Amendment 174

Health and Care Bill - Report (4th Day) (Continued) – in the House of Lords at 10:08 pm on 16 March 2022.

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Baroness Chakrabarti:

Moved by Baroness Chakrabarti

174: After Clause 164, insert the following new Clause—“Global health emergency international cooperationIn the event of the World Health Organisation declaring a public health emergency of international concern (“PHEIC”), the Secretary of State must within three months—(a) initiate or otherwise support and implement proposals temporarily to waive elements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS”) at the World Trade Organisation to assist wider global manufacturing of and access to health technologies;(b) waive such UK-registered patents, industrial designs, other intellectual property rights, and protections concerning undisclosed information relating to—(i) vaccines,(ii) medicines,(iii) diagnostics and their associated technologies, and(iv) materials,as necessary for combatting the emergency internationally; and(c) issue relevant emergency compulsory directions to enable the domestic manufacturing of generic and biosimilar products.”Member’s explanatory statementIn the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.

Photo of Baroness Chakrabarti Baroness Chakrabarti Labour

My Lords, the aim of Amendment 174 is to learn from mistakes made during this pandemic and ensure that, in the event of a public health emergency of international concern, our Government share and support others to share critical knowledge, data, research and intellectual property relating to vaccines, tests, treatments and their associated materials. By sharing this information and intellectual property we can scale up and, crucially, diversify the manufacturing of pandemic tools to ensure equitable access around the world, expediting our ability to end the emergency for all by winning the race against new variants.

Less than 10% of people in low-income countries have been double vaccinated. Lower-income countries are not prioritised. The status quo pharmaceutical model of supplying to the highest bidder means that low-income countries have to rely on the good will of high-income countries and companies to provide donations. Evidently, this has not proven effective in achieving global equitable access. Many low and middle-income countries therefore want to manufacture their own vaccines, tests and treatments so that they can have greater oversight of supply volumes, timelines for dispensing products and prices now and for the future. However, pharmaceutical companies have widely refused to share their technology openly. In addition, the United Kingdom, the EU and Switzerland have continuously blocked South Africa and India in their proposal to temporarily waive certain provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement—the TRIPS agreement—on all Covid-19 tools, vaccines, tests and treatments.

Amendment 174 seeks to remedy this. It calls for the Secretary of State to support or initiate a temporary global waiver of the TRIPS agreement within three months of a pandemic being declared at the WHO. This three- month period is there to give pharmaceutical companies the opportunity and the push to make plans for how they will voluntarily openly license their products and engage in transferring their know-how to companies with established manufacturing capacity. This time period is in step with the recommendations of the Independent Panel for Pandemic Preparedness and Response.

The pharmaceutical industry is an immensely powerful machine, and we need to work with it. But as history has taught us, through the HIV crisis, pricing for cancer treatments, and now with Covid-19, it does not always do the right thing. As we speak the WHO’s mRNA hub in South Africa based at a biotech company called Afrigen has managed to reverse engineer Moderna’s vaccine. As Moderna made a pledge not to enforce patents during the pandemic, Afrigen are doing well in its development. The project has been significantly slowed down by Moderna and BioNTech’s refusal to share their knowledge with the hub. This is just one example. There are over 100 potential mRNA producers across Africa, Asia and Latin America who could be producing vaccines now, if only they had access to the know-how and data, and were not restricted by the fear of patent infringement.

Amendment 174 is about encouraging the industry to do the right thing and the Government to take action to protect global health and live up to the slogan “global Britain”. It is not just political rhetoric but epidemiological fact that none of us are safe until we are all safe. If viruses are left unchecked, they will mutate and this pandemic is far from over; cases have risen hugely in South Korea, China and here in the UK of late. Talk of Covid-19 becoming endemic does not that mean it has disappeared. Malaria is endemic in many parts of the world, but it continues to kill hundreds of thousands of people every year.

This amendment will also initiate a great deal of cost saving for the NHS during pandemics. We are paying the highest recorded price for the Pfizer vaccine at £22 per shot. This amendment reaffirms our commitment to using in these emergency situations compulsory licences, one of the public safeguards in the TRIPS agreement to enable the domestic manufacturing of generic and biosimilar products, which would mean that any company within the UK with manufacturing potential could be making these vital medical tools.

