Memorandum submitted jointly by the Department
of Health, Department for International Development and Foreign
& Commonwealth Office
INTRODUCTION
1. The Government welcomes the Committee's
decision to select this issue as the subject of its first inquiry
and looks forward to assisting the Committee's considerations.
This memorandum is submitted jointly by the UK government departments
responsible for the government's contributions in this area. The
Memorandum outlines the Government's overall approach to working
through intergovernmental organisations on health and specifically
on communicable diseases. The annex responds to the questions
set out in the Committee's call for evidence.
2. The Government architecture for dealing
with all the aspects of these particular diseases does not fall
to any single Department or Agency. The answer to question 6 in
the Annex does outlines the roles of most of the key Departments.
TACKLING INFECTIOUS
DISEASE
3. Throughout the world, communicable diseases
are a threat to economic growth and human development. Tackling
communicable diseases is crucial for the UK's security and if
it is to meet many of the Government's domestic and international
Public Service Agreement targets.[1]
4. Over 50% of all child deaths are attributable
to diarrhoea, pneumonia, malaria, measles and AIDS.[2]
Most of these deaths are in developing countries. Without tackling
them we will not meet the Millennium Development Goals (MDGs).
5. The World Health Organization (WHO) reported
that in 2005 there were 8.8 million new cases of TB and 1.6 million
deaths. Yet, if TB disease is detected early and fully treated,
it quickly become non-infectious and is eventually cured. Early
and complete treatment is also essential to ameliorate the increasing
global problem of drug resistance.
6. HIV is one of the greatest threats to
eradicating poverty, sustainable development and achieving the
MDGs. In sub-Saharan Africa, it is the leading cause of death
and the World Bank has predicted that, unless action is taken,
parts of Africa will face "economic collapse".[3]
Treatment programmes are increasingly being rolled out, but in
the developing world (at the end of 2006, most recent figures)
just over two million people in low and middle income countries
were receiving therapy. This represents 28% of those in need of
treatment. Europe is affected by HIV too, particularly in some
of the new EU member states and neighbouring countries in Eastern
Europe. In Western Europe, infection rates are continuing to rise,
although deaths from AIDS have fallen.
7. But communicable diseases are also a
threat to the UK. A Chief Medical Officer's report, Getting
ahead of the Curve, was published in 2002.[4]
It outlined the threat of infectious diseases to England and identified
a strategy for how England would tackle communicable diseases
more effectively. The report said that while major infectious
diseases kill only a small number of people compared to the past,
infection is still important: 40% of people consult a health professional
each year because of infection.
8. Emerging diseases remain a constant threat
to the UK and other countries. Since the 1970s, there have been
at least 30 new or emerging infectious diseases. Most have not
shown rapid global spread, but some have. Severe acute respiratory
syndrome (SARS) was one example where there was rapid global spread.
Between March and July 2003, there were 8,000 cases of SARS in
26 countries and 774 people died In Canada, SARS was estimated
to have cost the economy C$1.5 billion in 2003 The global economic
impact of SARS was estimated at US$30 billion.
9. During the four years 2003-07, avian
influenza (H5N1) has infected over 350 people in 14 countries
and over 217 have died.[5]
This virus could mutate and cause a human pandemic. While there
has not been a pandemic since 1968 another one is inevitable,
whether or not it arises from H5N1. Estimates are that the next
pandemic will kill between two million and 50 million people worldwide
and between 50,000 and 750,000 in the UK.[6]
Socioeconomic disruption will be massive.
10. The Office of Science and Innovation
(OSI) 2006 report on the Foresight Project, Infectious Diseases:
Preparing for the Future, comprehensively outlines the threat
of infectious diseases today and in the future.[7]
It considers the ways that we can respond by developing systems
to detect, identify and monitor new and emerging infections.
11. Tackling communicable diseases requires
a concerted effort from governments, non-governmental partners
and multilateral agencies. When agencies work together they can
achieve much. Immunisation programmes are a case in point. They
have underpinned much of the gain made in childhood survival over
the last few decades in developed and developing countries. Smallpox,
which had previously affected 10 million people per year, claimed
its last victim in 1978. We are now all working to ensure that
polio becomes the second disease to be eradicated.
THE ROLE
OF INTERGOVERNMENTAL
ORGANISATIONS IN
HEALTH
12. The Government attaches vital importance
to the international architecture, including organisations such
as the United Nations and the international financial institutions.
As the Prime Minister said in his speech at the Lord Mayor's Banquet
on 12 November, "To build not just security but environmental
stewardship and prosperity free of global poverty, I want a G8
for the 21st century, a UN for the 21st century, and an IMF and
World Bank fit for the 21st century". The Foreign Secretary
has also stressed the crucial challenge of using the international
system to create the necessary synergies for action. In his first
speech in July he said that "The risk of financial crises,
climate change, and health pandemics cannot be mitigated by individual
countries; they require collective action on a global scale".
