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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, this new and, to my mind, very important committee had a good start with the chairmanship of my noble friend Lord Soley and the services of our Clerk, Robert Preston, and his team. They succeeded in confining a potentially vast subject into a manageable space and enabled us to discover some alarming and relatively unknown areas of concern. They are not unknown to all; my right honourable friend the Prime Minister identified dealing with disease and global pandemics as an element in the national security strategy last March, one which required a global response. My noble friend Lord Robertson of Port Ellen and the noble Lord, Lord Ashdown, wrote in the Times last June: "““The pandemic threat is not so serious just because of the possibility of a disease outbreak but because, in a world of people moving on this scale, a disease could be upon us long before we know it is even there … This is not a temporary state of affairs but a permanent one and an interdependent world is a world of shared destinies””." One of the most striking things that I learned was the high proportion—it is three-quarters—of new infections which come from animals by jumping the species. This is not new knowledge; it was only new to me. Most of us know that most of our common, communicable diseases began when the human race went in for agriculture and close proximity to farmed animals. Your Lordships might think, therefore, that those organisations which were set up to deal with animal health and those for human health would be aligned to share information and control measures most efficaciously. That is not what we found, as our report shows in some detail, yet the danger is greater now that animals are moved so far and so often for farming, hunting, food, laboratory and pet trades and on an increasingly globalised scale. People penetrate into the depths of the forest and the jungle more than before, and use its products more exhaustively. As my noble friend Lord Soley said, there is no set of international health regulations to deal with animal infections, and we recommended that there should be. I regret that the Government, in this case, did not agree with us. While there are, for instance, EU directives on some of these zoonotic diseases and some general directives for agriculture and food safety, there is none to oblige disease monitoring for nature and biodiversity. Some think that the UK does not match its DfID investment in research on avian flu with full enough assessment of all future risks posed by wildlife in general. Then there is the whole area of which animal viruses, among the myriad which infect animals, will make the jump and which will turn into lethal diseases. This science, too, is in its infancy, not least because the places where these jumps happen most often are the poorest countries, in the tropics, with fewest scientific resources to identify them. When we looked at the management of serious infections that had reached humans, we did see change and progress. Rationalisation of the complex web of organisations was being addressed by the international health partnerships launched by this Government. We saw a recognition that help with specific treatment would not, on its own, solve the systemic problems of poor health infrastructure and lack of health education which had allowed disease to flourish in the first place. The problems which poor societies have in diagnosis, in data collection and in storage were well understood, and new kinds of organisation on the international scene, which brought in all stakeholders, were achieving results. In particular, there was recognition in the Global Fund, the Global Alliance for Vaccines and Immunisation—GAVI—and others that representation from civil society was essential to achieving delivery of service and preventive education in poor countries. The arrival of a rights-based approach to health was able to break down barriers. Innovative funding mechanisms such as the International Finance Facility for Immunisation and advance market commitments, which this Government have done so much to develop and establish, have saved thousands of lives among those too poor to pay for medicine. The word ““poor”” keeps cropping up in any discussion of the control of infectious diseases. It is no accident that their toll is so infinitely less in rich countries. The best way to stop the devastating mortality of AIDS, malaria and tuberculosis and the other life-threatening plagues is to eradicate the poverty, poor living conditions, malnutrition and lack of clean water which are the daily lot of those who die before their time in such large numbers. These, the non-health determinants of health, are now analysed by the WHO. They also need on-the-ground analysis by the local and national governments concerned. This is where the redistribution of resources, which is intrinsic to democratic politics, saves lives. Inequality breeds disease and early death. Professor Sir Michael Marmot told us that if the WHO had health equity as a core value, it would be institutionally natural for the WHO to bring in the non-health causes of ill health such as education, poverty, trade, habitat and migration and to promote measures that alleviated their adverse effects. The new report of the WHO’s Commission on Social Determinants of Health, which Professor Marmot chaired, bears eloquent witness to the relationship between social justice and health. However, in our output-driven funding habits, it is hard to measure the impact of any non-health measure on any particular disease, unlike, say, immunisation, so there is a disproportionate incentive towards vertical programmes rather than improvements of the whole system. We have made recommendations to improve the focus, as well as the accountability, of both international and national health organisations through UK action. It is important, we thought, that the World Bank’s new strategy put health in the context of its overall strategy for poverty alleviation. Perhaps the clearest lesson from our seminars was that in devising mechanisms to protect our own populations from deadly diseases from distant places, we should remember that we will do this best if we join in removing their fundamental basis: the soil of poverty in which they flourish. Finally, as my noble friend Lord Soley said, the UK contributes sizeably to the intergovernmental organisations that we have been considering and many others. This committee is the only formal parliamentary scrutiny of that expenditure, and your Lordships might think that the taxpayer has a right to see this work continue.