Just today we heard that a draft copy of the waiver has been leaked, although it has been significantly watered down and reduced in scope. None the less it shows there is a global consensus that intellectual property monopolies are a barrier to accessing Covid-19 vaccines, tests and treatments. We need the Government to use this moment finally to do the right thing and support a waiver on all intellectual property covering vaccines, tests and treatments that can be utilised by all countries in the negotiations to come.

I also urge Her Majesty’s Government to use their influence as a faithful customer of Pfizer and Moderna to push them to share their technology with the WHO’s mRNA hubs and revoke the patents they filed on Covid-19 technologies. This amendment is about improving access to affordable life-saving health technologies for our NHS and worldwide during public emergencies. We can bolster pandemic preparedness and expedite our response to Covid-19 and future pandemics. I beg to move.

Photo of Lord Lexden Lord Lexden Deputy Chairman of Committees, Deputy Speaker (Lords)

I invite the noble Baroness, Lady Brinton, who is taking part remotely, to speak now.

Photo of Baroness Brinton Baroness Brinton Liberal Democrat Lords Spokesperson (Health) 10:15, 16 March 2022

My Lords, I have signed Amendment 174 in the name of the noble Baroness, Lady Chakrabarti. I thank her for introducing it and for making it clear that this aims for global pandemic preparedness. The World Health Organization set a target to vaccinate 40% of the world by the end of 2021. However, 92 countries missed this target due to a lack of access. Despite the funding from high-income countries to the WHO-run COVAX and Gavi schemes, low-income countries have remained at the back of the queue as high-income countries have been able to jump in ahead, using their money to get second and third doses for their own population.

Frankly, we need a better system for future pandemics. We need to understand that openly licensing newly developed Covid-19 technologies, waiving intellectual property rights and sharing the manufacturing know-how would allow more companies to begin producing life-saving vaccines, drugs and tests across the world. However, pharma companies have widely refused to share their technology openly. We also need to source other key critical control products, such as testing equipment, PPE and masks. Relying on too few suppliers in too few countries caused immense problems for the first six months of the pandemic, and again as subsequent waves hit those countries. In addition, the UK, the EU and Switzerland continue to block South Africa’s and India’s proposal to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS—on Covid-19 tools.

Despite regular pandemic exercises in this country, and despite previous experience with vaccines for other diseases not being shared with low-income countries, we have not learned the lessons. This amendment sets out what a Secretary of State should do within three months of the WHO declaring a public health emergency. I really hope that Ministers are prepared to help make progress on this issue. If not, and if the noble Baroness, Lady Chakrabarti, calls for a Division, we will support her from these Benches.

Photo of Lord Lexden Lord Lexden Deputy Chairman of Committees, Deputy Speaker (Lords)

I now invite the noble Lord, Lord Campbell-Savours, who is taking part remotely, to speak.

Photo of Lord Campbell-Savours Lord Campbell-Savours Labour

My Lords, this is an important amendment. To me, it is the most important in the Bill. It concerns preservation of life in conditions of general pandemics. If you leave worldwide vaccine manufacturing programmes to the free market, you will never fully deliver. Profit will always trump the public good, unless the state intervenes in some regulatory form or another. This is basically why I am a Labour person.

With that in mind, it is clear that the more we are told that the current arrangements for licensing and manufacturing are necessary for reasons of quality control, the more I am convinced that this is not the only consideration in mind. There are other considerations —primarily the need to maximise profit. There is nothing wrong with profit if the justification is reasonable. It drives initiative and entrepreneurship. However, when there are wider issues involved, as in the case of a global pandemic which threatens the well-being of nations and the international economy, there must be a consideration of the wider public good and benefit. I am not convinced that, apart from the case of the AstraZeneca project, public benefit has been the driver.

In Committee, I set out in some detail a case wider than this amendment for worldwide licensing arrangements based on the original amendment of my noble friend Lady Chakrabarti. I remain confused by the Government’s position, which seems ever reliant on research and limited production at home, with volume production overseas. I would have thought that there are lessons to be learned about supply volatility from the case of oil from Russia. Equally, with both China and India leading the world in vaccine supply—at the same time as both countries remain reluctant to support us over certain areas of dispute and crisis in foreign policy—alarm bells should be ringing. I remain of the view that we in the United Kingdom should lead the world in this area of research, development, manufacturing, licensing and supply.

