Examination of Witnesses (Questions 1142
- 1159)
MONDAY 23 JUNE 2008
Dawn Primarolo and Gillian Merron
Q1142 Chairman: Ministers,
I know that Lord Soley has been in touch with you to explain that
he is unavoidably absent this afternoon and has invited me to
take the chair. First, may I thank you both very warmly for coming
to give evidence to us and for the paper that the Government submitted
earlier on in our inquiry and also for the evidence that we have
already taken from officials. This session is being recorded and
you will receive transcripts so that errors can be corrected.
We will aim to finish by 1730 if that is all right. If at the
end of the day you feel you have missed anything out, we would
be grateful for any further notes you may care to let us have.
As you may know, there have been a number of key issues that have
emerged in this inquiry and the central question of global health
governance has been referred to many times, including in the Government's
evidence, where they say "The current architecture"—that
is, of international health—"is crowded and poorly
coordinated. Within the diverse group of organisations there is
no agreed vision or clarity over roles." I wonder if you
can tell us whether the Government has a strategy for addressing
this problem and, in particular, do you think that the international
community needs a formal structure to agree which different organisations
will accept different complementary roles? Could this encompass
the very large private and single-State organisations like for
instance the $45 billion Gates Foundation or the $15 billion US
Presidential PEPFAR fund on AIDS? If so, how could this be accomplished?
Gillian Merron: Thank you very much for inviting
us to be here. We are very glad to be here together to demonstrate
joined-up government, as indeed we have on this issue. To apply
myself specifically to the question, first of all, it is a situation
that we know needs to be remedied. It is a question that I think
it is important to ask: is it possible to create a formal structure
in which people will accept different but complementary roles?
Yes, it is possible and, yes, it is difficult. For me, the reason
we are in the crowded situation that we describe is because many
organisations have evolved over many years, sometimes in the absence
of others. Now, we find ourselves in a different situation, with
new challenges and a lot of new players. You mentioned some yourself—for
example, the Gates Foundation. Indeed, there is a role for them
to play. It is a fragmented place and, if I can refer first of
all to the United Nations, the development of the UN over 50 years,
the UN that we have today is very different to the UN that we
had 50 years ago. I think therefore it has grown up in a somewhat
fragmented way which is not now serving as well as it should do.
There is very much scope to improve the effectiveness and coherence
of intergovernmental organisations that are working on health
and communicable diseases. Our work is to strengthen their performance
and their accountability and to encourage more effective cooperation
between agencies. Our particular focus, as you will know, is the
International Health Partnership, which is about combining health
system strengthening, which is absolutely crucial as you will
have seen, I am sure, in our updated HIV and AIDS strategy. That
is a very good example of joint government working in the UK,
because it is a UK Government document, not just a DFID document.
I think that is its strength. The IHP is about strengthening health
systems, improved alignment by donors and international health
agencies. In the medium term we would like to see mergers happening
but we are realistic that that is not likely to happen in the
short term. We are very much supportive of the H8 and the leadership
of the World Health Organisation is very important. I myself met
with Margaret Chan, and I pay tribute to her in her role. She
is completely focused on the need to get results through the International
Health Partnership and to bring organisations together. There
is a lot of money, as you know, going into health globally but
we are not seeing the levels of results that we would want to
see. I just offer those as a few comments on the points that you
make.
Q1143 Chairman:
We will come on to the IHPs. But, just on what you have said so
far about strengthening performance and accountability, do you
think there is any formal mechanism by which this should be done?
Should that be led by the WHO?
Gillian Merron: Yes, the WHO certainly has the
mandate to lead on technical health issues. It is the correct
place for intergovernmental agreement on health. Margaret Chan,
as the Director-General, is very committed. We have seen improvements
in the WHO but it cannot act alone and that is important to stress.
We need to see UN reform. We need to see the other agencies all
working together. For me, we need to see UN country plans. It
is obvious; it needs to be re-stated and we need to be working
to achieve that.
Q1144 Lord Howarth of Newport:
I wonder whether you could give us a slightly fuller sense of
where the need to achieve greater coherence, greater strategic
impact, less duplication, more effectiveness really ranks in our
own Government's scale of priorities. How important is this to
the Government? How hard are we working on this? How much does
it matter? What are you really doing to effect change?
