Global Health Agencies and Vaccine-Preventable Deaths

Vaccinations against 14 diseases, including diphtheria, hepatitis B, measles, meningitis A, rubella, tetanus, tuberculosis and yellow fever have directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African region. Those gains in childhood survival highlight the importance of protecting immunisation progress in every country of the world.

In the covid pandemic, the vaccination programme was crucial in reducing deaths and in allowing us to return to a life free from lockdowns and to reduce societal restrictions. Covid demonstrated to all of us just how reliant our public health systems have become on effective vaccinations. It also taught us important lessons about how vaccines are distributed fairly—or not—during a pandemic. We must take steps at international level to avoid a repeat of richer countries stockpiling more vaccines than we could use, while poorer countries waited months on end for the first shipment to arrive.

If we cast our minds back to 2021, many of us were double or even triple-dosed with vaccines from Pfizer-BioNTech or Moderna, which have now become household names, but they supplied less than 2% of their vaccines to low-income countries. Three quarters of health workers in Africa had not received a single vaccine dose, and just 2% of people in low-income countries had received a single jab. The result, as we would imagine, was catastrophic, with avoidable loss of life. A report in The Lancet found that 600,000 people died as a result of the global failure to ensure that 40% of people in low- income countries were vaccinated in 2021. Even 40% is a low bar—we expected 100% of our citizens to have the vaccination.

The World Health Organisation is urging countries to work on concluding a new pandemic agreement, to ensure that the mistakes of the covid pandemic are not repeated. A new international, legally binding WHO instrument would strengthen pandemic prevention, preparedness and response and regulate the sharing of drugs and vaccines fairly, to avoid a repeat of covid-era failures.

Attempts by the WHO to pool intellectual property and scientific knowledge through the covid-19 technology access pool initiative were dismissed, and dismissed repeatedly in this House. Market-led redistribution through COVAX—the covid-19 vaccines global access scheme—and bilateral donations of vaccines, while highly noble, were deeply insufficient.

Dr Ghebreyesus, the director-general of WHO, said disparities in vaccine access were a “catastrophic moral failure”. He has since said that the pandemic treaty would help countries better guard against outbreaks and would be only the second time in the WHO’s 75-year history that it had agreed such a legally binding treaty—the previous one was a tobacco-control treaty in 2003. We must ensure that this treaty is a success, and I hope we hear endorsement from the Minister.

In September 2022, I travelled to Cape Town in South Africa to visit the mRNA vaccine technology transfer hub. In response to being left at the back of the vaccine queue and being locked out of innovative new medicines by giant businesses that put profit ahead of equitable distribution, scientists there have reverse-engineered Moderna’s mRNA vaccine. The mRNA technology is based on decades of public research, and the Moderna vaccine was almost entirely publicly funded, yet Moderna was the greatest and most private beneficiary from covid vaccinations. The model of drug development in which Governments pick up the tab for research and development, but pharma companies assume monopolies of drugs to guarantee profit, cannot continue. It is abhorrent and leads to continued global health inequity and preventable death.

Prior to arrival at the research and production facilities, I had expected a vast chemical and industrial plant. Instead, I found a tiny boutique company, working 24 hours, around the clock, but that in no way inhibits the impact its work can have. The shocking bit was that I was told that as little as 5 litres of vaccine—we know how big that is in a container—can supply up to 100 million doses. Having expected this huge industrial chemical plant, I found myself instead in a little room with what looked like a little pot still—I would say that, of course, coming from Scotland, with its whisky, but it was similar in scale to a pot still.

Equipped with the knowledge of how this technology works and is made, staff at the hub have the vision and ability to reproduce this vaccine to ensure equitable access for low and middle-income countries. The plan is for this to be scaled outwards, with small manufacturing plants spread throughout the world to provide for local and regional production of mRNA vaccines, turning on its head the narrative that pharmaceutical production must be high-cost and high-scale.

Crucially, this work has been shared with other scientists throughout the world. Indeed, there are 14 spokes— I love the imagery of the hub and spokes—in the rest of the world, which have become partners in creating an ecosystem in which knowledge is freely shared, production and access are more equal across the world, and a more resilient healthcare system, based on need, not greed, is built. That is a public health necessity, and it has the power to transform the way we provide medicines throughout the world.

As Charles Gore, the executive director of the Medicines Patent Pool, told me,

“this is the single most exciting health programme—no longer about dependency or donation, but about empowerment.”

