At its heart, the debate is not about a disease, drugs or development assistance but about people. It is about children without parents, hospitals without nurses, schools without teachers and fields without furrows because the farmers are too weak to plough the land. It is about death rates that are hugely inflated by the pandemic, knocking holes in the society and economy of many countries in many parts of the world.
The death toll from AIDS will continue to rise dramatically for at least a decade in Africa and, as other hon. Members have said, in other parts of the world such as Asia and eastern Europe. In the worst affected countries, which are in sub-Saharan Africa, economies will collapse, security will disintegrate and orphaned children will be abandoned as their families and communities are overwhelmed by the worst pandemic and health emergency in human history.
In those places and countries, decades of development progress will be simply wiped out, and far from achieving the millennium development goals, some of them will move further away from them by 2015.
The Secretary of State in an excellent introduction to the debate made the point about the fall in life expectancy in so many African countries. In 1960, the average length of life in Botswana was 47 years. By the mid-1980s, it had risen almost to a European level—62 years. Now, the average life expectancy in Botswana is 37 years. In 1960, in Zimbabwe, life expectancy was 50 years. By 1980, it had risen to 59 years, and it has now fallen to 43 years.
When we look at the scale of the crisis in Africa, we are bound to ask whether it could have been avoided. The answer to that question is, to a great extent, yes, if the political leadership and resources to fight the disease had been there earlier. Again, as the Secretary of State said, there are examples—Uganda and Senegal—where action was taken early and hundreds of thousands of lives have been saved as a result. This is a real lesson for India, China and countries in eastern Europe and central Asia that needs to be learned and acted on. Brazil has learned and acted on it, as has Thailand.
I congratulate the Government on their "Taking Action" strategy, particularly my hon. Friend the Minister, who has led a remarkable invigoration and change of Government policy. It is really a step change in the UK's response, and it will make a difference to the lives of people in many developing countries around the world. The new strategy puts the UK in a leadership position among donor countries, and other countries need to follow suit. If they do so, an even bigger difference will be made to the lives of more people in developing countries. I am utterly delighted that the Prime Minister has decided to give this issue priority during the UK presidencies of the G8 and the European Union next year. That provides the best opportunity to replicate the sort of step change that we have seen in this country's policy in other donor countries.
On funding, there is still a need for substantially more money to fight this pandemic. Last year, UNAIDS said in its annual report that donors spent £2.6 billion on HIV and AIDS assistance around the world. It estimates that £6.6 billion will be needed next year and £11 billion by 2007. The UK is rising to the challenge. When the Government came to office in 1997, the UK was spending £40 million of donor assistance on combating HIV/AIDS. Last year, that had risen to £250 million, and the UK's £250 million compares with the United States' £303 million in aid.
The contributions of other donors around the world are much smaller, however. The third biggest donor is Germany, which contributes about £60 million in aid a year. If the amount of aid given to combat this great health emergency is compared as a proportion of each country's gross national income, Ireland comes top of the list, contributing £430 for every £1 million of its income. That is interesting because it is a Catholic country. Catholic parts of the world have been criticised sometimes for not giving this emergency sufficient priority.
Second in the list comes the United Kingdom, which spends £300 per £1 million of gross national income, and Norway spends almost exactly the same amount. The Netherlands spends half as much as we do—£150 per £1 million of gross national income. Germany and the United States spend about £60, or one fifth of what we spend as a proportion of our national wealth. Italy, France and Japan spend just £20 per £1 million of their gross national income.
I would like to say a word or two about how the money is used. One of the things that it is used for is to buy condoms. Development assistance from all countries buys globally about 1 billion condoms a year, but half of them come from one donor country—from this country—and 1 billion is far too few. Yesterday, my all-party Africa group and the all-party AIDS group, led by my hon. Friend Mr. Gerrard, met a distinguished South African AIDS activist and campaigner, Zackie Achmat. He told us that, across Africa, three condoms are provided per sexually active man per year, so it is perfectly clear why the disease is still spreading. In South Africa, the richest country in Africa, the figure is just 10 condoms per sexually active man per year, and there is only one female condom for every six women in South Africa. It is hardly surprising that the sero-prevalence rate among girls is three or four times higher than it is among boys.