Gillian Merron: I could give a very specific
assurance to the Committee that our departments—the Department
of Health, DFID and the FCO—are working together on the
WHO institutional strategy. We are finalising that, and that is
the UK's engagement with the World Health Organisation, which
of course the Department of Health takes the lead on. If I could
clarify the kinds of areas where we would want to see performance
improved, I assure you, Lord Howarth, and the rest of the Committee,
if it is only one lesson I can leave you with, it is that results
are what matter. The amount of resources we commit is important.
I believe we have proved ourselves in that regard. However, the
UK plays a very important part in galvanising others, bringing
them to the table. Leadership and coordination are crucial, because
whilst I would like to see more resources coming into health,
as much as that, I want to see resources used better for greater
effect. I believe that the IHP is going to be helpful in that.
The H8 gives leadership, and the WHO of course is the main technical
leader. I would not expect them to be a funder. Just to mention
some of the improvements that we are looking at for the World
Health Organisation, perhaps to give some indication, because
that is what will come out of the institutional strategy, we would
like to see improving the way that there is work done at country
level, particularly with other multilateral agencies, including
the UN. We want to see more effective support to governments in
development and implementation, national plans on health, and
closer integration for the World Health Organisation's own approach
on that. Important in all this is making sure we have the right
mix and quality of WHO staff at country level. We also want to
see a properly functioning performance management system for WHO
staff, and a performance framework of course should include the
WHO's own indicators on communicable diseases. All of this we
are working to ensure through our institutional strategy which,
for me, is the best example I can give you of cross-government
working in the UK to get cross-international agency working globally.
If you ask me for my sense as a Minister, we are extremely focused
on it and we need to do more. I am very hopeful that the Committee's
deliberations will assist us in that.
Q1145 Chairman:
Shall we move on to the International Health Partnership, which
you have already mentioned, and which was prominent in the Government's
written evidence, where you refer to the launch by the Prime Minister
last September to strengthen health systems and improve alignment
by donors and agencies, including those with a disease specific
mandate, of which I remember Dr Tyson told us that there were
more than 100? How does the Government envisage the IHPs integrating
with the Global Fund Country Coordinating Mechanisms and also
with `One UN' model that we were told about which was being piloted
in eight countries bringing together donors, ministers and other
stakeholders?
Gillian Merron: For me, the launch of the IHP
was something of an important political milestone. I think it
is the first time the global health community have come together
with a clear signal that we cannot go on as we are. It is important
to recognise we have a crowded market place and we are not making
as much progress as we would like. That political commitment that
was shown was very important. In my own discussions, I am quite
clear that what the IHP cannot be is just a talking shop. What
it has to be is something that is implemented and very real, that
will contribute towards us meeting the Millennium Development
Goals. Three principles aimed at improving the health of the poor,
I feel, are important to elaborate. Country-led national health
strategies is the first point. Secondly, funding is coordinated
around these strategies. That does require organisations like
the World Bank, the Global Fund, GAVI and the bilateral donors,
like DFID and others, to sign up to that. Interestingly, there
are also moves to fund and support national strategies. Again,
that is a shift. The third point of course is the strengthening
of health systems. I have already mentioned our updated HIV and
AIDS strategy, which makes a commitment over seven years. The
strongest way we can deal with HIV and AIDS is to strengthen health
care systems. That is one side of it, but the other side of it
is that the developing country governments have to agree to invest
more to address bottle necks and to strengthen their planning
and accountability systems. The IHP is the organising framework
for support but it is requiring all the relevant players to come
to the table. I was in Zambia last week. The interesting thing
there was seeing the important role of civil society that I would
want to highlight to the Committee, because there the IHP is encouraging
civil society to work more closely with the Ministry of Health,
to address the needs of the people in local communities. I am
happy to give more detail about examples of improvements that
we have seen already, but the IHP is international organisations
and those countries that have signed up—we hope that more
will—saying, "We will commit ourselves to coordinate,
to work together on those three principles."
Q1146 Chairman:
You mentioned the need for coordination. I was wondering how the
IHPs can work with the Country Coordinating Mechanisms. Is that
a possibility for a further merger? We have only heard about one
merger between organisations at country level during the whole
of our evidence. I think that was a case of maternal and infant
health. Do you think that the IHPs could take on that role with
the Country Coordinating Mechanism? And can you think of any other
multilateral initiatives that require the attention of donors
and recipients at country level that might also be dealt with
through the IHPs? What about, for instance, the Global Early Warning
Response System or the Global Influenza Surveillance Network?
