Covid-19: Vaccinations and Global Public Health

Motion to Take Note

Moved by

To move that this House takes note of (1) the shortage of, and (2) the obstacles to the manufacture and distribution of, COVID-19 vaccinations in the Global South; and of the consequent implications for global public health.

My Lords, I am grateful for this opportunity to move the Motion standing in my name. Covid has revealed in every aspect of our lives the impact of inequality, has it not? In no case is that inequality greater than in access to vaccines and the means to manufacture them as between the north and south of our world, as well as between countries that have and those that do not—that is, poor and impoverished countries. The facts speak for themselves; I am grateful, as I am sure all noble Lords are, to the House of Lords Library for its research work on this.

The figures revealed are a stark reminder of the problem that we as a world face in relation to Covid and inequality. On 23 August, approximately 32.5% of the world’s population had received at least one dose of a Covid-19 vaccine, while 24.5% were fully vaccinated. That is in the world as a whole. However, only 1.4% of people in low-income countries had received at least one dose. I repeat: 1.4%, as opposed to 32.5%. There are many countries in the world, many of them in Africa—such as Chad, Burkina Faso, the Central African Republic, to name just a few—where the percentage of the population that is vaccinated is less than 1%. That is the reality on the ground. Of course, it presents a threat to us all because an unvaccinated world is a world in which variants that threaten us all are more likely to emerge. So, we have to find a way of addressing this imbalance.

We are also confronted too by the stark reality that, on existing projections, we are faced with a situation in which low-income countries cannot expect to have widespread vaccine access before late 2023. In the UK, we have bought enough vaccine to vaccinate the entire population more than three times over—on some calculations, four times over—and even after boosters have been given and the lower age groups have received their vaccinations, we will still be sitting on 210 million surplus doses. That is the figure that represents the reality of the gap between north and south.

The WHO estimates that some 16.2 billion doses will be needed for 2021-22 to achieve universal vaccination. That means that we are going to have to more than quadruple the world’s pre-Covid capacity to manufacture vaccines. That is the scale of the problem, but there is every reason to believe that, with the right attitude, approach and strategy, and with a willingness now to co-ordinate global action and to put the resources behind that action, the world could in fact meet the challenge. This is not one of those situations in which we can say, “Oh well, it’s all pretty terrible but really there’s nothing much we can do about it, that’s the way of the world”. Actually, it does not have to be the way of the world, because one thing we have learned from Covid is that where there is the concerted will, we can totally transform the picture. We know what has to be done, and what has to be done involves our Government being prepared to take a lead and the world recognising that existing mechanisms simply are not working.

My Lords, I congratulate the noble Lord, Lord Boateng, on securing this important debate, and I agree with every word that he said in his compelling contribution.

I am also grateful to the Association of the British Pharmaceutical Industry for its briefing, updating us on the substantial increase in manufacturing capacity for Covid vaccines. It is worth starting by noting the extraordinary work of our vaccine experts globally, from scientists such as Sarah Gilbert and her team who were working in January 2020, through to the manufacturing companies that have made the most extraordinary steps to provide over 5 billion doses of vaccine to date worldwide, with 41% of the world’s population having had at least one dose. But—and this is the reason for the noble Lord’s important debate today—shockingly, only 1.9% of people in low-income countries have had one dose to date.

The role of Gavi and the World Health Organization in encouraging high-income countries to share doses as soon as possible has been laudable, and those countries, including the UK, that have guaranteed funding to Gavi are also vital. Credit goes to our Government for stepping up to the plate early with those offers. The comments from the noble Lord, Lord Boateng, about the theory of COVAX versus the actual practical attitude of G7 countries were blunt and right, however.

Much money has been made available to Gavi for COVAX. The practical problem of sourcing new vaccine manufacturing has proved understandably difficult. That is why the World Health Organization has repeatedly asked high-income countries to donate substantial numbers of doses to low-income countries. We on these Benches urged the Prime Minister to set an example from the United Kingdom in his role as the chair of the G7, but sadly he did not. All that was repeated was the amount of money given to Gavi, which was no use when there was no manufacturing availability. The figure of a 1.9% rate of vaccination in low-income countries is testament to that.

My Lords, the vaccination effort, here in the UK and in many parts of the world, has been nothing short of incredible, with 5 billion vaccines developed, manufactured and distributed. Of course we must pay tribute to the scientists, health workers and all involved in that but, as the noble Lord, Lord Boateng, set out so powerfully, this incredible success has not been equitable across the world. I am grateful to the noble Lord for giving us the opportunity to debate this today.

I will add a further disturbing statistic to the noble Lord’s: 50% of the world’s vaccine supply has been bought by high-income countries, which account for just 16% of the world’s population. So the vaccine rollout has not been equitable, and indeed has exacerbated existing pre-pandemic inequalities.

