Vaccinations: Developing Countries

Stephen Crabb Excerpts

Wednesday 13th June 2018 Westminster Hall

[Stephen Crabb (Preseli Pembrokeshire) (Con)]

I beg to move,

That this House has considered the economic effect of vaccinations in developing countries.

It is an enormous privilege to serve under your chairmanship, Mr Evans. I am grateful to have secured time to lead what will probably be a short debate, but I hope a positive and useful one, on a subject on which this Government and successive British Governments of different colours have shown leadership and genuine commitment.

I am delighted to see the Minister in his place. He has had a busy time in Westminster Hall in recent weeks and I almost feel reluctant to drag him back here again, but I hope he finds the debate useful and enjoyable. I know that I and other hon. Members here today look forward to hearing his usual wisdom and intelligence on such matters during his winding-up speech.

Today, nearly half the world’s population, including 1 billion children, live on less than $2.50 a day. More than 1.3 billion people live in extreme poverty, which means they survive on less than $1.25 a day. We get so used to reading those statistics that it is sometimes easy to forget what the reality means. It means families who go to bed at night hungry, wake up hungry and then go to bed the following night still hungry. It means families where people are incredibly blessed to have access to anything more than a very basic education, if any at all. These are people for whom daily work is repetitive, painful and dangerous, and who certainly cannot afford for themselves or a family member to fall sick.

We know that behind every statistic there is a human being. According to UNICEF, 22,000 children die every single day due to poverty. I do not believe that anyone in this House, or the wider British public, finds that acceptable. With many other countries, non-governmental organisations, private individuals and institutions, Britain is committed to working to end that poverty and to tackle the conditions and causes that trap people and whole nations in cycles of poverty.

As a Conservative, I believe strongly that free trade, markets and the rule of law play a powerful role in lifting nations out of poverty, but I also know that they cannot bring an end to some of the deep-rooted factors that perpetuate cycles of poverty around the world. That is why I am hugely supportive of the fact that as a nation, privately and through taxation, we provide large sums of money to fund interventions that seek to establish sustainable long-term solutions in the poorest nations. Britain is a leader in international development not just by virtue of the size of the budgets we make available, but through the expertise we deploy.

[John Howell (Henley) (Con)]

Is my right hon. Friend aware that the number of deaths from vaccine-preventable diseases is around 2.5 million to 3 million per year, but the number of people being inoculated has reached a bit of a plateau? Does not that say something about how we should focus our activities to establish better relationships with mothers, to reach hard-to-reach groups in Africa and Asia in particular, so as to take this further forward?

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[Stephen Crabb]

I have heard that said, and I will go on to refer to the importance of reaching the hard-to-reach groups. There is evidence that that is the way to get, to put it crudely, more bang for our buck on the vaccinations spend, because the threat of outbreaks of killer diseases is higher for some of those isolated communities and families than for those elsewhere. My hon. Friend makes a useful point early in the debate.

For the last decade and more, there has been a political consensus that we should spend 0.7% of our GDP on international aid and assistance. At times in recent years, it has felt as though that consensus is being tested; certainly, the all-out assault on our aid budget in some sections of the popular press has had a corrosive effect, at least among some members of the general public. The discussion in the popular press is overwhelmingly dominated by questions over the headline funding commitment and the suggestion, repeated over and over again, that aid money could be better spent on domestic priorities.

While those of us who support Britain’s role as a leader in effective overseas development should never tire of restating the basic case for aid, we should also do more to draw attention to specific examples where UK aid has helped to achieve profound economic and social improvements in some of the poorest countries on earth. One area of British leadership and expertise that has received too little attention is the funding, development and distribution of vaccines against killer diseases, and I will use this short debate to highlight that. Diseases are not just an unpleasant inconvenience for a country; they ravage a nation’s economy, directly affect its ability to grow and hold back economic development. Diseases keep poor countries poor.

It was a British doctor, Edward Jenner, who pioneered the first vaccine at the end of the 18th century, when he used pus drawn from a cowpox boil to inoculate a boy against the killer smallpox—a story that many of us will have learned about in our schooldays. More than 200 years on, British science and medical research still lead the world in improving the health of people living in extreme poverty. The eradication of smallpox was one of the great achievements of immunology in the 20th century. Smallpox was once one of the world’s most feared and deadliest diseases. Just 60 years ago, it was endemic in dozens of countries containing around 60% of the world’s population. By 1980, it had been eradicated, following a concerted international effort.

More recently, polio, once epidemic, has almost been eradicated too, due to concerted vaccination efforts worldwide. It has been reduced by 99% globally and the number of polio-endemic countries has decreased from 125 in 1983 to just three today. That is the culmination of a remarkable international effort that brought together Governments, NGOs and many private individuals. Rotary clubs around the world, for example, took this up as a campaign and raised enormous sums toward the effort through community-led fundraising. Full eradication of the disease is within reach, showing again what can be achieved when we harness political will, public support, large-scale resources and world-class science. I believe that that formula is the key to so many of the interventions that will make the world a better place in the years ahead.