13. As the Foreign Secretary's speech indicated,
there is increasing recognition that, with accelerating globalisation,
health is an issue that needs to be addressed across national
borders as well as across a wider range of government departments
than those traditionally associated with health policy. In response
to this the Government is currently developing a cross-government
Global Health Strategy that identifies how the UK will engage
on health internationally for the benefit of the UK population
and UK health protection, and for the promotion of better health
worldwide, including how the Government engages with international
organisations to achieve this.[8]
14. Intergovernmental organisations, including
the UN agencies, development banks, global funds and health partnerships,
have a central role in health and specifically the control of
the spread of communicable diseases. For example, the World Health
Organisation (WHO) has a crucial role in disease surveillance
and in providing high quality guidance to countries on acceptable
standards of disease prevention and treatment. It also makes a
major contribution through technical assistance to countries in
boosting basic health services, monitoring health outcomes and
accessing resources from global funds. The World Bank plays a
complementary role in assisting the development of health systems
to deliver the basic health services which help control communicable
diseases. The World Bank and the regional development banks can
ensure that health is prioritised in national development frameworks
and budgets. They will not move away from disease-specific initiatives
but complement health systems strengthening through broader financing
for public services and longer-term budgetary support. Global
health initiatives such as the Global Fund to fight AIDS, TB and
Malaria (GFATM) and the Global Alliance for Vaccines and Immunisation
(GAVI) also have a key role. It is estimated that the GFATM now
provides 66% of all global TB and malaria funding, and about 22%
of global funding for HIV/AIDS. It is estimated that GAVI has
prevented 2.3 million premature deaths, and has provided 166 million
additional vaccines. UNITAID (a new partnership) provides significant
funding for medicines for AIDS, TB and Malaria, and negotiates
significant price reductions and invests in "niche"
or neglected products (eg paediatric formulations of antiretroviral
therapy).
PROMOTING A
COHERENT INTERNATIONAL
RESPONSE
15. The Government works in close partnership
with these organisations to promote global health and the achievement
of the health-related Millennium Development Goals (MDGs) generally
and specifically to combat communicable diseases. A key part of
this is promoting effective operation and working together. There
is considerable scope to improve the effectiveness and coherence
of these and other intergovernmental organisations working on
health and communicable diseases by strengthening the performance
and accountability of individual institutions and encouraging
more effective co-operation between agencies, and between the
agencies and governments. The International Health Partnership
launched in September 2007[9]
is combining health system strengthening with improved alignment
by donors and international health agencies including those with
a disease-specific mandate.
16. The UK is committed to promoting a more
coherent international response to health, based upon a sensible
division of labour and joint accountability in supporting country
plans and priorities. The current architecture is crowded and
poorly coordinated. Within the diverse group of organisations
there is no agreed vision or clarity over roles. This is particularly
the case for WHO (WHO is either engaged in, or hosts, multiple
partnerships) and the World Bank over assisting countries to develop
national health systems. The International Health Partnership
represents a UK response, which helps encourage a common framework
for action on global health and a balance between disease specific
(vertical) and health systems (horizontal) investment.
17. The Government considers that global
health initiatives will also continue to play an important role
but the transaction costs they impose on governments must fall
and they must collaborate better with national processes in implementing
countries. They should also support strengthening of health systems
that deliver health services more broadly—for example, ensuring
better integration of common interests, such as reproductive health
and HIV and AIDS services. The GFATM is well placed to do this,
and to support comprehensive approaches to AIDS, TB and malaria
and underlying health services. GAVI, with long term and predictable
financing provided through IFFIm—the International Finance
Facility for Immunisation—can play a key role in helping
countries put in place stronger systems for vaccine delivery as
part of the overall effort to improve health services.
18. In the medium term, the Government believes
the large number of existing initiatives should be rationalised
through mergers. In the shorter term, the global funds, regional
and international finance institutions and UN systems need to
demonstrate much closer collaborative support of country health
plans.
UN REFORM
19. The UK strongly supports the UN reform
agenda for achieving greater coherence, effectiveness and efficiency
of UN to deliver progress against the MDGs. DFID spends approximately
$1 billion a year through the UN. It is important that these funds
are given in a way that advances the UN reform agenda across the
totality of the UN system.
20. This means making hard choices about
funding the parts of the UN system that are reforming and performing
well. While overall the UN makes a significant contribution to
health, duplication, overlap and competition between agencies
(WHO, UNICEF, UNFPA and UNAIDS) and numerous global health partnerships
leads to inefficiencies.
21. At the global level, health funding
to UN agencies is often fragmented and insufficient for the implementation
of strategic plans. DFID seeks to provide, and encourage others
to provide, central institutional support through core funding
to UN institutions which demonstrate results, not earmarked funding
to fight specific diseases. At a country level the UK supports
the creation of "One UN teams" that will respond coherently
to countries' developmental priorities. DFID favours funding joint
programmes under unified UN country plans rather than standalone
health initiatives of individual agencies.
January 2008
1 http://www.hm-treasury.gov.uk/pbr_csr/psa/pbr_csr07_psaindex.cfm Back
2
UK Chief Medical Adviser. Health is global: proposals for a UK
Government-wide strategy. London: Department of Health, 2007 Back
3
Bell C, Devarajan S and Gersbach H (2003) The Long-run Economic
Costs of AIDS: Theory and an Application to South Africa,
World Bank, www1.worldbank.org/hiv_aids/docs/BeDeGe_BP_total2.pdf Back
4
Chief Medical Officer for England. Getting ahead of the curve.
London: Department of Health, 2002 Back
5
http://www.who.int/csr/disease/avian_influenza/en/index.html Back
6
National Framework for responding to an influenza pandemic Back
7
Office for Science and Innovation. Infectious Diseases: Preparing
for the Future The Foresight Project. Department of Trade
and Industry. 2006 Back
8
The rationale for the Global Health Strategy is outlined in a
report by the Chief Medical Officer for England-Health is Global:
Proposal for a UK Government-Wide Strategy Back
9
http://www.dfid.gov.uk/news/files/pressreleases/ihp.asp Back
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