The Covid-19 pandemic has impacted every corner of the world and, to avert further public health and economic disaster, we must address this vaccine inequality. It is in our enlightened self-interest to do so, as well as being the correct ethical thing to do. While the UK is gratefully reaping the benefits of a successful vaccination programme, that is not the case in the rest of the world. We know that economic recovery will be longer in poorer economies, compared to advanced ones, and that low-income countries will now face longer-term debt. We will see an increase in poverty and a reduction in spending on health systems. Unless we address this inequality of distribution, we will see the reversal of many of the impressive gains in development we have seen over the last few decades. Achieving the sustainable development goals by 2030 will be well out of reach.

The moral and ethical case for vaccine equity is clear; if that is not enough, so is the case for it being in our enlightened self-interest. It is right that wealthier countries should do more. Immunising many people in just a few countries, while in large parts of the world the virus remains unchecked, will simply allow more variants to emerge in these places. When variants appear, they will end up in the UK, in the end. We can close our borders and try to buy ourselves more time but, at some point, if the variant has sufficient biological advantages, it will spread around the world and into every nation. This is a global problem that must be dealt with globally.

My Lords, I thank my noble friend Lord Boateng for bring us this debate this afternoon. The pandemic in the last 18 months has been devastating around the world, and 18 months down the line we are in a position to address it with the development of the vaccine that has helped us to protect lives.

COVAX was set up to ensure that the Covid vaccine reaches the world’s poorest countries. Its aim is to vaccinate healthcare workers, social care workers and those who are over 65 and high risk within a community. COVAX was created as a global procurement mechanism to distribute vaccine around the world. A recent report on economics intelligence from the Financial Times showed that low-income countries would have only 1.4% of the 5 billion vaccines delivered. This means that they will not be able to vaccinate 60% of their populations by mid-2022. The knock-on effect will plunge these countries into longer term debt. This debt will also spiral out of control, leading to increased poverty and reduced spending on countries’ health systems.

Another report which came out in July stated that 170,000 doses of the Moderna vaccine were at risk of expiring within two weeks. NHS doctors have also reported thousands of Pfizer and Moderna shots being discarded. There are signs that the Government are encouraging the pharmaceutical companies to share their know-how and technology to waive intellectual property, but there are also signs of hoarding of doses by high-income countries. This is said to be caused by the pharmaceutical companies, which have control over the vaccine.

The British Government have announced that they intend to donate 100 million doses, while the US President announced that the US intends to donate 500 million doses of the Covid vaccine to poorer countries in the next year. This was announced at the G7 meeting of world leaders earlier this year. Do the Government understand that the pandemic is not going to wait a year before taking more lives?

My Lords, I declare my interest as a vice-chair of the APPG on Vaccinations for All, and I thank the secretariat for the briefing they provided to me and other noble Lords. I thank the noble Lord, Lord Boateng, in particular for bringing forward this important debate.

Some months ago, at the beginning of the vaccine programme, Nicky Tyler and her husband, my noble friend Lord Tyler—Paul Tyler—contacted me, because Nicky felt when she got her vaccination that she wanted to be able to donate to people who had not. We worked together to get a facility where people could donate individually to COVAX. As a result of that fundraising effort and with the assistance of the then Lord Speaker and noble Lords from across the House, including the noble Baroness, Lady Lawrence, we managed to raise some funds. We did not raise huge amounts because, unfortunately, the Government and NHS bureaucracy could not get in gear to offer people that chance at point of use, but it was useful revenue none the less.

But all the time the frustration was that we knew that while money was going to be needed, money was not actually the key issue. The key issue was supply. The problem was not only that we in the West, in the UK and other countries, were hoovering up vaccines; we have heard all the statistics. But now we hear—the noble Baroness, Lady Sugg, and the noble Lord, Lord Boateng, cited the figures—that, absolutely disgracefully, we were taking from COVAX as well: 539,000 doses, as has been said. That was more than went to Africa in that month. So, not only did we screw up the way things were supposed to work by all our bilateral deals; we then went and effectively stole from the multilateral vehicle—heads we win, tails you lose. That is not just bad policy; it is morally bankrupt and callously wicked policy. Whoever the Ministers are who signed that up should hang their heads in shame.

It is easy to talk about vaccines in terms of billions of doses and hundreds of thousands taken from COVAX, but the reality is that this is about people. It is about people in these African countries who are not getting vaccinated, who are getting sick, and many of whom are dying. It is utterly wrong, and I hope the Minister will take up the questions from noble Lords and assure us not only that we will not take from the COVAX Facility anymore but that we will return those doses.