British medical and scientific research remain world leaders in the fight against vaccine-preventable diseases. We are part of numerous initiatives and alliances, recognising that multilateral co-ordination and use of public resources to leverage in private sector funding provide a strong platform for this work at a global level. I am sure the Minister will update us on some of those initiatives in his winding-up speech.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my right hon. Friend on securing the debate and on the speech he is making. On the issue of private company and pharmaceutical involvement in the development of vaccines, there has been a challenge, as we saw with the Ebola outbreak, in that this is not an area of great profit for pharmaceuticals; it is difficult for them to recoup their investment from lower-middle income countries. The pharmaceutical model needs more encouragement of pharmaceuticals to invest in development of vaccines such as Ebola. What would he say to encourage that?

[Stephen Crabb]

My hon. Friend, who knows an enormous amount about this field, makes an important point. We are essentially dealing here with a case of market failure, where markets in the purest sense do not work in bringing through vaccine development and distribution in some of the poorest countries. I will talk about that later. I am about to talk about GAVI, the Vaccine Alliance; the model on which it operates is based on tackling exactly that problem, where there is not sufficient market demand in a poor country to create the financial incentive or pull for pharmaceutical companies to invest there profitably.

GAVI was created in 2000 and it brings together the public and private sectors with the shared aim of creating equal access to vaccines for children living in the world’s poorest countries. Britain was one of its original donors, and today we provide around 25% of its funding. There is also the global health fund, which was created to accelerate the end of HIV/AIDS, tuberculosis and malaria as epidemics, and for which UK funding averages around £360 million a year. Last year, the global health fund partnered with GAVI and Unitaid to provide around $50 million to pilot the world’s first malaria vaccine for young children in Ghana, Kenya and Malawi. That vaccine has been 30 years in the making in fighting a disease that still claims thousands of lives each year.

Back in 2015, the former Prime Minister, David Cameron, announced a plan to tackle the risk of global health pandemics that included the establishment of a UK vaccines research and development network. The network’s focus is to bring together experts from industry, academia, philanthropy and Government to invest in projects on vaccines and vaccine technology to combat diseases with epidemic potential, such as Ebola and Zika, in low and middle-income countries. Britain has led from the front in the global fight against killer diseases.

Vaccines are widely recognised as an important mechanism for controlling infectious disease outbreaks, although they are by no means the only mechanism. In fact, the supply of clean water, for example, is even more important in reducing the burden of infectious diseases. However, it is right that the international effort to develop and distribute vaccines against deadly diseases, of which Britain is a key part, is a strategic priority for our overseas aid policies, and it needs to remain so.

At the heart of that challenge is the market failure referred to by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Outbreaks of some of the world’s deadliest diseases occur only intermittently, and often in the world’s poorest countries, meaning that there might not be a strong market incentive for the pharmaceutical industry to develop vaccines for such diseases.

The UK Government are taking concerted and co-ordinated action to address that market failure. For example, the UK has committed to invest £120 million between 2016 and 2021 in the development of new vaccines for diseases with epidemic potential, in line with the expert advice provided by the UK Vaccine Network. The UK is also helping to build laboratory capacity, surveillance networks and response capacity in low and middle-income countries to deal with the threat of antimicrobial resistance, which militates against the efficacy of drugs in treating diseases.

Some of the health impacts of vaccinations are widely known. For example, between 2010 and 2016, 109 million children were given the pneumococcal vaccine to protect against the main cause of pneumonia, saving an estimated 760,000 lives. In 2017, nearly 1 million people were vaccinated against cholera when an epidemic threatened South Sudan. Only 400 people lost their lives, thanks to an integrated approach that also incorporated surveillance, investigation of and response to cases by rapid response teams, the provision of clean water and the promotion of good hygiene practices. We could cite many other examples.

However, the wider economic benefit of vaccination programmes to the poorest nations has not been fully explored. More research and data are needed to help us to tell the full story of how and why investing in vaccinations helps to alleviate poverty and create stronger foundations for economic success. We certainly know that high out-of-pocket expenditures contribute to poverty, and healthcare can be one of the most significant such expenses for those living in poor countries. In 2010, the World Health Organisation reported that the cost of healthcare prevented many poor people from seeking treatment while simultaneously pushing 150 million care seekers into poverty each year. Put simply, poor people getting sick is likely to make them even poorer and to wreck their future earning potential. When that picture is repeated across families and communities, the consequences can be dire.

At economy level, we have evidence of the ravages that killer diseases can cause. For example, the 2014 Ebola crisis in west Africa disrupted international trade and travel, cost at least $2.8 billion in lost growth and killed more than 11,000 people in the three countries worst affected by the outbreak—Sierra Leone, Liberia and Guinea. It had a severe developmental impact in those counties, placing already weak health systems under extreme pressure, and had a negative impact on employment and school attendance rates.

