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When I read the report, it was not apparent to me why a committee of your Lordships' House should have produced it. I am very glad that it did, because it brought to the subject a detachment which made its findings all the more pertinent. From looking on the web, I know that the reaction around the world has been very appreciative, and I congratulate the committee on that.
The report is timely for two reasons. To echo a point made by the noble Lord, Lord Desai, in the current financial economic situation, it is clear that
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Recent events since the report was produced have demonstrated how important it is. In December 2008, cholera infected 80,000 people in Zimbabwe. As far as we know, approximately 4,000 of them died. Of that outbreak, the WHO said:
“Given the outbreak’s dynamic, in the context of a dilapidated water and sanitation infrastructure and a weak health system, the practical implementation of control measures remains a challenge”.
That was a very diplomatic way of describing a desperately sad and avoidable situation. It brought home to me the need to implement fully these international health regulations and to extend them to any disease, wherever it comes from, so that there is a global public health surveillance system, with state parties having an obligation to prevent or control the spread of disease, but in which civil society can report the true incidence of disease if a Government fail to do so. That is a tremendously important point.
I read this report in conjunction with the report from the Intergovernmental Panel on Climate Change. It announced in 2007 that projected climate change related exposures are likely to affect the health of millions of people. Climate change will affect infectious diseases in two ways. There will be an increased risk of water- and food-borne disease, and there will be changes in vector-borne diseases. The IPCC predicted an increase in diarrhoeal disease in any place where water or food becomes contaminated—for example, after flooding—and where warmer weather leads to food poisoning due to problems with food storage. It is not possible to overestimate the extent to which climate change will have an impact on health.
Only last month in the British Medical Journal, Anthony McMichael of the Australian National University estimated that climate change could lead to an additional 20 million to 70 million people living in malarial regions in sub-Saharan Africa. He drew the clear lesson that:
“Poverty cannot be eliminated while environmental degradation exacerbates malnutrition, disease and injury ... Infectious diseases cannot be stabilised in circumstances of climatic instability, refugee flows and impoverishment”.
“This requires bold and far sighted policy decisions at national and international levels”,
and greater carbon emission cuts than those proposed a decade ago. To everything the noble Lord, Lord Soley, said, you have to add this extra dimension of the health impact of climate change.
I have one slight criticism of the report. In concentrating on the big three infectious diseases—HIV/AIDS, TB and malaria—the report did what in a way the noble
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None the less, those neglected tropical diseases afflict an estimated 1.1 billion of the 2.7 billion people who live on less than two US dollars a day. The burden of such diseases on those people is perhaps greater than on others. In neglecting to follow those, we did perhaps miss something. I suggest to the noble Lord, Lord Soley, that, as part of his campaign—which I wholeheartedly support—to have a standing committee of the nature of his, its next report could look at those neglected tropical diseases and the work of international government organisations on them.
Having given a slight brickbat, I want to give a bouquet. The report and its recommendations about TRIPS helped to build up some of the pressure which resulted last week in that announcement from GlaxoSmithKline. I am the Liberal Democrat health spokesperson. I happen not to make a habit of congratulating drug companies, but this time we should. It was an extraordinary statement, and I add to what the noble Lord, Lord Soley, said. GSK said that it would cut prices for all drugs in the 50 least developed countries to no more than 25 per cent of UK and US levels, and less if possible. It will put any chemicals or processes over which it has intellectual property rights that are relevant to finding drugs for neglected diseases into a patent pool so that they can be explored by other researchers. It will reinvest 20 per cent of any profits it makes in the least developed countries into hospitals, clinics and staff. It will invite scientists from other companies, NGOs or Governments to join the hunt for tropical disease treatments at its dedicated institute in Spain.
Campaigners from charity organisations have understandably expressed regret that that does not include the HIV medicines. Nevertheless, they realise that it is a tremendous step forward. It will alter dramatically the whole architecture of that complex relationship of intergovernmental organisations, NGOs and private companies. I hope that there will be a compensating change on the part of other private companies, and on the part of Governments as they seek to move forward to the next stage—just as they did when the Gates Foundation came along to make its contribution.