Do we need separate organisations to do all those jobs?
Dawn Primarolo: That is a very good point in
trying to respond to what is the interaction between in-country
and the multilateral bodies. What we are trying to do around discussions,
whether it be animal and human health or the balance of investment,
is to firstly start from the principle that what we need is that
each organisation is very clearly focused on its core remit. We
need them. They do vast jobs which are important, and there is
cross-over, as you would see in a Venn diagram. The first thing
that we would want to make sure is that we do not lose the focus
on the core remit, which is part of the discussions that we are
having both as Government through the Global Health Strategy and
at the WHO through the Institutional Strategy, and also looking
at the balance of funding. Then we need to move on from that to
make sure that, having satisfied ourselves that we will not lose
that core focus, there can be coordination and that it is sensible
in country, so there is not duplication. It is a slightly different
way of approaching the point that you made earlier, Lord Avebury,
about making sure there is not duplication here, but equally we
should not underestimate—I know your Lordships have not
and certainly Gillian and I do not as Ministers—the vastness
of the challenges for global health development and the very great
difficulties in setting priorities. I think it is a very fine
balance. Through our efforts, supported by the Foreign and Commonwealth
Office as well through Lord Malloch-Brown, the three of us working
very tightly together trying to advance these arguments, that
is really where we are trying to get to. Clearly we see the WHO
as the best placed with the skills and we have huge confidence
in them as an organisation to manage those protocols and those
bilateral arrangements.
Q1147 Baroness Whitaker:
I suppose this is really a DFID question. I was very pleased to
hear you say, Minister, that civil society was particularly important
in implementing health policy. I saw some evidence from the International
HIV/AIDS Alliance hoping that DFID might make more substantial
investments in civil society in their responses. Perhaps you could
tell us a little bit about DFID's view of what should be done
to encourage civil society.
Gillian Merron: Civil society is crucial because
it is about securing political will. The thing that I have learned—and
I am sure many Members of the Committee would agree—is that
often where we come to the biggest block to progress is political
will. We would probably all understand as politicians that when
people in our countries speak and demand we listen. Without that
voice, it is harder to make the case. That is why civil society
is so important to us. In Malawi this week just gone, where I
was also visiting, I saw perhaps one of the best examples of community
engagement that I could imagine, which was DFID-supported. In
visiting a community, it was based on our work in Nepal which
has been highly successful in reducing maternal mortality, because
it was giving a voice to the people in that community who, with
the greatest confidence, I think would have impressed all Members
of the Committee. It certainly took my breath away. Young women
stood up and said, "This is why we are dying in childbirth.
This is what needs to be done. This is what has improved and this
is what now needs to improve." To be quite honest with you,
it would be hard not to listen to that because they just spoke
sense. Civil society has to develop that voice and then politicians
have to hear it. When I meet with ministers, when I visit various
countries, I have various messages to take there, as doubtless
people bring to us too, but it is not sufficient that I say, "We
need to work harder on maternal mortality." The men and women
of that country also need to do that. I hope through that you
can hear that we have in-country very specific plans for developing
that voice because, without it, I do not think we can secure that
political will to greatest effect. I am increasingly seeing how
powerful that is in making change. I think here civil society
is very strong and we almost take that for granted. When we go
to developing countries, we are talking about sometimes a very
new voice. Again, our level of expectation has to be there, but
certainly DFID is very clear about the role and importance of
it, yes.
Q1148 Lord Geddes:
Dawn Primarolo, you made a very interesting comment a couple of
minutes ago on promoting—my words, not yours—the WHO
as being the obvious body, the natural body, to lead. The thing
that has worried me throughout this inquiry is that, sometimes
for very understandable reasons, there are an awful lot of chiefs
and relatively few indians. What mechanism could be used to try
and reduce the number of chiefs and increase the number of indians
so that you really get a focused, international, global strategy
on this subject?
Dawn Primarolo: Our view is that by the discussions
that we are having now with the WHO on the institutional strategy,
it seems to me, it is how we interlock as well and how we hold,
as members of the WHO, the WHO accountable for what it delivers.
