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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, I add my thanks to the noble Lord, Lord Soley, for introducing the report so comprehensively and charmingly. There is a lot of worry about how a flu pandemic should be handled. Professor Neil Ferguson of Imperial College has described a very useful computer model to test a number of strategies to limit the spread of the disease. As there is no vaccine, they suggest anti-viral prophylaxis in order to reduce the risk of infection among approximately 20,000 people in the vicinity of the initial cluster of flu victims. He estimated that a stockpile of 3 million doses of anti-viral treatments could be needed to eliminate an outbreak. The question that springs to mind is—I have already indicated this to the noble Baroness—has the Department of Health such quantities of anti-virals available? The report contains criticisms of the WHO, as mentioned by the noble Lord, Lord Soley. Many of us have had experience of this organisation and have found some aspects of it rather unsatisfactory. No doubt this tends to colour our judgment. It is right therefore to stress, as did the noble Lord, Lord Soley, that the present director-general, Dr Margaret Chan, has brought a very welcome breath of fresh air to Geneva, and that things have changed very much for the better in the past few years. The report records complaints about excessive bureaucracy in the WHO headquarters but the director-general's programme of reform of the management structure has been much admired. Others have criticised what they describe as the disconnect between the headquarters in Geneva and the regional offices, especially the regional office in Africa (AFRO). Uniquely within the United Nations system, the six regional directors are elected and naturally tend to feel responsible to the countries that elected them, as well as to the WHO. In practice this federal system has worked well during the past year or so in spite of past difficulties. The director-general meets the regional directors at least three times a year; two are whole-day meetings and the third is a retreat for several days. Concerns have been expressed that the regional governance of the WHO could get in the way of a co-ordinated and effective approach to disease outbreaks. The revised international health regulations that were adopted by all WHO member states in 2005 make it clear that authority lies with the director-general. When a serious outbreak of a disease occurs, the director-general herself does the risk assessment, has the final say and advises on any action to be taken. There have also been recent developments in building greater coherence among the main organisations working in global health. The heads of four United Nations oganisations, UNICEF, UNFEA, UNAIDS and WHO, and the four financing organisations, the World Bank, the Gates foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance, now meet every six months to align their work more closely. The last meeting was just three weeks ago. It is worth pointing out that the Global Fund to Fight AIDS, Tuberculosis and Malaria has the largest health budget in the world. It is an international financing institution investing the world’s money to save lives. To date it has committed $14.9 billion in 140 countries to support large-scale prevention and care programmes against these three diseases. Two million have been treated for HIV/AIDS, 4.6 million for tuberculosis and 70 million bed nets have been distributed. As the noble Lord, Lord Soley, mentioned, the Gates foundation contributes more than the whole of the WHO budget. There was a feeling that the WHO was becoming rather uneasy about that. But, again the director-general has made it clear that she does not regard that as a problem. There was some controversy over the WHO announcements about leprosy some years ago but that was based on a misunderstanding over technical terms. The WHO had earlier stated that its goal was to reduce the prevalence of leprosy to less than 1 in 10,000. Its policy of recommending that the duration of treatment should be reduced from two years to one year thereby halved the prevalence which gave the impression that the WHO was claiming that it had solved the problem. The subject of prevention, especially HIV/AIDS, is dealt with in paragraphs 47 to 49, which emphasise that prevention means changing behaviour. As my noble friend Lady Eccles stated, changing behaviour is much more difficult than treatment. What is so disturbing is that the AIDS epidemic involves more and more women worldwide, with 17.7 million women being HIV positive, which is more than ever before. In sub-Saharan Africa they constitute two-thirds of people living with HIV/AIDS. In South Africa young women are four times as likely to be HIV infected than young men. As president of the Mildmay centre, I was involved in the establishment of the first hospice in Europe for those dying of HIV/AIDS and later the first in Africa, just outside Kampala, with enormous help from the noble Baroness, Lady Chalker, who guided us into concentrating on outpatient work and teaching. In the Mildmay centre in Uganda it was not unusual to see 100 children in a day all with AIDS, all orphans, a third of them with tuberculosis and many with malaria and the most terrible shingles and lice that I have ever seen because their immune systems were so depleted. However, I was very impressed with the HIV/AIDS prevention programme set up by the President Museveni of Uganda which reduced the incidence from 31 per cent to 5 per cent among pregnant women. Those are hard, reliable data. The ABC programme—abstinence or postponement, be faithful and condoms—has also been successful in other African countries. The WHO advocates a policy that is comprehensive and inclusive, and embraces the ABC policy, which is also supported by our Government. The Leader of your Lordships’ House stated that the Government subscribe to the successful campaigns of ABC, but not one to the exclusion of others—it is important to stress that. It is of interest that many teenagers are choosing abstinence or postponement as a safer policy. Tragically, teenage girls in many countries have no power to refuse, and face physical abuse and even death if they do not comply. In approaching the difficult subject of prevention, we need to be open to many different approaches, especially as there are such diverse cultures worldwide. About 40 per cent of the world’s population is at risk of malaria. More than 500 million people become severely ill with malaria every year, and 1 million people die. Twenty per cent of all childhood deaths in Africa are from malaria. The Conservatives are committed to spending half a billion pounds a year tackling malaria, until the millennium development goal has been met. We will work with African countries to abolish tariffs on anti-mosquito bed nets in sub-Saharan Africa. We will establish a fund, worth £5 million a year to begin with, to help fund international placements for British health workers and support links between the NHS and health systems in poorer countries. There are many who already give generously of their time and expertise in developing countries, and we need to give them more encouragement and make it easier for them to have leave of absence from their work here. Working on Mercy ships in west African countries for most of my holidays, I have been so impressed with healthcare workers who volunteer for periods of anything between two years and 22 years. The Conservatives will abandon what we believe are Labour’s plans to cut staff numbers at DfID, and we will rapidly increase its budget. British aid will be properly scrutinised for effectiveness, and results will be linked directly to independently audited evidence of real progress in these poor countries. We also plan to establish an anti-corruption hotline on the front page of the DfID website. All DfID programmes will have a designated anti-fraud officer who could be approached, anonymously if necessary, by anyone who suspects corruption. Their e-mail address and phone number would be published on the relevant pages of the DfID website, both in English and local languages. We will also consider giving some aid money directly to poor people as aid vouchers, redeemable for development services of any kind from an aid agency or supplier of choice. The noble Lord, Lord Soley, mentioned that animal welfare is very important in the food chain, and spoke about outbreaks of infection. That reminds me of the widespread distribution of the virulent campylobacter organism, which affects 70 per cent of chickens in the United Kingdom. The chickens are killed by being stretched by the neck and feet, upside down, on a conveyor belt. They are then electrocuted, which makes the muscles contract, emptying the contents of their alimentary tract. As they are upside down, the campylobacter is sprayed all over them. They are then put in a big vat, where they become campylobacter soup. When the chickens are chopped up and put into polythene bags, they are infected with campylobacter. This is all right provided the chickens are adequately cooked. However, if they are chopped up on a board that is then used to prepare a salad, you can understand how the infection takes hold. This report has inevitably focused on developing countries and we are often critical of the widespread infections there. However, we in the United Kingdom are not always paragons of virtue.