The issue of vertical and horizontal health programmes is one of the most interesting parts of the whole report. I listened carefully to what the noble Lord, Lord Soley, said about not being able to have either a horizontal or vertical approach; that will not work, and it is a question of finding a balance. I wondered whether the Government, working with countries with which they have particularly close relationships and the NGOs and IGOs working in them, might find two countries in which it was possible to come up with models reflecting a different type of balance between them. The sticking point seems to be that national Governments do not know quite how to come up with a model that is effective for them. There are no models to which they can go.
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One of the most striking pieces of testimony in the report was that of Professor Borriello about zoonomic diseases. The interesting thing he talked about was that the UK’s panel for newly emerging infections includes medical and veterinary staff, and people involved in food science. Given that 75 per cent of emerging diseases are zoonomic, I ask the Government whether we can work on that model in conjunction with a low-income country to see whether the model could be adapted to its situation, whereby it could come up with a structure enabling those with knowledge in veterinary science, food science and health to work together. It is not a matter of us exporting our models intact, because they will not necessarily be applicable, but we can take the points of models that work and enable people to adopt them. That is an important point.
I end by echoing some of the points of the noble Lord, Lord Crisp. We have in this country a wealth of experience that we would do well to export. I would go further than the noble Lord and include Defra as well as some of the other departments. We should look upon this not solely as an act of generosity on our part. I well remember, during the outbreak of foot and mouth, a colleague in the Commons, Ed Davey of Kingston, had tremendous trouble getting a refugee who was a qualified vet from Iran—a nation where foot and mouth is endemic and every vet knows exactly what it is—fast-tracked into being able to work with those dealing with the emergency here. We have a lot to receive as well as to give from such partnerships.
The four nations of the United Kingdom work jointly but in slightly different ways via the Health Protection Agency and others. The noble Lord, Lord Desai, is right: during the next few years of austerity and hardship it will be extremely difficult politically to maintain our level of international development aid. It will require courage on the part of the Government to do that and the provision of a great deal of information—this report is a welcome addition to that—to dispel some of the myths about our expenditure on international aid, to enable people to see that it constitutes investment in the health of the world, and that we are part of that world just like anybody else. If one major task needs to be carried out above all else, it is to improve co-ordination and governance, to which the committee referred. This report is an excellent basis on which to start. I very much look forward to hearing the noble Baroness’s reply to the points noble Lords have made.
4.11 pm
Lord McColl of Dulwich: My Lords, I add my thanks to the noble Lord, Lord Soley, for introducing the report so comprehensively and charmingly. There is a lot of worry about how a flu pandemic should be handled. Professor Neil Ferguson of Imperial College has described a very useful computer model to test a number of strategies to limit the spread of the disease. As there is no vaccine, they suggest anti-viral prophylaxis in order to reduce the risk of infection among approximately 20,000 people in the vicinity of the initial cluster of flu victims. He estimated that a stockpile of 3 million doses of anti-viral treatments could be
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The report contains criticisms of the WHO, as mentioned by the noble Lord, Lord Soley. Many of us have had experience of this organisation and have found some aspects of it rather unsatisfactory. No doubt this tends to colour our judgment. It is right therefore to stress, as did the noble Lord, Lord Soley, that the present director-general, Dr Margaret Chan, has brought a very welcome breath of fresh air to Geneva, and that things have changed very much for the better in the past few years.
The report records complaints about excessive bureaucracy in the WHO headquarters but the director-general's programme of reform of the management structure has been much admired. Others have criticised what they describe as the disconnect between the headquarters in Geneva and the regional offices, especially the regional office in Africa (AFRO). Uniquely within the United Nations system, the six regional directors are elected and naturally tend to feel responsible to the countries that elected them, as well as to the WHO. In practice this federal system has worked well during the past year or so in spite of past difficulties. The director-general meets the regional directors at least three times a year; two are whole-day meetings and the third is a retreat for several days.
