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International Covid-19 Response: Innovation and Access to Treatment

Volume 683: debated on Thursday 5 November 2020

I beg to move,

That this House has considered the UK Government’s role in ensuring innovation and equitable access to treatment within the international covid-19 response.

I thank the Backbench Business Committee for giving us the time to have this debate. I also thank the hon. Member for Rotherham (Sarah Champion), who is in her place, for co-sponsoring the debate with me. We applied for the debate before the summer, but it arguably could not be more timely, given the encouraging news yesterday from the chief investigator of the University of Oxford covid vaccine trial. Results of the trial are due before the end of the year, and there is a small chance of a vaccine being available by then. I echo the comments of the chair of the all-party parliamentary group on coronavirus, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran): that is promising news, but we should not rely on a vaccine alone.

As has become increasingly clear over the course of this pandemic, a vaccine will not be a silver bullet, and for any vaccine to work effectively, we have to suppress the virus sufficiently within the general population in the first place. None the less, the production of a successful vaccine would be a landmark moment in the fight against covid-19; I recognise and commend that.

In that regard, the reality in the UK is that we are, in relative terms, fortunate. Our scientists and researchers are leading the battle through their ongoing work. We have deals in place in relation to six of the vaccine candidates currently being developed. The Government have now bought access to 340 million potential future doses of vaccine. That equates to five doses for each person in the UK. When a vaccine candidate’s efficacy is proven, we will be at the global forefront of rolling it out—with, I am sure, a particular focus on our healthcare workers and the most vulnerable in our society, many of whom, including in my constituency of North East Fife, have been shielding or taking extra precautions for some months.

As we consider our own situation, we also have to recognise that, as things stand, if a vaccine candidate is approved soon, billions of people—two thirds of the world’s population—are likely to have no access to such a vaccine until 2022 at the earliest. While we might live in hope that a vaccine will be with us in the next six months in the UK, for others, it is a matter of years. That is because, right now, access to covid vaccines is a zero-sum game. A limited number of candidates are being manufactured by a small handful of companies only, and between them, they do not have the capacity to produce dosages in the billions required at a global level.

When the world’s wealthy countries, representing about 13% of the world’s population, bought up access to 50% of future covid vaccine doses, it became very hard for the remaining 6.8 billion people on the planet to obtain the same protections. Almost inevitably, it is less affluent nations, and in particular the most vulnerable countries, that are crowded out. It is important to remember that this is not limited to vaccines, and we are not talking hypothetically about what might happen in the future. It is happening right now, because there are already huge inequalities in access to covid treatments that already exist.

The hon. Lady is laying out clearly the inequalities in the world. I have been present in a number of debates this week in which Members have highlighted the inequalities faced by some ethnic groups and religious minorities. When it comes to receiving any covid help, they are at the end of the queue. When it comes to getting the vaccine, they will be at the very end of the end of the queue. Does she agree that those ethnic minorities and persecuted people must have an opportunity to get a vaccine?

Absolutely. I thank the hon. Gentleman for his intervention, and I entirely agree with his sentiments. We have seen that those who are on the frontline, those who are marginalised in our society and those from minority backgrounds are often the most impacted, so it is even more important that we consider the treatments and vaccines that are available for them.

The two drugs that have been proven so far to help treat covid-19 are dexamethasone and remdesivir. The entire global stock of remdesivir was bought up by the United States Government during the summer, hence Donald Trump was in a position to receive the drug when he became unwell. What is left of the stock is currently accessible only at a very high price. The manufacturer, Gilead, sells it at almost £2,000 for a five-day course of treatment, yet it is believed that the cost to produce it is £7.

Fortunately, dexamethasone is widely available and a cheaply sourced steroid. If a patient suffering from covid requires ventilation, administering this drug reduces the chance of death by up to a third. That is great news and has greatly improved outcomes for patients who need to be ventilated. But for there to be a chance for that drug to be effective, there must be enough ventilators available for patients who need them, and there must be enough oxygen to supply those ventilators. Again, in some of the most vulnerable places globally, access to those things are very limited. In South Sudan, for example, a report earlier this year stated that there were only four ventilators available in the whole country—four.

This debate is not just about the cost of drugs or vaccines. It is also about the resources, technology and equipment needed to manage a pandemic successfully. Even with easily accessible and cheaper treatments, there is no equality of access internationally. As things stand, we run a serious risk that by 2022 we will inhabit a two-tier planet in terms of the pandemic response.

I congratulate my hon. Friend on securing this important debate. Does she share my concern that those parts of the world where people do not have immediate access to healthcare systems also do not have furlough schemes, and people do not have the money to be able to isolate? The public health aspect is just as important as access to medicines.

I entirely agree. Dare I say it, but even the UK’s Prime Minister this week accepted that the isolate part of the test, trace and isolate system is not working. That is largely driven by the fact that people who have an economic need to continue to work will do so if the supports are not available, and that must be true in other parts of the world as well.

