HC Deb 26 April 1961 vol 639 cc583-94

Motion made, and Question proposed.

That this House do now adjourn.—[Colonel J. H. Harrison.]

11.41 p.m.

Mr. R. E. Prentice (East Ham, North)

The subject that I wish to raise is the policy of the Government towards what I consider to be one of the most exciting and challenging efforts made by any of the United Nations agencies—the malaria eradication campaign which was launched by the World Health Organisation in 1955 to wipe out malaria all over the world.

The point at issue in this brief debate is the financing of the campaign and the Government's attitude towards it, but in the background lies a problem of tremendous importance to the human race, as one realises when it is appreciated that about 1,200 million people are still living in countries where they suffer to a greater or lesser extent from malaria, that a few years ago about 3 million people a year died from malaria and that in Africa even today about one in eight of the children die from malaria.

This is, therefore, a tremendous human problem which is also a tremendous economic problem, because one of the features of the disease is that it has a debilitating effect upon the communities where it is rife. People come to accept their fate as normal in the sense that they are suffering at recurring periods from this disease. It makes people lethargic and robs them of the will to work. Therefore, the eradication of malaria in under-developed countries is, apart from the human considerations, a tremendous piece of economic capital investment, and it has tremendous effects in increasing the standards of life.

I understand that in India today there are still about 50 million people a year who become ill from malaria. The annual cost of malaria to the Indian economy has been estimated at more than £180 million a year. Yet an eradication campaign in India to get rid of malaria throughout the whole country would cost less than half the annual economic cost of the disease.

In Ceylon, where malaria has been eradicated, it has been estimated that the economy has been saved about £4 million per annum. In one year this is six times as much as the cost of the eradication campaign.

We are, therefore, dealing with a subject which has tremendous implications for the human race. I must now turn to the main issue, which is the way in which the World Health Organisation has been organising and financing the campaign.

In the immediate post-war period, the World Health Organisation and a number of Governments began an intensive campaign fighting malaria by the use of DDT and other insecticides. Good progress was reported in the early years. It was felt that there would be a steady reduction of malaria year by year and that one could therefore look forward to its disappearance by stages over a period.

Then, in about 1950 or 1951, it was realised that some strains of the malaria-bearing mosquito were developing resistance to the insecticides—DDT and the other substances—and that, although a number of insects were killed, a proportion was surviving which would then breed again. Because of that, the experts had to face the fact that they could no longer rely on steadily reducing the impact of malaria year by year, and that there had to be an intensive campaign with a view to wiping out the malaria-bearing mosquito altogether. Against that background, in 1955 the World Health Assembly launched the eradication campaign.

In doing so, the Assembly decided that the campaign should be financed by what was called the Malaria Eradication Special Account, which, in this age of initials, became M.E.S.A., but which is more often called the World Malaria Fund. The view of our Government at that time was that that was not the right way to finance it and that it should have been financed through the regular budget of the Organisation, and a number of other Governments took the same view. But it was decided to do it this way.

The campaign was started and by 1958 was under way, with real progress being made in the field. It was fairly soon realised that the fund itself was not meeting with the response hoped, and by the end of 1959 the position was serious. Only little more than £4 million had been subscribed and of that about 95 per cent. had been subscribed by the United States of America and the other 5 per cent. by relatively poor countries. Neither Britain nor any of the other developed countries had made a contribution to the special fund.

I quote from the report given to the Executive Board by Dr. Candau, the Director-General of the World Health Organisation: We had no illusions that the campaign would be easy. But the problems are being solved and, if eradication fails, it will not be for technical reasons but because we have not got the money to carry it out. The problem was brought to the World Health Assembly which in 1960 issued an especially strong appeal to all the countries concerned to contribute to the special fund.

As a result of that appeal, some other countries joined in. The Soviet Union offered a contribution, as did Australia, Norway and Western Germany, and other countries which up to that point had refused to join in. The British Government still refused. Questions have been asked in the House and there was a debate in another place on the matter. The Government's reasons could be summarised in this way: firstly, they felt that Britain was already making a big enough contribution because we were the third biggest contributor to the regular budget of the World Health Assembly, and we were also contributing in our own Colonial Territories and through United Nations technical assistance, and we ought not to be expected, therefore, on top of that to make a contribution to the special fund; they also felt that the regular budget was a better and fairer method doing this job.

