It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who is a fellow member of the all-party group on vaccinations for all.
Let me start by giving some context. Vaccinations have been around for a long time, with evidence showing that the first form of vaccination for smallpox occurred in China approximately 500 years ago, but it was not until 1796, when English physician Edward Jenner published evidence showing that his smallpox vaccine was effective, that vaccinations in the west really took off. Since that time, vaccinations have been hugely successful in preventing numerous infectious diseases. In the past 100 years we have seen vaccinations successfully prevent diseases such as diphtheria, tetanus, anthrax, cholera, plague and typhoid, and more recently polio, measles, mumps and rubella.
Many of us will remember receiving vaccinations at school and thinking nothing of it, but the diseases that those vaccinations prevented could have killed us had we been born decades previously. It is safe to say that immunisation has stood the test of time as one of public health’s most cost-effective interventions, saving up to 3 million lives every year. It is estimated that between 2011 and 2020, vaccines will avert an estimated 20 million deaths and 500 million cases of illness.
Since its inception in 2000, Gavi, the Vaccine Alliance, has contributed to the immunisation of more than 690 million children and helped to prevent more than 10 million deaths by virtue of its ability to acquire vaccines in bulk and to enable access to those vaccines by the world’s poorest countries. The United Kingdom is one of Gavi’s global partners, and through it UK funding has helped to immunise 76 million children against vaccine-preventable diseases, saving 1.4 million lives over the past 19 years.
There is no doubt that without sustained access to vaccines, disease outbreaks and pandemics would be inevitable. With the annual global cost of a severe pandemic being roughly $570 billion, or approximately 0.7% of global income, vaccinations are the best financial option available for fighting pandemics. The World Health Organisation has estimated that between 2001 and 2020 the economic benefits of vaccination could reach up to $820 billion.
On top of the distribution of and process of providing vaccines, and as well as the benefit of patients’ physical immunity to various diseases, there is also a long-term benefit in the establishment of strong primary and public healthcare systems in places where vaccinations are a new introduction in the fight against diseases. With my hon. Friend the Member for City of Chester (Christian Matheson) and the hon. Member for Erewash (Maggie Throup), I was recently part of a delegation to Ethiopia organised by RESULTS UK to look into how Ethiopia is tackling the prevention of tuberculosis. I was impressed by the health system there, in particular the excellent health extension workers, who provide immunisation in the more rural parts of Ethiopia, such as Bishoftu. They store vaccinations in solar-panelled refrigerators. The public health message conveyed by these dedicated health extension workers and community health workers was clearly working well, as were the distribution hubs that delivered the medicines to the outposts in the most efficient manner possible. The people of Ethiopia can be very proud of how they have reduced infectious diseases, and I am sure that they will strive to eradicate infectious diseases altogether.
Huge progress has been made in the virtual eradication of certain diseases through immunisation. For example, cases of wild polio have been reduced by 99.9% since 1988, down from 350,000 cases in 125 countries to just 33 cases in just two countries in 2018. Despite that, millions of children still miss out on basic vaccines, and one in 10 children around the world still receive no vaccines at all. According to figures from the advocacy organisation RESULTS UK, only 7% of children in the poorest 73 countries receive all 11 of the WHO-recommended vaccines, and almost 40% of unvaccinated children—approximately 8 million of them—live in fragile humanitarian settings.
The success of the prevention of infectious diseases through vaccinations has meant that the world has become a healthier, more prosperous place to live. As
infant mortality decreases, there is a risk in presuming that immunisation is a done deal, and that political and financial investments could be put to better uses. We must make sure that we are not complacent in assuming that the problem has been solved, as complacency would be incredibly detrimental and risks putting millions of lives at risk. We are already seeing immunisation rates fall across many countries, as they reduce the funding for immunisation once they reach a certain level of reduction of infectious diseases, only to see rates then rise and so have to start again from the beginning.
We have the knowledge, resources and expertise to prevent millions of unnecessary deaths every year, yet in Africa alone more than 30 million children under five suffer from vaccine-preventable diseases every year, and more than half a million of those cases result in death. Disparities in immunisation coverage and equity across and within countries mean that children from the poorest families, from the most remote areas and from marginalised groups continue to be left behind, with only 7% of children in the poorest 73 countries receiving all 11 of the WHO vaccines.
For example, there is still a problem in getting vaccines to children who belong to pastoral, rural communities, because despite some of the best and most ingenious refrigeration techniques, it proves difficult over the last mile to keep the vaccinations at the right temperature so that they do not degrade. It is now essential that global immunisation efforts prioritise reaching those who are left behind and currently receive no vaccines at all. These children must be reached with vaccines and other health interventions to ensure that we meet the sustainable development goals and that the UK meets its “leave no one behind” targets.
A changing world means that a large proportion of under-immunised children are located in middle-income countries or fragile and conflict-affected states. We must ensure that our aid investments are fit for purpose and can reach these children, no matter where they are. The UK should be focused on reaching the poorest children, not the poorest countries. We must also not forget that malnourished children do not respond as well to vaccinations.
To ensure that vaccines are most effective, investment in infrastructure is vital. Strong and functioning health systems are required to deliver vaccines. It is essential that at the same time as investing in immunisation systems, we invest in strengthening health systems. This will enable more vaccines to reach more children and allow for the easier introduction of new vaccines. Gavi must continue and increase its investment in its work to strengthen health systems, which must be tailored to meet countries’ needs, and the UK must ensure that its bilateral work on health systems strengthening complements Gavi’s work. Investing in immunisation delivers on impact beyond immunisation to the whole health system, because reaching every child with free vaccines requires multiple points of contact with a health system, and offers the opportunity to increase access to multiple health services, such as nutrition, making vaccines excellent value for money and central to achieving universal healthcare.
Polio funding has had a far-reaching impact by, for example, supporting 70% of global surveillance systems and funding health workers who deliver other essential
vaccines and health interventions. But polio eradication efforts could be compromised as countries struggle to mainstream polio essential functions into weak health systems. Domestic resource mobilisation and country ownership are key to managing the transition, yet in the 16 polio-priority countries, the average Government expenditure on routine immunisation within immunisation budgets is just 31%.
The UK must continue to prioritise polio transition as an issue in order to ensure not only a polio-free world, but that it is working with countries to help them understand and plan for a transition away from polio funding. I ask the Government to redouble their commitments to vaccinations and to make ambitious commitments to financing Gavi and the GPEI in their upcoming replenishments over the next 18 months and remain a leader in the global immunisation efforts.
I also ask the Government to ensure that the focus of global immunisation efforts is on reaching those left behind who currently receive no vaccines at all. We need to ensure that all investment in immunisations is focused on strengthening immunisation systems so that every child receives the full schedule of recommended vaccines.
Great progress has been made in eradicating infectious diseases, but we must not be complacent and we need to ensure that we keep our eye on the ball and do all we can to help those in the hardest to reach and poorest areas to get the vaccinations that they need.