We are moving into an era of further pandemics as research-spawned accidental releases inevitably will reoccur, or perhaps they will not even be accidental in origin. There are huge foreign policy benefits to be gained arising out of being the world’s primary producer and licensee of these vaccines. When you help people, they remain indebted. That is the approach China is taking in many areas of its foreign policy.

I will give an example. The French Government funded my higher education in France 60 years ago. To this day, I remain indebted to France, with a lifetime feeling of obligation. This is often the case for foreign students. I believe that if we had been suppliers and licensees to the world over the recent period, in particular Africa and the third world, the payback would have been immeasurable, with huge implications for foreign policy.

I will exaggerate to make my case: suppose we had been supplier and licensee to China. Can noble Lords imagine what influence such beneficence would have had on Chinese public opinion and, perhaps ultimately, on Chinese foreign policy? A friend in need is a friend indeed—we should never forget that.

I appeal to the Government, even at this late stage in the current pandemic, to think long term, and create the vaccine supply, manufacturing and licensing programme that my noble friend Lady Chakrabarti is advocating. Her amendment seeks at least a temporary, time-agreed waiver. It is a start. I am using her amendment to argue a wider case, a new vision. Her excellent amendment puts in place a building block on which a longer-term strategy should be constructed. We should lead by helping others to help themselves. The rewards are inestimable.

Photo of Lord Russell of Liverpool Lord Russell of Liverpool Deputy Chairman of Committees

My Lords, I was happy to add my name to this amendment to give it a bit of cross-House balance. Like the noble Baroness, Lady Brinton, I am an officer of the all-party parliamentary group on coronavirus. In the last two years, we have had a bellyful of coronavirus; we have heard ad nauseum about the problems and the tragedies that it has created and encompassed, and that is partly what leads to this amendment.

It is self-evident that the United Kingdom, and most of the rest of the world, was unprepared. Countries that had experienced SARS, particularly in south-east Asia, had a better idea of what they were getting into. Frankly, however, for most of us in the West, it was the blind leading the blind. Looking in the mirror today—and accepting our failings, and the unease that we in the developed world should surely feel for largely having prioritised looking after our own—is for me, certainly, distinctly uncomfortable.

The aim of Amendment 174 is very simple: equitable access to affordable health technologies for all. One of the biggest challenges is how to deal with the exclusive intellectual property rights that exist in the healthcare sector. Only 7% of people in low-income countries have been double vaccinated. Only an additional 14% have had one dose.

Noble Lords should remember where the variants have come from. The exception, of course, is alpha, for which global Britain is responsible, so that is something that we can be proud of. Beta came from South Africa, gamma from Brazil, delta from India, and omicron is truly global because it started in about 10 countries simultaneously. The two countries that went it alone, rather proudly, in developing their own vaccines—China and Russia—have produced manifestly inferior vaccines, which have not been subject to proper, clinical peer scrutiny.

I give two examples of the problem we face. First, Pfizer’s new antiviral treatment excludes most Latin American countries, and generic versions—unless Pfizer does something about relaxing its intellectual property—may not be available in those countries until after 2041. Secondly, Tocilizumab, an antiviral manufactured by Roche, which is based on UK government-funded research, is unable to be manufactured in countries with established production capacity because Roche is enforcing its patents in these countries. There is a global shortage of this particular treatment.

Tackling the complex world of healthcare intellectual property is not easy. In my past career as a headhunter, I worked with clients that were large, complex, well-funded, international pharmaceutical companies, so I know full well the level of intellect and resource that they put into their intellectual property defences. We must apply ourselves in a disciplined and determined way at an international level; this is a chance for Great Britain to prove that it is indeed global. As an aside, during Oral Questions this morning, some of us on the Cross Benches were playing a game where, every time somebody from the Government Front Bench mentioned global Britain, another notional £10 clinked into the pockets of the Cross-Bench Christmas drinks fund; this afternoon, we had a particularly fruitful Oral Questions. As a mantra, it is meaningless unless it has real content behind it.

We need to develop a rapid response plan for the next pandemic. We will demonstrate that we have intellectual and moral myopia if we fail to do it. In a nod to Amendment 170, which we debated earlier, we should not show that we are content to let the less-developed world suffer from what I would describe as unassisted dying. That is unacceptable.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

My Lords, I rise briefly to offer Green support for this amendment, which I would have signed had there been space.