The mRNA hub has huge potential, not only to act against covid vaccine inequity, but to manufacture treatments for a range of diseases, including diabetes, cancer, HIV, malaria and tuberculosis. It is therefore vital that we reaffirm our commitment to vaccination programmes for preventable diseases and to the global health agencies that provide them in the aftermath of the covid pandemic, which had a significant impact on the distribution of vaccinations.

In 2022, the WHO and UNICEF reported that there had been the largest sustained decline in childhood vaccinations in approximately 30 years, which all of us should be seriously worried about. In 2021, there were 12.4 million zero-dose children—an increase of 3 million from 2019. UNICEF’s immunisation road map to 2030 is being designed to address the setbacks in childhood immunisation programmes due to the covid-19 pandemic. The WHO’s “Immunisation Agenda 2030” is a global health plan focused on improving access to vaccines for all; it is looking to achieve 90% coverage for essential vaccines given in childhood and adolescence and to halve the number of children completely missing out on vaccines. Gavi’s 5.0 strategy includes the vision of

“Leaving no one behind with immunisation”

by 2030 and has a core focus on reaching zero-dose children and missed communities.

A large proportion of UK Government contributions to vaccination programmes are provided through global health initiatives such as the Global Fund, Gavi, the Vaccine Alliance and the WHO. However, the decision— I keep having to repeat this—to cut UK official development assistance spending from 0.7% to 0.5% of gross national income has had a massive impact. The Minister will speak about the Government’s £1 million pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria. That is welcome, but the fact remains that it is a cut of almost 30% from their 2019 pledge. STOPAIDS has said:

“This is a disastrous decision that risks 1.54 million potential lives lost and over 34.5 million new transmissions across the three diseases, setting back years of progress.”

In recent years, a new malaria vaccine has reached nearly 2 million children, yet evidence to the International Development Committee from the malaria campaign organisations Malaria No More UK and Medicines for Malaria Venture stated that the aid reductions put the UK’s strategy at risk. They also said that cuts to broader health programmes would have significant knock-on impacts for malaria. While I have the opportunity, I would like to put on record my thanks to the drug discovery unit at the University of Dundee, in my constituency, which is world-leading in work on a single-dose treatment for malaria, in terms of both preventing it spreading and protecting people from getting it.

Support for global health agencies and for vaccines is vital in stopping preventable deaths, but that must be part of a well-funded, coherent global health strategy. The UK Government must therefore reverse their death sentence cuts to ensure that children throughout the world have access to vaccines that increase their prospects, as well as to public health systems that will be there for them during the rest of their lives.

As we know, one of the key principles of the sustainable development goals is that we leave no one behind, and the hon. Member for Dundee West outlined the lessons that we learned through the covid-19 pandemic and how we must redouble our efforts to address those. Last July, on a visit to Mitundu Community Hospital in Malawi, I was able to see at first hand the critical work of the expanded programme on immunisation. The hospital is an hour south of the capital Lilongwe, and it is where, in 2019, a little girl named Lusitana became the first child in the world to receive a dose of the groundbreaking and British-backed RTS,S malaria vaccine. During the visit, I also met five-year-old Evison Saimon, the second child to receive the vaccine in all its doses. Saimon and his mother talked about how delighted they were not to have malaria in their household. We can read all the things we like, but it really comes home to us when we actually go and meet families abroad and see this important work being done.

We also heard from representatives of Malawi’s expanded programme on immunisation and the national malaria control programme about how the pilot programme is being rolled out, with safety concerns managed and household surveys showing the positive impact on individual families and communities. Since the introduction of the vaccine, Malawi has seen a consistent reduction in cases and deaths in the age group eligible to receive the vaccine. Across the three pilot countries—Ghana, Kenya and Malawi—more than 4.5 million doses have been administered through the implementing countries’ routine immunisation programmes, reaching nearly 1.7 million children. The World Health Organisation estimates that RTS,S could save the lives of an additional 40,000 to 80,000 African children each year once implemented at scale. It is especially important to note that the pilot was financed through an unprecedented collaboration between three global health funding bodies—Gavi, the Global Fund and Unitaid, with GSK donating up to 10 million doses. We have so many good examples of GSK’s UK involvement, which we can all be proud of.

At this critical juncture in the fight against malaria, we really must not allow global progress to continue to stall. We must support the groundbreaking malaria vaccines and see how other countries, such as the 28 countries across Africa that are due to roll out a vaccine in the next few years, go with the roll-out of the programme. Vaccines have a limited impact if they do not reach the communities that need them most and are not joined up with other strategies, such as insecticide bed nets—I know that colleagues here have seen those—and occasional spraying, which we also saw when we were in Malawi. We also know that health data management systems are crucial to understanding the impact of those important measures.