We all of us recognise our limited resources with massive challenges
and expectations so that it is necessary that the WHO is able
to prioritise and then to be accountable for that. If we look
at our relationship as one member, but also as Ministers, we see
this in the UK as well. For us as Ministers, we have to be accountable
for the resources that have been spent and to explain why that
happened. It seems to me that by the institutional strategy, by
agreeing on some clearly identified objectives, goals, coupled
with recognising what needs to be done in country and cooperation
with other international bodies that also might be working, in
that way we can have a dynamic that pushes that forward. We recognise
what the pressures are. I think that will bring it about. A point
was made about reform and development globally in terms of other
funds, the Gates Fund for instance, and how that interaction would
then occur. It seems to me that a WHO that wants to be able to
embrace and engage with something like the vast resources that
we are talking about being available in the Gates Fund does require
it to be clear on its core remit, focused on delivering that and
then be able to coordinate and be flexible where it is necessary.
I think that will start the process of what you are suggesting.
I have to put in a caveat. We are talking about a huge challenge
for the organisation where each member is trying to say, "These
are our priorities. This is what we want you to do" and pulling
them from one end to the other. I think that is a way to deliver
what you are seeking.
Gillian Merron: The Prime Minister launched
an initiative on the reform of international institutions in January,
which is key to the point that you are raising, which is quite
understandable. There are three main areas to DFID's work on this.
First of all, about gathering and strengthening the base of evidence.
That is particularly important in respect of accountability. Secondly,
promoting reforms of various agencies and, thirdly, seeking to
increase effectiveness at country level. I would say, particularly
when you look at the United Nations, that is very key to seeing
them operating as One Country plans. It just makes so much sense.
We need to encourage that to happen. I mentioned the long term,
about seeing mergers. We would like to see mergers amongst some
of the international initiatives. We also recognise that is longer
term but just to give the Committee an idea we feel we should
brainstorm around mergers—for example, the Global Fund and
GAVI—and, in the future, UNAIDS. Then, of course, there
is the UN country programme. It is a big challenge. These are
big beasts and we believe that the fact that they are big beasts
will not put us off. It is all the more reason to work with them
and with others to secure institutional reform, because I do feel
that is going to be crucial to delivering the results and improving
the lives of poor people. That is what we are here for, not to
create huge organisations that sustain themselves. I feel quite
strongly on that.
Q1149 Lord Jay of Ewelme:
I was very glad to hear that last answer. I was going to ask whether
you had any specific examples to give us and what the mergers
in the medium term might be. I would like to bring us back to
Whitehall and joined-up government and the institutional approach
which you are taking here in pursuit of the government's Global
Health Strategy. Health is one of those classic issues which cuts
across many different departments—I suppose, in particular
here, the Department of Health, DFID and the Foreign Office. You
have already said you are an example of joined-up government by
being here together and you have talked about the importance also
of working with the Foreign Office. But I just wondered whether
you could go a little bit beyond that and say how you envisage
the structure which will emerge from these deliberations. Do you
see there being, for example, a lead department among the three?
We were quite interested when we were in Switzerland to see that
the Swiss were giving their Foreign Ministry the lead in international
health issues. DFID having the lead would be another one. I suppose
another model would be the equivalent of a Climate Change Office
which brings together officials in different departments to handle
a specific issue. I just wondered if you could say something to
us about how you see the results emerging from the discussions
you are having to ensure effective Whitehall coordination, which
is crucial to this.
Dawn Primarolo: Currently we are working on
developing a joint strategy for the government, a Global Health
Strategy which is about how the whole of government should be
interacting and working with the WHO. That includes the Department
of Health, DFID, the Foreign and Commonwealth Office but does
reach across to some other departments as well, depending on what
we are considering, the BERR or the MoD under some circumstances.
Q1150 Lord Jay of Ewelme:
And Defra on animals, presumably, too?
Dawn Primarolo: Indeed. There is an Inter-Ministerial
Group on Global Health, which is chaired by myself in the Department
of Health. I hesitate to say the lead department. I would describe
it as the department with responsibility to coordinate. That is
rather long.
Q1151 Lord Jay of Ewelme:
Why do you hesitate to say the lead department?
Dawn Primarolo: Because I think that what is
important in developing the Global Health Strategy is that, whilst
the Department of Health clearly has a very big role to play,
particularly with its expertise in terms of health protection
and health security and our experience in the domestic situation,
it is not only about health and should not only be left to health.
