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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, it is with great humility that I answer this debate. As I read the committee’s report and evidence over the past week, I realised what a very important contribution its work has made on this vital issue. I am not surprised that this was the first subject that the committee tackled. I congratulate my noble friend Lord Soley on a truly excellent and comprehensive report and on securing this debate today. I agree with the remarks of the noble Baroness, Lady Barker, about the welcome that the report has received across the world. My noble friend has offered me the opportunity not only to place on the record the Government’s thanks for the committee’s work but to update the House on developments since its report. I am pleased to say that progress has been made even since its publication in July. As noble Lords will know, the Government published Health is Global, the UK’s global health strategy, in September 2008. This strategy, along with the 2007 DfID health strategy, sets the framework for our work on global health between now and 2013. Health is Global highlights the links between domestic health and health beyond our shores, as well as the role of a variety of players, including intergovernmental organisations, in improving both. It includes commitments to work for better health security, including tackling infectious disease, and more effective international organisations that can help get the job done. Since the launch of Health is Global we have seen the start of the most serious global economic crisis in decades—referred to by several noble Lords, including my noble friend Lord Desai. Finding innovative and sustainable solutions to global health challenges remains as pressing a concern as ever. Indeed, I echo my noble friend Lord Desai’s remark that this is an economic pandemic. After last year’s food and fuel crises, we now face a huge challenge to maintain the fight against global poverty. Impacts on health will vary greatly by country and context, but past downturns show common patterns. The impact on the poor will be especially serious: nutritional standards are likely to fall, as will the ability to spend on private healthcare. Given their importance in channelling resources, intergovernmental organisations will be crucial to our response. I also agree with my noble friend about the need for coordination and for our Government and other Governments to maintain support levels in this field. It is self-evident that many health risks today require international collective action. Let us consider, for example, the threat of a worldwide influenza pandemic, mentioned by the noble Baroness, Lady Eccles, and other noble Lords. In October 2008 the Government launched a new international pandemic influenza preparedness strategy, which aims to reduce the risk of a global pandemic through co-ordinated action at national and international level, action designed to enhance our collective ability to prevent, detect and respond to a pandemic. At the heart of this strategy are issues that the committee’s report highlighted. We recognise the need to improve infectious disease surveillance and response systems in developing nations. This is why, in addition to our share of the substantial contributions made by the European Commission, the UK has already committed more than £35 million towards the international effort to tackle avian and pandemic influenza. Much of this funding is channelled through international organisations and is being used for a wide variety of activities, including strengthening national public health surveillance systems, enhancing outbreak containment and virus eradication in animals, improving non-medical responses to pandemic flu, and strengthening health system capacity. We are also playing a leading role in developing the WHO global pandemic influenza action plan, which will increase the availability of vaccines for a pandemic, including for developing countries. It is also vital to encourage engagement and research across veterinary and human health sectors globally, in support of what is known as a ““One World, One Health”” approach. A number of UN system agencies and the World Bank have launched a strategic framework, Contributing to One World, One Health. This applies the lessons learnt from avian influenza to emerging infectious diseases at the animal, human and ecosystems interface. The UK has played an active role in developing this framework and will participate in discussions to be held next month in Winnipeg, hosted by the Canadian Government. These discussions will decide which diseases should be addressed and how the strategy should be implemented. The challenge will be to apply the benefits gained in our experience of avian and pandemic influenza planning to a broader range of infectious diseases, while not losing the focus on pandemic planning. The role and co-ordination of the work of the intergovernmental organisations is key to all this, as the report points out many times. Our view remains that there is evidence of strong liaison between the various international bodies in disease surveillance at the animal-human interface. However, global co-ordination in pandemic preparedness planning more generally could be improved. The UK’s international strategy on pandemic influenza commits us to bringing together the key international organisations working on pandemic flu preparedness in order to promote improved co-ordination and synergy. I hope this will confirm to my noble friends Lord Soley and Lady Whitaker that the Government take this very seriously indeed. We will host this meeting in June. In June the Government published a new AIDS strategy, which underlines the UK’s commitment to continued global leadership on AIDS, and to the goal of universal access to comprehensive HIV prevention, treatment, care and support by 2010. Achieving universal access is a global