpts

Wednesday 28th April 2021 Commons Chamber

[Nigel Adams]

I thank my hon. Friend for that point. I am not particularly aware of the arrangement that France and Germany have and whether that is a commercial arrangement that the Indian Government have entered into, but it is certainly something we can look into. We have been working incredibly closely with our technical experts in the Department of Health and Social Care on how to respond to the most urgent needs, while ensuring that the equipment sent can be used and will make a difference. Donating oxygen cylinders, as some people have called for, has been rejected, as compatibility issues would prevent them from being refilled within India. We are taking the lead from the Indian Government on what their most urgent priorities are, so that we can ensure that whatever support we provide matches their requests.

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

The Minister keeps repeating that no one is safe until everyone is safe, but the reality is that 80% of all covid vaccines have been delivered in just 10 wealthy countries, and COVAX is struggling to obtain vaccines. Unless there is greater international solidarity, other healthcare systems like India’s will collapse, and vaccine-resistant variants will inevitably threaten those who live here. Does the Minister not accept that the UK needs to play its part by lifting the ban on exporting vaccines, sharing covid technology with others and increasing, rather than slashing, overseas aid?

[Nigel Adams]

I cannot think of many countries that are doing more than the United Kingdom on vaccines for the international community. It was absolutely right that we moved through the United Kingdom’s vaccine priority list for our own roll-out, and, as I have said in answer to a previous question, there are currently no surplus doses. I am proud of the fact that we are one of the biggest donors to COVAX. COVAX will be supporting the distribution of 1.3 billion vaccines across 92 countries that need that support, which includes India.

Hong Kong National Security Legislation

Philippa Whitford Excerpts

Wednesday 1st July 2020 Commons Chamber

[Dominic Raab]

I thank my hon. Friend, the Chairman of the Liaison Committee, for that. He makes a range of important points. On Chinese expertise, I do not think the Chancellor of the Duchy of Lancaster was referring to the Foreign Office. In any event, I can provide the reassurance that we have some of the finest Mandarin-speaking diplomats around the world and we are exceptionally well represented in Beijing by Her Majesty’s ambassador, Dame Barbara Woodward. We are increasingly, across Government, looking at all aspects of our relationship with China. Obviously, the House is interested in and will know about Huawei. My hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat), the Chair of the Foreign Affairs Committee, who is no longer in his place, referred to the situation in universities, and rightly raised the question, as, in fairness, did the hon. Member for Wigan, about an integrated strategy. Clearly, as we bring forward the integrated review, China’s role in the world and our relationship with China will be an essential element of that, and that work is already under way.

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

China’s national security law completely undermines previous agreements on the status of Hong Kong and those who live there. It is a threat to judicial independence and freedom of the press, as well as to political, civil and human rights. Given Huawei’s ties to the Chinese state, instead of a long, tedious review of the 5G contract, will the Government not take a stand now and cancel it?

[Dominic Raab]

I certainly share the hon. Lady’s views on our responsibilities to the people of Hong Kong and our concern about their treatment. In relation Huawei, as I have already said to the House, given the US sanctions, it is currently under review by the National Cyber Security Centre. We will come forward with our response in due course.

Covid-19

Philippa Whitford Excerpts

Tuesday 17th March 2020 Commons Chamber

[Dominic Raab]

I thank my hon. Friend for the way in which he has raised his question. The insurance industry makes its decisions in a commercial way, and obviously we and the Transport Secretary are liaising very closely with it, but certainly the call has been made to the Foreign Office to give as clear advice as possible. So we are advising, not least with the Easter holidays coming up, against all but essential travel globally. We are not going to make decisions for individual people, families or schools, but it seems to me that those are the kinds of trips that would now have to be looked at, and we would expect the insurance and the airline industries to follow, based on that very clear advice that we have now given.

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

The Foreign Secretary mentioned that the Government have been consulting with the G7, but they have not been consulting with European Governments through the European Centre for Disease Prevention and Control. May I ask: apart from ideological reasons, why not? It is very concerned that the focus here has been on behavioural science and not on epidemiology.

[Dominic Raab]

The hon. Lady asks a perfectly reasonable question. May I reassure her that we are taking the best scientific advice that we have got in the UK? The circumstances in different countries will change. Part of that is about the timing and the peak within which coronavirus hits an individual country. She talked about co-operation with EU partners. I am consistently on the phone talking to all our European partners about all these issues, whether that is the multilateral drive to tackle coronavirus with support for vulnerable countries, research and development, or the particular logistical issues with getting constituents home. The diplomacy with our European friends has never been more intense.