It is important that we look for the policy synergies in other
departments as well and we are working together. That is what
it is designed to do. I suppose, as I am Public Health Minister,
if the Government thinks that the only person who deals with public
health is the Public Health Minister, we would be missing a beat:
transport, environment, housing, and it is the same here. The
Department of Health is the lead department in that sense. It
is coordinating and working with in partnership and parallel through
the Inter-Ministerial Group. Clearly, the Foreign and Commonwealth
Office has a great interest as well in this for global security
as well as other issues. That strategy which we are finalising
as Ministers now and agreeing will set the outline for how the
departments should work together through the Inter-Ministerial
Group. We will be able to bring in departments as we need them
if there is a cut-across into that department. I think it recognises
what everyone is bringing to the table. Of course, the Department
of Health has very considerable expertise but the partnership,
particularly between DFID, the Foreign and Commonwealth Office
and the Department, is important here.
Gillian Merron: I want to mention a particular
area which I think will be a good one and show joined-up working,
although I have already mentioned the HIV and AIDS updated strategy.
We have some evidence of us working together, but global shortage
of health workers is a huge challenge and a huge possibility for
working together. I have been in discussion with Lord Crisp about
his report and where we can go. Clearly, we have to work very
closely together. I think the Committee can be reassured that
not just goodwill but the structures are in place to do it. Obviously,
the Department of Health has the seat on the WHO and we work quite
happily with that. We are just seeking to maximise the benefits
out of our working together.
Dawn Primarolo: A recent example with the work
that we did with the Departments of Education and Health was with
regard to professionals—in this case health and educational
professionals—who are going to do a placement. There were
some arrangements that were necessary with a great amount of effort
by government that were very important to those individuals around
a consideration of pensions and maintaining them in the national
insurance scheme for obvious reasons for them individually. You
can go from quite small but nonetheless important issues like
that right the way through to the workforce.
Q1152 Chairman:
When we heard evidence from Dr Silberschmidt, from the Swiss Federal
Office of Public Health, he made great virtue out of the fact
that health is an explicit part of the foreign policy of the Swiss
Government. I notice that in the Health is Global document,
which was presumably for discussion, the question was asked: "How
can global health be more explicitly integrated into UK foreign
policy?" I wonder how far you have got in your thinking on
that subject and whether in particular you are going to respond
to the Royal College of Physicians' discussion on communicable
diseases at their conference which was held on 29 April.
Gillian Merron: We are very happy to respond
to their views. There is a further question. That is the role
of health in respect of economic growth. If I could revert back
to my comments on political will, my view is that in the UK we
take for granted that people understand that a healthy, well-educated
population is essential to growth. I am not convinced that is
the case in developing countries. I believe it is an argument
we cannot avoid having. Referring to Baroness Whitaker's comments,
the role of civil society is crucially important in holding the
government to account. There can be a tendency, which we have
to overcome, that health is isolated. It is not. It is a contributor
to other policies and well-being and that includes political and
economic. This is an area that we need to be developing more but
I do feel civil society has a role there.
Dawn Primarolo: There is a slightly different
approach from us and the Swiss. The Swiss were looking at how
they can make sure that government action was coordinated, absolutely
vital. What our Global Health Strategy is doing is looking at
areas of policy as part of our global health policy that we want
the departments not only to be coordinated but to focus on. It
is responding to the same propositions about the need to coordinate,
but it is putting in as well the idea of policy objectives, fair
and free trade, development of effective health systems, so we
can begin to see then how that would pull a number of government
departments into that, to make sure that we were not inadvertently
crossing over an objective that we had set somewhere else. Obviously
that is a very big objective for us and this is right at the beginning,
but we are quite hopeful that this strategy will provide that
first stage.
Q1153 Lord Howarth of Newport:
We are talking about how to enlist the most useful contributions
from a variety of departments. One of the suggestions that Dr
Silberschmidt made to us was that it would be of outstanding benefit
to developing countries if they had more of what he called Health
Diplomats, people who were trained to negotiate with the IGOs,
with the big NGOs, with the bilateral donors, because one of the
difficulties for a recipient country is that there is this bombardment
of goodwill coming from all these different directions and it
is extremely difficult to assimilate all this help, to coordinate,
to prioritise and to make sure that you do get the right kinds
of help and that you are best placed to use it most effectively.
