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 rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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