Not only does immunisation save lives, but it has a profound knock-on effect for families, communities and countries. The economy is helped enormously in many parts of the world by such important, life-saving initiatives. As part of Gavi’s mission to save lives and protect people’s health by increasing the equitable and sustainable use of vaccines, it has helped to vaccinate more than 1 billion children in 78 lower-income countries.

Other hon. Members have mentioned the opportunity for more manufacturing in country. I was pleased that FCDO representatives and other partners recently joined us for a roundtable in the House to talk about the opportunity to work with the Serum Institute, which was so crucial during covid-19. That would be a triangular partnership between India, the UK and many African countries. The hon. Member for Dundee West has seen that in action in South Africa, and I am sure that it can be rolled out across other African countries too.

I would be grateful if the Minister could update us on the Government’s intention to continue to support these vital global agencies in working to end vaccine-preventable deaths with strong pledges at the upcoming replenishments of Gavi and the Global Fund. Will he also update the House on the steps that the Government are taking to help to build and support research and development, as well as manufacturing, in particular to build capacity in vaccine manufacturing?

On the British science side, which is so important, what is the Minister doing to support the higher education sector, particularly where we have important collaborations? There have been setbacks due to Brexit and bumps along the road. What is he doing to promote and support our excellence in research, particularly the deep pockets of research in our universities? They sometimes report feeling a bit unsupported, and I know that the Minister will wish to put on record his support for international students being welcomed in the UK and for the rebuilding of collaborations across Europe, as well as for work with US partners and in country in Africa. I look forward to hearing his thoughts.

Secondly, in relation to spreading British higher education skill into Africa, I point out to the hon. Lady the recently announced programme for the Tropical Health and Education Trust, which I launched in London. THET does a huge amount of good work in this respect. We had an excellent programme some 10 years ago, and I am very pleased indeed that we have been able to renew that.

All my colleagues who spoke in the debate shone a spotlight on our lifesaving work with partners, including Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid. We see strong support in every part of the House for those lifesaving efforts, and I am very grateful for the contributions of Members here today in that respect.

I will endeavour to respond to all the points raised, but first I want to make a point specifically about Gavi, which I was asked about by the hon. Member for Ealing, Southall. He will, I think, recall that in 2011, when I had the privilege of being the International Development Secretary, we did the Gavi replenishment in London, and there has been a subsequent replenishment since that time. The point that I want to make to him is that that pivotal replenishment in 2011 was very heavily supported. Incidentally, we know that 83% of the British public thought that spending taxpayers’ money on vaccinating children under five in the developing world should be supported; they showed approval for that. I thought that was a very encouraging statistic then, and I have hopes for the upcoming replenishment, on which I wish to assure the hon. Gentleman. I cannot put a figure on the table now, but both I and the Foreign Secretary are very focused on the replenishment, because we know the good that this work does, which the hon. Gentleman so eloquently set out. We will undoubtedly be key supporters of the replenishment when we make our contribution.

I was also asked about the Global Fund. If I may say so, I thought that the hon. Member for Dundee West was a little unfair in criticising the figure. It was the first significant pledge when I returned to the Government in October 2022; we managed to get the system to agree. My right hon. Friend the Chancellor of the Exchequer was very keen on spending the money on the Global Fund, as was the Prime Minister, who emphasised the importance of the work, and £1 billion—a thousand million pounds—of taxpayers’ money is not to be sniffed at. If the hon. Member for Dundee West looks at what Peter Sands, the chief executive of the Global Fund, said at the time and subsequently about Britain’s support, both financial and in many other ways, I am sure that his spirits will be lifted.

In respect of the pandemic accord negotiations, which the hon. Member also mentioned, although I have nothing to say today, I think that they are proceeding well. The British Government have spent a great deal of time on that this week, and I hope that when the announcements are made in due course by Tedros from the WHO, the hon. Gentleman will be pleased and relieved at what we are able to achieve.

Vaccines have saved more than 150 million lives over the last 50 years, including more than 100 million children. That is six lives saved every minute for five decades. I am sure that we can all agree that this is one of humanity’s greatest achievements. The UK’s support for childhood vaccinations around the world has played its part, together with institutions including the World Health Organisation, Gavi, the Global Fund and Unitaid. However, the covid pandemic threatened to undo our hard-won progress, sparking the largest reversal in child vaccination rates in three decades and leading to increased outbreaks and deaths. Although vaccination rates have recovered since, global health is, as with everything, bound up with geopolitics. We stand at a crucial juncture in that respect. In these increasingly challenging times, we can only maintain our progress on global vaccines by uniting forces and standing together to ensure the health of future generations.