He thought that, if developing countries more often had skilled
negotiators who could field and absorb the support that was being
offered, that would be a good thing. Is that something that we
have thought about? Have we thought that, for example, our own
Foreign Office, perhaps in combination with DFID or the Department
of Health, would be able to assist in training people who would
then go back to their own countries to perform that kind of role?
Gillian Merron: It might be interesting for
the Committee's considerations that we have taken the view—and
it is the Committee's starting point—that we think it is
very crowded out there and to acquire that level of expertise,
rather than getting developing countries to respond to our architecture,
we feel the right thing to do is to revise and reform our architecture.
A very specific example is in Zambia. Whilst we are not the biggest
donor on health, we are the Zambian Government's preferred partner
to deal with. There is a great discipline there. They only deal
with the UK. The WHO represents the constituency of other countries.
It works very effectively. My instinct is that we should be tackling
the problem rather than expecting others to respond to us. I was
reading that Vietnam had had over 700 missions come through the
country. That is probably a full-time job for a team of people.
Is it the best use of resources that we have a full-time team
of people to accommodate us and every other country that wants
to come and see or is it better that we organise ourselves? My
strong feeling is we should be organising ourselves and exerting
greater discipline, and it is happening. The African Development
Bank uses this very well. We do have a constituency where we have
a lead country and they are represented. The other point in all
of this that matters is that it should be country-led rather than
us telling countries how to reform themselves. I can see why somebody
would suggest that but that would not be my instinct. Interesting,
though!
Q1154 Baroness Whitaker:
We have heard that three-quarters of emerging infectious diseases
originate from animals but that the international systems for
human and animal health operated by WHO and OIE are not integrated,
so we tend to find out about new animal diseases—for instance,
H5N1 avian influenza—only after they have jumped across
the species barrier and infected humans. The Prime Minister, when
he was stating what the national security strategy was going to
be, said, "On disease and global pandemics, our priority
is to improve early warning systems." Is there not a strong
case for bringing together international human and animal disease
surveillance onto a common basis? And, if so, what is the Government
doing about it?
Dawn Primarolo: I think there is a case for
better coordination. If we look at the activities at an international
level, whether it be the WHO dealing with human pathogens or OIE
dealing with animals, and then we see the collaboration between
those two agencies and the links to the Food and Agricultural
Organisation, and all of those feeding into groups, we can see
that in that architecture there is a possibility for the exchange
of information. Of course, there is an argument for there to be
better communication between those. The real problem is the data
that is available to the system in the first place. That is the
surveillance, the corner stone of it. We can see that there are
quite significant problems in countries for getting us that early
warning surveillance. Again, we cannot underestimate the huge
scale that we are dealing with here. Those are dependent on very
difficult things like accuracy of diagnosis of the disease, reports
through reliable infrastructures, capture of health data and demonstrating
politically that the will to share early suspicions of diseases
is very important. The challenge internationally is that the information
still remains incomplete. Yes, there is therefore a case to strengthen
the capability of developing countries in particular to have the
internationally agreed protocols of notification. Again, that
is something that we perceive that the WHO has a key role in.
It is very important for us to support them and encourage them
wherever we can. The separation of animal and human diseases in
different agencies is not unique internationally. We do it here
for good reasons. It comes back to the point I was making earlier
about a core focus but looking for the synergies. The work that
we do to support the WHO in its efforts, whether it be the veterinary
laboratories at Weybridge which are one of the international places
and certainly the European or the HPA laboratories for human pathogens
at Mill Hill, the work we are doing on pandemic planning both
for ourselves and engaging with the WHO and sharing our experience.
I think today at an international meeting we were talking about
what the UK is doing and whether that can be translated into an
international dimension and example. That is the way we are going
to have to proceed. We have to recognise the challenges that that
gives us, and that makes it all the more important that the work
Gillian was talking about in building capacity in country, using
the networks, particularly civil society and connecting that fits
together. I suppose that is a very long answer. Our problem is
not coordination at the international level; it is making sure
we get the surveillance in country and the timely information,
which is a different problem.
Q1155 Baroness Whitaker:
The work that we do diplomatically in the WHO is presumably related
to the surveillance of human disease. The WHO cannot be expected
to reorganise OIE and FAO to make sure that there is more accurate
prediction of animal diseases of this sort which are likely to
be dangerous to humans. Does your being joined-up also extend
to the animal health side internationally?