In February, Health Affairs published a study, jointly authored by researchers at Harvard University and GAVI, that looked at the health and economic benefits of vaccinations, which it showed have a poverty-alleviating benefit, especially for the poorest people. Although the study raised some specific questions about the delivery of vaccination programmes, distributional impacts and the transition away from aid-funded programmes as countries move across the poverty eligibility threshold, it nevertheless helped to strengthen the case for continued investment in vaccinations and helped to give us a fuller picture of how good aid spent well does exactly what we claim it does—saves lives and reduces extreme poverty.

[Dr Poulter]

My right hon. Friend makes an important point. Aid initiatives are far too often evaluated purely on what they cost the Department or organisation giving the money, but cost-benefit analyses that look at the wider economic and long-term healthcare benefits are how we should evaluate aid spending in the future. Will he join me in urging the Department for International Development to look at using those more effectively in the future when looking at how it spends its money?

[Stephen Crabb]

My hon. Friend makes an excellent point and I absolutely agree with him. That is exactly the kind of research and evidence that the Department and other bodies need to provide as those who believe in and support our overseas aid spending seek to make and restate the case for it over and over again. It is a powerful message with which to challenge sceptics and cynics.

In 2016, Johns Hopkins Bloomberg School of Public Health examined the projected return on investment in vaccinations between 2011 and 2020 in 94 low and middle-income countries. Looking only at the direct costs associated with illness, such as treatment and lost productivity, it found that the return for every £1 spent on vaccines was £16. When it expanded its analysis to look at the broader economic impact of illness, it found that the return was around £44 for every £1 spent. Such studies point to investment in vaccinations being an important means of improving health equity and reducing poverty, and to vaccinations providing value for money.

There is another aspect to this: investment in vaccinations in the poorest countries is also an investment in our own national security and resilience. I am always wary of the self-interest argument when it comes to defending overseas aid, and I think people generally see through those arguments, but polling evidence indicates that the general public understand that killer diseases such as Ebola do not respect borders and shows greater support for aid that focuses resources on tackling those diseases.

I will wrap up in a few moments, but I will close with several recommendations and observations, which the Minister will perhaps respond to today or follow up in writing at a later date. What efforts is Britain making, through its international partnerships and on its own, to improve vaccine coverage rates among the very poorest, ensuring that aid is spent on those who need it most and for whom it has the biggest benefit?

Distributional impacts should be taken into account when decisions are made about introducing or expanding vaccination programmes, and programmes accruing greater benefits to the poor should be prioritised over vaccines with less equity impact. Hard-to-reach families and people in isolated areas should be priority targets, as investment among those people significantly reduces the likelihood of disease outbreaks, which are more costly in lives and the money needed to respond.

Despite significant progress since 2000, today, nearly one infant in 10—that is, around 30 million children—does not receive any vaccinations, and more than 1.5 million children under the age of five die from vaccine-preventable diseases every year. Pneumococcal conjugate vaccines immunise against the most common cause of pneumonia, but they remain inaccessible to millions largely due to high prices, thus leaving behind the poorest and most marginalised children.

[John Howell]

I thank my right hon. Friend for giving way again; he is being most generous with his time. Does he see a role for the Prime Minister’s trade envoys in this sphere? We are often assigned to countries that fall into the categories that he has been talking about and we have a seminar coming up on the healthcare applications of what we can do. I do not think that that should concentrate solely on encouraging healthcare companies into those countries; it should also look at how we can help to develop those programmes.

[Stephen Crabb]

My hon. Friend makes an extremely important point. There are well established networks nationally in the UK and internationally, which bring policy makers together with academics, scientists and researchers who look at these issues. Surely within that there needs to be a role for people with a trade focus to link that investment angle into it as well. There would probably be a lot of interest, particularly among some of the private sector interests that are part of those networks, in seeing people such as Government trade envoys getting on board and helping with these programmes.

GAVI’s advance market commitment pilot, supported by the UK Government, has created a temporary but pioneering funding model that is changing the picture that I described—the poorest and most marginalised not getting access to vaccines—and it is doing so by changing the market. That funding mechanism can reduce the price of vaccines, such as the ones I have described for pneumonia, by creating an incentive for new manufacturers to enter the market and increase competition. The advance market commitment has succeeded in reducing the usual delay between introduction of a new vaccine in developed and in developing countries from 10 to 15 years to just three, reducing inequalities in access between rich and poor countries.

As we look to the future of programmes such as GAVI and the global health fund, which I was describing a few moments ago, we know that decisions will need to be made in due course about Britain’s ongoing support for those programmes. Those decisions will not necessarily be made anytime soon, but I urge the Minister and his teams, as they prepare for the replenishment conferences for GAVI and the global health fund, to bring together as much high-quality research and evidence as possible to enable them to make a strong, positive decision to continue funding those vital, life-saving programmes and, crucially, to explain that and show members of the public that it is a really good investment of our aid money for the future.

Investments in vaccines remain an enormously effective use of aid and contribute directly to achieving the sustainable development goals. Britain has a powerful track record to point to and we should do more to highlight that—not in the sense of being self-congratulatory, but to help to strengthen the broader case for overseas aid. Britain’s leadership in the field of vaccinations flows directly from the political consensus of a decade ago to expand our overseas aid budget and direct it towards some of the most difficult global challenges. The remarkable international effort on vaccinations underlines the importance of reforging that consensus and protecting UK aid.

