World Immunisation Week

Rory Stewart Excerpts

Thursday 2nd May 2019 Commons Chamber

[The Secretary of State for International Development (Rory Stewart)]

I beg to move,

That this House has considered World Immunisation Week.

It is an enormous privilege and pleasure to stand here for the first time as Secretary of State, but it is a deeper pleasure to be in the Chamber talking about immunisation. Immunisation is an extraordinary story that illustrates why international development really matters, how complicated it can be, in public policy terms, to pull off, and how important it is to be able to communicate to the public and others how, in the end, preventing the terrible loss of a child from polio can be connected right the way back to scientific research, businesses, international co-operation, and very brave doctors and health workers on the ground.

[Chris Bryant (Rhondda) (Lab)]

May I be the first person in the Chamber to warmly welcome the Secretary of State to his new post? It is a delight sometimes to see a square peg in a square hole—if that does not sound rude, somehow or other. I warmly congratulate him on his new job.

Is not one of the most disturbing developments of recent years the fact that there are politicians around the world, in some of the most advanced societies, who preach an anti-immunisation message, which will lead to the unnecessary death of children?

[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.

[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.

[Dan Carden (Liverpool, Walton) (Lab)]

I genuinely welcome the new Secretary of State to his role. In his first two weeks as Prisons Minister he visited both the prisons in my constituency, which I thought showed a great sense of responsiveness to what was needed at the time. I hope that something along the same lines, and a close working relationship, will feature in his new role. I am also delighted that he used his first speech as Secretary of State to advance a robust intellectual defence of our aid spending, and I congratulate him on that.

We know why immunisations matter and why today’s debate is so important. Vaccines are, quite simply, a matter of life and death. Between 2 million and 3 million lives are saved every year thanks to immunisations, and in recent decades they have drastically reduced suffering caused by infectious diseases that were once commonplace. Smallpox was completely eradicated in 1977 through a global vaccination programme, and the world is now close to eradicating a second disease, polio. My own grandad contracted polio and lived with it for 27 years, and when I was growing up I heard a great deal about the impact of a disease that paralyses the people affected by it. I pay tribute to one of my constituents, Andy Gilliland, a polio survivor who has lobbied alongside the One Last Push campaigners; I am delighted to have become one of the campaign’s polio champions since he lobbied me.

Thanks to successful vaccination schemes the world over, today’s generation and our children do not have to suffer from the diseases that were all too commonplace for our grandparents. Immunisations are not only saving lives, but are a cornerstone of global health security. They are vital to the achievement of several of the United Nations sustainable development goals and to ensuring that no one is left behind. They also provide a vital gateway to wider public health services. If you are a child or parent being given a vaccination, this may be the first time that you interact with the public health system. The simple act of being immunised can boost your chances of going on to access important services such as family planning, birth registration, testing and screening, and regular healthcare. For the hardest to reach, immunisation can be the start of proper inclusion in the public health system.

I am proud that the UK’s Department for International Development is a world leader in global health. That has been possible only because of the House’s commitment to spending 0.7% of our country’s income on overseas aid and to maintaining an independent DFID. However, I want us to do more. Twenty million children around the world are still under-vaccinated. Fewer than 10% of children in the world’s poorest countries receive all the vaccinations that they need. In Africa alone, more than 30 million children under five suffer from vaccine-preventable diseases every year, and more than half a million of those cases result in death.

Sadly, in recent years global immunisation rates have stalled, and in some places have even decreased. Key barriers to full immunisation include the high prices of vaccines, and a growing movement of vaccine hesitancy. It is clear that we still have our work cut out if we are to reach all children, across the world, with the essential vaccinations that they need and deserve.

As the Secretary of State said, next year Gavi, the global vaccine alliance, will be up for replenishment at a conference hosted by the Government here in London, and this year the Global Polio Eradication Initiative is being replenished at a conference in Abu Dhabi. The UK should make significant pledges to make sure both are fully funded, and should make the pledges promptly enough to encourage other donors to do likewise. I therefore hope the Minister will use today’s debate to update the House on the Government’s replenishment plans for both of these funds.

Let me be clear, however, that replenishing funds is only one step to ensuring all children are vaccinated; we can and must do more. Gavi is leaving millions of under-vaccinated children in middle-income countries without all the vaccinations they need. That is because the scheme uses a country’s GDP to determine whether it is eligible for support. This is a crude way to assess need: a country’s GDP does not take into account the specific needs of that country and its population’s health needs. It fails to take into account the state of its health system, and, crucially, GDP measures do not take into account in-country inequalities.

[Rory Stewart]

indicated assent.

[Dan Carden]

The Secretary of State is nodding, and I appreciate that.

This means many of the world’s poorest children are in fact living in middle-income countries with a GDP that makes them ineligible for either official development assistance or Gavi support. I hope the Secretary of State will listen to the all-party group on vaccines for all, which has called for Gavi to bring about new criteria beyond a country’s GDP.

Let me now turn to another major threat to universal immunisation coverage. It is a threat that we face both here in the UK and right across the world: vaccine hesitancy, a phenomenon that the World Health Organisation has not only warned is on the rise but has now identified as one of the top 10 major threats to global health for 2019. This year’s theme of “Protected together: vaccines work!” also points to the difficulties in this area.

Since 2014, the number of countries reporting hesitancy has steadily increased, and in 2017 only 14 countries out of 194 reported no vaccine hesitancy. In England, dangerous false stories about immunisations are routinely spread on social media. The likes of YouTube and Facebook are failing to clamp down properly on those who peddle these lies. We must take tougher action and tell the truth about immunisations because the increasing refusal of vaccines has been described by the head of NHS England as a “growing public health timebomb.”