Dawn Primarolo: I think there is that cross-over
when it is necessary and when it is identified that H5N1 and the
possibility of a mutation into humans that the ability to be able
to forecast that or to map it is absolutely dependent on having
received timely and accurate information from the country concerned.
That goes back to the institutional questions as well about who
is the most appropriate and where is the information and whether
the international architecture could do with some change in terms
of the UN has a system for influenza coordination and there are
these other bodies involved. What we want to make sure is not
that they all try and do the same thing. They do what is appropriate
and timely information goes to the right place. That is broadly
there if we can get the information in and people focus on what
they should be doing, not what they think they should be doing.
Q1156 Lord Howarth of Newport:
Does our government play a part in programmes to strengthen the
infrastructure in developing countries of animal health care,
as we seek to do with human health care, and to ensure that within
those countries the strategies are coordinated?
Dawn Primarolo: The answer to that must be Yes—through
the OIE, but I would need to check that. My understanding, dealing
in the UK between HPA and Defra, is the necessity for the interaction
when it is appropriate.
Gillian Merron: I think we should let you have
a note on this.
Q1157 Lord Geddes:
Is the experience of the Department of Health in particular that
the instances of nations coming up front and advising international
authorities of animal disease and indeed the jumping across to
the human side—is there a lessening of reluctance or an
increase of reluctance to divulge that? One can quite understand
that for economic reasons countries might say, "We want to
keep quiet on this." What is the experience of the Department
of Health?
Dawn Primarolo: The experience is that with
these great challenges—SARS is another example—countries
recognise that early detection and prevention is the best way
to deal with it. The expertise and the support that they need
to advance that is something that can be accessed through the
WHO or with the UN, through its system of influenza coordination.
I am not saying that is absolutely everywhere but that is recognising
that the best way to deal with these highly contagious, dangerous
infections is early intervention which means you have to have
early identification so that the countermeasures can be deployed.
I attend on behalf of the Government the G8 Global Health Security
meetings, and the discussions that we have there give me no reason
to believe that that is not the case. Of course, it is a challenge,
as you rightly say. If you have one farmer with a few chickens
and the whole family livelihood depends on it and some of them
are sick, there are issues there that need to be recognised and
dealt with.
Q1158 Lord Desai:
TB is the biggest killer of people who are HIV-positive. We have
been told that. We need to have some coordination and synergy
between the two. We have been told that neither TB nor TB/HIV
co-infection is fully incorporated into DFID's strategy for tackling
HIV/AIDS. You talk about Government support for more integration
in the latest document. What are you specifically doing about
it?
Gillian Merron: I am aware that the Committee
has been told this. I was rather surprised, not least of all because
I was looking back at the requests from the various lobby groups.
We had a very considerable, very open public consultation and
it informed us immensely in terms of our updated strategy. One
of the requests from the lobby was to address TB and TB/HIV co-infection
in the updated strategy. That is what the updated strategy is
all about. AIDS is certainly closely associated with other diseases
and health issues. TB and HIV are certainly fuelling each other.
We are well aware of that and I would certainly agree it is the
leading cause of death amongst people living with HIV. The need
for integration is quite clear because of the challenge in drug-resistant
TB infections on top of that situation. We are fully aware that
we need to do more to bring services together. We are not just
supporting the integration of AIDS services with other health
services, including those for TB; our updated HIV/AIDS strategy
sets out firstly a health spending target over seven years which
I referred to earlier of £6 billion. That is all about the
importance of stronger health systems and full coordination and
integration of HIV and TB services. What it means in reality is
having the health workers, the drugs and the facilities in place
to be able to bring those two together. I can give particular
examples. The Committee will be aware that we support many programmes
in this whole area. For example, our commitment to the Global
Fund to fight AIDS, TB and Malaria and UNITAID, the new drugs
purchase facility. We also have very specific programmes to tackle
AIDS and TB in specific countries: China, India and South Africa.
In a number of countries where DFID is working, including Zambia
and Malawi where I have just returned from, there is a very well
established coordination of TB and HIV programmes. If the Committee
would like more information, I would be very glad to supply that.
Our whole line is about the best way to deal with HIV, TB and
a number of others, to strengthen health concessionaire systems.
Q1159 Chairman:
We would be grateful to have that.
Gillian Merron: I would be pleased to supply
it because I feel it would give the Committee a very clear indication
of how we are working and doing it well.
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