As I was saying, the most affluent countries will inevitably benefit, in terms of vaccines, access to treatment, some form of recovery and a return to aspects of day-to-day life, which we so miss in this place and beyond. For the majority of people in this world, that will, arguably, be a limited prospect; it would be a hollow victory indeed if we can get the virus under control while many people around the world continue to suffer. It would be a false victory, too. Let me go back to the comments made by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) that I mentioned at the start. In order for a vaccine to be effective, we need to suppress the virus both at home and abroad, because coronavirus does not respect national borders. No one is safe until everyone is safe. That approach has been endorsed by the UK Government. I thank them for recognising that covid-19 medical products need to be treated as global public goods and for making commitments to deliver on that.

I congratulate the hon. Lady on securing the debate and apologise for the fact that we have not been able to field a Front-Bench spokesperson from the Scottish National party today. I endorse everything she is saying and the points she is making about the importance of global access to a vaccine, when it is developed. As she says, it should be treated as a common good. We have to seek assurances from the Minister that the UK Government will live up to that, given all the changes they have made to their foreign policy, with the merger of the Department for International Development and the Foreign and Commonwealth Office, the risk to scrutiny from that, and the potential abolition of the Select Committee chaired by the hon. Member for Rotherham (Sarah Champion). We have to keep up that pressure on the Government, and I hope we will get a positive response from the Minister today.

It is always good to find common ground with a fellow Scottish MP, and I absolutely endorse his comments. One reason my party was so opposed to that merger was exactly that: the UK is seen as a global leader in this regard and we do not want anything to risk the continuation of that.

I congratulate the Government on making commitments to deliver on covid medical products being treated as a public good, for example, by contributing to the covid-19 vaccine global access facility, which will help procure and equitably distribute vaccines for covid. I look forward to hearing from the Minister today, but I urge her that we must do more. We must ensure that what the Government are doing on behalf of their own citizens does not unintentionally undermine global efforts. There is simply not enough global co-ordination on equality of access, and the UK has a moral duty to engage further. It is the highest per capita buyer of future vaccine doses in the world; we have bought up 10% of potential doses, despite making up less than 1% of the global population. I wish to mention two steps—which I hope the Minister will consider and commit to—that will be vital in ensuring that equality of access for these treatments and technologies is delivered as they come to fruition.

First, the Government need to recognise that currently there are just a handful of vaccine candidates, which means that production capacity is limited. One important step the UK Government could take is to work through international institutions to help encourage reform of the patent system, given the exceptional circumstances of this pandemic. Currently, there are legal safeguards for members of the World Trade Organisation, which means that members can override patent monopolies if public health is at threat. Germany, Australia and Canada have already taken those steps. South Africa and India have also proposed at a recent WTO meeting that all intellectual property monopolies relating to covid-19 tools, medicines and vaccines should be waived. In these exceptional circumstances, the Government need to be engaging with those ideas.

It is also worth noting that many of the vaccine candidates are being produced or developed using public funds. According to the charity STOPAIDS, the cost of development of the Oxford-AstraZeneca vaccine, whose successful outcome we are all awaiting, is being covered by public money, from the UK Government and others. It is a public-funded exercise. Concerningly, STOPAIDS reports that from July next year AstraZeneca will have the ability to determine the future price of the vaccine. Given the timescales that I have outlined, as well as the ongoing uncertainty as we enter winter, with cases climbing again in many parts of the world—we are all too aware of that in this Chamber—clarity on this is essential. We cannot have nations crowded out during vaccine development and then priced out once the vaccine is available.

So much public money is being spent on covid-19 research and development, in all our interests, and it is therefore right that the Government ensure that the products created as a result of that spend are accessible to all. These reports give more weight to the idea of relaxing patents, and that leads me to my second point, which is transparency.

The Government should attach stringent conditions to future funding of covid research and development, to ensure that public money is not being invested into products that will go on to generate exorbitant profits for their owners who, as a result of public funding, have developed a vaccine at low or no cost or limited risk. Those steps will also help to speed up research and development, and will arguably make products more affordable, enabling generic competition, driving prices down and ensuring that people from all over the globe, from the wealthiest nations to the most disadvantaged, can access covid treatments in a swift and timely manner. I hope that the Minister will take those issues into consideration.

The developing situation of what is almost a vaccine nationalism must end. Let us start to engage even more fully with multilateral institutions and our allies. Let us work together to ensure that, this time next year, we are celebrating a pandemic in abeyance worldwide, rather than still being in the shadow of this deadly virus.

I thank the hon. Member for North East Fife (Wendy Chamberlain) for calling for the debate, and I hope that my speech will amplify the points that she is making.

The International Development Committee, which I chair, has been examining the impact of the coronavirus on developing countries, and the contribution of the UK Government to initiatives to help the global south tackle the pandemic. A key part of the UK’s strategy for the global south is funding an array of partnerships and collaborations aiming to develop, at speed, vaccines, therapies and tests for preventing, treating and diagnosing the disease. The Government have allocated the lion’s share of their global coronavirus funding to the race for those products—£388 million initially for vaccines, therapies and tests and, more recently, another £571 million for the production, purchase and distribution of vaccines. That is very welcome, but a key concern that emerged throughout the evidence that we received was about the importance of legal and practical measures to guarantee equitable access to corona vaccines, medicines and tests around the world, based on need, not economic power. The former chief scientific adviser to the Department for International Development, Professor Charlotte Watts, told the IDC:

“It is not only about finding a vaccine that is going to work, but how to ensure that there are the resources and future investment in production capability, so that that can be distributed to low and middle-income countries.”