Concerns have been expressed that the regional governance of the WHO could get in the way of a co-ordinated and effective approach to disease outbreaks. The revised international health regulations that were adopted by all WHO member states in 2005 make it clear that authority lies with the director-general. When a serious outbreak of a disease occurs, the director-general herself does the risk assessment, has the final say and advises on any action to be taken.
There have also been recent developments in building greater coherence among the main organisations working in global health. The heads of four United Nations oganisations, UNICEF, UNFEA, UNAIDS and WHO, and the four financing organisations, the World Bank, the Gates foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance, now meet every six months to align their work more closely. The last meeting was just three weeks ago. It is worth pointing out that the Global Fund to Fight AIDS, Tuberculosis and Malaria has the largest health budget in the world. It is an international financing institution investing the world’s money to save lives. To date it has committed $14.9 billion in 140 countries to support large-scale prevention and care programmes against these three diseases. Two million have been treated for HIV/AIDS, 4.6 million for tuberculosis and 70 million bed nets have been distributed.
As the noble Lord, Lord Soley, mentioned, the Gates foundation contributes more than the whole of the WHO budget. There was a feeling that the WHO was becoming rather uneasy about that. But, again the director-general has made it clear that she does not regard that as a problem. There was some controversy over the WHO announcements about leprosy some years ago but that was based on a misunderstanding
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The subject of prevention, especially HIV/AIDS, is dealt with in paragraphs 47 to 49, which emphasise that prevention means changing behaviour. As my noble friend Lady Eccles stated, changing behaviour is much more difficult than treatment. What is so disturbing is that the AIDS epidemic involves more and more women worldwide, with 17.7 million women being HIV positive, which is more than ever before. In sub-Saharan Africa they constitute two-thirds of people living with HIV/AIDS. In South Africa young women are four times as likely to be HIV infected than young men.
As president of the Mildmay centre, I was involved in the establishment of the first hospice in Europe for those dying of HIV/AIDS and later the first in Africa, just outside Kampala, with enormous help from the noble Baroness, Lady Chalker, who guided us into concentrating on outpatient work and teaching. In the Mildmay centre in Uganda it was not unusual to see 100 children in a day all with AIDS, all orphans, a third of them with tuberculosis and many with malaria and the most terrible shingles and lice that I have ever seen because their immune systems were so depleted. However, I was very impressed with the HIV/AIDS prevention programme set up by the President Museveni of Uganda which reduced the incidence from 31 per cent to 5 per cent among pregnant women. Those are hard, reliable data. The ABC programme—abstinence or postponement, be faithful and condoms—has also been successful in other African countries. The WHO advocates a policy that is comprehensive and inclusive, and embraces the ABC policy, which is also supported by our Government. The Leader of your Lordships’ House stated that the Government subscribe to the successful campaigns of ABC, but not one to the exclusion of others—it is important to stress that. It is of interest that many teenagers are choosing abstinence or postponement as a safer policy. Tragically, teenage girls in many countries have no power to refuse, and face physical abuse and even death if they do not comply. In approaching the difficult subject of prevention, we need to be open to many different approaches, especially as there are such diverse cultures worldwide.
About 40 per cent of the world’s population is at risk of malaria. More than 500 million people become severely ill with malaria every year, and 1 million people die. Twenty per cent of all childhood deaths in Africa are from malaria. The Conservatives are committed to spending half a billion pounds a year tackling malaria, until the millennium development goal has been met. We will work with African countries to abolish tariffs on anti-mosquito bed nets in sub-Saharan Africa. We will establish a fund, worth £5 million a year to begin with, to help fund international placements for British health workers and support links between the NHS and health systems in poorer countries. There are many who already give generously of their
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The Conservatives will abandon what we believe are Labour’s plans to cut staff numbers at DfID, and we will rapidly increase its budget. British aid will be properly scrutinised for effectiveness, and results will be linked directly to independently audited evidence of real progress in these poor countries. We also plan to establish an anti-corruption hotline on the front page of the DfID website. All DfID programmes will have a designated anti-fraud officer who could be approached, anonymously if necessary, by anyone who suspects corruption. Their e-mail address and phone number would be published on the relevant pages of the DfID website, both in English and local languages. We will also consider giving some aid money directly to poor people as aid vouchers, redeemable for development services of any kind from an aid agency or supplier of choice.
