Ebola

Lord Collins of Highbury Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble Lord, Lord Fowler, for ensuring that this vital issue remains high on the political agenda. Last November, my noble friend Lady Kinnock initiated a similar debate, and many of the concerns raised then remain relevant today. The Government’s response on the ground has been positive, so far providing more than £200 million for treatment, facilities, expediting NHS staff who heroically volunteer and helping to finance trials and develop new treatments and vaccines for Ebola.

The UK medical workers who have volunteered in their hundreds to join the fight against Ebola in Sierra Leone are playing a critical role in the front-line response. The tragic case of nurse Pauline Cafferkey highlights their exceptional bravery and compassion. My thoughts—and, I know, those of everyone here and all noble Lords—are very much with Pauline and her family during this very difficult time.

As we heard from the Statement in the other place on Monday, Save the Children is conducting an urgent review, which I understand will involve representatives from Public Health England. Clearly, the sooner we know the results, the better. Can the Minister update the House on the review? When are the results likely to be published? As the next group of NHS volunteers leave for west Africa in the coming weeks, they will want to know whether procedures and guidance will be changed in the light of that case. Will the noble Baroness also liaise with the Department of Health to ensure that the employment and careers of volunteers who show their compassion are not adversely affected by any further quarantine restrictions that may be introduced following the review?

The role of British volunteers has been significant in the campaign against Ebola. What plans do the UK Government have to establish a standing roster of medical workers for possible deployment in future health emergencies? As we have heard in this debate, this crisis underscores the importance of investing in a strong system of research and development for global health. In Justine Greening’s own words, new technologies are,

“vital if we are to improve the health of the poorest people through better treatment and prevention”.

The UK Government have shown leadership in supporting solutions, including product development partnerships. PDPs have been instrumental in bringing through 37 new therapeutic products for poverty-related diseases registered over the past decade. Will the Minister commit to prioritising within DfID, and promoting among other key donors, the need properly to fund and support R&D for global health?

The three countries facing the largest burden of Ebola are among the poorest countries in the world and, as we have heard, have some of the most fragile health systems. They have had insufficient investment in infrastructure, the healthcare workforce, health information systems and medical supplies and equipment over decades. What is the Minister’s assessment of the state of preparedness for Ebola in neighbouring countries? What plans do the Government have to provide specific support to the high-risk countries on the WHO watch list to reduce the risk of further outbreaks? What is the Minister’s assessment of the factors contributing to the decline of cases in Liberia? What lessons from Liberia are being applied to the UK response to Ebola in Sierra Leone?

As we have heard in this debate, the main issue has been health systems not being resourced or strong enough to deal with the issue. That is a key factor. Universal health coverage, whereby there is access for all without people having to suffer financial hardship when accessing it, is a key way that we can make countries more resilient to health concerns such as Ebola before they become widespread emergencies. Universal health coverage is a clear and quantifiable goal, and 2015 is the year when international development will be high on the international agenda. On 19 January, negotiations start in New York on the replacement of the millennium development goals. I know that I have asked this before, but I ask the noble Baroness to support universal health coverage in the language of the health goal in the successor to the MDGs, the SDGs. I ask her to back that strongly because, as we have heard in this debate, universal health coverage is the key to avoiding such catastrophes in the future.

AIDS, Tuberculosis and Malaria

Lord Collins of Highbury Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating the debate. I also thank him for his lifetime commitment to the battle against HIV and AIDS, and, more importantly, against the prejudice and stigma that all too often hinder treatment and prevention.

The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. As noble Lords have said, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment. About 12.3 million people have been tested and treated for TB. Some 450 million mosquito nets have been delivered. Of the goals it set in relation to its work on HIV, TB and malaria for delivery in 2016, the fund has already achieved 100% of its HIV goal, 115% of its malaria goal, but, regrettably, only 58.5% of its TB goal. As we have heard, despite the huge progress on malaria in particular, still more needs to be done. I was shocked to hear yesterday a DfID scientific adviser state that half the children in high-risk areas still sleep without nets.