It is worth recalling why equitable access to medicines is such a concern. First, let me take the example of the antiretrovirals for HIV and AIDS. In Durban in 2000, at the XIII International AIDS Conference, Justice Edwin Cameron of the South African Constitutional Court famously declared that he had been living with AIDS for 33 months, but that,

“there are 24 or 25 million people in Africa who at this moment are dying, and they are dying because they don’t have the privilege that I have of purchasing my life and health.”

In 2000, the anti-retroviral drugs capable of transforming AIDS into a manageable illness were far beyond the means of most South Africans, costing up to $10,000 a year—much more expensive than any other country when compared with generic substitutes. When South Africa passed legislation to facilitate the use of cheaper, generic and imported products on public health grounds, 39 multinational pharmaceutical companies banded together to sue the Government for violating WTO rules. Rightly, that resulted in a PR disaster for the pharmaceutical industry. The case was dropped and the WTO recognised member states’ rights to take such measures to protect public health and, in particular, to promote access to medicines for all. But even now, the use of that safeguard is largely limited to the original HIV/AIDS drugs because of the complexities required in legislation, health system weaknesses and political pressure.

Let us look at cancer. Cancer drugs are a lucrative pharmaceutical market—for example, representing 27% of the sector’s revenue in the US. Efforts to set prices to recoup research and development costs over a set period are one thing, but funding the inflated billion-dollar trade in whole companies holding just one or two attractive patents seems less defensible. Whatever the reason, low and middle-income countries invariably find the prices set to take advantage of demand in a high-income country an insurmountable barrier to access. Pricing invariably results in wide variations in survival rates. For example, the US five-year overall survival rate for breast cancer is 84%, compared with just 12% in Gambia. That is hardly equitable.

Finally, I want to talk about polio. The polio story is essentially a triumph, with a 99% reduction in cases since the start of the global effort in 1985. However, each year, the oral polio vaccine, which is widely used in the global south, is linked to outbreaks of the disease where the wild virus has been eliminated. The injectable vaccine is an inactive virus, but it costs about $3. The oral vaccine, at about 12 cents, contains live virus. Unfortunately, children can shed a mutated version of the live virus in their stools, which can then infect unvaccinated children in areas with poor sanitation. Clearly there are other considerations than just costs when comparing injected and ingested doses of medicine, but the reality is that cost kills.

Let us hold these examples in our mind as we consider equitable access to future coronavirus products. And let me be blunt: the prospect of the international community behaving morally, or at least rationally, on a global scale over the distribution of an effective vaccine, or even accurate and simple tests, at an affordable price, is not good. In his September speech to the first virtual United Nations General Assembly, the Prime Minister rightly lambasted the international community over its fractious and competitive reaction to the procurement of personal protective equipment during the first wave of the pandemic—and that was just over masks and aprons. Imagine the pressure on every Government to deliver the long-awaited panacea of covid-19 immunity to their own populations.

Any rational response to the pandemic must surely take account of the science and the almost unique status of this crisis by incorporating the sustainable development principle of leaving no one behind. No one will be safe and secure until everyone is covid-free. For once, everyone’s interests are overtly aligned. The UK finds itself in a unique moment in time when we can reposition ourselves as a global leader for good. The soft power gained by doing the right thing for the very poorest in the world, and by standing up to those looking to profit from others’ misery, will be immeasurable. I am grateful for the leading role the UK has taken to date in the development of covid vaccines and products.

I will be brief, because there is pressure on time, but I just want to say that the hon. Lady is making an incredibly powerful speech that is demonstrating the importance of the scrutiny that her Select Committee has been able to provide. I want to re-emphasise the point I made to the hon. Member for North East Fife (Wendy Chamberlain) that the Scottish National party fully supports the continuation of that Committee, either as a non-departmental Select Committee or as a wider official development assistance-scrutinising Committee. I hope that those on the Government Benches will bear that in mind.

I am extremely grateful for the hon. Member’s support of the International Development Committee. Development is a specific and key area of the work that we do, and it demands parliamentary scrutiny.

I ask the Minister to give us some certainty today on the Government’s commitment and resolve to fight to ensure that covid drugs and treatments are accessible to everybody, not just those with the deepest pockets. Will the Government support the proposed waiver of all intellectual property monopolies related to covid-19 tools, as put forward by India and South Africa to the WTO? Can the Minister confirm that, for all R&D projects that the UK has funded, transparency on finances and an obligation for resulting products to be free from monopolies were embedded in those contracts at the start and will be enforced? Finally, will the Government follow Germany, Australia, Canada and Israel in championing the use of legal safeguards that all World Trade Organisation members can implement to override patent monopolies if public health is at risk?