The noble Lord, Lord Soley, mentioned that animal welfare is very important in the food chain, and spoke about outbreaks of infection. That reminds me of the widespread distribution of the virulent campylobacter organism, which affects 70 per cent of chickens in the United Kingdom. The chickens are killed by being stretched by the neck and feet, upside down, on a conveyor belt. They are then electrocuted, which makes the muscles contract, emptying the contents of their alimentary tract. As they are upside down, the campylobacter is sprayed all over them. They are then put in a big vat, where they become campylobacter soup. When the chickens are chopped up and put into polythene bags, they are infected with campylobacter. This is all right provided the chickens are adequately cooked. However, if they are chopped up on a board that is then used to prepare a salad, you can understand how the infection takes hold.
This report has inevitably focused on developing countries and we are often critical of the widespread infections there. However, we in the United Kingdom are not always paragons of virtue.
4.24 pm
Baroness Thornton: My Lords, it is with great humility that I answer this debate. As I read the committee’s report and evidence over the past week, I realised what a very important contribution its work has made on this vital issue. I am not surprised that this was the first subject that the committee tackled. I congratulate my noble friend Lord Soley on a truly excellent and comprehensive report and on securing this debate today. I agree with the remarks of the noble Baroness, Lady Barker, about the welcome that the report has received across the world.
My noble friend has offered me the opportunity not only to place on the record the Government’s thanks for the committee’s work but to update the House on developments since its report. I am pleased to say that progress has been made even since its
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Since the launch of Health is Global we have seen the start of the most serious global economic crisis in decades—referred to by several noble Lords, including my noble friend Lord Desai. Finding innovative and sustainable solutions to global health challenges remains as pressing a concern as ever. Indeed, I echo my noble friend Lord Desai’s remark that this is an economic pandemic. After last year’s food and fuel crises, we now face a huge challenge to maintain the fight against global poverty. Impacts on health will vary greatly by country and context, but past downturns show common patterns. The impact on the poor will be especially serious: nutritional standards are likely to fall, as will the ability to spend on private healthcare. Given their importance in channelling resources, intergovernmental organisations will be crucial to our response.
I also agree with my noble friend about the need for coordination and for our Government and other Governments to maintain support levels in this field. It is self-evident that many health risks today require international collective action. Let us consider, for example, the threat of a worldwideinfluenza pandemic, mentioned by the noble Baroness, Lady Eccles, and other noble Lords.
In October 2008 the Government launched a new international pandemic influenza preparedness strategy, which aims to reduce the risk of a global pandemic through co-ordinated action at national and international level, action designed to enhance our collective ability to prevent, detect and respond to a pandemic. At the heart of this strategy are issues that the committee’s report highlighted. We recognise the need to improve infectious disease surveillance and response systems in developing nations. This is why, in addition to our share of the substantial contributions made by the European Commission, the UK has already committed more than £35 million towards the international effort to tackle avian and pandemic influenza. Much of this funding is channelled through international organisations and is being used for a wide variety of activities, including strengthening national public health surveillance systems, enhancing outbreak containment and virus eradication in animals, improving non-medical responses to pandemic flu, and strengthening health system capacity. We are also playing a leading role in developing the WHO global pandemic influenza action plan, which will increase the availability of vaccines for a pandemic, including for developing countries.
It is also vital to encourage engagement and research across veterinary and human health sectors globally, in support of what is known as a “One World, One
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The role and co-ordination of the work of the intergovernmental organisations is key to all this, as the report points out many times. Our view remains that there is evidence of strong liaison between the various international bodies in disease surveillance at the animal-human interface. However, global co-ordination in pandemic preparedness planning more generally could be improved. The UK’s international strategy on pandemic influenza commits us to bringing together the key international organisations working on pandemic flu preparedness in order to promote improved co-ordination and synergy. I hope this will confirm to my noble friends Lord Soley and Lady Whitaker that the Government take this very seriously indeed. We will host this meeting in June.
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