The fund is short of its TB targets because countries do not have the capacity to run programmes of the scale of those for HIV and malaria. As the noble Lord, Lord Chidgey, said, the fund provides more than 80% of international financing for TB, more than 20% for HIV and 50% for global malaria. As my noble friend Lord Cashman said, the UK contributed £1 billion to the fund in December 2013, saving a life every three minutes. Again as we have heard, the UK has pledged £1 billion to the Global Fund for the next 2014-16 round, but this funding is capped at a total of 10% of the total sum raised. The US contribution, which is huge, is also capped at 33% of the total funds pledged.

Sadly, as the noble Lord, Lord Fowler, said, the Global Fund is still short of its funding target. Given its importance to the global response to these three diseases, what action have the Government taken to ensure others step up to the mark in this round of funding? Also, if these fail, will the Government commit to disbursing the full £1 billion, regardless of whether other countries pledge or not? As the noble Lord said, the Global Fund has led the way on integrating TB and HIV programmes as recommended by the World Health Organization. When I raised in an Oral Question last December just how integrated DfID’s bilateral HIV programmes were, the Minister agreed to write to me. In fact, in her subsequent letter the noble Baroness stated that DfID,

“responds to partner countries’ health priorities”,

including tackling TB/HIV co-infections. The noble Baroness assured me that DfID will ensure that this approach is followed where we have bilateral TB/HIV programmes.

Of the 28 countries DfID lists as partners, 14 are on the list of high-burden TB countries and two are on the list of high-burden drug-resistant TB countries. In which case, I am concerned as to why TB is not identified as a health priority in any of those countries. Does the Minister accept that DfID could better integrate its TB/HIV programme in its bilateral arrangements and help to build the capacity of national TB programmes? Further, there is a £2 billion a year funding gap for TB that the Global Fund cannot fill. TB is an infectious disease that does not recognise national boundaries. Failure to control the disease in one country can and will lead to resurgence in others that have successfully tackled the disease.

The Global Fund helps countries purchase drugs, diagnostics and vaccines to tackle the three diseases. However, for many conditions, such as paediatric HIV, as we heard from the noble Baroness, Lady Barker, and TB—particularly drug-resistant TB—we do not have drugs of sufficient quality. I conclude by stressing the point I made on Monday in Grand Committee: there is a strong case for DfID to scale up its investment in R&D for TB, HIV and malaria to develop the treatments needed to eliminate these three diseases. I, too, would welcome the meeting suggested by the noble Baroness, Lady Barker, to raise these issues and the concerns of many people.

Global Development Goals

Lord Collins of Highbury Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank my noble friend Lord McConnell for initiating this timely debate. The EU is calling 2015 the European Year for Development, with the intergovernmental negotiations commencing in January and with a view to finalising work in July ahead of the September summit to determine global plans for the next 15 years. As my noble friend said, last week the United Nations Secretary-General published an advance copy of his synthesis report which draws upon the Open Working Group proposals for 17 goals and 169 targets. Six essential elements are identified, although the Secretary-General does not detail explicitly how these elements should be used in the negotiations. I ask the Minister: what initial assessment the Government have made of the implications of the UN Secretary-General’s report? I share the concerns of my noble friend Lord Cashman. Given that the Secretary of State and the Prime Minister have both commented on a number of occasions that 17 goals and 169 targets are “too many”, what will the Minister’s priorities be in the post-2015 negotiations? Which goals would she be happy to see either merged or discarded from the final list?

As my noble friends have said, our country’s commitment to the world’s poorest and most vulnerable is not just morally right; it is in Britain’s national interest. Just as important is how our actions can help shape global opinion. We need to convince those who are able to do much more and empower others to stand on their own two feet. We need global agreement on tax transparency, need to ensure that companies pay their tax in-country, and need to support Governments to collect their own taxes to reduce aid dependency and foster good government. If we are to unlock development, the UK must push for bold and visionary global agreement on development over the next 15 years.

As we have heard in today’s debate, there are three vital areas that are the greatest areas of inequality that the world faces. First, we must set new global priorities to give everyone universal access to healthcare. Secondly, climate change is a development issue and must form an integral part of global effort over the next 15 years. Finally, we must protect human rights, as my noble friend Lord Judd so ably argued, working to help eliminate exploitation, to protect the rights of women and girls and to protect workers’ rights.