I would like to start by congratulating my hon. Friend the Member for North East Fife (Wendy Chamberlain) on securing this debate. It is a great pleasure to be part of a debate that actually gives me a huge amount of hope. I was a science teacher before I was an MP, and I spent a lot of time explaining to young people why science can be exciting and why it is the one thing that connects humans, no matter where they may be across the globe. Science is universal, regardless of our sex, creed, or wherever we may have been born. What a great time to be a science teacher! During coronavirus, by studying science someone could literally save the fate of the world. I am particularly proud that scientists in Oxford are leading from the front with the vaccine right now, and we should not forget that these times of great turmoil often spark moments of enormous human ingenuity, and we should celebrate that.

Whenever we have such moments, however, we first have to go through times of strife, and we must recognise—it is important that the House is united on this point—that it is not just morally right to ensure equitable access to these vaccines and therapeutics, but it is also scientifically smart. It is in our own self-interest, and regardless of whether people feel good going to bed at night knowing that we have done that, it is also the thing that will save us.

No one is free from these diseases until everyone is free, and I am sure hon. Members will have been struck by today’s news from Denmark, where on the mink farms it has been discovered that the virus has passed from humans to mink, and then back. The virus has mutated, and 12 people in Denmark now have that new mutation. The entire mink population is to be culled, to try to keep that at bay.

My first thought was that I am very much against mink farming, but let us put that to one side. My second thought was, “Well, that’s Denmark.” Denmark has a well developed public health arm in its Government, and they are able to act within 24 hours and introduce those measures. What about other countries that do not have that kind of safeguard? We have been talking about vaccines and therapeutics in the fight against coronavirus, but what if we forget about that public health arm, and as a result end up with a new mutation that will make those vaccines pointless as we will not be able to catch up? That underlines the importance of ensuring that all such matters are taken into account.

My hon. Friend the Member for North East Fife has already spoken about how intellectual property rights need to be reformed, and I have a few questions for the Government. Why have we not supported the TRIPS waiver proposal? What was our rationale for not doing that? Why did we not endorse the WHO covid technology access protocol? That global initiative is meant to prevent monopolies from blocking global access to coronavirus vaccines, and I do not understand how we in this House can say that we believe in global access to these vaccines, yet not back that protocol. It does not make any sense.

Finally, it is important to mention the context of aid and 0.7% of gross national income. Ministers have said helpfully at the Dispatch Box that they have no intention of changing or de-escalating that figure, and keeping up the pressure to ensure that that does not happen is important. As we have seen throughout the pandemic, there are already knock-on effects on other countries. In October we saw media reports about 2.5 million girls around the world being forced into child marriages over the next five years, and enormous rises in child labour in India. Suicide rates in Malawi have skyrocketed as a result of the economic downturn due to covid-19, and the UN’s “Global Report on Food Crises” warns of famines of “biblical proportions” as a result. Such economic disparities are just going to grow as the response to the virus continues, and I hope that the Government will lead from the front, and that “Global Britain” is not just rhetoric but backed up by action and not only words.

I will end on another point of hope. I hope that coronavirus will be the start of a reformation of what has been a creaking international global response over the past few years. I also very much hope that later on today we can declare that Biden has won, because Trump out of the White House would certainly help that cause. The next big crisis—the one that makes coronavirus look like just a warm-up to the main act—is of course the climate. Climate is linked to biodiversity, and biodiversity links to more likelihood of future pandemics. It is in our self-interest to use this crisis to create the new international order that will help us with our country’s and our planet’s future.

I thank the hon. Member for North East Fife (Wendy Chamberlain) for securing this important and timely debate. I pay tribute to the many organisations that have campaigned so powerfully on this issue, including Global Justice Now, Doctors Without Borders, and Just Treatment.

We are in the middle of battling a global pandemic, and in order to successfully overcome it, there must be a united cross-border approach. Anything less only undermines the United Kingdom’s reputation as a development superpower. It also jeopardises the health of our citizens, given the rapid speed at which the virus travels around the world. The Government’s failure to provide equitable access to covid vaccines means that many developing countries that already have overstretched and underfunded healthcare systems will suffer further still if they are unable to access affordable covid vaccines. As a member of the International Development Committee —it is great to see the Chair of the Committee, my hon. Friend the Member for Rotherham (Sarah Champion), in the Chamber—I know how the coronavirus crisis could set development progress back by 30 years. That is completely unacceptable, and a failure to intervene to prevent it would be wanton disregard for our international obligations. Countries in the global south should not continually be down the pecking order: they must be prioritised in order to help them, and us, to overcome this deadly virus.