Whatever may have been the virtues in that argument, it was a wrong policy in which to persist. The views of the Government have been stated at the World Health Assembly and have been out-voted. I should have thought that, as a good member of the United Nations and in view of the tremendous human issues involved, we would have come into line with the decisions reached and contributed to the fund. The argument that we were already contributing extra through our Colonial Territories, and so on, was out-balanced by the fact that those territories were themselves receiving aid and being helped by the eradication campaign and that the United States of America, the biggest contributor to the special fund, was also the biggest contributor to the regular budget and also making a special effort through its own Pan-American Health Organisation.

I feel that, in view of that and in view of the fact that the Soviet Union and other countries were joining in, we ought at that stage to have changed our policy. I should like to hear the comments of the hon. Lady on that.

More particularly, I want to refer to the position as it has developed this year. The World Health Assembly met again in New Delhi in February, reviewed the whole position, recognised that the special account was still not receiving contributions on the scale needed, and decided after all to adopt something like the original proposals of the British Government. It decided that the main burden would have to be shifted on to the regular budget of the World Health Organisation. I suppose it would be fair to say that it was the persistent attitude of the British Government over the years that led to that decision being reached.

If one looks at the conclusions in detail, these points emerge. It decided that the administrative costs of the campaign should immediately be passed over to the regular budget. Secondly, it decided that the cost of the programme in the field should be transferred by stages beginning in 1962, that there should be a rather larger transfer in 1963, and that the whole of the programme should be carried by the regular budget from 1964 onwards. Thirdly, it decided that certain countries would have to receive special credits—that is, countries with low national incomes which were carrying out an eradication programme of their own. There were seven countries specified to be in that position in the first year. Fourthly, it decided that the special account should be continued on the voluntary basis, first in order to meet the cost of the programme in the two-year period until the regular budget transfer, and secondly, to meet the question of credits to those nations I have mentioned. The way in which I read this resolution is that the special account would need to be continued indefinitely to pay for those credits. I am not sure whether this is a correct reading or not. I should like to hear from the hon. Lady on that matter in more detail. Whether that is so or not, certainly up to 1964 quite a heavy burden will be placed on the special account.

I come to the point: what should be the attitude of Her Majesty's Government now? I submitted a Question on 28th March to the Minister of Health as to what his policy would be and rather expected that, having gained the point on the main issue, the British Government would now be prepared to contribute to the special account in the interim period. I was very disappointed to get the reply which said that this would not be the case and that even in this interim period they would not be prepared to make a contribution to the special account. I should like to know why that is so. I think that the hon. Lady should tell the House. It seems to me that because the special account has to carry this heavy burden in the interim period—and we would all agree that it is vital that the programme itself should not suffer from lack of funds—we ought to meet the needs of the New Delhi resolution, which included an appeal to all the countries concerned to contribute to the special account.

I should like also to be told what is to happen and what is to be the attitude of the Government if it turns out between now and 1964 that there is a shortage of funds so serious that the programme itself is affected. Would the British Government be prepared to support the idea of a supplementary budget for the World Health Organisation in order to bring in extra funds, and, if so, how long that would take? Do they think the World Health Organisation has enough in reserve funds to meet such a contingency? Otherwise, a shortage of funds would hold up the programme. In view of that, and in view of the terms of the New Delhi resolution, would it not now be better for the Government to reconsider their attitude, and to say that they will make a contribution to the special fund?

We have to see this against the challenge of the malaria eradication campaign itself. It is wonderful that we should have now reached a stage at which it is possible in the foreseeable future to wipe out malaria throughout the world. I hope that the hon. Lady will agree that the British Government should not, by their dogmatic adherence to one method of financing the project, do anything to harm the progress of the project; not only that, but that they should do nothing which would appear to be harming it.

It appears to me that in the last few years the Government have not considered the effect of their attitude on opinion in the countries that suffer from malaria. If the impression were to be given that we do not care enough about the project, it would be a very serious matter. We should not drag our feet in any way, nor appear to do so. For those reasons, I should like to see a change in the Government's attitude; and to hear that they have decided to make a contribution to the world malaria fund.

