Prevention is better than cure

The ongoing struggle to reduce the cost of vaccines in developing countries like Ghana.

 

Monday saw me in Committee room 1 in Westminster amongst Parliamentarians and health and development activists at the start of World Immunisation Week. Now I am in Ghana where more than 50 years ago I was inoculated against polio. This has now been eradicated in Ghana by the sort of mass immunisation campaign that I am privileged to see launched here this week.

Today, in Ghana the target is two of the biggest child killers in the world pneumonia and diarrhoea. These two diseases account for an estimated 20 per cent of all under 5 deaths in the country, but are largely preventable through the introduction of the pneumococcal and rotavirus vaccines. In the UK we take for granted the access and availability of these vaccines and we have little experience of the fatal impact of these diseases. But pneumonia and diarrhoea each kill roughly 500,000 children under 5 every year and 85 per cent of the diarrhoea deaths caused by rotavirus are in the developing world. In Ghana the fatal impact of these diseases is very real.

I am travelling to Ghana with the GAVI Alliance. This unique partnership between governments, North and South, civil society, and private sector philanthropists and businesses has revolutionised the market in and delivery of vaccines globally and saved the lives of millions. The origins of GAVI's funding lie in the very special coming together of activists and government that led to the UK’s historic commitments to the UN 0.7 per cent of GDP target for development. This is an enduring achievement of the last Labour government. The good news is that this saw the advent of a new national consensus. The consequence of which is that David Cameron and Andrew Mitchell, who hosted the last funding conference for GAVI, have committed a further £814 million pounds to the cause. This recognises not simply the need I see so clearly demonstrated in Ghana and indeed throughout my work in Africa but also of the effectiveness of GAVI and its unique model. This builds local ownership whilst intervening in world markets to reduce the cost of vaccines to developing nations through innovative funding mechanisms. The IFFIm on which I worked with Gordon Brown during our time at the Treasury was the first of these. Designed and championed by a very special partnership between the treasury, the city, and civil society including the Vatican, it proved to be a groundbreaking approach to securing sustainable funding for development. I am now seeing first hand in Ghana the product of a next generation initiative, the Advanced Market Commitment (AMC), which is delivering life saving pneumococcal vaccines to the poorest countries at a 90 per cent price reduction compared to the cost in the US and EU. And it has accelerated the pace of delivery so that by 2015 an additional 700,000 lives ought to be saved.

The child that I saw my self struggling for breath in the arms of her father, whilst a weeping mother looked on at the Princess Marie Louise Hospital in central Accra ought not to be joined by countless others. Politics and the budget process that protects DFID’s spending are too often disparaged by so many in the sadly cynical and disillusioned country that we have become. Not least by so many young people who have been turned off completely by the whole process. We all need reminding from time to time why politics and the contest of ideas and values matter so desperately. And why we need to restore and revitalise our own politics.

One of GAVI’s strengths, as I see it, is that GAVI builds and supports local ownership and participation. A traditional leader in rural Ghana told us through his linguist, the original version of our own Number 10 spokesperson, why he had called together the village community to get vaccinated. Ghanaian health professionals had proudly outlined the “cold chain”, the logistical triumph that will ensure that children in the remotest parts of Ghana will still get access to the vaccine in good time and at maximum effectiveness. The Health Minister rightly outlined the Ghanaian taxpayers’ contribution to the funding of the whole process supported by GAVI. This is best practice in international development. Britain’s contribution ensures that somewhere in the world every 2 seconds a child is being vaccinated and a life is saved every 2 minutes from diseases that no child in the UK ever dies. On my way back from the medical field unit so similar to the one my mum took me all those years ago now, I saw a “Tro-Tro”, Ghana’s ubiquitous minivan taxi system. They are famed for the proverbs emblazoned on them with great colour and decorative flourish. This one simply said, “Prevention is better than cure". 

Paul Boateng is a former chief secretary to the Treasury, ex-High Commissioner in South Africa and a Labour peer

Paul Boateng, a former British high commissioner to South Africa, MP, cabinet minister and civil rights lawyer, is a member of the House of Lords and a trustee of the Planet Earth Institute

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The DUP scored £1bn for just ten votes – so why be optimistic about our EU deal?

By March 2019, we’re supposed to have renegotiated 40 years of laws and treaties with 27 ­countries.

If Theresa May’s government negotiates with the European Union as well as it negotiated with the Democratic Unionist Party, it’s time to cross your fingers and desperately hope you have a secret ­Italian grandfather. After all, you’ll be wanting another passport when all this is over.