I turn now to the all-party Africa group's report and the Government's response to it. I am embarrassed by the kind things that Members on both sides have said about my role, which should not be said because the work was very much a collective effort by Members of both Houses and all parties. I want to say a particular word of thanks to my hon. Friend the Member for Walthamstow. Ours is a fairly newly established group and, at the beginning of our project on HIV/AIDS, we took advice from him and colleagues in his all-party group. That advice was invaluable, and they continued to give us help and advice throughout the production of the report.
As chair of the all-party group, I should perhaps declare an interest. To produce the report, we received funding from five sources and we are grateful to all of them—the Royal African Society, the Henry J. Kaiser Family Foundation, Merck and Co. Incorporated, CAFOD and ActionAid.
I thank the Secretary of State for the detailed and comprehensive written response that he made to the report. We shall make that available, alongside the report itself, on our website and the Royal African Society's website. He was kind to congratulate the committee on the work that it has done, but it is relatively easy to develop policy. It is much harder to commit oneself to policy as a Government. It is heart warming and reassuring to see that so many of the all-party group's recommendations have been fully endorsed by the Government, who have the responsibility to fund the recommendations and carry them out.
I particularly welcome the statement that the Secretary of State made in his response that prevention must remain the mainstay of action. Of course, it is necessary to put large sums of money into medication for those who are HIV positive, but that must not divert resources from prevention, otherwise this epidemic will continue to grow.
I was also especially pleased to find out that the Department for International Development will support Governments to incorporate nutrition and food security into their AIDS strategies. That is essential because a good diet is the first line of defence against this disease. I welcome our Government's commitment to work on nutrition with the World Food Programme and UNICEF on their planning on HIV/AIDS.
I could spend a long time telling the Government how much I welcome and support their response, but there are four aspects of policy on which I would like them to push forward a little further. When the group took evidence, we were told that some €10 billion were unspent in present and former European development funds, so we suggested that the money should be reallocated to programmes to combat HIV/AIDS. I am especially grateful to the director general of the EuropeAid Co-operation Office, Koos Richelle, who responded in detail to us and clarified the situation, as did the Secretary of State in his formal response to our report. We overstated our case, so I am happy to backtrack on that point. However, €1.4 billion of the €11 billion remaining in EDFs six, seven and eight is committed to projects that are currently dormant, and I was glad that the Secretary of State said that that money needs to be recommitted to new projects. When the Under-Secretary winds up the debate, will he give us an indication of the proportion of the €1.4 billion that might be reallocated to work on HIV/AIDS? If, as I suspect, he cannot answer that today, will he undertake to discuss the matter further with the new European Commissioner?
The group heard evidence from Dr. Peter Piot, the executive director of UNAIDS, that Uganda's Finance Minister had told him that he was unable to use all the aid offered to the country to deal with HIV/AIDS because doing so would breach the International Monetary Fund's public expenditure ceilings. We raised the matter with the IMF and Peter Heller, the deputy director of its fiscal affairs department, came to Westminster to meet us. He subsequently convened a meeting in Washington DC on
Mr. Heller made the important point that it would be less difficult for the Governments of poor countries to accept aid if it were provided as grants rather than loans because it would put less pressure on their public finances. He also said that aid must be predictable because macro-economic problems are created if aid flows stop and start—my right hon. Friend the Secretary of State referred to such problems in his response. Erratic aid flows also create clinical problems. If people are prescribed anti-retroviral drugs for a year or two, but then the money dries up and they no longer receive them, one consequence, in additional to the dire human consequences for the people concerned, is that viral-resistant strains of HIV will emerge. Those strains will no longer be controllable by drugs and will spread to Europe and other parts of the world.
So there are good clinical and economic reasons for aid flows to be planned years in advance and to be consistent. That underlines the importance of us getting commitments from other donors to do what we have done and to increase dramatically the funding for this particular aid purpose.
I was especially pleased to see the commitment in the Secretary of State's response to work
"with partners including the Bretton Woods institutions to ensure that HIV/AIDS funding is treated as exceptional investment and not delayed or reduced because of expenditure frameworks."
There could not be a clearer commitment to the need for the Bretton Woods institutions to redefine their policies.
