Global Health, Global Britain Contents

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3Aid and global health

Global health security

34.The UK is the second largest state donor on health,87 and has been at the forefront of recognising health as a security issue. “Health Is Global: A UK Government Strategy 2008–13” was a “game-changer”, explicitly recognising disease outbreaks abroad as a security risk at home.88 The country is a leader in the global health field. Jeremy Hunt told us that:

“Britain is one of a small group of countries that could play a defining leadership role because of international respect for the NHS and our global connections. Despite the things that went wrong last year, we are respected as a country that tends to take things such as the threat of pandemics seriously.”89

35.However, the Government has not published an updated comprehensive cross-government global health strategy since “Health is Global”, despite calls from the Independent Commission for Aid Impact.90 The lack of a public, up-to-date strategy risks damaging scrutiny and undermining coordination with UK partners, and leaves the role of health within aid spending unclear.91 A refreshed strategy has been in development since at least 2019,92 but the FCDO told us that it would not decide whether to publish the strategy until after the upcoming spending review.93

Aid cuts

36.The pandemic has triggered changes in UK aid and foreign policy. In June 2020, the Prime Minister announced the merger of the FCO with DFID, justifying the decision with reference to the pandemic:

to protect ourselves against another calamity, the UK will need to work alongside our friends to strengthen international bodies such as the World Health Organization, and help vulnerable countries to improve their health systems and achieve greater resilience. It makes no sense to ask whether it amounts to aid or foreign policy: they are one and the same endeavour94

In November 2020, the Government announced a cut to the overseas aid target, from 0.7 to 0.5 percent of gross national income, again justifying its decision with reference to the pandemic.95 There has been a lack of transparency around the cuts, with much of the information in the public domain drawn from statements by NGOs and multilateral bodies, rather than being shared in a proactive, clear and comprehensive form by the FCDO. In the absence of this information, we wrote to each relevant Department to request details of changes in aid programmes they manage.96

37.Strengthening health systems in low- and middle-income countries is key to building resilience to future pandemics, according to many pieces of evidence we received.97 If a country’s health system is weak and over-burdened, it will have a limited ability to respond to new outbreaks. Tackling other infectious diseases can help to develop the capacity and infrastructure to cope with the next pandemic, reduce the strain on health systems, and build trust between health authorities and affected communities.98 According to the Global Fund:

The capabilities and infrastructure we need to prevent future threats are largely the same as those we need to defeat existing diseases. Most low and middle-income countries based their COVID-19 responses on the laboratories, disease surveillance, community networks and supply chains that were created to fight HIV, TB and malaria.99

38.The FCDO told us that it had adopted this approach, moving towards a focus on strengthening countries’ capacity to run quality health systems and expand universal health coverage: “That strengthens global health security, because ultimately, those front-line services that we are helping to build will be where the next pandemic is identified and treated”.100 Despite these words, the Government is planning major cuts to spending on some health programmes for lower-income countries.101 For example, it will reduce funding for neglected tropical diseases by 90 percent,102 while a programme supporting health research for low- and middle-income countries saw a 50 percent reduction in its budget.103 The WHO has said that the funding cut to neglected tropical diseases is likely to cause between 20,000 and 30,000 deaths.104 UK Research and Innovation, which directs the government’s science investments, warned of significant impacts on its work, after its aid allocation was cut by almost 50 percent.105 This has hit research into areas such as malaria prevention—a field that contributed to the development of the AstraZeneca vaccine.106 This comes at a time when covid-19 has already increased deaths from other illnesses and disrupted other medical treatments, particularly in lower-income countries.107 When we asked the then-Foreign Secretary about these cuts, he told us that the Government had made the strategic decision to “[focus] our fire” on covid-19, as the “foremost public health challenge”.108

39.The pandemic has highlighted the global nature of health security, and the need for greater international cooperation in this area. In an interconnected world, health security is inextricable from foreign policy. A cross-Government strategy on global health security is important to UK leadership in this area, and transparency is vital to ensure proper scrutiny. It is near-certain that there will be another pandemic in the coming years, and the Government should learn the lessons of covid-19 and use them to prepare for the next pandemic. This should not mean focusing on covid-19 to the exclusion of other health issues—strengthening health systems around the world is an important part of building resilience to new outbreaks. Global health security should not be allowed to slide down the agenda once covid-19 is under control in the UK. In its response to this report, the FCDO should update the Committee on the progress of this strategy. It should complete and publish its global health strategy by the end of 2021.

40.The Government argued that the FCO-DFID merger would be an opportunity to align aid spending with diplomatic policy, with the potential for gains in global health security. We are concerned that the Government is squandering this opportunity by making ill-considered cuts to vital global health programmes. It is short-sighted to cut spending on neglected tropical diseases, or health research for lower-income countries, in order to focus on covid-19. These steps could undermine the response to covid, and put us all at greater risk from the next pandemic. In particular, cutting spending on important medical research and development programmes is a dangerous false economy, and could endanger Global Britain’s reputation as a science superpower. We are disappointed by the lack of transparency over the cuts, and over how the decisions have been made. In response to this report, we recommend that the FCDO provides us with a full account of the changes faced by aid-funded health programmes, with details on how decisions have been made on which to cut. It should publicly commit to reinstituting previous levels of funding to health research programmes as soon as the fiscal situation allows.