Ensuring that everyone in the world has access to affordable healthcare is essential to end poverty. It is deeply unfair that 3 million people die every year because of a lack of vaccine for preventable illnesses. As we heard in the previous debate, there have been 1.5 million AIDS-related deaths, when we have treatments that could have kept those people alive. Three-quarters of those living in low-income countries lack access to decent healthcare. In India, a middle-income country, the situation is the same. Universal health coverage reduces inequality and would prevent 100 million people a year from falling into poverty. It is the bedrock of human development. This year the Ebola virus has killed thousands across west Africa. The UK’s response to the humanitarian health crisis has been strong. However, the main issue here was health systems not being resourced or strong enough to deal with the issue. Universal health coverage, whereby there is access for all without people having to suffer financial hardship when accessing it, is the key way that we can make countries more resilient to health concerns such as Ebola before they become widespread emergencies. UHC is a clear and quantifiable goal. Will the Minister support UHC in the language of the health goal in the SDGs?

I turn now to climate change, which hits the world’s poorest people the hardest. It causes severe weather events. The poor live in areas that are most affected by climate change and lack the resilience to cope with drought, flood and food insecurity. Given the clear links between climate change, inequality, poverty and economic development—the most recent example, which my noble friend Lord McConnell referred to, being Typhoon Hagupit, or Ruby as it is known in the Philippines—yet again it appears that those who had the least were those who have lost the most. Does the Minister agree that a post-2015 agenda without a stand-alone goal on climate change will undermine the potential of the entire agenda?

Empowering countries to stand on their own two feet is not just about new powers for more Governments; it should result in changes for working people as well. Decent jobs under decent conditions for decent pay are a vital part of development, providing a permanent route out of poverty. But there are 168 million child labourers working across the world, and those who work in developing countries often work in ill defined jobs in the so-called grey economy. Formal employment would better ensure workers’ rights and avoid exploitation at the hands of unscrupulous companies. We need to stop clothing made by people working in horrendous conditions reaching our markets and we must demand action from major companies to stamp out child labour from their supply chains. Labour will reverse this Government’s decision to withdraw funding from the International Labour Organization and we will work with the International Trade Union Confederation to ensure that those who want to work hard can get on.

Finally, as we have heard in the debate, almost half the world’s wealth, totalling $110 trillion, is now owned by just 1% of the population. Seven out of 10 people live in countries where economic inequality has increased in the past 30 years. As we have also heard, gender inequality is the most persistent form of prejudice but inequalities can occur across urban/rural divides or have different ethnic, religious or racial group dimensions. Discrimination on the grounds of disability is also a critical factor fuelling inequality, as was pointed out by the noble Lord, Lord Low. Given that inequality is an issue of pandemic proportions—which goes beyond simply ensuring that no one is left behind—I ask the Minister whether her Government are willing to commit to the need for a stand-alone goal on inequality in the post-2015 agenda.

Malala Yousafzai

Lord Collins of Highbury Excerpts

Wednesday 10th December 2014 Lords Chamber

[Baroness Northover]

Many people in the Government of Pakistan are aware of that and there is an encouraging increase in the number of girls as well as boys in school.

[Lord Collins of Highbury (Lab)]

My Lords, obviously education is key to women’s rights. The issue that we heard about last week was the London conference on Afghanistan. Can the Minister update the House on the outcomes of that conference, particularly for girls’ education and women’s rights?

[Baroness Northover]

There was a major emphasis on girls’ education and women’s rights and I participated in many events to do with that. I was very impressed by what the wife of the President said about the need to shape their own future, otherwise others will do so.

Tuberculosis

Lord Collins of Highbury Excerpts

Monday 8th December 2014 Grand Committee

Asked by

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to work with global stakeholders to address investment in research and development in global health, and particularly to support the development of new tools and treatments for tuberculosis.

[Lord Collins of Highbury (Lab)]

My Lords, an estimated 13.7 million people die every year from or in connection with a group of diseases known as “poverty-related and neglected diseases”. These include TB, HIV, malaria, dengue fever, yellow fever and many others.