Our Government must take the lead in tackling this crisis, but pharmaceutical companies must also play their part in finding a cure. Currently, the Government are handing billions to big pharma, which is taking very little risk while maintaining monopoly control of the drugs once they are developed. For example, AstraZeneca has stated that its costs in developing a covid vaccine at Oxford University will be fully covered by Governments. This approach will serve only to exacerbate gross health inequalities and cannot be tolerated during a pandemic when tens of thousands of lives are at stake. Terms and conditions must be attached to any funding the Government provide to ensure innovations for all those who need them, including those living in low-income and middle-income countries. Indeed, the Government should not relinquish their responsibility to introduce stringent public interest conditions on their funding to ensure equitable access. That means, with millions of pounds of public money going into the research and development of future covid medical technologies, that it is critical that the final products are sold at cost, and that the pharmaceutical companies do not profiteer from public funding when Governments are required to buy back the products that they initially funded the development of.

We are now in the ninth month of this crisis, yet there remains no clear policy from this Government to ensure that grantees ensure effective technology transfer, open sharing, and licensing of covid medical technologies to ensure that there is sustainable follow-on development and manufacturing globally, especially in the very poorest countries. That is why more than 130 cross-parliamentarians, led by the all-party parliamentary group on vaccines for all, wrote to the Government, as far back as April, to call for equitable access to a coronavirus vaccine. This followed the announcement that £250 million will be pledged to its funding, research and development. We have yet to see any stipulations attached to this funding. This is despite a YouGov poll commissioned by the Wellcome Trust that found that 96% of adults in the UK believe that national Governments should work together to ensure that all treatments and vaccines are manufactured in as many countries as possible and distributed globally to whoever needs them. Therefore, I would like to hear from the Minister whether the Government will stipulate that, as a condition of any covid funding, any vaccine and medical product developed as a result of public money will not be patented and exclusively licensed.

I would also like to hear from the Minister whether the Government will join more than 30 countries in supporting the World Health Organisation’s covid accessible technology initiative, aimed at making vaccines, tests, treatments and other health technologies to fight covid accessible to all. This would stop situations arising like the one I mentioned with AstraZeneca, which followed assurances from Oxford researchers that they would maximise access to the vaccine through open licensing before they subsequently signed an agreement with the pharmaceutical company. Although it has claimed that it will not make any profit from the vaccine during the pandemic, it was recently revealed that AstraZeneca has built a clause into the deal that states that the covid-19 crisis will be considered over in July 2021, regardless of what the situation is globally, at which point it will be able to hike its prices and begin profiteering. As the Financial Times made public last month, AstraZeneca’s deal with Oxford University allows it to make as much as 20% on top of the cost of goods for manufacturing the vaccine, and it has declined to reveal how much it is to produce.

The hon. Member for North East Fife made a very important point regarding the proposal set out by South Africa and India to waive intellectual property rights on health advances against covid-19. At-cost prices for pharmaceutical companies should be the norm, not the exception. Any profiteering will clearly hamper the ability of Governments and health systems around the world, including our own national health service, to be able to afford enough vaccines to meet the needs of their populations. We cannot have a situation whereby this or any other crisis is being privatised and putting at risk the lives of those who cannot afford or access vital vaccinations.

Will the Minister therefore provide assurance that the Government do indeed have plans to ensure responsible pricing for this vaccine both for our own health service and those of our global partners, and do so over the time-limited assurances such as those provided by AstraZeneca? Will the Minister also explain the Government’s reasons for failing to demand transparency of the conditions attached to public research and development funding, as well as for licences and agreements related to the Oxford University and AstraZeneca covid vaccine? This immoral situation cannot be allowed to continue, and the Government must now consider issuing Crown use licences in the case of future shortages of life-saving covid products and medicines.

This will help to offset the failure of the current patent system, which has dominated biomedical research for decades and hindered the rapid roll-out of equipment in countries that urgently need it as well as access to affordable vaccines. That is why I supported the call by the shadow Foreign Secretary, my hon. Friend the Member for Wigan (Lisa Nandy), earlier this year, ahead of the global vaccine summit in the UK, to end the unilateral approach to accessing vaccines at the expense of other countries as well as to overturn export bans on potential covid products.

As I have made clear, multilateral collaboration is not simply the only way to ensure equitable access for all, but the only path for putting in place a global cure to end this pandemic, prevent an endless cycle of lockdowns and ensure that our country’s physical and economic health recovers as quickly as possible.

I thank my hon. Friend the Member for Rotherham (Sarah Champion) and the hon. Member for North East Fife (Wendy Chamberlain) for securing this debate, which could not have come at a more important time.

Our ability to rise to the challenge that Members have laid out so compellingly today is in many senses dependent on the outcome of the US election and the UK’s response to it. I think I probably speak for many in this House when I say that the approach the United States has taken to participation in global efforts to tackle covid-19 has been of serious concern to many of us. We know that a potential Biden Administration would mark a change in the approach of the United States, but do the Government have a strategy for a second-term Trump Administration? What is their strategy to convince the United States to change course? The UK is due to host the G7 next year. We cannot afford to see a repeat of what happened earlier this year, when despite all the talk of the special relationship, the Prime Minister was unable to persuade the United States even to participate.

The director general of the World Health Organisation said recently:

“The greatest threat we face now is not the virus itself. Rather, it is the lack of leadership and solidarity at the global and national levels.”

I think we all accept that the issues around vaccine, treatment and diagnostics have the potential to become a competition and to pit people against one another both within countries and between them, and that this poses a significant challenge for the Government.