Universal Health Coverage

Philippa Whitford Excerpts

Wednesday 10th July 2019 Westminster Hall

[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.

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

Should we not also emphasise that vaccines will not work properly on a malnourished child? We need to see these subjects as two sides of the same coin.

[Alistair Burt]

The hon. Lady is absolutely right and speaks with great experience. A child may be physically alive, but the weaker a child becomes through lack of nutrition, or through existing on the barest rations, the more prone they are to disease, and the harder it is to ensure that preventive measures work. That is absolutely correct.

I wonder whether the Minister wants to venture an opinion on the Department for International Development remaining a stand-alone Department. It might be slightly unfair to expect an answer from him on that, but I hope that this debate will leave him in no doubt of the value that we see in an independent-minded DFID. It is always part of the Government, as I occasionally had to remind officials, but it very much has its own stand- alone processes.

I hope others will cover all those points, and that I have helped to lay the ground, and made it clear how important this House feels universal health coverage is, and how proud we are of the United Kingdom’s previous contribution and its determination to keep that up. There is a clear sense that we are a world leader, through the work of our hard-working experts. The Minister should know that he has the full backing of the House in his determination to make sure that this issue remains as important to him as it has been to me and all my predecessors.

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

It is a pleasure to serve under you, Mr Robertson. I declare an interest in this subject, as I travelled to Ethiopia with RESULTS UK and saw the impact of setting up vaccination services as the initial building blocks towards universal healthcare. I pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) for opening this debate and for his work as a DFID Minister. I am the chair of the all-party parliamentary group on vaccination, and I really welcome the commitment he showed in giving evidence to our inquiry on the next decade of vaccines. Our report was published in January, and I thank the team he worked with at the time.

As the right hon. Gentleman said in his introduction, universal health coverage is the idea that everyone should have access to quality healthcare without ending up in financial hardship. Half the world’s population simply does not have that, while 100 million people are thrown into extreme poverty when trying to access healthcare.

The UK has absolutely been a leader in this sphere. It is the No. 1 funder of Gavi, The Vaccine Alliance, which helps to provide affordable vaccines to low-income countries, and also helps those countries to develop their own systems to deliver vaccines. I particularly welcome the £1.4 billion commitment to the Global Fund and the fact that it was made in advance of the replenishment date. The replenishment of the polio eradication initiative is coming up this November, and the UK making a pledge in advance helps to put pressure on other countries to make similar commitments. The Global Fund is particularly involved in tuberculosis, HIV and malaria, which shows that this about not just a single thing, but a combination of vaccinations, antiretroviral drugs and malaria nets. Underneath all that, there is the need for clean water, among other things.

Vaccination itself has saved 20 million lives in the last decade. In 1988, when the polio eradication team came together, there were 350,000 cases of polio a year. Last year, there were 33 cases, in a difficult area on the border between Pakistan and Afghanistan. There is no treatment for polio. One problem when people talk “anti-vax” and say, “I don’t believe in vaccination” is that they do not remember what these illnesses look like. When I was in Ethiopia, we pulled into a garage to get petrol, and I saw a young man of about 30 standing there with the obvious deformity of flaccid paralysis from polio. The last time that I saw someone in that situation, it hit me like a boot in the face.

On Monday, we held an event in the House for polio survivors, and I thank those hon. Members who attended to hear their stories. Many of the older polio sufferers now use wheelchairs and are not therefore as recognisable as the children with polio, who used callipers or crutches. People are complacent and have forgotten the harm that polio can do and is doing elsewhere.

The Global Polio Eradication Initiative has done an incredible job using oral drops, which are critical because the gut protection a child gains from an oral vaccine protects against the further spread of the virus. The injectable form we use here protects the individual, but they can still spread the disease. It is therefore crucial that we eradicate it.

The problem is that, previously, we talked as though we would achieve eradication—obviously, we had hoped to achieve it by next year—and then look at transition. However, much of the infrastructure, staff and funding used to eradicate polio is also holding up the basic vaccination systems in low-income countries. In fact, people are now reluctant to take the oral vaccine. Some of that is because they say, “Here you are again, back in our village with your drops, but I can’t get my baby treated for another condition. We don’t have clean water. My children aren’t even fully immunised.” That is why we need the transition. Universal health coverage is now critical to achieving the eradication of polio; if there are outbreaks in Nigeria or elsewhere, it is because the routine levels of immunisation are simply not high enough.