Research and development is expensive. Some estimates claim that developing a new drug through commercial routes can cost £1 billion. Naturally, pharmaceutical companies therefore invest in developing products where there is a potential to see a significant financial return to pay for the original development costs and, ultimately, to make a profit. Because the diseases that I have mentioned primarily affect poor people, there is no financial market to incentivise commercial sector pharmaceutical development and accordingly very few new products are developed.

Where there is an affluent market, as is the case with adult HIV drugs, we can see significant private investment. In comparison, there are very few formulations of paediatric HIV drugs, where the market is smaller and more heavily based in developing countries. There is therefore a market failure in developing drugs, diagnostics and vaccines for diseases that impact predominantly on low-income and middle-income countries. This market failure is similar to the failure of the commercial sector to develop new antibiotics—again because there is insufficient financial return on offer for such products.

In the absence of the commercial sector, public and philanthropic organisations attempt to fill the gap, but progress is slow. The purpose of today’s debate is to highlight that there are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. In 2002, DfID launched the Commission on Intellectual Property Rights, which looked at the impact of intellectual property on development policy. In a landmark document, it recommended that Governments should invest more to explore the impact of IP on development. DfID supported this recommendation by sponsoring the establishment in 2003 of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health, which paved the way for global reform efforts.

However, those efforts have since stalled and significant controversy remains over the role of IP within global health research and development, particularly around de-linkage, a term meaning separating the incentive for R&D from the potential financial returns, a point that I made in an Oral Question to the Minister last week, on World AIDS Day. During that exchange, I also mentioned the launch that day of Access Denied, a report by the All-Party Parliamentary Group on HIV and AIDS, which the noble Baroness confirmed that she was attending, and of course I saw her there. In response to questions at the launch about the absence of a formal response from the Government to the report, the Minister promised to share her speech notes with the all-party group so that they could be viewed publicly. Does she still intend to do so? Can she tell me whether her department will be championing within government the recommendation from both the All-Party Parliamentary Group on Global TB and the HIV/AIDS all-party group that the UK commission an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a de-linked model?

Global reform efforts have stalled. There is a lack of global consensus around the reforms necessary to drive improved investment in global health and there is a lack of global co-ordination around what is funded. What steps will the Minister take to initiate dialogue between the pharmaceutical industry, civil society and the Government to reach an agreement over a possible R&D treaty in the run-up to the World Health Assembly in 2016?

Product development partnerships, of which I am sure we will hear more in today’s debate, are non-profit organisations which attempt to fill the gaps in global health R&D. They receive public and philanthropic donations, build partnerships with pharmaceutical companies and attempt to develop new drugs, diagnostics and vaccines. Successful examples of these are found in the TB field, with Aeras helping to bring a new vaccine through trials and TB Alliance aiming to bring a new drug regimen to the market. There are many other examples of successful partnerships in the fight against malaria. Again, I am sure that we will hear more of that in this debate. Nevertheless, products from PDPs, despite often being publicly funded, are sometimes protected by patents, which make them more expensive.

On a similar theme, the UN Secretary-General recently stated:

“Public funding often subsidizes private sector research, at times leading to the public being priced out of the benefits through disadvantageous licensing and patent”.

The reports from the all-party groups on HIV and TB—the latter came out last year, which prompted me to table this debate—recommend that DfID should continue to support R&D through product development partnerships. However, both argue for a commitment to open access, generic production and a non-patent-monopoly-based approach. Will the Government commit to reviewing PDP funding with regard to a potential top-up of funding and will they commission a paper examining the impact of open access requirements on products generated with public money? Can the Minister tell me what her department will be doing to address the growing problem in middle-income countries, as highlighted in the Access Denied report, of funding being pulled out from all directions, including from the Global Fund, while the pharmaceutical industry continues to expect such Governments to afford higher prices for ARV treatment?

DfID is one of the world’s leading funders of global health. Its commitment to the Global Fund will save a life every three minutes. Commitments to Gavi could save a life every two minutes. The work of these organisations relies on having appropriate drugs, diagnostics and vaccines to test and treat people. If we are to move beyond investments to control diseases such as TB, HIV and malaria and towards eradication, we desperately need new tools. We will not eliminate HIV unless we have a cure, nor wipe out TB without an effective vaccine.