Let me be clear: reaching the world’s children with vaccination remains a top priority for Britain, as set out so clearly in our widely endorsed international development White Paper. We are determined to enhance our partnerships with individual countries and strengthen our collaborations with organisations such as Gavi, which will help continue to save countless lives.

The UK has supported Gavi since its inception 24 years ago. By bringing together Governments, private sector foundations, civil society organisations and vaccine manufacturers, it has vaccinated—that is to say, Britain has vaccinated—more than 1 billion children, saving more than 17 million lives. I am glad to say that Britain was one of the six original donors, and it hosted Gavi’s most successful summits, in 2011 and then in 2020, when we committed £1.65 billion over five years. Later that year, at the UN General Assembly, we pledged an additional £548 million to the Gavi COVAX advance market commitment to support lower income countries with covid vaccines.

We are now looking ahead, working closely with Gavi to develop a strong strategy for the next five years. That includes reaching all children with routine immunisations, and better integrating that with primary healthcare services. We want to improve co-ordination with other global health institutions to ensure that programmes are sustainable and, most importantly, led by countries themselves.

We are also looking ahead to the gathering hosted by the French Government, the African Union and Gavi this summer in Paris. President Macron will launch an accelerator mechanism to help African vaccine manufacturers produce vaccines in Africa and become commercially sustainable on a long-term basis. The UK looks forward to announcing the details of our support for that work, demonstrating the importance we place on a united global effort to improve access to vaccines and better prepare for future health emergencies. Those are all things that I have discussed in detail with Akinwumi Adesina, the president of the African Development Bank.

The roll-out of the malaria vaccines, which were referred to, not least by the hon. Member for Hornsey and Wood Green, highlights the role the UK has already played in end-to-end support of innovation vaccines. First, working in collaboration with partners in India, our world-leading scientists helped to develop these game-changing new vaccines, which must be used in combination with bed nets and chemoprotection. Then, supported by UK funding, Gavi, the Global Fund, Unitaid and the World Health Organisation set up pilots to provide the evidence necessary for a wider roll-out, and Britain’s MedAccess, so brilliantly led by Michael Anderson, worked with Gavi to secure the vaccine supply.

The vaccine roll-out will protect more than 6 million children from malaria by the end of next year. This is the first time that Gavi and the Global Fund will be working together on a single disease, and it presents a wonderful opportunity to strengthen their efforts even further. The wider work to prevent and treat diseases such as malaria, HIV and TB is also helping to save countless lives.

Britain was a founding donor to Unitaid 20 years ago, and has contributed more than half a billion pounds over the years. Today, more than 170 million people benefit from health products supported by Unitaid every year, from the latest HIV treatments to next-generation mosquito nets. Two weeks ago, on 24 April, I was delighted to join a parliamentary reception hosted by Unitaid, at which I reiterated Britain’s firm support for it.

Another great example of our investment in cutting-edge research and development is the recent deployment in Nigeria of the innovative MenFive vaccine. That revolutionary new shot is a powerful shield against the five major strains of the bacteria that cause meningitis. The research into MenFive was funded by Britain and developed through a partnership between PATH—a global non-profit organisation—and the Serum Institute of India. The roll-out of 1 million vaccines in northern Nigeria came from Gavi-funded stocks approved by the World Health Organisation last year. MenFive will be rolled out in other countries—Niger is expected to start vaccinating imminently—giving a big boost to our work to end meningitis globally by the end of the decade. That is exactly the kind of scientific innovation that Britian will continue to support, driving further break- throughs that will help to wipe out other preventable diseases.

While we are speaking of the future, let me turn to the matter of replenishments for our partners for the next 12 months, including Gavi, the Global Fund and the World Health Organisation. As I confirmed in my opening remarks, we are considering how and where our funding can have the greatest impact, and we look forward to announcing our contributions at the replenishment events.

I hope I have done justice to the work that Britain has done with our partners, which has saved countless lives. Those collaborations and scientific breakthroughs have enabled us to eradicate smallpox, and—thank goodness —we are on the verge of eradicating polio, which the hon. Member for Ealing, Southall raised. Children around the world are now protected against 19 deadly diseases through routine immunisation via Gavi.

There is, of course, more to do, and we will keep up the momentum. Nobody should die of a preventable illness, and everyone, everywhere should have access to these wonderful innovations. That is how we build a healthier and fairer world for all.