The noble Baroness, Lady Chakrabarti, referred to today’s report that a watered-down version of the India-South Africa proposal for a TRIPS waiver looks likely to go through the WTO. I quote Max Lawson, co-chair of the People’s Vaccine Alliance:

“After almost 18 months of stalling and millions of deaths, the EU has climbed down and finally admitted that intellectual property rules and pharmaceutical monopolies are a barrier to vaccinating the world.”

Bouncing off the comments of the noble Lord, Lord Russell, I think that the Cross Benches might find an even larger drinks fund if they go for “world-leading” as the key phrase to identify. The comment from Mr Lawson shows that, collectively, the world has done very badly throughout the Covid pandemic and done very poorly by the global south. If the Government want to be world-leading, they could leap in right now and accept the noble Baroness’s amendment.

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health)

My Lords, I congratulate my noble friend Lady Chakrabarti, the noble Baronesses, Lady Lawrence and Lady Brinton, and the noble Lord, Lord Russell, on supporting and promoting this amendment. Its explanatory statement says:

“In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.”

I cannot see why anybody would object to that.

I would like to say one more thing. The former Prime Minister, Gordon Brown, has led this country on how one should respond to a global pandemic with his work at the World Health Organization on the importance of sharing knowledge, vaccines and technology across the world. This amendment is about the pandemic that is coming down the track as well as the one we are dealing with at the moment, so we on these Benches certainly support it.

Photo of Lord Browne of Ladyton Lord Browne of Ladyton Labour

My Lords, I support this amendment. I do not intend to repeat the excellent points that have been made by others because the case in equity—and the case in our own interests—is absolutely compelling in my noble friend’s excellent amendment. However, for a short period of time, I do intend to test just how good the Government’s resistance to this is; I will do so by referring to the Minister’s own speech in Committee on this very amendment. I will ask two questions of the Minister; I hope that he will be able to answer them because, if he cannot, there is no resistance to this amendment.

On 9 February, on the ninth day in Committee, the noble Lord the Minister repeated the Government’s oft-repeated view on this issue when it has been debated in your Lordships’ House that

“the Government remain open to all initiatives that would have a demonstrably positive impact on vaccine production and distribution. However, we believe that waiving intellectual property rights would have the opposite effect. Doing so would dismantle the very framework that helped to develop and produce Covid-19 vaccines at the pace and scale now seen. It would risk undermining the continued innovation in vaccines and technological health products that is required to tackle a virus, especially as it mutates and evolves, so we believe that doing so would be a mistake.”

Our domestic experience of this is the AstraZeneca vaccine, which was produced with 97% of the funds coming from government or philanthropy and only 3% from investment. Can the Minister therefore say what is the data, other than assertion from pharmaceutical companies, that supports this conclusion that the Government have come to? There must be data to indicate that vaccine waivers have had this detrimental effect; otherwise, the Government are not entitled to come to this conclusion. Try as I might, I have never heard a Minister, when resisting this equitable approach to vaccines, ever explain the data to your Lordships’ House.

I turn to my second question. Later in that same speech, in his fourth paragraph, the Minister said that

“Research contracts afford greater flexibility and more powerful levers than the amendment”,

and went on to say that they can produce

“requirements around access to medicines in the developing world.”—[Official Report, 9/2/22; col. 1704.]

Can the Minister tell the House of any contract that the Government have agreed that has had that result? Has this alternative, which the Government pray in aid, been deployed by them to such an effect that it has significantly bitten into the unbelievably unjustifiable inequity in the share of vaccines around the world?

Photo of Lord Sentamu Lord Sentamu Crossbench 10:30, 16 March 2022

My Lords, I was not going to speak, but I am driven to respond to what I have just heard. I first declare an interest as chair of Christian Aid, which works in some 29 countries, most of which have experienced what I call vaccine inequality. We constantly get letters urging us to try to help.

As far as the British Government are concerned, in relation to some of those countries, the money and the way that they have tried to help—which must be acknowledged—certainly with AstraZeneca, there has been a far greater equity coming out. When we had the Kent variant, the Government were very quick to share that information with everybody else. What I think the amendment is asking is that, when the World Health Organization declares a health emergency, if we have information we should make it available immediately.