DfID’s R&D strategy expired at the end of 2013 and has not been replaced. Will the Minister state the UK Government’s long-term strategy to secure the development of the new drugs, diagnostics and vaccines needed to eliminate HIV, TB and malaria? Will the Minister reassess the Government’s decision to cut funding for the development of AIDS vaccines as part of a larger review of the scale of investment that the Government are making to ensure that we have the pipeline of new medical tools that the world so desperately needs?

Syrian Refugees: Food Aid

Lord Collins of Highbury Excerpts

Tuesday 2nd December 2014 Lords Chamber

[Baroness Northover]

I will need to write to my noble friend with the details of that.

[Lord Collins of Highbury (Lab)]

My Lords, the one thing that is clear is that this crisis will not come to an end in a short period. Does the Minister therefore accept that longer-term funding for host government authorities is necessary to ensure that their national infrastructures do not collapse under the weight of the refugees?

[Baroness Northover]

The noble Lord is right that a huge amount of support will need to go to these countries. That is what the United Kingdom is in fact doing, both as regards support within Syria itself but also for those countries around, some of which, as he well knows, were under a lot of pressure before this crisis occurred and are under further pressure. We have to ensure that the situation that developed in Iraq does not develop elsewhere.

HIV and AIDS: Vaccine

Lord Collins of Highbury Excerpts

Monday 1st December 2014 Lords Chamber

Asked by

[Lord Collins of Highbury]

To ask Her Majesty’s Government what assessment they have made of the progress in developing a vaccine in order effectively to address global HIV/AIDS.

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, today is, of course, World AIDS Day, and we have committed nearly £1 billion to tackling HIV through our programmes. There has been some progress on HIV vaccine research recently but no major breakthrough, although there are a number of promising research avenues. Expert opinion varies and it is not possible to say when a viable vaccine will be developed.

[Lord Collins of Highbury (Lab)]

I thank the Minister for that response. UNAIDS highlighted that only 24% of children living with HIV currently have access to HIV treatment. Given the clear need for more investment, will the Minister support the recommendation in the report launched today by the all-party group, Access Denied, to carry out an inquiry into alternative models of research and development investment, which separate the costs of R&D from the demands of profitability?

[Baroness Northover]

I will be speaking at the launch of that report later this afternoon, and no doubt we will have further discussions about it. One of the striking things about this is that in terms of research and development funding for new product development in 2012—the most recent figures available—33.6% went to HIV/AIDS, 17.1% towards malaria and 15% towards TB, so it is not a neglected area. But research into the vaccine is proving exceptionally difficult and the trials have proved disappointing. It is therefore necessary to move back to basic research and drive it forward that way. Meanwhile, a lot of effort is going into research and development on treatments. As the noble Lord will know, over the past decade there have been great advances in treatment. One of the key things, as my noble friend Lord Howe just indicated, is making sure that people know their status and are treated.

India

Lord Collins of Highbury Excerpts

Wednesday 26th November 2014 Grand Committee

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble and right reverend Lord, Lord Harries, for initiating this debate. India, as we have heard, is the largest democracy in the world, with a population of over 1.2 billion, and an emerging global power. It became a middle-income country in 2008 and, while it has made incredible progress in recent times in lifting millions out of poverty, the gap between the haves and the have-nots remains huge. Caste, ethnicity and feudalism remain strong drivers of inequality.

Fifteen years ago there were only two dollar billionaires in India; today there are 46. The total net worth of India’s billionaire community has climbed from about 1% of GDP to 12%, yet India spends less than 4% of GDP on the important areas of education and health. More than half of all children drop out of school before the age of 14, and the majority of those are female. Almost 12% of children between five and 15 are identified as child labour and there are about 2.4 million people living with HIV and AIDS. As we have heard, India is still home to one-third of the world’s people living below $1.25—that is 80p—a day and the average income is one-third that of China. The disparity between India’s states is significant, too; eight of them are home to 65% of India’s poor. Poverty reduction in these states remains critical to global success in meeting the MDGs.

In November 2012, the Secretary of State for International Development announced that from that point the UK would approve no new financial grant aid to India. What assessment has been made of the impact of DfID’s efforts to responsibly complete by 2015 all commitments to ongoing projects? Will the Minister update the House on those programmes, which have been focused on the poorest people in India’s low-income states, such as Madhya Pradesh, Bihar and Orissa? What steps are the Government taking to ensure that the post-2015 framework specifically tackles economic and other inequalities within countries through goals, targets and other mechanisms?

