Vaccinations: Developing Countries — [Mr Nigel Evans in the Chair]

Part of the debate – in Westminster Hall at 3:31 pm on 13th June 2018.

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Photo of Alistair Burt Alistair Burt Minister of State (Department for International Development) (Jointly with the Foreign and Commonwealth Office), Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development) 3:31 pm, 13th June 2018

It is a pleasure to serve under your chairmanship, Mr Evans, and I thank all colleagues for taking part in today’s debate and for the way it has been handled.

I thank my right hon. Friend Stephen Crabb for the way he introduced this debate—indeed, others have mentioned the passion with which he spoke. Such passion is appropriate for the leader of Project Umubano, and for a number of years he has played an integral part in the Conservative party’s social action programme in Rwanda and Sierra Leone. He spoke about the non-partisan nature of this debate, and that was emphasised by contributions from the hon. Members for Dundee West (Chris Law) and for Birmingham, Edgbaston (Preet Kaur Gill). There is no issue between colleagues in the House on this subject, and we are rightly proud of successive Administrations of all shapes and colours, and the work that has been done in making the United Kingdom a global leader in vaccination.

My right hon. Friend drew attention to the history of vaccination and the United Kingdom’s involvement in it. He mentioned our position in contemporary medicine, research and development, and spoke about looking forward to the next stage. As the title of the debate suggests, he then moved from that historical perspective to the wider economic benefits of vaccination, and emphasised a link that is not made often enough.

Jim Shannon spoke, as he always does, with passion, commitment and great wonder about the success of these programmes. Sometimes there is immense concentration in the press and media of everything that is wrong, but in the world of medicine, lives have been saved by finding opportunities to invest in things that have led to a reduction in diseases that were once all too common, including in our own childhoods, let alone 50 or 100 years ago. Medicine has made a remarkable contribution, and the hon. Gentleman was right to mention that. He encouraged us all to keep going on the eradication of polio, and he can be sure that we will.

My hon. Friend Bill Grant linked access to our success and the importance of research, and he spoke with pride about his involvement with Rotary. I, too, am a Rotarian—I am an honorary member of the Rotary club of Sandy in Bedfordshire. I recently met Judith Diment, who is chair of the polio advocacy taskforce. Rotary has done remarkable work on that issue, and we pay tribute to everything it has done over the years.

My hon. Friend Jeremy Lefroy contributes a remarkable amount to this House through his work on malaria and in east Africa, and he related the importance of vaccine research in those areas. The hon. Members for Dundee West and for Birmingham, Edgbaston had some questions, and if I may, I will return to those at the end of my contribution—on this occasion I actually have some time, so I will be able to answer one or two of the questions, although not all of them.

Let me bring this back to basics and the practice of vaccination. My dad is a doctor, and I am old enough to have needed injections for polio when I was very young, as that was before the wonderful man developed his oral vaccine on a sugar cube. My dad had to give me my polio injections, and I hid under every available table in the surgery because as a small boy I was terrified of needles. He will be tickled pink to know that I am responding to a debate on vaccination today, bearing in mind the struggle he had to get near me with a needle. I am eternally grateful that he did, because those vaccinations protected me—as they did many others—from the ravages of polio. My dad is still with us, so he will be able to get a copy of this debate and realise that all those days from long ago are still remembered fondly by his son. This issue is that personal. My hon. Friend the Member for Strangford referred to the moment of pain caused by a mother when a child gets vaccinated, although she knows that it will do so much good in future, and today we are remarking on the remarkable good that is done.

The number of children dying each year almost halved between 1990 and 2012—a significant achievement. Nevertheless, around 375,000 children still die every year from diseases that could be easily prevented by vaccines. As we all agree, the challenge is most acute in the developing world, where nearly 1 million children die every year from pneumonia. In 2016, 7 million people were affected by measles, resulting in nearly 90,000 deaths. It is therefore right that the UK works through organisations such as GAVI, the Vaccine Alliance, the Global Polio Eradication Initiative and the World Health Organisation to tackle vaccine-preventable diseases.

Clearly there is a strong moral case for the UK and its international partners to support developing countries to tackle the scourge of vaccine-preventable disease—the contributions to the debate have shown that we all understand that. However, the economic case for vaccination—a subject that my right hon. Friend the Member for Preseli Pembrokeshire homed in on—is also unquestionable. Vaccinating against childhood diseases is one of the most cost-effective health interventions. As colleagues have said, for every £1 spent on immunisation, there is a direct saving of £16. Those savings include healthcare costs, lost wages and lost productivity due to illness. Vaccination is a key driver towards reducing childhood mortality globally, and vaccines administered in 41 of the world’s poorest countries between 2016 and 2030 will prevent 36 million deaths.