Secondly, on the question of equity, we have just had a big Commonwealth service in Westminster Abbey and there are particular people—noble Lords may not believe it—who come from those 54 countries of the Commonwealth who still look to the United Kingdom as giving them not only language but the ability to understand the sheer pressure of inequality. I would have thought that this particular amendment would help us to answer some of our supporters out there in the global south by saying that we are very serious, given some of the help that has been provided—though it has not gone far enough; the antivirals and all those drugs have not been given equitably. I therefore ask the Minister to realise that the issue is not whether we have or have not done enough; it is that, if there is a global health emergency—locally and internationally—the Secretary of State is in a better position sometimes to speak and to help those who are struggling and finding it difficult.

Nkrumah said that Ghana would not be free until the rest of Africa was independent, and I believe the same is true now. I have had my double vaccine and my booster, but I am not fully vaccinated until the rest of the world is vaccinated.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank all noble Lords who have taken part in this debate for the passion they have shown. I think we are all concerned by vaccine inequity—as noble Lords have rightly said, we are getting our third or fourth vaccines while some people have not had their first yet—but we also have to be clear how we get to this stage. It is easy to say, “We spent this much money on public research and that led to the vaccines”, but it is not as simple as that. It may have led to the research but that does not lead to the production of millions of vaccines that can be distributed worldwide. There is a clear difference between pure research and turning that into actual vaccines and, once they are produced, getting them into people’s arms. You can certainly deliver them to countries but they do not always reach the arms. We have heard stories of vaccines being thrown away because of a lack of distribution in particular countries.

The sharing of knowledge has played and will continue to play an important role in the rapid scale-up of Covid vaccine production. The UK Government are very committed to addressing vaccine equity on every front. As the son of people who came from outside the EU—not white, privileged Europe—I believe very strongly in global Britain.

The experience of the pandemic has shown that it is voluntary collaboration that has made real, positive impacts on vaccine delivery. The scale-up of vaccine production at record pace has been driven by more than 300 voluntary partnerships. This unprecedented collaboration around the world has meant that global Covid vaccine production now stands at nearly 1.5 billion doses per month. Voluntary partnerships such as AstraZeneca and the Serum Institute of India, and Pfizer-BioNTech and Biovac in South Africa, show what is possible if you work together.

The intellectual property framework has been crucial in facilitating this knowledge sharing. Indeed, the legal certainty it produces cannot be overstated. It gives innovators the confidence to form partnerships and continue investing in the innovative health products and technologies that have contributed so positively to our global pandemic response. The intellectual property framework similarly supports the production and dissemination of vaccines and other products across the world.

Yes, 97% of the investment in research is public funding, but research is not vaccines. There needs to be a whole chain from that pure research to scaling up and distribution, and universities cannot do that. Waiving intellectual property rights would dismantle the very framework that has facilitated this collaboration. It would undermine not only the knowledge sharing that has helped to develop and produce Covid-19 vaccines at the pace and scale now seen but the framework needed to support the development of new vaccines and treatments, should these be needed in future.

It should also be noted that the least-developed countries are exempt from implementing the Trade-Related Aspects of Intellectual Property Rights—or TRIPS—Agreement, meaning that they already have a de facto TRIPS waiver. In addition, the TRIPS Agreement already provides flexibilities to enable countries to achieve their public health objectives, and we fully support the right of these countries to use these where needed—but you have to build the capacity. Low and middle-income countries can access medicines in times of emergency through flexibilities that allow them to manufacture or import without the consent of the patent holder.

For these reasons, the UK does not consider intellectual property rights a barrier to supplying and improving access to Covid-19 goods. The noble Lord, Lord Russell, can put another £10 in the Christmas bag. Instead, we shall continue to be a visible champion of those elements of the intellectual property framework that support effective knowledge sharing.

The noble Baroness will be aware that we have contributed vaccines through the COVAX scheme—a partnership of the Coalition for Epidemic Preparedness Innovations, Gavi, the Vaccine Alliance, UNICEF and the World Health Organization—but we know that is not enough. As noble Lords have rightly said, we have to learn from what we have done during this pandemic. One part of my ministerial portfolio that I am very proud of is international relations and health diplomacy. A constant theme in my G20 and G7 Health Ministers’ meetings is how we tackle these vaccine inequities and learn the lessons that many noble Lords have rightly raised.