commitment. Responsibility for making progress towards it lies with national Governments, supported by effective partnerships of bilateral and multilateral agencies, as well as civil society and the private sector. International agencies have played a key role in recent successes on AIDS, as already mentioned by the noble Lord, Lord McColl, but it bears repetition. For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a key role in a 20-fold increase in funding, from $485 million in 1997 to $10 billion in 2007, and has helped AIDS treatment increase from 100,000 people in 2001 to 3 million in 2008. There have been challenges too, but the AIDS response has helped to sharpen focus on approaches that can help. The noble Baroness, Lady Eccles, and the noble Lord, Lord McColl, quite rightly also drew our attention to the need for changes in people’s behaviour and the impact of HIV and AIDS on women and children. The UK Government played a key role in the launch of the multi-stakeholder global malaria action plan in September. I do not apologise for using all these terms and acronyms because this report, as everybody has mentioned, is absolutely full of such terms. The UK contribution, which was announced by the Prime Minister, includes 20 million bed nets by 2010; increased funding for research and development of up to £5 million by 2010; and £40 million over two years for the affordable medicines facility to increase access to the latest and best malarial drugs. This ambitious programme needs active and co-ordinated participation by intergovernmental organisations if it is to succeed. The committee rightly recommended that we continue to promote integrated strategies for combating TB and HIV. This Government are committed to tackling HIV and TB co-infection and recognise the need to upscale efforts to deliver universal access to TB and HIV prevention, treatment, care and support services by 2015, as well as to increase investment and facilitate research to promote the development of better tools for prevention, diagnosis and treatment of TB. DfID’s AIDS strategy supports the integration of HIV and AIDS and DfID has made a significant commitment to spend £6 billion over seven years to 2015 to strengthen health systems and services. This includes the integration of HIV and TB services. All this must be set in the context of progress against the health-related millennium development goals. In July 2007 the United Nations Secretary-General and the Prime Minister launched the MDG ““Call to Action””, encouraging the international community to accelerate progress to reach the millennium development goals. The subsequent United Nations high-level event in September 2008 saw countries, charities, foundations and businesses pledge $16 billion to help reach the goals. I am very happy to hear from the noble Lord, Lord McColl, of his party’s support for all this activity. I add one small partisan point: I welcome the turnabout of the Conservative Party in its policy on international aid, but it is slightly rich to suggest that this Government, with their record, will be reducing their commitment in any way. We are keen to track the implementation of the actions announced at the high-level event and to maintain the momentum and focus that the event produced to get the MDGs on track. We also want to support the resolution already proposed by the UN Secretary-General and the President of the General Assembly on the MDG review summit in 2010. The high-level event also saw the launch of the Taskforce on Innovative International Financing for Health Systems, co-chaired by the Prime Minister and the president of the World Bank. The task force will explore new sources of finance to help developing countries achieve the health MDGs. International organisations are at the heart of the response to the challenges of protecting UK health and of meeting the MDGs. But, as the report made clear, the very complexity and fragmentation of the international health architecture makes it hard for Governments, especially those in the developing world, to use these resources as effectively as possible; this is the labyrinth referred to by my noble friend. The Government are committed to help to deliver a more rational, effective and efficient health architecture, better at protecting the health of England and helping developing countries to achieve the MDGs. In the global health strategy we commit to working with the WHO and other UN agencies to consolidate existing funding flows to the UN so that we have fewer and more effective agreements, to supporting consolidated UN country programmes in developing countries, to providing incentives to UN organisations to work together and to setting these organisations stretching targets that deliver results and value for money. I will give three examples of how we are putting this commitment into practice. First, the International Health Partnership was launched by the Prime Minister in September 2007. It seeks to build stronger health systems by applying the Paris principles on aid effectiveness to the health sector. The International Health Partnership will play a vital role in bringing agencies together. From the developing country perspective, it is the organising framework to ensure the most effective and sustainable allocation of resources, both domestic and external. Secondly, there is the UK WHO institutional strategy. We have now finalised our institutional strategy on the WHO; it sets out how we will work with the organisation between now and 2013. The document is on the Department of Health website. This joint strategy, which was agreed between the WHO and three government departments—the Department of Health, DfID and the FCO—takes on board many of the recommendations in the report. For example, the strategy commits us to streamlining some of the funding that we allocate for the WHO in line with performance against agreed priorities. It sets specific indicators and targets for delivery