At the beginning of this crisis, there was a chaotic and cut-throat global scramble for PPE and medical supplies. Some countries introduced export controls on vital equipment, even to neighbouring countries and allies. Prices were inflated as countries sought to outbid one another, and while scientists and doctors across the world have worked together to understand and fight the virus, they have too often done so in a vacuum of global leadership.

I hope the Minister will confirm today that she shares our view that this just will not do. There is a clear moral obligation that we must not shy away from in ensuring that some of the poorest people in the world are not shut out from access to treatment, diagnostics and vaccine, but there is also the reality that a second global wave would have disastrous consequences for Britain, for our health and for our economy.

This is not easy. There are going to be hard decisions and difficult trade-offs ahead. Decisions will have to be taken about who is first in line for a vaccine in the UK and how to ensure that it reaches the maximum number of our own citizens while extending it to people in every country across the world. That is why I hope that we will hear a clear strategy from the Government based on three principles. The first is clarity: who will be prioritised for access to a vaccine? The second is transparency and the reasoning behind those choices so that there is no implication of unfairness. The third is implementation: how will we ensure that sufficient quantities of a vaccine are produced and distributed equitably around the world?

A two-dose vaccine presents significant challenges in the United Kingdom, let alone in countries without infrastructure or with significant numbers of internally displaced people or people in refugee camps, which have already been seriously affected by covid-19. A vaccine that has to be stored at temperatures well below freezing also presents serious challenges in the United Kingdom, so we can imagine the challenge in other parts of the world.

We must learn from the mistakes that we have made so far. Too often, we have been too slow to act. We must have a clear strategy now from the Government, so that as soon as better treatments, diagnostics and a vaccine are available, we are ready to move.

We welcome the Government’s participation in COVAX, but sufficient progress has not yet been made. Will the UK use its position as a Gavi board member to ensure that COVAX has adequate doses to vaccinate priority groups, such as health workers in participating countries, and that the design is equitable, effective and genuinely global in scope?

I welcome the Government’s commitment to fund multilateral initiatives and institutions, such as the Coalition for Epidemic Preparedness Innovations and the World Health Organisation, but the Minister will be aware that there remains a multibillion-pound funding gap around the access to covid-19 tools accelerator and other initiatives. What is she doing to address that and what specific diplomatic efforts have been taken so that others around the world step up and play their part?

Like my hon. Friend the Member for Rotherham, I am enormously proud of the work that our life sciences and research institutions are doing here in the United Kingdom, but there is a significant challenge to ensure that intellectual property works for public health. Will the Government commit to transparency of all bilateral deals signed between the UK Government and pharmaceutical companies related to covid technologies and products? Will the Minister ensure that every deal agreed as part of COVAX is published in full, and that any agreement mandates transparency around all costs of development and production?

The success of COVAX depends on the ability of low and middle-income countries to afford co-payments. The Minister will be aware of concerns that the current proposed price arrangements may require some Governments to redirect money that is usually reserved for other immunisations or health services. Can she press for financing arrangements to be realistic and flexible to take into account the economic impact of the pandemic?

We welcome the commitments of some pharmaceutical companies to supply vaccines at cost, but there are reports that those pledges are for only a limited duration. Can the Minister tell us when the not-for-profit price commitment made by AstraZeneca as part of the deal with Oxford University is due to expire? If that decision is conditional on determining when the pandemic is over, who will make that determination?

What estimate has been made of the effect of the expiration of that commitment on the affordability of the vaccine for developing countries? Will conditions related to public health interests be attached to UK public funding? What work is being done to ensure that we are sharing technologies, know-how and data to allow us to deliver and upscale the manufacture of a vaccine across the world quickly?

Although the world has been slow to come together at a political level, the scientific community has been genuinely inspirational in reaching across borders to try to get us to global safety more quickly. The Chinese Government may have been slow to warn the world about the pandemic, but the same cannot be said for Chinese doctors and researchers who bravely blew the whistle on things that they saw happening in their communities. They have worked together in a difficult political environment, as tensions have been raised, and as the ramping up of hostilities between countries, particularly the US and China, has created a highly politicised, very risky environment for medical and scientific co-operation. Will the Minister tell us what efforts the UK Government are making to support those researchers, medics and scientists and the continued collaboration between them, and to de-escalate the rhetoric and tension among vital global partners?

This pandemic is a truly global crisis: it has reached every corner of the earth. More than 1.2 million people have died, with millions more suffering ill health, often for months on end. Just as here in Britain the virus has highlighted long-standing socioeconomic and racial inequalities, so covid-19 threatens to exacerbate the gulf between rich and poor around the world. It risks undoing decades of work to reduce poverty and tackle inequality globally, and many of the world’s vulnerable refugees, the displaced, those in conflict settings and those without access to adequate healthcare are exposed to the worst effects of the virus. We cannot stand for that, so there is no question but that the UK must rise to meet this unprecedented challenge. A global crisis requires a global response and now is the time to stand together and show leadership. If the Government are prepared to rise to the scale of the challenge ahead, I assure the Minister that they will have our full support.