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the right hon. Member for Preseli Pembrokeshire (Stephen Crabb) on bringing this matter to Westminster Hall for consideration today. I am very happy to make a contribution to support his proposals and the views that he has put forward.

When I look at my own life and at my two beautiful granddaughters, I know that there is little in the world that I would not do to protect them and help them, because that is what a father and a grandfather would do. There is no medication that I would not fight for, and that is why I have been trying to help my constituents to secure medication for their ill child and why I continue that fight, with help from the relevant Ministers. This is not the day for that debate; this is a separate debate, but I wanted to illustrate how much it would mean to me if I had to have medication to try to save my child and what I would do to make that happen. I do not think that there is one person in this Chamber who would not have the same opinion; we would do everything within our power to make it happen.

I think of those children in Africa and, indeed, throughout the world whose parents and grandparents have nothing; they have little or no way to get the help that their children need. As fathers and grandfathers, our compassion for them is illustrated through our own personal beliefs and through our actions to help those who do not have the ability to help themselves. That is why I am supportive of aid going to make a difference to the health of people in those nations, and why I have always supported DFID’s commitment and the Government’s commitment to the DFID aid programme. It may not be popular with everybody, but let us think about what it achieves. I will illustrate in my contribution what it achieves. It achieves a massive amount of help for the people who need it, and I am very supportive of that.

Prevention is better than cure. We have been practising that for some time on our own shores. It is why our newborns, every three months, have new injections that make them scream and their mothers squirm with guilt for knowingly causing them pain. The short-term pain will prevent massive life-threatening illnesses in the future and is of course well worth it, as we all know through our own parenthood.

It is estimated that the aid that we give GAVI between 2016 and 2020 will fully deliver on the UK target to immunise 76 million children and save 1.4 million lives. If ever anyone needed motivation for doing this, surely that is it—76 million children immunised and 1.4 million lives saved through the programme that we do; it is done by our Government. That is a tremendous result for the amount of aid that we grant for immunisation purposes. The fact is that through prevention we save money and promote economic growth, in that a child who is prevented from having a debilitating illness will be able to attend school and eventually start work and be able to provide, rather than being a drain on their family.

The right hon. Member for Preseli Pembrokeshire explained that when sickness comes into a family, the opportunity to earn is restricted right away, and that affects the whole family. That is the truth. If there are multiple cases in a family—two or three children and perhaps a father who is unable to earn and a mother who is not well—all of a sudden the problem is compounded. It is so important to recognise that.

There has been massive success with immunisation in Africa, and that must continue. For it to do so, we must have adequate funding and perhaps work more with partners across the world to ensure that they also have—I say this very gently—the conscience and the compassion that they should have for those who are less well off. The Vaccines for Africa Initiative website outlines success stories. There are some; let us not pass this by and say that we have not done well, because we have, but we can do more.

In 1977, smallpox was eradicated after a successful 10-year campaign carried out by the World Health Organisation. It was through our efforts with our partners that we made that happen. Before the vaccination programme began, smallpox threatened 60% of the world’s population and killed every fourth person infected. That was the magnitude of smallpox. Vaccinologists are applying the lessons learned during the eradication of smallpox to control and eliminate many other vaccine-preventable diseases, so lessons learned have become good practice. That indicates how we have learned and how we intend to do better in the future.

The development of an effective vaccine against polio was heralded as one of the major medical breakthroughs of the 20th century. Currently, several different formulations of polio vaccine are in use to stop polio transmission. Poliovirus infections have fallen by more than 99%, from an estimated 350,000 cases in 1988 to 416 reported cases in 2013. Let us dwell on that for a second: a 99% reduction resulting from an immunisation programme. If that is not good news, there is something wrong with what we are listening to. That is what can be done if we have the commitment, the effort, the finance and the drive to make it happen. Our Government have been involved in that programme; our Minister and his Department have been involved in making it happen.

More than 5 million people have escaped paralysis since the launch of the Global Polio Eradication Initiative in 1988 by the World Health Organisation and its partners, of which we are one. Polio has been eradicated in the western hemisphere, and many other countries have been declared polio free. Again, that is tremendous news. As at the end of 2012, polio was endemic in only three countries in the world. The website to which I referred states:

“According to the GPEI, if enough people in all communities are immunized, the polio virus will be limited to spread and it will die out.”

That has to be our goal: the complete eradication of polio. High levels of vaccination coverage against polio must be maintained to stop transmission and prevent outbreaks. The GPEI is constantly assessing the optimal use of the different vaccines to prevent paralytic polio and stop poliovirus transmission in different areas of the world. We have come so far, but we need to be vigilant to ensure that there is no comeback and that polio is totally eradicated.

