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Lord Alton of Liverpool (CB)
My Lords, in her prescient, topical and important speech, the noble Baroness, Lady Sheehan, asked a number of important questions of the Minister. I look forward, as I know other Members of the Committee will, to his response later in his remarks.
The noble Baroness was right to remind us of the importance of fair access to medicine and the role of pharmaceuticals. Any vaccination programme for Covid-19 should be equitable and fair. She referred in her remarks to some work done at Liverpool University, which I will return later in my remarks.
In her amendment specifically, she draws our attention to the International Covenant on Economic, Social and Cultural Rights of 1966, and, as she has done in her remarks, reminds us of the public health safeguards within the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS.
Earlier this year, with other noble Lords who serve on the International Relations and Defence Committee, I participated in hearings which led to the publication on 10 July of our report entitled The UK and Sub-Saharan Africa: prosperity, peace and development co-operation. The inquiry was chaired by the noble Baroness, Lady Anelay of St Johns.
We became acutely aware of the potentially catastrophic effect of Covid-19 on already fragile economies and societies. John Hopkins University suggests that across the continent of Africa, with its population of around 1 billion people, there have been about 37,000 deaths, compared with 230,000 in Europe. Indeed, there have been more deaths in the United Kingdom than in the whole of Africa. But we must treat the data with some caution and even scepticism. Reporting in many places is rudimentary, with Nigeria carrying out just 2.7 tests per 1,000 people, compared with 381 in the United Kingdom, so the data may have to be treated with caution.
Mercifully, the reported death rate—18,000 in South Africa, for instance—does seem to be lower than in some parts of the world, perhaps assisted by younger populations; few homes for the elderly; less common incidence of type-2 diabetes and obesity; more outdoor living and low travel; and experience of dealing with Ebola, malaria and AIDS. We should nevertheless be concerned that, as recently as last week, the World Health Organization said there had been a substantial rise in deaths and recognised that disparities in our health systems and economic power could still see an acceleration in infections and fatalities.
The smouldering pandemic in Africa has been held at bay by swift and significant lockdowns in many African countries, leading inevitably to significant loss of jobs. That cannot be sustained indefinitely. These fragile economies will see increases in destitution and chronic poverty if we are unable to ensure protection for all as and when a vaccine becomes available.
James Duddridge MP, the Africa Minister, told the inquiry that, as a consequence of Covid-19, the World Bank projected 40 million to 60 million additional individuals falling into extreme poverty, and it has been projected that the economy of sub-Saharan Africa will be between 2.1% and 5.1% smaller by the end of the year. The London School of Hygiene & Tropical Medicine told the inquiry that the region was likely to face particular contextual challenges from Covid-19, including
“economic, social and cultural inequalities, lack of personal protective equipment … and the additional health burden of communicable and non-communicable diseases”.
It cited three factors which could worsen the impact:
“overcrowding and large household sizes”,
which increases transmissibility, a
“high baseline prevalence of co-morbidities”
and
“lack of intensive care capacity”. Share
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Dr Ngozi Okonjo-Iweala, the African Union’s impressive special envoy appointed to mobilise international support for Africa’s efforts to address the economic challenges African countries will face as a result of the Covid-19 pandemic, said that Covid-19 had
“come with a huge exogenous shock”.
“the supply chains for many of the products Africa imports, such as pharmaceuticals”
She also said that
—it imports 94% of them—have been disrupted by Covid and that prices for those products have gone up, as the noble Baroness, Lady Sheehan, said.
Dr Okonjo-Iweala said that unless there was careful and quick action, Covid-19
“could reverse the gains of the last two decades”.
Among six responses that the UK could make, she urged support for funding the Africa Centres for Disease Control and Prevention, but also appealed for help with vaccinations when, and if, a vaccine becomes available. She said we should
“make sure that we have volume and quantity for everyone and that poor countries are not locked out”.
She said that the United Kingdom could play a very important role in being active in the international group to make sure that happens.