Vaccination provides economic benefits many times beyond the direct costs of vaccinating children, which is why it is such a high impact investment. As the hon. Member for Dundee West reminded us, if we take into account broader economic and social benefits, the return on investment rises from £16 to £44 for every £1 invested. The wider economic benefits of vaccination are vast.

By preventing illness, whole families are freed from crippling medical costs, which in turn can have a substantial effect on poverty reduction. Unexpected healthcare expenses push about 100 million people into poverty every year, making medical impoverishment one of the main factors that force families below the World Bank’s poverty line. A vaccinated child is more likely to be healthier, live longer and have fewer and less serious illnesses. Healthier and more productive populations trigger a virtuous cycle that results in enormous economic gains. Vaccinated populations therefore form a more productive labour force, resulting in higher household incomes and economic growth.

There is a clear positive relationship between immunisation and education. Vaccines support cognitive development, so children learn more and have more opportunities. In the Philippines, for example, routine immunisation was found to raise average test scores among students. When translated into earning gains for adults, the return on investment was shown to be as high as 21%. In Bangladesh, measles vaccination was found to increase school enrolment of boys by 9%.

There is also an effect on the next generation. Children of educated parents are more likely to be vaccinated and healthier. In Indonesia, for example, child vaccination rates are just 19% when mothers have no education, but increase to 68% when mothers have at least a secondary school education.

Additionally, the decrease in child mortality as a result of routine immunisation can have a significant impact on a country’s economy by reducing fertility rates. Since more children are expected to survive, families have fewer children. A lower birth rate has significant effects on child and maternal health, as well as a broader economic impact, not least in the role that it might play in the development of women’s opportunities in their societies. Up to 50% of Asia’s economic growth from 1965 to 1990 is attributed to reductions in child mortality and fertility rates. Overall, the savings that come from the need to pay for fewer medical interventions, combined with a healthier, more productive labour force and demographic dividends, create more economically stable individuals, communities and countries.

Let me turn to some of the questions asked by hon. Members. First, we are very proud to be the largest investor in GAVI, the Vaccine Alliance. The UK recognises the strong and convincing economic arguments for vaccines as being a clear development best buy. That is why we, through the Department, have supported GAVI since its inception in 2000.

Since then, our investment has supported the immunisation of 640 million children and has contributed to the prevention of nine million deaths from vaccine-preventable diseases. Those are remarkable figures that, as my right hon. Friend the Member for Preseli Pembrokeshire said at the start of the debate, and as we have all said, we do not talk about nearly enough. If someone is looking for a demonstration to put to the people of the positive advantage not just of UK aid, but of any country’s development budget, and of why they are useful, vaccination is possibly the single most obvious example that they can give.

Between 2016 and 2020, the UK’s support to GAVI will directly enable 76 million children to be vaccinated and will save 1.4 million lives. Investment through GAVI represents a particularly high rate of return. The £16 direct return for every £1 invested, which I mentioned earlier, rises to £18 in the 73 developing countries that GAVI supports. Overall, between 2001 and 2020, in GAVI-supported countries, the long-term gains associated with a more productive workforce are expected to add up to £260 billion. Every year, as a result of vaccinations, each of those 73 countries will avoid more than £3.5 million in treatment costs.

Critically, GAVI not only delivers vaccines on an impressively large scale, but works to bring down the cost of vaccines to make them more affordable for the world’s poorest countries. Since 2011, GAVI has enabled a 43% reduction in the total cost of immunising a child, from $33 to $19. That price cut means that UK taxpayers’ money goes much further and delivers a much greater impact, and brings those products within the reach of poorer countries’ Governments, which was a key point made by the hon. Members for Birmingham, Edgbaston and for Dundee West. Our support for GAVI is explicitly designed to ensure that Governments in developing countries gradually increase their contributions until they eventual transition away from aid, which the price cut also helps with.

In response to the point made by the hon. Member for Dundee West about bilateral funding, some time ago the United Kingdom made a decision to put its support for vaccination into GAVI, because it has a wider reach than our bilateral funding programmes. That is why the contribution to GAVI has been so strong: it allows us to reach more children. We continue to offer bilateral support to health systems to make them more sustainable. Of course, GAVI will work in some of the areas where the UK is also working directly through the Department.

On the need to ensure that vaccinations support equity, the financial benefits of vaccines are mostly accrued by poorer households, which are more susceptible to financial shocks from unexpected healthcare expenses. Immunisation programmes reduce the proportion of households facing catastrophic out-of-pocket health expenses. GAVI ensures that the right people are reached through the three equity measures in its monitoring framework, which track vaccination coverage by geography, poverty status and the mother’s education. We work with GAVI to ensure that the vaccinations are reaching the poorest, as my right hon. Friend the Member for Preseli Pembrokeshire said in his opening remarks. GAVI is designed to do so, and we will continue to work with it on that.