Measles vaccination has not had the same success, but it is still a fantastic success story. It resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide. During the same period, measles cases dropped by 58% from 853,500 down to 355,000—again, a massive drop and good news. The World Health Organisation recommends that every child receives two doses of the measles vaccine. I remember receiving it as a child in the 1960s quite well. I remember the swelling on my arm and the pain, but my dad stood next to me and made sure I had it done. He was always there to comfort me as well.

According to a report by the Measles & Rubella Initiative, African countries have made the most progress—fantastic progress. They reduced measles deaths by 86% between 2000 and 2014. That is another fantastic, well recorded success story of what we have done. Such stories ensure that we continue aiming for the eradication of these diseases.

Meningitis is a serious public health problem among 25 countries in the African meningitis belt. Every one of us, as elected representatives, has had constituents who have had meningitis in their family. We know of the blotches, the faintness, the dizziness and the tiredness. We know that if our child or grandchild has those symptoms, our knees knock with worry about meningitis, but in African countries meningitis is very real. It extends from Senegal, on the shores of the Atlantic ocean, to Eritrea along the Red sea. Meningitis is prevalent right across that stretch of Africa.

Half a million people living in that region are at risk from epidemic meningitis each year. In 1996, there was a particularly devastating meningitis outbreak, which caused more than 250,000 cases and 25,000 deaths. That was mainly due to the Neisseria meningitidis group A, or Men A, as it is referred to. Within 10 years, the Meningitis Vaccine Project developed an affordable Men A conjugate vaccine. The vaccine reduced the incidence of meningitis of any kind by 94%—is that not fantastic?—following a mass immunisation programme in Chad, in west Africa. If we can immunise, we can stop the disease, deaths, pain, suffering, sickness and illness, and that has to be good.

[Stephen Crabb]

I am enjoying listening to the hon. Gentleman’s speech. He captures well the sense of awe and wonder around some of the achievements that have been notched up in recent decades. Does he agree that we should be telling some of those stories in the school curriculum? As we think about Britain’s future global role, we should think about how to inspire a new generation of young British scientists to dedicate their education to going the last mile to finally eradicate some of the diseases he has been talking about.

[Jim Shannon]

The right hon. Gentleman is absolutely right. Too often, we focus on the negativity of life. Here is a positive thing we are doing. Others will speak afterwards with great knowledge of the subject matter and I look forward to their contributions. I am greatly encouraged by the young people of today, who have an eagerness and willingness to help others. That encourages me, as a grandfather and as the Member of Parliament for Strangford. I see talent, interest and compassion among young people today, who want to help. We should have this as part of our curriculum and education programme, so that we tell others and put a bit of pride back into what we do. That is why I am being positive in my speech. Sometimes we do not tell our story, but we should.

[Stephen Crabb]

On the subject of inspiring young people, is he aware of programmes such as the ONE campaign’s youth ambassadors programme, which links in young people with an interest and uses them to tell a story back to their own peer group about some of these exciting developments?

[Jim Shannon]

I am aware of that programme and the right hon. Gentleman is right; it is a smashing programme and can do great things. It can help young people to develop their personalities and their characters in a way that is good for everyone. That is the ultimate, perfect society that we all wish to live in. There are many young people who inspire us and give us great courage for the future.

I am blessed to have a great many church organisations, mission groups and individuals in my constituency of Strangford, both in Newtownards and across the whole constituency, which carry out individual projects, mostly in Africa and some in eastern Europe. They do smashing rebuild programmes for schools and medical centres. They do water aid projects as well. That is a subject for a different debate, but when it comes to ensuring that people do not have health issues, it is important that they have access to clean water. I pay credit to the churches and missions in my constituency, which do tremendous work, unselfishly giving their time, money and effort, and—I will say as a Christian—their prayer time as well. Those things are very important in trying to reflect the opinion of a constituency and how people think—how generous people are when it comes to giving, both financially and physically.

The work I have referred to must continue. We must play our part in helping other nations to fund this work for the good of humanity. It works, because we work together. How many things in this world can we do when we do it together, with a passion, belief and drive that we are all committed to? I say gently that we have to put our own people first, but that we also have to help ourselves outside our boundaries. I believe this is a great way for us to play our part. The inspiring programme that the right hon. Member for Preseli Pembrokeshire referred to is something for our young people to do—so many people want to do something. Our Minister and our Government are committed to doing the same. We should be encouraged by what we are doing, but we know that we have more to do. We have a plan of action in place—a plan of action that is working and that can do more.

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[The Minister of State, Department for International Development (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Evans, and I thank all colleagues for taking part in today’s debate and for the way it has been handled.

I thank my right hon. Friend the Member for Preseli Pembrokeshire (Stephen Crabb) for the way he introduced this debate—indeed, others have mentioned the passion with which he spoke. Such passion is appropriate for the leader of Project Umubano, and for a number of years he has played an integral part in the Conservative party’s social action programme in Rwanda and Sierra Leone. He spoke about the non-partisan nature of this debate, and that was emphasised by contributions from the hon. Members for Dundee West (Chris Law) and for Birmingham, Edgbaston (Preet Kaur Gill). There is no issue between colleagues in the House on this subject, and we are rightly proud of successive Administrations of all shapes and colours, and the work that has been done in making the United Kingdom a global leader in vaccination.