I thank all Members for contributing to the debate. In particular, I am grateful to the hon. Members for North East Fife (Wendy Chamberlain) and for Rotherham (Sarah Champion) for securing the debate. I also pay tribute to the hon. Member for Rotherham for her work on this issue in her role as Chair of the International Development Committee. As a former member of that Committee, once upon a time, I recognise the work that it has done over many years.

I am conscious that Members asked a number of specific questions of me on a number of themes. I will do my best to answer as many of them as I possibly can, but I shall also make some comments of my own.

Innovation and equitable access to treatments are critical in the fight to end the covid-19 pandemic. The UK is committed to ensuring rapid and equitable global access to safe, effective vaccines, therapeutics and diagnostics. On 26 September, the Prime Minister told the United Nations General Assembly that

“no one is safe until everyone is safe”—

a phrase that I have heard Members use in this Chamber on many occasions. It is that important that I am sure we will continue to use it.

The Prime Minister also told the UN General Assembly:

“The health of every country depends on the whole world having access to”

safe and effective vaccines, treatments and tests. The Government are working to deliver on that commitment through our innovation and scientific co-operation, our leading levels of funding and our close collaboration with other nations and multilateral partners. Scientific co-operation has led to swift breakthroughs and enhanced our collective knowledge of how to tackle this virus. The UK has played its part by supporting clinical trials of life-saving treatments and backing vaccine research at the University of Oxford and Imperial College London.

In June, the recovery trial based at the University of Oxford announced that dexamethasone, a low-cost corticosteroid, was the first treatment in the world shown to reduce the risk of mortality in hospitalised covid-19 patients who required oxygen or ventilation. Dexamethasone is a widely available and—crucially—affordable drug that is now being used to help covid-19 patients. This was the first robust clinical trial anywhere in the world to show a treatment that significantly reduces patient mortality for those with covid-19. Such a breakthrough was possible only thanks to our world-class British life sciences, and has been described by Dr Tedros, director-general of the World Health Organisation, as a “lifesaving scientific breakthrough.”

From the beginning of the pandemic, we have focused on robust clinical research. This enables us to take evidence-based decisions, backed by rigorous science, to improve access to effective treatments both in the UK and around the world. More broadly, the UK is committed to collaborating with public and private partners at home and abroad to accelerate development and equitable access in all countries to affordable health technologies to respond to covid-19. This includes exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing that promote affordable access for all while also providing the incentives that help to foster the innovation needed to create new vaccines, treatments and tests.

The UK is proud to be the largest donor to the access to covid-19 tools, or ACT, accelerator. The ACT accelerator brings together leading international organisations in global health to support collaboration in developing and ensuring access to the new vaccines, treatments and diagnostics that will be needed to bring this pandemic under control.

I will cover that point off later, if I may, but I make clear that we have made commitments to the ACT accelerator partners across the health technologies of up to £813 million. Our commitment is very clear. That includes up to £500 million to Gavi, the vaccine alliance, for the COVAX advance market commitment. The support will also help to ensure access to covid-19 vaccines for up to 92 low and middle-income countries, providing up to 500 million people with vaccinations. The UK is also the largest ACT accelerator donor to the Foundation for Innovative New Diagnostics, or FIND, which is leading the way in developing diagnostic tools for the world’s poorest countries.

In terms of treatments, the UK is providing up to £40 million to the covid-19 therapeutics accelerator, alongside the Bill and Melinda Gates Foundation, the Wellcome Trust, Mastercard and other funders. The covid-19 therapeutics accelerator and Unitaid lead the work of the ACT accelerator therapeutics partnership. Unitaid has a track record of helping companies to bring affordable health technologies to developing country markets quickly, and the UK is the second largest funder.

Our funding to the ACT accelerator is supporting a pipeline of promising treatments, including monoclonal antibodies and new antivirals. New clinical trial data will emerge in coming weeks. The ACT accelerator is also preparing the way for the rapid deployment of new therapeutics as soon as possible after they have proved effective. We have seen some impressive results so far, but we recognise that the scale of the crisis means more funding will be needed across all three health technologies. We will continue to work with our international partners to encourage them to join us in stepping up their support and to support new and innovative solutions to address this challenge.

The UK is proud to be at the forefront of international efforts to develop vaccines, treatments and tests and ensure equitable access for the world’s poorest countries, but we recognise that we cannot do that alone. Only through global collaboration with our international partners and working through effective multilateral systems will we bring the pandemic under control. That is why on 30 September, the Foreign Secretary co-hosted a side event at the UN General Assembly with the UN Secretary-General, the World Health Organisation director-general and the Health Minister of South Africa. The event raised up to $1 billion in bilateral contributions for the COVAX advance market commitment. The World Bank also announced a package of $12 billion of support for countries to access vaccines, treatments and tests, and a coalition of 16 industry leaders announced a shared commitment to equitable access, including not-for-profit pricing. The commitments by this range of partners are a powerful demonstration of the international support for the ACT accelerator and the need for partnership across the international system.