In welcoming the role that the Government played in convening the third donor-pledging conference for Gavi, the Vaccine Alliance, on 4 June, and in commending them on providing additional funding to the Africa Centres for Disease Control, the Select Committee addressed the issue of vaccination lockout. In paragraph 292, it formally recommended:
“Access to a vaccine for COVID-19, should one be successfully developed, must be available on the basis of need. The Government should continue to work with international partners—including through Gavi, the Vaccines Alliance and the Coalition for Epidemic Preparedness—to ensure any such vaccine is made available to developing countries, including those in Sub-Saharan Africa.”
This takes us to the submission made to the All-Party Parliamentary Group on Coronavirus by the Missing Medicines coalition, whose recommendations are addressed in part by this amendment. The APPG and the amendment challenge the seeking of preferential access to vaccine candidates, rather than supporting international mechanisms to guarantee an adequate number of vaccine doses. At its heart is the proposition, with which I agree, that any new vaccines and treatments should be considered a public good. This has to mean making them affordable and universally available. In turn, this will require open sharing, transparency around research and development and licensing agreements—and where public funding is involved, that should certainly be a condition.
Perhaps the Minister could assure us, when he comes to reply to a point made by the noble Baroness, Lady Sheehan, that we will do that and explain whether we intend to work with C-TAP, the Covid-19 technology access pool—and if not, why we are not doing so. It is self-evident that exclusive licences over Covid-19 technologies will not only affect pricing and hinder research but prevent those countries with capacity being able to produce the staggering number of doses that will be required to meet global demand.
Deterring inflated prices for new health technologies and vaccines aimed at stopping the pandemic in its tracks is imperative, but the signs are not good. The noble Baroness referred to Gilead: take its ring-fencing of the repurposed Covid-19 treatment remdesivir, which has led to the US hoarding 90% of the available product, notwithstanding the ability of many other manufacturers to produce that drug. This monopoly has enabled Gilead to charge $2,340 per five-day treatment course, which Liverpool University estimates can be made for just $9.
I might add that significant public funds were poured into the development of that drug—it would be interesting to hear from the Minister whether he knows precisely how much—and have gone into the development of similar drugs as well.
It is obscene and no better than speculative profiteering if that gain is not passed on to people without these mark-ups. The failure to organise wholehearted, altruistic collaboration also leads to what has been called a vaccine arms race—the noble Baroness referred to it—in which high-income countries have first-come, first-served access and poorer countries face the danger of being locked out.
As of August 2020, high-income countries had already placed orders for more than 2 billion doses. The United Kingdom is the world’s highest per capita buyer, with a potential stockpile of six unproven vaccines, with 340 million doses for a population of 66 million. That is five doses for every citizen. Perhaps the Minister could tell us how much public money and private funding has gone into the development of those six vaccines.
Interestingly, a YouGov poll found that 96% of the United Kingdom public support that idea that national government should work with others to ensure that international collaboration and equitable distribution takes place. That finding is asserted in new paragraph (d) of the noble Baroness’s amendment. It rightly rests on the WTO agreement on trade-related aspects of intellectual property rights and the public health safeguards contained within it. This would elevate our commitment to health equality and accessibility, adumbrated in the 2016 and 2017 resolutions of the United Nations Human Rights Council, reinforcing calls in the 2030 sustainable development goals for medicines and vaccines for all. The Government have the power to use Crown licences to prevent patent monopolies impeding access to medicine, and they have successfully used that power in the past, both in application and as an effective threat. They should not hesitate to do so again.
Unless the vaccines are globally available, with some evidence that immunity may last for only about three months, the chance of resurgence remains extremely high. Residual hotspots in third-world world countries represent a threat to the health of our own nation, as well as the obvious continuing threat to our neighbours. The correct action is surely to manifest the work that we do in a collaborative vaccination effort.
Many of us complain about the hardships resulting from the lockdowns associated with Covid.
The African Union’s Dr Ngozi Okonjo-Iweala told our Select Committee that fears across developing nations were not about lockdowns, but about being locked out—locked out because of monopolies, vested interests and self-interest.
Compared with countries that have been capitalising and profiteering on the back of Covid-19, the United Kingdom has values and a reputation of which we are justifiably proud. The amendment in the name of the noble Baroness, Lady Sheehan, gives us an opportunity to demonstrate that that reputation is well deserved.