My right hon. Friend drew attention to the history of vaccination and the United Kingdom’s involvement in it. He mentioned our position in contemporary medicine, research and development, and spoke about looking forward to the next stage. As the long title of the debate suggests, he then moved from that historical perspective to the wider economic benefits of vaccination, and emphasised a link that is not made often enough.

The hon. Member for Strangford (Jim Shannon) spoke, as he always does, with passion, commitment and great wonder about the success of these programmes. Sometimes there is immense concentration in the press and media of everything that is wrong, but in the world of medicine, lives have been saved by finding opportunities to invest in things that have led to a reduction in diseases that were once all too common, including in our own childhoods, let alone 50 or 100 years ago. Medicine has made a remarkable contribution, and the hon. Gentleman was right to mention that. He encouraged us all to keep going on the eradication of polio, and he can be sure that we will.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) linked access to our success and the importance of research, and he spoke with pride about his involvement with Rotary. I, too, am a Rotarian—I am an honorary member of the Rotary club of Sandy in Bedfordshire. I recently met Judith Diment, who is chair of the polio advocacy taskforce. Rotary has done remarkable work on that issue, and we pay tribute to everything it has done over the years.

My hon. Friend the Member for Stafford (Jeremy Lefroy) contributes a remarkable amount to this House through his work on malaria and in east Africa, and he related the importance of vaccine research in those areas. The hon. Members for Dundee West and for Birmingham, Edgbaston had some questions, and if I may, I will return to those at the end of my contribution—on this occasion I actually have some time, so I will be able to answer one or two of the questions, although not all of them.

Let me bring this back to basics and the practice of vaccination. My dad is a doctor, and I am old enough to have needed injections for polio when I was very young, as that was before the wonderful man developed his oral vaccine on a sugar cube. My dad had to give me my polio injections, and I hid under every available table in the surgery because as a small boy I was terrified of needles. He will be tickled pink to know that I am responding to a debate on vaccination today, bearing in mind the struggle he had to get near me with a needle. I am eternally grateful that he did, because those vaccinations protected me—as they did many others—from the ravages of polio. My dad is still with us, so he will be able to get a copy of this debate and realise that all those days from long ago are still remembered fondly by his son. This issue is that personal. The hon. Member for Strangford referred to the moment of pain caused by a mother when a child gets vaccinated, although she knows that it will do so much good in future, and today we are remarking on the remarkable good that is done.

The number of children dying each year almost halved between 1990 and 2012—a significant achievement. Nevertheless, around 375,000 children still die every year from diseases that could be easily prevented by vaccines. As we all agree, the challenge is most acute in the developing world, where nearly 1 million children die every year from pneumonia. In 2016, 7 million people were affected by measles, resulting in nearly 90,000 deaths. It is therefore right that the UK works through organisations such as GAVI, the Vaccine Alliance, the Global Polio Eradication Initiative and the World Health Organisation to tackle vaccine-preventable diseases.

Clearly there is a strong moral case for the UK and its international partners to support developing countries to tackle the scourge of vaccine-preventable disease—the contributions to the debate have shown that we all understand that. However, the economic case for vaccination—a subject that my right hon. Friend the Member for Preseli Pembrokeshire homed in on—is also unquestionable. Vaccinating against childhood diseases is one of the most cost-effective health interventions. As colleagues have said, for every £1 spent on immunisation, there is a direct saving of £16. Those savings include healthcare costs, lost wages and lost productivity due to illness. Vaccination is a key driver towards reducing childhood mortality globally, and vaccines administered in 41 of the world’s poorest countries between 2016 and 2030 will prevent 36 million deaths.

Vaccination provides economic benefits many times beyond the direct costs of vaccinating children, which is why it is such a high impact investment. As the hon. Member for Dundee West reminded us, if we take into account broader economic and social benefits, the return on investment rises from £16 to £44 for every £1 invested. The wider economic benefits of vaccination are vast.

By preventing illness, whole families are freed from crippling medical costs, which in turn can have a substantial effect on poverty reduction. Unexpected healthcare expenses push about 100 million people into poverty every year, making medical impoverishment one of the main factors that force families below the World Bank’s poverty line. A vaccinated child is more likely to be healthier, live longer and have fewer and less serious illnesses. Healthier and more productive populations trigger a virtuous cycle that results in enormous economic gains. Vaccinated populations therefore form a more productive labour force, resulting in higher household incomes and economic growth.

There is a clear positive relationship between immunisation and education. Vaccines support cognitive development, so children learn more and have more opportunities. In the Philippines, for example, routine immunisation was found to raise average test scores among students. When translated into earning gains for adults, the return on investment was shown to be as high as 21%. In Bangladesh, measles vaccination was found to increase school enrolment of boys by 9%.

There is also an effect on the next generation. Children of educated parents are more likely to be vaccinated and healthier. In Indonesia, for example, child vaccination rates are just 19% when mothers have no education, but increase to 68% when mothers have at least a secondary school education.