11.56 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

My hon. Friend the Member for East Ham, North (Mr. Prentice) has put the case extremely cogently, and has in no way exaggerated the importance of the eradication of malaria. The successes of the post-war period in eradicating this disease in large areas of the world are among the most significant things that have happened for the human race. I believe that the possibility of the total elimination of malaria is far more important, and of far more significance to humanity—and I say this at the risk of appearing to be reactionary and conservative—than all the space travel and the putting of men into orbit that can be achieved by the great countries.

We are all greatly disappointed that the British Government have appeared to be dragging their feet in this matter. I know that the standard excuse, and I have heard it many times in this House, is that the Government feel that they contribute adequately to the agencies of the United Nations and are in principle opposed to contributing to special funds. I have never found that a particularly convincing argument. As my hon. Friend explained, there is here a need for some special contribution over an interim period, and I should have thought that Her Majesty's Government could meet such a demand without infringing that principle—even though one may not agree with that principle.

I hope that tonight we shall not hear the same rather niggling and parsimonious arguments that we have heard in the past, and that the hon. Lady will remember that in this matter, as in so many others, what this country does can influence many other countries; that we are looked to to give a lead. I do not honestly think that there can be any international cause which more deserves the Government's support than does that of eliminating malaria totally from the earth, which is a possibility if only the effort is made today.

11.59 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

I hope that the hon. Member for St. Pancras, North (Mr. K. Robinson) will not accuse me of being niggling, as I have given him some of my precious time for reply, and I must try to say quite a Jot in the remaining ten minutes.

The hon. Member for East Ham, North (Mr. Prentice) gave some of the history of this case, and much of the information about this particular activity of the World Health Organisation. I hesitate to take up time on further facts, but I must to some extent do so for the record because, with the hon. Member, I think it important to have it on the record, and to correct some misunderstandings.

We already contribute to malaria eradication in four ways—through the W.H.O. regular budget, through the U.N.I.C.E.F., through the U.N. Technical Assistance Fund—both of which make contributions to the W.H.O.—and, though this may not be strictly relevant it has a part to play in malaria, through the grants under the Colonial Development and Welfare Acts. The total expenditure under these Acts during the last twelve years was £760,000.

I mention those things because the situation is complicated and I think tends at times to become artificial in the light of the fact that the W.H.O. uses money from other sources as well as from the Malaria Eradication Special Account to carry out its operations against malaria. In fact, in 1961, of all the work done through the W.H.O. on malaria eradication the contribution from the M.E.S.A. was about one-third, and I think that I should again put the figures on the record.

The M.E.S.A. contributed 5.7 million dollars. The regular budget contributed just over 714,000 dollars. The extended programme of technical assistance contributed 639,000 dollars. The Special Malaria Fund of the Pan-American Health Organisation contributed just over 3 million dollars, and the other extra-budgetary fund, which was mainly the U.N.I.C.E.F., contributed over 8 million dollars, making a total of nearly 19 million dollars. It will be seen that this effort through M.E.S.A. was in fact a topping-up process of the whole of the effort of the W.H.O. in malaria eradication.

As the hon. Gentleman said, the M.E.S.A. was established in 1955 on the initiative of a group of about twenty-five countries. In those early days the major Powers, including the United States, were against this arrangement, regarding it as incorrect and unconstitutional to try to finance a great scheme of this kind by soliciting additional voluntary contributions from Governments. Subsequently, in 1957, the United States changed its policy and, as a great gesture, contributed 5 million dollars to the M.E.S.A.

The idea of a concentrated campaign to eradicate malaria has always seemed to us an essential part of the work of the W.H.O. We felt too that it was wrong in principle to try to finance it through voluntary Governmental contributions outside the regular budget of the W.H.O. That was the view of the Government, as the hon. Gentleman said.

We made our position clear from the beginning. We have never felt that it would be right to embark on voluntary Governmental contributions. We have made it clear that we are ready to see the cost of this enterprise transferred to the regular budget, and through the regular budget to pay our share.

The W.H.O. had its latest General Assembly in New Delhi almost exactly two months ago. This Fourteenth Assembly decided—that is, the majority decided, because, although the United Kingdom pays over 7 per cent. of the W.H.O. regular budget, it is only one of about a hundred voting members—to adopt a scheme which had the support of the United States of America whereby gradually over a period of four years these costs of the malaria eradication scheme, which are at present met by M.E.S.A., are to be transferred from the special account to the regular budget.