In previous debates on the topic, I have stressed my view that clear guidelines about who will be supplied with anti-retroviral drugs need to be used in developing countries. I have suggested that it might make sense for donors to create a toolkit that developing countries could use to help to work out where the health priorities lie. Clinical priorities are fairly clear about the stage of the disease when it is most appropriate to prescribe drugs, but there are other more difficult issues of social criteria, such as keeping the parents of small children alive so that they do not become orphans, and of economic criteria, such as keeping health services and schools functioning.
I recognise that it is a difficult policy area, especially for people in Europe because it would be extremely difficult if we were seen to be setting policies here about who should live and who should die in Africa. For reasons that I understand, Ministers have been unwilling to go as far as I should like. In the summer, I went on holiday to Kenya and spent a little time with DFID health advisers looking at the work that our aid programme is doing on HIV/AIDs in and around Kisumu. I saw that clear guidelines are being developed to ensure that priority is given to those who need it most. I was particularly glad to see in the Government's response to the all-party Africa group's report the statement:
"We fully support the work of UNAIDS, WHO and other UNAIDS co-sponsors in developing normative guidance and toolkits for developing effective multi-sectoral HIV and AIDS responses."
They have grasped a difficult issue and I am pleased to see a clear statement of policy as a result.
I welcome the Government's recognition of the need for African Governments to assess current and future impacts of the epidemic on key sectors of the economy, such as health care and education. The Government's response gives examples of where they have supported assessments of the impact of the disease—that is to say, the impact of a number of people dying—on education in Rwanda, Zimbabwe and Botswana. However, a similar assessment needs to be done in every country where prevalence is high—perhaps where it is higher than 5 or 10 per cent. It also needs to be done in all sectors of the economy. Health care and education are probably the two most important, but public sector management, banking and the legal profession could also be considered. The impact on agriculture should certainly be assessed.
When I was in Malawi during the famine two years ago, I sat around a table with 14 senior officials from its Department of Agriculture. We talked about what would happen if, in a few years' time, they faced another famine. I was interested in how they would cope with it and whether they would learn any lessons, but it was not clear how the lessons would be learned. Afterwards, someone explained that a majority of those 14 officials were HIV-positive and would not be there if there were a famine in five years' time. It is impossible to replace that kind of expertise in two, three or five years. We need to deal with the impact of the disease on key sectors of the economy and to plan now the training of sufficient numbers of people to deal with future needs.
As a first step, every country affected by the crisis needs not only an assessment of the impact, but the development of a training strategy to enable the human resource gaps that exist now and that will grow in the coming years to be filled. One of the difficulties of training people is that the trainers are dying as fast as those they train. The Secretary of State told us that Malawi is losing teachers more quickly than it can train them, but it is also quickly losing those who train teachers.
The all-party group asked the Government to examine whether the UK's experience of distance learning—through the Open university, for example—and the BBC World Service's considerable experience of distribution of distance learning packages through broadcasting in developing countries could be applied to Africa. In their response the Government say that
"Such programmes would need to be implemented through African educational institutions."
The Government are right—only in-country institutions will know what shape the training should take, how best to distribute it, and how to integrate broadcasting and other distance learning methods, such as internet training packages, with other parts of their training framework. I agree strongly with the Government in that respect. Some important work has already been done: an open university has been established in Tanzania, and our Open university collaborates with the university of South Africa, their distance learning university. I hope that the Government will continue to work on that idea.
My final quote should be from an African—Zackie Achmat, whom some of us met yesterday and who is a South African AIDS activist and campaigner. We in the UK are not accustomed to NGOs congratulating the Government, but Zackie Achmat said:
"Blair has done a superb job on increasing the budget for HIV".
Before Ministers smile too widely, I should say that I am sure that NGOs abroad are just as fickle as NGOs here, and our Government will have to continue innovating in policy terms and strengthening our commitment in this field if they are to retain NGOs' support.
The G8 and EU presidencies next year will provide enormously important opportunities to get a greater level of commitment from other donor countries. I wish the Government every success in using the presidencies to build a bigger international base of support for the work that they are leading. I shall urge Members of Parliament whom I know in other G8 and EU countries to press their Governments to deliver when they attend summits chaired by our Prime Minister, and I hope that colleagues here will do the same. If we all pull in the same direction, we might achieve not only in this country, but throughout donor countries and the rich world as a whole, the change of policy that is needed because of the nature of the crisis.