Seth Berkley, the head of Gavi, pointed out a shocking figure to us when we set up the APPG. He said that although we think we are doing a great job, 85% of children in low-income countries are vaccinated only with DTP3—one of the very basic vaccines—and we put a tick next to them. However, only 7% of children in those countries are fully vaccinated and receive all 11 vaccines recommended by the WHO. More than 90% of children are still vulnerable to disease, and 15% have had no vaccinations at all, so we still have a lot of work to do.

I commend the UK for the 0.7% commitment to aid, which must be maintained. DFID must be maintained as a separate Department, not just for its function, but to show that commitment and drive. If our constituents say, “Charity begins at home, so why on earth are we bothering to spend money miles and miles away?” we should remember the Ebola outbreak and the fear over people arriving at Heathrow and having their temperatures taken. With air travel, the world is now a very small place, so infectious diseases threaten everyone. Vaccines will be critical to preventing antibiotic resistance, which threatens us all.

We should see our commitment both as a way to help those countries to invest in their children’s health, which helps them to develop economically and—a little selfishly—as a way to protect ourselves. Vaccination on its own will not be enough unless it is part of a system of universal health coverage that improves the health of all people, particularly the future generations of developing countries.

--- Later in debate ---

[Dr Murrison]

I was about to say that I am really comfortable to do so, because the decisions he made, and those he is associated with vicariously, are good ones. I am happy to have inherited his portfolio, but he is a difficult act to follow, that is for sure.

My right hon. Friend identified all the issues in his contribution, as I would expect him to do. He started by highlighting universal health coverage and its contribution to SDG 3, but he also made the point that universal health coverage touches on the other SDGs as well. In advance of the high-level meeting on 23 September, he was right to ask about the aims and ambitions the UK Government have for that meeting. They are encapsulated in getting more money—obviously—and getting better quality and integrated healthcare. That is something many of the contributions have touched on one way or another. I have been struck by the level of support for an holistic approach to delivering universal healthcare.

We have talked about immunisation and about the mistake we would be making if we simply imagined that going around the world offering people vaccinations and inoculations would be “job done”. It really would not be. Those interventions would be treated with a great deal of suspicion by communities, as they are at the moment, if that were all we were offering. It has to be much more than that; it truly has to be integrated. I look forward to making this point loud and clear in September in New York.

On a broader theme, as I have gone around the world, I have been struck by the roll-out of healthcare systems. Very often, there is a temptation for politicians to roll out shiny things that they can demonstrate to their constituents. That generally means hospitals, and hospitals are great things, but they may not be the right thing in low and middle-income countries.

[Dr Whitford]

In the four health systems across the UK, we are trying to address our obsession with hospitals and tertiary centres, realising we have not got enough resources in primary care, and certainly not in prevention. We need to share that knowledge with developing countries.

[Dr Murrison]

I agree with the hon. Lady. In the context of low and middle-income countries, my focus would be on primary healthcare and public healthcare, by which I understand something slightly different from public healthcare in the context introduced by the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), who speaks for the Opposition, and I will come to that in a minute. The focus needs to be on prevention and on things that deal with the problems that the poor are exposed to, first and foremost. The difficulty with shiny stuff—electorally obliging though that might be—is that it risks exacerbating health inequality; shiny things tend to be in urban centres and accessed more easily by the better-off, rather than the poor, and particularly the rural poor. We need to be very careful about that.

We need to introduce the notion that countries themselves must grow their healthcare systems, and a number of contributions touched on that. That means addressing unpleasant things such as taxation. In addressing universal health coverage, we need to ensure that we encourage Governments to establish proper mechanisms for raising taxation, so that countries can ultimately stand on their own feet. I am pleased that the UK has introduced some trailblazers in that respect—the four in Africa are Rwanda, Ethiopia, Ghana and Uganda, and the other is Pakistan—where we will be assisting Governments to build structures that will make their healthcare systems sustainable in the longer term.

A number of contributions touched on polio. I know that will be the subject of my grilling later by the hon. Member for Liverpool, West Derby (Stephen Twigg)—I will say lots of nice things about him in anticipation that he will give me an easy ride this afternoon. I am sorry that he is standing down; it will be a great loss to the House, and I urge him to think again. Polio is on the cusp of being defeated. There were 33 cases last years, from only three countries—only two countries, really. We must make sure the boot remains on the carotid, because there is a real risk that, if we are tempted to divert funds from this, we will be back to square one. That would be a tragedy because of the lives that would be lost, and because, at some point, we would have to pick up the pieces. It makes no sense, in raw economic terms, to relieve the pressure on that particular nasty at this point. I hope we will make sure in September that the pressure stays on that particular one of the “Captains of the Men of Death”.