As the debate has highlighted, poverty in India is not just economic; it is also linked to social factors. The Dalit community suffers serious deep abuse and discrimination, as we have heard from the noble and right reverend Lord, Lord Harries. As we have also heard, despite positive government action and constitutional safeguards, excluded groups, when attempting to access their rights, often face a serious backlash, human rights violations and increasing atrocities amid a culture of impunity. As this debate has highlighted, it is not just about whether we have the laws; it is about whether those laws are implemented and complied with and whether people who break them can get away with it. I stress that point to the Minister.

--- Later in debate ---

[Lord Collins of Highbury]

My Lords, the clock has now started again, so I will be quick. As today’s debate has strongly highlighted, it is not just about stronger laws; it is about implementation and compliance.

As I am talking about laws, I personally am sad that there is still no word on why India cannot rid itself of colonial laws that make homosexuality illegal. I hope that the Government can continue to make representations on that issue.

We have also heard in this debate about the diaspora community in the UK and the close relationship between India as the biggest democracy and the UK as the oldest. That also means that the issues that we have been debating today, particularly caste discrimination, relate to us in this country as well. They exist in this country—hence this House agreeing last year to add caste, as an aspect of race, to the protected characteristics in the Equality Act 2010.

I know that this is going slightly beyond the remit of this debate, but it is incredibly relevant. In May 2014, the Government announced that the first of the public consultations outlawing caste-based discrimination had been delayed until autumn this year. We are now nearing the end of autumn; for some of us it is well past the end. I know that it is not necessarily the responsibility of the noble Baroness, but I would be grateful if the Government would let us know when we can expect to see this consultation. How long can it be delayed? That concludes my remarks.

Health: HIV

Lord Collins of Highbury Excerpts

Monday 17th November 2014 Lords Chamber

[Baroness Northover]

My noble friend is probably aware that we are a major donor to the Global Fund, which works internationally in middle and low-income countries. She is right that our bilateral programmes focus on the poorest countries, but through our enormous contribution to the Global Fund—we are the second largest international donor in this area—we are supporting those with HIV in middle-income countries.

[Lord Collins of Highbury (Lab)]

My Lords, I am aware that the Minister recently visited the IAVI lab in London. What consideration has her department given to the role of a vaccine in controlling the HIV/AIDS epidemic?

[Baroness Northover]

Like the noble Lord opposite, I had an extremely instructive visit to the IAVI lab at Imperial College. He will have noted, as I did, the challenge of trying to find a vaccine for HIV because of the difficulty with the way the virus mutates. This is in contrast, for example, with seeking to find a vaccine for Ebola. We continue to emphasise the need for research in this area, but it is immensely challenging.

Ebola

Lord Collins of Highbury Excerpts

Thursday 6th November 2014 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank my noble friend for initiating this vitally important debate, and like her I welcome the Government’s response on the ground and their decision to provide more than £200 million for trials developing new treatments and vaccines for Ebola, working alongside a range of partners from both the public and private sector.

This crisis underscores the importance of investing in a strong system of research and development for global health. As the noble Lord, Lord Patel, said, the fundamental lesson is that we do not know what else is around the corner in terms of other viruses and infections. It is also possible that efforts to control the Ebola virus in those countries affected by the outbreak risk setting us back on the gains made against malaria as health systems have been pushed to breaking point and people avoid using them because they fear contracting Ebola. In 2012, malaria killed 7,000 people in these countries. As we have heard, most of them were children. What steps are being taken to ensure that we are offering other health services alongside containing and eliminating the Ebola virus in west Africa?

The long-term impacts for these countries will be catastrophic. What are we doing to ensure that other local services such as education and local markets are not severely impacted? My party has called for universal health coverage and access to be placed at the centre of global development. The noble Baroness, in response to an earlier question of mine, said the United Kingdom supports the development of health systems in developing countries, but as we have heard, the United Kingdom—the home of the National Health Service—is still opposing making universal healthcare and access an explicit goal at the UN. Can the Minister explain why?