Additionally, the decrease in child mortality as a result of routine immunisation can have a significant impact on a country’s economy by reducing fertility rates. Since more children are expected to survive, families have fewer children. A lower birth rate has significant effects on child and maternal health, as well as a broader economic impact, not least in the role that it might play in the development of women’s opportunities in their societies. Up to 50% of Asia’s economic growth from 1965 to 1990 is attributed to reductions in child mortality and fertility rates. Overall, the savings that come from the need to pay for fewer medical interventions, combined with a healthier, more productive labour force and demographic dividends, create more economically stable individuals, communities and countries.

Let me turn to some of the questions asked by hon. Members. First, we are very proud to be the largest investor in GAVI, the Vaccine Alliance. The UK recognises the strong and convincing economic arguments for vaccines as being a clear development best buy. That is why we, through the Department, have supported GAVI since its inception in 2000.

Since then, our investment has supported the immunisation of 640 million children and has contributed to the prevention of 9 million deaths from vaccine-preventable diseases. Those are remarkable figures that, as my right hon. Friend the Member for Preseli Pembrokeshire said at the start of the debate, and as we have all said, we do not talk about nearly enough. If someone is looking for a demonstration to put to the people of the positive advantage not just of UK aid, but of any country’s development budget, and of why they are useful, vaccination is possibly the single most obvious example that they can give.

Between 2016 and 2020, the UK’s support to GAVI will directly enable 76 million children to be vaccinated and will save 1.4 million lives. Investment through GAVI represents a particularly high rate of return. The £16 direct return for every £1 invested, which I mentioned earlier, rises to £18 in the 73 developing countries that GAVI supports. Overall, between 2001 and 2020, in GAVI-supported countries, the long-term gains associated with a more productive workforce are expected to add up to £260 billion. Every year, as a result of vaccinations, each of those 73 countries will avoid more than £3.5 million in treatment costs.

Critically, GAVI not only delivers vaccines on an impressively large scale, but works to bring down the cost of vaccines to make them more affordable for the world’s poorest countries. Since 2011, GAVI has enabled a 43% reduction in the cost of immunising a child, from $33 to $19. That price cut means that UK taxpayers’ money goes much further and delivers a much greater impact, and brings those products within the reach of poorer countries’ Governments, which was a key point made by the hon. Members for Birmingham, Edgbaston and for Dundee West. Our support for GAVI is explicitly designed to ensure that Governments in developing countries gradually increase their contributions until they eventual transition away from aid, which the price cut also helps with.

In response to the point made by the hon. Member for Dundee West about bilateral funding, some time ago the United Kingdom made a decision to put its support for vaccination into GAVI, because it has a wider reach than our bilateral funding programmes. That is why the contribution to GAVI has been so strong: it allows us to reach more children. We continue to offer bilateral support to health systems to make them more sustainable. Of course, GAVI will work in some of the areas where the UK is also working directly through the Department.

On the need to ensure that vaccinations support equity, the financial benefits of vaccines are mostly accrued by poorer households, which are more susceptible to financial shocks from unexpected healthcare expenses. Immunisation programmes reduce the proportion of households facing catastrophic out-of-pocket health expenses. GAVI ensures that the right people are reached through the three equity measures in its monitoring framework, which track vaccination coverage by geography, poverty status and the mother’s education. We work with GAVI to ensure that the vaccinations are reaching the poorest, as my right hon. Friend the Member for Preseli Pembrokeshire said in his opening remarks. GAVI is designed to do so, and we will continue to work with it on that.

[Stephen Crabb]

Will the Minister address the question asked by several hon. Members about why the levels of inoculation seem to have plateaued internationally? Is that correct and, if so, what might be the underlying causes? I hope he will forgive me if he had planned to come on to that in the next few moments.

[Alistair Burt]

I cannot give my right hon. Friend the figures, but let me say two things. First, in some areas, there has been a reaction against vaccination. Earlier this year, two vaccinators in Pakistan, a mother and a daughter, were killed. The Pakistani Government have worked with others to try to change the nature of the programmes, but that is a reminder of how brave some health workers have to be. In some cases there is a supposed religious objection to vaccination, and in others it can be more direct.

Secondly, yesterday, in another context, I mentioned in the House the issues that are being faced in Yemen due to the de facto Houthi authorities in the north of Yemen, which have refused permission to transport vaccines into Sana’a. That has meant that 860,000 people in the north have not received vaccines, while hundreds of thousands of people in the south have benefited from the campaign. The Department is working closely with the World Health Organisation and through diplomatic channels to help unblock the use of vaccines in Yemen, particularly in Houthi-controlled areas.

In some areas, the cause is conflict; in others, it is an ideological response or a false fear that has been spread. In some areas, vaccinators are somehow seen as being connected to the west, and it is easy for false stories to spread. All those things need to be combated, and perhaps one way to do that is to ensure that there are more local programmes, because it is essential that the effort of vaccination continues, as all hon. Members have said.