My Lords, as we have heard from previous speakers—particularly the noble Lord, Lord Boateng, in introducing this debate—the shortage of Covid-19 vaccines in the global south is serious but it could be corrected. Many ideas have come forward, but the thing to underline in this debate is that it is a question of different parts of Governments, not just in this country but all over the world, working together with their departments of trade and their technical people to get production in many of the more developed global south countries that could provide vaccines themselves. I will come back to that matter in a moment.

It is 24 years now since my time as an FCO Minister and a development Minister. I have worked with NGOs during that time on the prevention of all sorts of diseases, but in none of them—malaria, HIV/AIDS, tuberculosis and other preventable diseases, including sight loss through trachoma—have we seen such fast development of a solution to the problem we face. We have seen very fast development by some outstanding companies. That development and that knowledge should be shared across the world, not kept to the more developed countries.

It is imperative that we change our developed-nations storage, as I call it, of vaccines, with 27 million doses in this country, plus the Canadians and others, as has been said. Oxford University reported last month that 32.5% of the world’s population had received at least one dose but that only 1.4% of the population of low-income countries had done so, and most of those are in the global south.

I can accept that higher-income countries hedged their bets in the early months of the Covid-19 infection, but surely there is now a case, when we and other higher-income countries have been successful in administering the vaccine—91 million doses of vaccine have been administered to citizens in the UK alone—for us to stimulate and donate more doses, even beyond the pledges made at the G7 meeting and other meetings.

I note that 54 African countries have received about 31 million doses of vaccine through COVAX, and the G7 is now committed to 870 million doses via COVAX, but the real problem seems to be with intellectual property rights. I have a few key questions for my noble friend on that. They concern the waiving of IP rights, both on vaccine production in low-income countries and on distribution. What has happened to the WTO discussions involving the director-general, Ngozi Okonjo-Iweala, about developing a text to give developing countries access, where there is expertise, to vaccine production under the guidance of the established vaccine providers? What is being done about getting the supply of the tested vaccines to low-income countries as soon as possible?

My Lords, I thank the noble Lord, Lord Boateng, for securing this debate and his excellent introduction, and I have enjoyed the uniformly excellent contributions to it.

It is worth going back a step and thinking about the nature of the world in which the Covid-19 virus arrived. This is a world of massive, almost unenvisionable inequality. Rich countries have drained $1.52 trillion from the global south since 1960, according to a calculation from the anthropologist, Jason Hickel. I refer to his paper in New Political Economy, which looked at the unequal exchange in the post-colonial era, the rate of which increased dramatically in the neoliberal structural adjustment period imposed on the global south, taking us to the point where Covid arrived. The global north was drawing from the south $2.2 trillion each year through unequal pricing, which is a reflection of unequal power. That has been calculated as being enough to end extreme poverty in the world 15 times over, or it could pay for far more Covid vaccines than we actually need.

At the same time, we have seen destruction of natural worlds and the dumping of plastics and toxic wastes on those nations. We have an economic system—a power imbalance—which sees multinational companies having far more power than entire nations, or even groups of nations.

Then we come to what is happening with Covid vaccines. Here I am particularly pleased to be following the noble Baroness, Lady Chalker of Wallasey, and to pick up on her point about how we are not taking the knowledge of the world and sharing it with the world. Currently, the cost of vaccinating the world is five times what it should be if pharmaceutical companies were not profiteering by charging five times as much as it costs to produce vaccines. These calculations are made by the People’s Vaccine Alliance, which includes the African Alliance, Oxfam and UNAIDS. Pfizer-BioNTech and Moderna have been charging Governments as much as $41 billion above the estimated cost of production of vaccines. To bring this to a national level, Colombia is estimated to have paid $375 million more than the cost price of the vaccines that it has been able to purchase. They are making vaccines for $1.20 a dose; COVAX is paying on average five times that.

My Lords, it is a great honour and privilege to participate in this important debate secured by my noble friend Lord Boateng. Coronavirus has taught us that the future is never going to be business as usual and that the virus knows no boundaries either. People all over the global south—Africa in particular—are hungry for change, not charity. That includes harmful, unequal, discriminatory global agreements. A truly global Britain must stop blocking solutions to end the Covid-19 pandemic. They must be available, affordable, suitable to the people we care for and adapted to the place where they live. Imagine trying to keep vaccines cool and effective in blistering temperatures without electricity for refrigeration. People get sick and die needlessly because of these obstructions.

Millions of people are still waiting to benefit from the important medical innovations of the past year and a half. Intellectual property is deepening social and racial injustice across the globe. Shared Covid-19 vaccine know-how to increase global production and supply is needed. Can the Minister tell us whether the Government will support this? Vaccines made in the global south—for example, in Madagascar, Nigeria, Kenya, South Africa, India, Senegal, Zimbabwe, Brazil and so on—could be a game-changer in the Covid-19 response. Lives over profit is not too much to ask—or is it?