to improve the monitoring of the agency’s performance. As part of this process, DfID is making additional funds available on a performance-related basis to the WHO at 10.3 per cent of baseline funding this year and 18.7 per cent next year. The UK gave $358 million to the WHO in 2006-07, which makes us the organisation’s second largest donor. The institutional strategy is key to holding the organisation to account for that funding and improving its performance. The third example is our support for the WHO’s work on partnerships. A number of global health partnerships are hosted by the WHO, and it is involved in many others. This year’s World Health Assembly will consider a report on the WHO’s approach to these, including the criteria to help the organisation to decide whether to get involved in new partnerships and, if so, what the organisation’s involvement should be. We are pleased that the WHO is looking at this complex area, and we will work closely with it to get this right. I shall now address some of the specific questions raised by noble Lords. My noble friend Lord Soley talked about vertical versus horizontal health system strengthening programmes. I thought that he explained it with great eloquence. It was new to me when I read the report, and I found it very interesting indeed. We agree with my noble friend that both vertical and horizontal support are essential; it is not a question of either/or. The World Bank has an important role to play in both, and we agree with the committee that the bank needs to invest in health infrastructure in collaboration with other players in the health field. That is our approach to the World Bank on this issue. My noble friends Lord Soley and Lady Whitaker and the noble Baroness, Lady Barker, raised the issue of surveillance for human disease and what the OIE does in it regard. I have already said that we think the system works quite well, although we continue to push generally for improved surveillance in countries and for co-ordination internationally. My noble friends Lady Whitaker and Lord Desai both mentioned the work of the Commission on Social Determinants of Health led by Sir Michael Marmot. The UK is very active in this area. Late last year it hosted a global conference opened by the Prime Minister in order to take this work forward. I am pleased to say that we sponsored a resolution at the recent executive board meeting of WHO member states and we are determined to see progress in this area. The noble Lord, Lord Crisp, raised two main issues which I am pleased to be able to respond to. I thank him for his comments on using UK expertise to support health systems in developing countries. His own report in this area has been very influential. The implementation of this report’s recommendations, now being taken forward by DfID and the Department of Health, is a great example of cross-government work. The noble Lord will have direct experience of the need for this. On our global health strategy, which he mentioned, we have a commitment for the Health Protection Agency to also develop its international role along the lines he suggested. We agree with his point on innovative staffing. The key is to get the most appropriate workforce where it is needed. My noble friend Lord Desai called for more co-ordination. His remarks echo those of most noble Lords: this is a great challenge. He also mentioned the issue of the sovereignty of resources getting in the way of preparedness. The WHO is currently taking forward an intergovernmental process to improve the system for sharing influenza viruses with more equitable access to benefits such as vaccines. The UK strongly calls for all countries to share their influenza viruses, so to speak, to enable risk assessment and to transfer this to the manufacturers of vaccines for viruses. I agree with the analysis made by the noble Baroness, Lady Barker, of the links between climate change and health issues. She is absolutely right. She asked what we were doing to support developing countries integrating the animal and human surveillance systems. So far we have pledged £35 million to help developing countries do this, £20 million from DfID over three years channelled through multilateral agencies, such as the WHO. I have a list here of about seven other acronyms, but you get the gist. We will reprioritise DfID’s country aid programme if we are requested to do so. We aim to determine how best to contribute to improving an animal and human surveillance system for the HPAI in vulnerable areas of the world. We want to continue working with partners on virus-sharing and better distribution of benefits, and to consider further funding once the strategic framework has been agreed in Canada at the conference I referred to. I am grateful to the noble Lord, Lord McColl, for his specific question about the quantities of antiviral available to eliminate an outbreak of flu pandemic. The UK will have enough antiviral available to treat 50 per cent of its population by the end of next month. A 50 per cent attack rate is, noble Lords will appreciate, the worst-case scenario for the next pandemic based on previous pandemics this century. The World Health Organisation has an antiviral stockpile donated by manufacturers amounting to 5 million treatment courses which can be used to contain the pandemic wherever it started, so it can be got to wherever it is needed. I think the noble Lord won the prize for the yuck factor in this debate with his very eloquent and informed description of the treatment of chickens. As we might have anticipated, a debate led by my noble friend, with contributions from distinguished colleagues around the House, is one of the highest quality. It has taken forward the thinking on this vital issue, and I hope that my noble friend recognises from this response how seriously the Government take the issue and how grateful we are for the committee’s work. I thank all noble Lords for their excellent contributions today.