I appreciated the comments made by right hon. and hon. Members about nutrition; they were absolutely right. The hon. Member for Central Ayrshire (Dr Whitford) rightly said in an intervention that there is no point vaccinating people if they are undernourished. It is nonsense epidemiologically and in public health terms to do so, and we must adopt an integrated, holistic approach to universal health coverage. If we can get that across to people in New York in September, we will have done the world a great service.

I am proud to be a member of a Government who are fully committed to not just the Global Fund but other funds that require replenishment. Our leadership has been salutary over many years—not just under the present Government, although I am pleased about the commitment they have made to the Global Fund—and I am confident, whoever wins in two weeks’ time, to answer the point made by the hon. Member for Dundee West (Chris Law), that that process will continue.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 30th October 2018 Commons Chamber

[Mark Field]

I know that my hon. Friend takes a strong view on this matter. We do all that we can to raise the legitimate concerns brought up by all Members in this House with the Governments in both New Delhi and Islamabad. However, we believe that the pace of progress is for India and Pakistan to determine.

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

8. What diplomatic steps the Government are taking to improve access to healthcare in Gaza.

[The Minister for the Middle East (Alistair Burt)]

The Government remain deeply concerned about the humanitarian situation in Gaza. I regularly raise with the Israeli authorities the need to ease restrictions there. Our ambassador to Israel discussed Gaza with the Israeli authorities on 17 October. The UK supports healthcare in Gaza through the International Committee of the Red Cross, and is a strong supporter of the UN Relief and Works Agency for Palestine Refugees, which provides basic healthcare in Gaza.

[Dr Whitford]

As well as many breast cancer patients not being allowed out of Gaza for treatment, it is very difficult for doctors to get out to access training, so Medical Aid for Palestinians has recruited specialists to bring the training to them. But on our visit last month, I was formally denied permission to enter Gaza and two other doctors on our team never received theirs. This totally wrecked our teaching programme. Will the Minister make representations to the Israeli authorities to allow these medical projects in Gaza to continue unhindered?

[Alistair Burt]

First, I have already done so. Secondly, although it is of course a matter for Israeli authorities to make those decisions, the value of the visits of the hon. Lady and her team cannot be overestimated. Thirdly, we are all in her debt for the work that she does to support those suffering conditions in Gaza.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 26th June 2018 Commons Chamber

[Boris Johnson]

My strong advice is for people to look at our Be on the Ball website, where they can follow Foreign Office advice, and to not to let their hopes run away with them.

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

T10. Last month, when the House debated the shooting of unarmed protesters on the Gaza border with high-velocity live rounds, the Minister talked about pushing for an investigation, yet three days later the UK abstained on a UN vote on an investigation. Why?

[Alistair Burt]

Because both the resolutions brought forward by the Human Rights Council and the UN Security Council were biased and not likely to produce the required answer. That was why we did not support them. We still maintain that there should be an independent and transparent investigation and we have raised the issue with the Israeli authorities directly.

Gaza Border Violence

Philippa Whitford Excerpts

Tuesday 15th May 2018 Commons Chamber

[Alistair Burt]

As I have answered a number of times already, Hamas’s part in this has to be opened up. It is clear from statements already intercepted that it was prepared to use any breaches in the fence for its own purposes, and it is clearly one part of this terrible event. The questions illustrate my sense of concern about the binary view of all this. There are many parts to trying to solve and deal with this, and it is the responsibility of the United Kingdom to make that clear, but my hon. Friend was right to raise concerns about Hamas’s activity.

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

Having worked in Gaza for almost a year and a half as a surgeon, I am one of the few people in this Chamber who has seen the result of live ammunition and what it does to the human body. Various Members talk about breaching the fence, but most of those injured were nowhere near the fence. More than 200 children and 17 medics were injured. They were not trying to invade Israel. How will the British Government push for an inquiry, and will they understand that, while Hamas may have manipulated people to encourage the scale of the protest, the despair that I see when I visit Gaza is the underlying cause? If we do not get a peace process, that will get worse.

[Alistair Burt]

We all defer to the hon. Lady’s contribution and expertise in terms of her work in Gaza and the efforts that she has made, and there is much in what she says that everyone should acknowledge and take note of. The despair and the hopelessness in Gaza are indeed prime movers in people’s concerns and in their wanting to see a change. The United Kingdom recognises that. That is why some of our efforts today at the United Nations will be in support of the UN Secretary General’s special envoy as he looks to do things in Gaza and for Gaza to seek to relieve that pressure. It is one part of the equation, and the hon. Lady was right to raise it.