I think I should make it clear that at that Assembly the secretariat of the W.H.O. and the United States representative put forward a number of the schemes, the purpose of which was one way or another to transfer the cost of the M.E.S.A. to the regular budget. The United Kingdom delegate supported the scheme which would put any shortfall in voluntary contributions immediately on to the regular budget. He explained that this, no doubt, would lead to a considerable increase in the United Kingdom contribution to the Budget, but we were prepared to accept that on the understanding that it would mean proper budgetry control and fair sharing of the campaign between members.

The United States delegate, I understand, said it was clear that the programme could not continue on the present basis since it was lacking in two essential attributes—that is, certainty of continued and unbroken effort, and the full co-operation of all the parties concerned. He went on to say that financing by voluntary effort was frequently the most efficient method of beginning new activities, but once it became a regular feature of the work of an organisation, proper support was needed. The scheme adopted was one sponsored by the United States representatives, which provided for the transfer by stages and to a system of credits to countries carrying out their own malaria eradication schemes and having a low per capita income.

The administrative and operational costs—over 600,000 dollars—have already fallen on the regular budget in 1961, so we are paying our share of these. An additional 2 million dollars will fall on the regular budget for 1962, 4 million dollars on the regular budget for 1963, and the whole cost, about 6 million dollars, on the budget for 1964. This means an increase of over 20 per cent. in the budget for 1962 as compared with the original budget for 1961, the highest increase on record in the World Health Organisation, and I would remind the House that the United Kingdom is the third largest contributor to this budget, after the U.S.A. and the U.S.S.R. The working budget approved for 1962 is 23.6 million dollars, compared with 18.9 million dollars for 1961.

So in addition to our share in the administrative costs we shall pay 140,000 dollars of the additional 2 million dollars in 1962, 280,000 dollars of the additional four million dollars in 1963, and 420,000 of the total cost in 1964. In addition to this, the Assembly in February last, decided that during the transitional period member countries who are carrying out malaria eradication campaigns and have low per capita incomes, will get, through the budget, credits of 75 per cent. in 1962,, 50 per cent. in 1963, and 25 per cent. in 1964 to offset the increases in their contributions to the regular budget which this 20 per cent. increase in the total would otherwise cause.

About two-thirds of the member countries will get credits under this scheme, so, in effect, it is a group of about thirty member countries with relatively large per capita incomes which will in future share the burden which was in the past borne by a few volunteers but mainly by the United States, who contributed about 90 per cent.

As already mentioned, we have repeatedly made it clear, both within W.H.O. and in this House, that the earlier plan based essentially on voluntary contributions by Governments to a fund which forms no part of the regular budget, was not a proper way to finance a big programme of this kind.

In the past only about half the member countries have contributed to the special voluntary fund and, as already said, about 90 per cent. has been contributed by the United States of America.

This is a matter on which there is clearly room for differences of opinion, but the Government do not accept the view that we have an obligation to depart from our decision of principle and to make voluntary contributions. We have made it clear that we are ready to help through the proper machinery of the budget, where we should be doing so along with other member countries who make their properly assessed contributions and take a fair share of this responsibility.

There is no question of the United Kingdom not supporting malaria eradication provided the scheme is a practical one, and our record shows this. We have made substantial contributions to the technical side with research work, scientific knowledge, the application of that knowledge in the field, and with training facilities. Sir Gordon Covell, the Ministry's adviser on malaria, was awarded the Darling Prize at the last Assembly in New Delhi, with Dr. Gabaldon of Venezuela.

The additional scheme based on voluntary contributions by Governments is not the right way, but we are prepared to take our share of this on a regular World Health Organisation budget. This is what is happening. It is true that it is phased over the next four years, but we would have been willing to accept immediate transfer to the budget, but on the system now adopted we shall be bearing a substantially increased contribution over the years. To answer the hon. Member's question about a supplementary budget—and if that is put forward it will not I think, be for the first time—if the process is expedited, we are prepared to face that.

In the future the Director-General of W.H.O. will be able to go on planning more effectively than he has done in the past since he can put his trust in the resources of the regular budget rather than in the particular generosity of the U.S.A. Therefore, I hope that it will continue in the right way and thus ensure continuity in the job of work we all want to see done.

Question put and agreed to.

Adjourned accordingly at eleven minutes past Twelve o'clock.