Last week, the British Government hosted the Global Pandemic Preparedness Summit to learn those lessons: to make sure that we brought together all our experiences as countries, learned from those and asked what we could do next time. I was very privileged to host a working lunch with several overseas Health Ministers, as well as Dr Richard Hatchett, CEO of CEPI; Dr Seth Berkley, the Gavi CEO; and Dr Tedros, the director-general of the World Health Organization, sitting next to me. One of the issues that came up in our discussions was, rather than developing and less-developed countries relying on donations via COVAX, how we ensure that, first, there is more local and regional manufacturing of vaccines through public-private partnerships and, secondly, that vaccines get into people’s arms as quickly as possible once they are manufactured or are imported into a country. We need to avoid those situations where vaccines were wasted because they were not stored or transported properly, or where there was difficulty distributing them once inside a country.

With international partners, we are looking at a whole range of issues and new technologies, such as new distribution methods. Some noble Lords may well have read about drones being used to deliver vaccines to certain remote areas. Before using these drones, it is all very well having all these vaccines in the capital, but how do you get them into people’s arms? We have to look at that area. Intellectual property rights are irrelevant here. The fact is that the vaccines are there but you have to get them into people’s arms. We have to train more vaccinators and we need better transport.

We agree that the vaccine supply must be matched by the capacity of health systems to deliver them, and we have been working to strengthen health systems around the world. Our recently launched health systems strengthening position paper sets out this Government’s determination to do more to build overall capacity, from policy through to delivery.

But there are other issues. Just as there are the vaccine-hesitant in this country, there are many vaccine-hesitant people in other countries. Our African vaccine confidence campaign is working with experts in countries such as Botswana, Ghana and Uganda to reinforce communities’ trust and build demand from the ground up. Once again, you can get the vaccines there but you have to get them into people’s arms. We have also been working to minimise constraints on supply chains, such as tariffs. This has been demonstrated by our sponsorship and promotion of the trade and health initiative as well as the unilateral measures we have taken, including tariff suspensions.

We have also provided support for the development of regional manufacturing capabilities. This includes technical support to develop business cases for the manufacture of vaccines in South Africa, Senegal and Morocco. We are working with the COVAX supply chain and manufacturing task force to champion other practical efforts to scale up capacity. We believe that we are doing lots of things with our global partners—with Gavi, CEPI and the World Health Organization.

To be honest, I am incredibly inspired by some of the work that I see going on. This is about building real capacity. It is about transferring knowledge and technology and making sure that we have that capacity. It is about making sure that we live up to global Britain, in which I firmly believe given my own family history—not from white Europe, but from a global perspective. I believe very strongly in that. I believe that waiving intellectual property rights will not help overcome these challenges. I may be passionate about this but I feel very strongly about it. I feel strongly about global Britain. I feel very strongly about my distant relatives who come from developed countries and about my own history, my own heritage. I feel much more strongly about this than noble Lords may well feel.

This is the right approach. I am hugely encouraged by this international co-operation and the potential of new technologies to help. I would be very happy to continue to engage with the noble Baroness. I think we probably share the same passion for making sure that this happens. Given that, I hope she will consider withdrawing her amendment.

Photo of Baroness Chakrabarti Baroness Chakrabarti Labour

I am grateful to all noble Lords who spoke at this late hour, including the Minister. With respect, however, the numbers just do not stack up. I am so glad that the Government have now donated over 30 million shots, but these have almost all been AstraZeneca, which has lower efficacy against the now-dominant omicron variant. Moderna belatedly allocated a mere 110 million shots for a continent—Africa—with an estimated population of 1.3 billion people. Pfizer has allocated only 2% of its global supply to COVAX. We are just not getting enough shots to enough people, and so the variants develop.

I am grateful to everyone and I would happily keep speaking to the Minister, who is always courteous in his responses, but I really do think that it is time to test the opinion of the House.

Ayes 82, Noes 115.

Division number 5 Health and Care Bill - Report (4th Day) (Continued) — Amendment 174

Aye: 82 Members of the House of Lords

No: 115 Members of the House of Lords

Aye: A-Z by last name

No: A-Z by last name

Amendment 174 disagreed.

Amendment 175 withdrawn.