Vaccine nationalism was raised by Members on the Opposition Benches. In the UK, we are challenging vaccine nationalism. We are a leading supporter of the COVAX facility, which is open to all countries and aims to make vaccines widely available when they are proven. At the UN General Assembly, we used our diplomacy to convene countries in support of that and announced UK aid to fund the COVAX advance market commitment.

Intellectual property rights provide incentives to create and commercialise new inventions, such as life-changing vaccines. They keep innovators innovating, creators creating and investors investing. The UK believes that a robust and fair intellectual property system is a key part of the innovation framework that allows economies to grow while enabling society to benefit from knowledge and ideas. Multiple factors need to be considered to ensure equitable access for all to covid-19 vaccines. These include increasing manufacturing and distribution capacity, measures to support or incentivise technology transfer, ensuring that global supply chains remain open, and ensuring that effective platforms are utilised to voluntarily share IP and know-how.

The UK has long supported affordable and equitable access to essential medicines. We have not signed the solidarity call to action, but we remain committed to collaborating with public and private partners, including by exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing.

I would just like to make a bit more progress so that I can cover as many points as possible.

Several hon. Member asked about the allocation of vaccines. I assure them that this is being considered. The World Health Organisation’s allocation framework recommends the highest priority populations by age, underlying conditions and health workers—estimated at about 3%. We cannot prevent a country from administering doses as they want, but there is a framework and countries will submit national deployment plans that will be reviewed by the WHO and COVAX.

The hon. Member for Strangford (Jim Shannon) raised the issue of inequalities for minority groups. I assure all hon. Members that we are working closely with organisations such as UNICEF and Gavi in that regard. These are organisations that we have worked with for many years.

I really hope that the House is reassured by the Government’s comprehensive approach to supporting innovation and equitable access to covid-19 vaccines, through scientific co-operation, working with industry, funding and multilateral collaboration. The UK is leading efforts to respond to the pandemic by developing and delivering the medical tools that are essential to ending the pandemic for everyone everywhere, but we must all work together to develop safe, effective and affordable vaccines, treatments and tests that can be produced quickly and made available to all.

I appreciate the Minister giving way. I just want to challenge her on the use of the word “voluntary” when it comes to intellectual property sharing and access to the vaccine. With all respect, big industry—particularly big pharmaceuticals—is not known for equitable sharing on a voluntary basis, so will the Minister please answer this specific point? When the UK taxpayer has been putting money into R&D, what right do we have to ensure that the information that we are paying for is shared in an equitable way?

As I explained, we believe that a robust and fair intellectual property system is a key part of an innovation framework that allows economies to grow while at the same time enabling society to benefit from knowledge and ideas. There are existing mechanisms that facilitate the sharing of IP—for example, expanding the mandate of existing organisations such as the Medicines Patent Pool to cover covid-19.

We have played a leading role, with our international and national partners, to identify end-to-end solutions that ensure affordable access for all, such as mechanisms to support the voluntary sharing of IP and know-how, manufacturing at scale and ensuring that no one is left behind, including the poorest and most vulnerable. We are committed to collaborating with public and private partners in the UK and internationally, including by exploring voluntary arrangements and approaches such as non-exclusive voluntary licensing, to help deliver what we all want, which is the promotion of affordable access while providing incentives to create those new innovations.

To conclude, it is fair to say that, if we are to defeat covid-19, and if we are to achieve a global recovery and avoid a future pandemic, we must work together across borders. Covid-19 is a virus that has no respect for borders or barriers, which is why the UK is promoting multilateral solutions to end the pandemic, working with international organisations, our partners in the G7 and G20 and industry.

I thank all Members who contributed to the debate, particularly my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the hon. Members for Rotherham (Sarah Champion) and for Stockport (Navendu Mishra). A year ago, I was commencing a career break at the start of the general election campaign. On my election to this place—I dare say it was the same for all Members here—none of us foresaw what was coming in 2020.

I remember speaking in my former role as the Liberal Democrats’ International Development spokesperson about the real concern that covid-19 was going to rip through the global south. In some respects, we have not seen that, for a variety of reasons, including the younger populations in some of those countries. That is a positive thing. However, we do not understand the impact of things such as long covid or the mutations that my hon. Friend the Member for Oxford West and Abingdon talked about. Although the debate has rightly focused on the vaccine, we have to acknowledge that the public health infrastructure and access to other treatments is a real issue in developing countries and will make the delivery of vaccines more difficult.

The UK is a global leader in this area and has been for a number of years. I note the Minister’s commendable actions to date, but it is clear that there are still key steps to be taken. It is also clear that other countries are now taking those steps, on issues such as patents, waivers and support for the World Health Organisation’s C-TAP—covid-19 technology access pool—which, without UK support, risks being undermined. I thank the Minister, but it is clear that there is much still to do, rather than just giving assurances. We need key commitments and sign-ups, and it is clear that opposition Members will continue to press for those.

Question put and agreed to.


That this House has considered the UK Government’s role in ensuring innovation and equitable access to treatment within the international covid-19 response.