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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, it is a great privilege to thank my noble friend Lord Soley for having initiated and having led this inquiry in a most efficient and charming manner. We finally got to grips with what is really an enormously complex subject. Before I turn to the topic of the report itself, let me reflect that today we are going through another global pandemic, a financial one. If only there were as many institutions around the world talking to each other about disease control as there are talking about financial problems, the situation might not be as bad as this. I can put it no more strongly than that. As my noble friend said, while in the report we concentrated on four major diseases, many others are no less important. We just did not have the time to deal with them. In poor countries especially, these other diseases are just as important as the four we looked at. We were also as much concerned with globalisation on the health front as with the role played by intergovernmental organisations in combating global diseases. I want to make some points that have not yet been made because the report has been welcomed by my noble friend Lord Soley and others. We thought that we would encounter a jungle out there of overlapping jurisdictions all interfering with each other in trying to deal with the problems of the four global diseases, but instead we found a much greater degree of clarity among the people involved, especially those at the WHO. They know what they are doing and have ways of co-ordinating with other players in the field, so that while from the outside it may look messy, it is not as untidy as we thought it would be. On the nature of structures, there is a contrast between vertical and horizontal health issues. In my view, the vertical structures are not in a sense co-ordinated enough because we have institutions like the WHO, to which DfID contributes in a vital way, and many other similar organisations. Poor countries find themselves receiving visits from unco-ordinated groups from different nations, each bringing their own agenda and each wanting a return from the recipient country on the buck they have given. We were told that in countries like Tanzania and Malawi, officials in the health ministries have to host as many as 340 delegations a year. I do not know when they find the time to do any proper work. We ought to worry about whether there is a way of co-ordinating this stuff so that fewer delegations visit individual countries, and those that do, do not just push their own little angle. Rather they should ask about outcomes on the ground as a result of donations and worry less about whether a particular country’s dollars have resulted in a particular cure. The question should be: has a cure been achieved? Given the fragility of staffing levels both in terms of organisation and health needs in poor countries, devising some sort of co-ordinating mechanism would make a tremendous contribution. This requires on the part of taxpayers in the rich countries a bit of trust that, although we do not quite know where the DfID dollar has actually gone, we can take it that their dollar has been properly utilised and that outcomes will show how that has been the case. The global structure needs to become slightly more co-ordinated and less nationalistic and protectionist over individual donations and the return on them. I turn now to one or two other problems. In the case of pandemic flu, we face a problem that is not unknown in international relations: countries are often unwilling to share evidence of the occurrence of an outbreak. That happened famously in Indonesia. Countries are very often afraid of the economic impact it will have on investment, business and tourism if they admit to a problem. Again, we have to find mechanisms of compensating countries which are honest and come up with a warning that will benefit all of us. We have to tell them that if there are problems and if costs are incurred, the World Bank or some other agency such as the International Monetary Fund will compensate them, but the importance for the world at large is that they share this information and share it as quickly as possible. Problems of sovereignty in terms of both the recipient and donor countries often get in the way of efficiently tackling the problems of disease. The matter may not be the specific responsibility of a particular government department but one about which the global leadership should think carefully what to do. One of the lessons we would obviously like to learn from what we have done is the tremendous importance not only of the need for more resources at the vertical structures but also, as my noble friend Lady Whitaker said, of the horizontal parts of the health problem, which is the general problem of tackling poverty. It is extremely important, at a time when we are all feeling rather hard up in terms of the financial meltdown, that the global leadership—the G8 especially, and the G20—does not resile from the task of keeping up international aid so that the flow of international resources which is most needed by the poorest countries continues. Yes, we are slightly worse off, maybe by 10 per cent or 15 per cent, but even so we are still 20 to 30 times better off than those people who are really at the front line of suffering from some of these diseases. It behoves us not to fall back but to keep our commitment to helping tackle health problems in the poorest countries as far as possible.