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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, it is a true delight to take part in this debate. I thank the noble Lord, Lord Soley, the committee and the staff with whom he worked for producing a really excellent and interesting report. I thank him for the informative and engaging way in which he introduced a very complex report examining quite deep seated issues. It is a very timely analysis of a really complex set of organisations with overlapping roles, multiple areas of expertise and fragmented funding streams. That is a recipe for disaster if ever there was one. When I read the report, it was not apparent to me why a committee of your Lordships' House should have produced it. I am very glad that it did, because it brought to the subject a detachment which made its findings all the more pertinent. From looking on the web, I know that the reaction around the world has been very appreciative, and I congratulate the committee on that. The report is timely for two reasons. To echo a point made by the noble Lord, Lord Desai, in the current financial economic situation, it is clear that there will be an ever growing need to demonstrate the efficacy and efficiency of international aid programmes. I also think that we have a golden hour in which to engage with the new US Administration in a spirit of partnership which was perhaps not possible with the previous Administration. The US Administration and their policies are one of the biggest factors in the international health scene. In addition, we have the forthcoming G8 summit. For reasons that I shall make clear later on, we have at the end of 2009 the important UN conference on climate change. Recent events since the report was produced have demonstrated how important it is. In December 2008, cholera infected 80,000 people in Zimbabwe. As far as we know, approximately 4,000 of them died. Of that outbreak, the WHO said: "““Given the outbreak’s dynamic, in the context of a dilapidated water and sanitation infrastructure and a weak health system, the practical implementation of control measures remains a challenge””." That was a very diplomatic way of describing a desperately sad and avoidable situation. It brought home to me the need to implement fully these international health regulations and to extend them to any disease, wherever it comes from, so that there is a global public health surveillance system, with state parties having an obligation to prevent or control the spread of disease, but in which civil society can report the true incidence of disease if a Government fail to do so. That is a tremendously important point. I read this report in conjunction with the report from the Intergovernmental Panel on Climate Change. It announced in 2007 that projected climate change related exposures are likely to affect the health of millions of people. Climate change will affect infectious diseases in two ways. There will be an increased risk of water- and food-borne disease, and there will be changes in vector-borne diseases. The IPCC predicted an increase in diarrhoeal disease in any place where water or food becomes contaminated—for example, after flooding—and where warmer weather leads to food poisoning due to problems with food storage. It is not possible to overestimate the extent to which climate change will have an impact on health. Only last month in the British Medical Journal, Anthony McMichael of the Australian National University estimated that climate change could lead to an additional 20 million to 70 million people living in malarial regions in sub-Saharan Africa. He drew the clear lesson that: "““Poverty cannot be eliminated while environmental degradation exacerbates malnutrition, disease and injury … Infectious diseases cannot be stabilised in circumstances of climatic instability, refugee flows and impoverishment””." Further, he said: "““This requires bold and far sighted policy decisions at national and international levels””," and greater carbon emission cuts than those proposed a decade ago. To everything the noble Lord, Lord Soley, said, you have to add this extra dimension of the health impact of climate change. I have one slight criticism of the report. In concentrating on the big three infectious diseases—HIV/AIDS, TB and malaria—the report did what in a way the noble Lord, Lord Desai, said it did. It tended to overlook what are called the neglected tropical diseases. I understand why the committee did that. Those diseases are less likely to have an impact in Britain, and that was the remit of the committee. None the less, those neglected tropical diseases afflict an estimated 1.1 billion of the 2.7 billion people who live on less than two US dollars a day. The burden of such diseases on those people is perhaps greater than on others. In neglecting to follow those, we did perhaps miss something. I suggest to the noble Lord, Lord Soley, that, as part of his campaign—which I wholeheartedly support—to have a standing committee of the nature of his, its next report could look at those neglected tropical diseases and the work of international government organisations on them. Having given a slight brickbat, I want to give a bouquet. The report and its recommendations about TRIPS helped to build up some of the pressure which resulted last week in that announcement from GlaxoSmithKline. I am the Liberal Democrat health spokesperson. I happen not to make a habit of congratulating drug companies, but this time we should. It was an extraordinary statement, and I add to what the noble Lord, Lord Soley, said. GSK said that it would cut prices for all drugs in the 50 least developed countries to no more than 25 per cent of UK and US levels, and less if possible. It will put any chemicals or processes over which it has intellectual property rights that are relevant to finding drugs for neglected diseases into a patent pool so that they can be explored by other researchers. It will reinvest 20 per cent of any profits it makes in the least developed countries into hospitals, clinics and staff. It will invite scientists from other companies, NGOs or Governments to join the hunt for tropical disease treatments at its dedicated institute in Spain. Campaigners from charity organisations have understandably expressed regret that that does not include the HIV medicines. Nevertheless, they realise that it is a tremendous step forward. It will alter dramatically the whole architecture of that complex relationship of intergovernmental organisations, NGOs and private companies. I hope that there will be a compensating change on the part of other private companies, and on the part of Governments as they seek to move forward to the next stage—just as they did when the Gates Foundation came along to make its contribution. The issue of vertical and horizontal health programmes is one of the most interesting parts of the whole report. I listened carefully to what the noble Lord, Lord Soley, said about not being able to have either a horizontal or vertical approach; that will not work, and it is a question of finding a balance. I wondered whether the Government, working with countries with which they have particularly close relationships and the NGOs and IGOs working in them, might find two countries in which it was possible to come up with models reflecting a different type of balance between them. The sticking point seems to be that national Governments do not know quite how to come up with a model that is effective for them. There are no models to which they can go. One of the most striking pieces of testimony in the report was that of Professor Borriello about zoonomic diseases. The interesting thing he talked about was that the UK’s panel for newly emerging infections includes medical and veterinary staff, and people involved in food science. Given that 75 per cent of emerging diseases are zoonomic, I ask the Government whether we can work on that model in conjunction with a low-income country to see whether the model could be adapted to its situation, whereby it could come up with a structure enabling those with knowledge in veterinary science, food science and health to work together. It is not a matter of us exporting our models intact, because they will not necessarily be applicable, but we can take the points of models that work and enable people to adopt them. That is an important point. I end by echoing some of the points of the noble Lord, Lord Crisp. We have in this country a wealth of experience that we would do well to export. I would go further than the noble Lord and include Defra as well as some of the other departments. We should look upon this not solely as an act of generosity on our part. I well remember, during the outbreak of foot and mouth, a colleague in the Commons, Ed Davey of Kingston, had tremendous trouble getting a refugee who was a qualified vet from Iran—a nation where foot and mouth is endemic and every vet knows exactly what it is—fast-tracked into being able to work with those dealing with the emergency here. We have a lot to receive as well as to give from such partnerships. The four nations of the United Kingdom work jointly but in slightly different ways via the Health Protection Agency and others. The noble Lord, Lord Desai, is right: during the next few years of austerity and hardship it will be extremely difficult politically to maintain our level of international development aid. It will require courage on the part of the Government to do that and the provision of a great deal of information—this report is a welcome addition to that—to dispel some of the myths about our expenditure on international aid, to enable people to see that it constitutes investment in the health of the world, and that we are part of that world just like anybody else. If one major task needs to be carried out above all else, it is to improve co-ordination and governance, to which the committee referred. This report is an excellent basis on which to start. I very much look forward to hearing the noble Baroness’s reply to the points noble Lords have made.