The Northern Irish party has played an absolute blinder, securing not only £1bn in extra funding for the region, but ensuring that the cash is handed over even if the power-sharing agreement or its Westminster confidence-and-supply arrangement fails.

At one point during the negotiations, the DUP turned their phones off for 36 hours. (Who in Westminster knew it was physically possible for a human being to do this?) Soon after, needling briefings emerged in the media that they were also talking to Labour and the Lib Dems. In the end, they’ve secured a deal where they support the government and get the Short money available only to opposition parties. I’m surprised Arlene Foster didn’t ask for a few of the nicer chairs in Downing Street on her way out.

How did this happen? When I talked to Sam McBride of the Belfast News Letter for a BBC radio programme days before the pact was announced, he pointed out that the DUP are far more used to this kind of rough and tumble than the Conservatives. Northern Irish politics is defined by deal-making, and the DUP need no reminder of what can happen to minnows in a multiparty system if they don’t convince their voters of their effectiveness.

On 8 June, the DUP and Sinn Fein squeezed out Northern Ireland’s smaller parties, such as the SDLP and the Alliance, from the region’s Westminster seats. (McBride also speculated on the possibility of trouble ahead for Sinn Fein, which ran its campaign on the premise that “abstentionism works”. What happens if an unpopular Commons vote passes that could have been defeated by its seven MPs?)

The DUP’s involvement in passing government bills, and the price the party has extracted for doing so, are truly transformative to British politics – not least for the public discussion about austerity. That turns out to be, as we suspected all along, a political rather than an economic choice. As such, it becomes much harder to defend.

Even worse for the government, southern Europe is no longer a basket case it can point to when it wants to scare us away from borrowing more. The structural problems of the eurozone haven’t gone away, but they have receded to the point where domestic voters won’t see them as a cautionary tale.

It is notable that the Conservatives barely bothered to defend their economic record during the election campaign, preferring to focus on Jeremy Corbyn’s spending plans. In doing so, they forgot that many of those who voted Leave last year – and who were confidently expected to “come home” to the Conservatives – did so because they wanted £350m a week for the NHS. The Tories dropped the Cameron-era argument of a “long-term economic plan” that necessitated short-term sacrifices. They assumed that austerity was the New Normal.

However, the £1bn the government has just found down the back of the sofa debunks that, and makes Conservative spending decisions for the rest of the parliament fraught. With such a slim majority, even a small backbench rebellion – certainly no bigger than the one that was brewing over tax-credit cuts until George Osborne relen­ted – could derail the Budget.

One of the worst points of Theresa May’s election campaign was on the BBC ­Question Time special, when she struggled to tell a nurse why her pay had risen so little since 2009. “There isn’t a magic money tree that we can shake that suddenly provides for everything that people want,” the Prime Minister admonished. Except, of course, there is a magic money tree, and May has just given it a damn good shake and scrumped all the cash-apples that fell from it.

That short-term gain will store up long-term pain, if the opposition parties are canny enough to exploit it. In the 2015 election, the claim that the SNP would demand bungs from Ed Miliband to prop up his government was a powerful argument to voters in England and Wales that they should vote Conservative. Why should their hospitals and schools be left to moulder while the streets of Paisley were paved in gold?

The attack also worked because it was a proxy for concerns about Miliband’s weakness as a leader. Well, it’s hard to think of a prime minister in a weaker position than May is right now. The next election campaign will make brutal use of this.

Northern Ireland might deserve a greater wodge of redistribution than the Barnett formula already delivers – it has lower life expectancy, wages and productivity than the British average – but the squalid way the money has been delivered will haunt the Tories. It also endangers one of the Conservatives’ crucial offers to their base: that they are the custodians of “sound money” and “living within our means”.

Labour, however, has not yet quite calibrated its response to the DUP’s new-found influence. Its early attacks focused on the party’s social conservatism, pointing out that it is resolutely anti-abortion and has repeatedly blocked the extension of equal marriage through “petitions of concern” at Stormont.

This tub-thumping might have fired up Labour’s socially progressive supporters in the rest of the UK, but it alienated some in Northern Ireland who resent their politicians being seen as fundamentalist yokels. (Only they get to call the DUP that: not Londoners who, until three weeks ago, thought Arlene Foster was the judge who got sacked from Strictly Come Dancing.)

And remember: all this was to get just ten MPs onside. By March 2019, we’re supposed to have renegotiated 40 years of legislation and treaties with 27 other European ­countries. Ha. Hahaha. Hahaha.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 29 June 2017 issue of the New Statesman, The Brexit plague

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