In particular, we cannot afford to lose the chance to eradicate polio, and we have to be very careful. The rise in measles may be connected to some false stories about vaccines. There appears to be a market for people who want to spread those false stories, not only in developing countries but in places such as the United States. Fake news has to be combated. The outstanding research in this area makes it very clear that the benefits of vaccination far outweigh any potential medical consequences, of which there are some from time to time, but in a very tiny proportion of people. It is essential that the public grasp that.

Let me return to other remarks by hon. Members. We have talked about how we can ensure that future research is done in areas where the economic benefits of a vaccine may be questionable and about what help we can give. That is not an easy issue to tackle or to be absolutely certain about, because the specific diseases market is highly variable and pharmaceutical companies need to know that they will make a sufficient profit for a new market initiative to be possible.

However, things can be done to assist with that. GAVI’s advance market commitment, which the hon. Member for Birmingham, Edgbaston mentioned, has done significantly well, and we have provided finance to support it. It now produces 150 million doses of the pneumococcal conjugate vaccine annually at a price of $2.95, which is significantly lower than market price. GAVI also provided £390 million as an advance purchase commitment for the Ebola vaccine, which enabled Merck to make 300,000 doses available. In the Democratic Republic of the Congo, that vaccine was implemented 13 days after the Ebola outbreak was announced.

There are ways in which the international community can help to ensure that some of the costs are borne collectively, but that is not always an easy process, so there will always be issues about how to develop the vaccine and how to pay for it. The Government are well engaged in dealing with those.

I will conclude and offer my right hon. Friend the Member for Preseli Pembrokeshire a chance to respond. As well as the support for GAVI, the UK invests in vaccines in developing countries in a range of ways. We are a leading supporter of eradicating polio, as has been mentioned. That investment brings economic returns of many times the magnitude, and a stronger global economy that will benefit us all.

Hon. Members also mentioned Ebola. The handling of the recent outbreak contrasts with that of the previous one. The WHO and the Department supported the development of two Ebola candidate vaccines during the 2014 outbreak that have been brought through into the most recent one. These are some examples of how we—through DFID, GAVI and bilateral programmes to strengthen and sustain health systems—have been able to put vaccination at the very top of the agenda, as the most cost-effective way of dealing with health problems.

I conclude by acknowledging the dedication and hard work of all the health workers around the world, who often put their lives at risk to deliver vaccines to children, even in the hardest-to-reach places; by saying that I am very proud of the United Kingdom’s investment in vaccines in developing countries, and I say that on behalf of us all as this is a non-party issue; and by saying that saving the lives of children and improving the lives of families in some of the world’s poorest countries is simply the right thing to do.

Finally, I will say that the exchange between the hon. Member for Strangford and my right hon. Friend the Member for Preseli Pembrokeshire about the inspiration that can be gathered for this work and the promotion of it through schools, so that people are more aware of what we can do, is the way that we should finish today. Sometimes this place has to deal with difficult subjects that occasionally colleagues fall out over—not this one. This is something we can agree on and we can all use our own influence to ensure that a new generation of young scientists, young doctors and young health professionals are inspired to work, not only in this country but throughout the world, knowing how important vaccination will continue to be.

[Stephen Crabb]

Thank you, Mr Evans, for calling me to speak again.

By way of wrapping up, I will just thank the Front Benchers. I thank my right hon. Friend the Minister for that very useful update he has given at the end of this debate. I also thank the other Front-Bench spokespeople, the hon. Members for Dundee West (Chris Law) and for Birmingham, Edgbaston (Preet Kaur Gill).

This has been a very useful debate; I have certainly learned a tremendous amount. I am grateful to all the colleagues who have spoken or made interventions, and for the spirit in which they did so. As my right hon. Friend the Minister said, this is an issue on which there should be no differences at all between the parties. It can bring this House together as something to unite behind, not to be self-congratulatory, but to recognise the remarkable progress that successive British Governments have helped to achieve internationally, in partnership with so many other international bodies and other Governments.

I will finish by asking the Minister to urge his team at the Department to keep briefing us and updating us on these developments. Do not keep Members in the dark—not that he does at all. However, there is a powerful story that we all want to tell in our constituencies about this issue, and it would be incredibly helpful if he and the NGOs that his Department works with provided us with as much information as possible.

[Alistair Burt]

Perhaps I might make an immediate commitment. I will write to all colleagues here, on the back of this debate, to set out some of the facts that have been raised by us all and, as it were, do it in the form of a factsheet, which they will then have available to give to constituents. I am very grateful to my right hon. Friend for the suggestion.

[Stephen Crabb]

I am grateful to my right hon. Friend the Minister for that response.

Finally, Mr Evans, I thank you. As ever, you have chaired this afternoon wonderfully. Diolch yn fawr.

[Mr Nigel Evans (in the Chair)]

As someone who has witnessed the vaccination, via the Department for International Development, of many babies under a tree in Uganda with the International Development Committee, may I say what a privilege it has been to chair this debate?

Question put and agreed to.

Resolved,

That this House has considered the economic effect of vaccinations in developing countries.