By Maham Malik
The UK is yet to dedicate a pledge to the Global Fund, an international organisation targeting Aids, Malaria, and Tuberculosis (TB) in areas of high prevalence, and has saved 50 million lives as of 2021. The Global Fund raises money in cycles of 3 years, and in this cycle, the Global Fund has asked for a 30% increase in funding in order to gain back the progress that was lost over the previous 3 years due to the COVID-19 pandemic. An analysis by the ONE campaign has calculated that: A £1bn, pledge instead of £1.8bn (the required 30% increase), would mean $1.3bn of potential US contributions would be lost, leading to 1.5 million lives being endangered and 28 million people contracting new infections.
This brings up another fundamental question:
What has the UK contributed to global health overall, and how have recent events changed this?
UK Legacy on Global Health
The UK has an overall high standing in the world of global health, and has historically prioritised global health as shown by the spending of foreign aid. In 2020, the UK was the second largest donor to health after the USA, and the percentage of UK aid given to global health causes has seen an overall increase from 2016-2020. (https://donortracker.org/united-kingdom/globalhealth). In regards to the Global Fund, it is their third biggest public donor, and played an instrumental role in its creation in 2002. (https://www.theglobalfund.org/en/government/profiles/united-kingdom/)
In the following year, UK prime minister Tony Blair and George Bush announced that they would increase their cooperative efforts in the fight against HIV/AIDS. Richard Feachem, Executive Director of the Global Fund, said that “Without the strong support of these governments, and Prime Minister Blair and President Bush personally, the Global Fund would not exist as a leading financier of effective interventions against the three diseases”.
More recently, David Cameron proved to be a prime example of UK leadership on global issues. He increased the aid budget to 0.7%, tripled funding to fight malaria, and increased research funding for infectious diseases. Under David Cameron, the UK displayed international leadership by dramatically scaling up aid spending and establishing British Ebola labs to combat Ebola.
After Cameron, Theresa May stepped up UK investment in the fight against AIDS, TB and malaria by increasing the UK pledge to the Global Fund by 16% in 2019.
The Current Aid Circumstances
In 2021, the UK decreased its foreign aid from 0.7% of their Gross National Income (GNI) to 0.5%, citing the economic impact of COVID-19 pandemic. The UK is the only G7 country to decrease their aid during this time, and this cut is expected to continue until at least 2024. Since 2009, this aid has predominantly been received by Africa, followed closely by Asia,(https://www.gov.uk/government/statistics/statistics-on-international-development-final-uk-aid-spend-2020/statistics-on-international-development-final-uk-aid-spend-2020#analysis-of-uk-oda-spend), with the top recipient countries including Ethiopia, Nigeria, and Somalia according to 2020 data.
So where does the money go? In 2021, Global health was cited as one of the seven funding priorities set out by the Foreign Commonwealth & Development Office (FCDO) (https://www.gov.uk/government/speeches/uk-official-development-assistance-oda-allocations-2021-to-2022-written-ministerial-statement), whose responsibility is to spend a majority of this allocated aid. However, the cuts made will negatively impact global health, and will impact the most vulnerable. The MP Andrew Mitchell famously said that the fall in aid “will be the cause of 100,000 preventable deaths, mainly among children”. Focussing on healthcare, the UK government has reported that in Africa, the largest decrease in aid was seen in the health sector.
The ONE Campaign, a global movement to end extreme poverty and preventable disease by 2030, reported in an analysis that the aid cuts will mean that 11.6 million children, women, and girls will no longer be reached by nutrition-related interventions, primarily affecting Nigeria. Also related to health, 5.3 million women and girls will not longer be supported with family planning. (https://www.one.org/international/impact-of-uk-aid-cuts/#2)
The cuts have also been felt in other healthcare areas, such as when the UK made no donation at the Nutrition for Growth summit, decreased funding for WaterAid, and also for Unicef. [EM1]
Another move made by the UK government that was widely criticised regarding global health, was the merging of Department for International Development (DFID) and Foreign & Commonwealth Office (FCO) to create the Foreign Commonwealth & Development Office (FCDO). Fears regarding the negative effects that this merger could have on aid distribution have recently become apparent
Aside from the change in amount of aid, the aid distribution has also changed. UK aid for 2021-2022 is to be provided to 39 countries and territories, a stark decrease from the previous year’s 136 (https://commonslibrary.parliament.uk/research-briefings/cbp-9224/).
Together, these two events have come together to bias the countries where aid is spent, where business and political benefits to the UK take precedent over the needs of countries. Out of the 34 remaining countries, less than half are low-income countries (https://blogs.bmj.com/bmj/2021/06/11/uk-aid-cuts-will-put-global-health-systems-at-risk/), whereas over half of the 102 cut countries are low-income countries. This BMJ article also highlights the phenomenon of donor concentration: when a country predominantly recieves aid from a few donors. This means that some countries felt the loss of UK aid more strongly than others; particular examples are of Gambia and Eritrea, who’s health aid predominantly consisted of UK aid (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00149-8/fulltext).
Summarised here are a few of the recent changes in the UK’s impact on global health, and how it is impacted by regional politics and events. However, this is only a snapshot of the current situation and there are many other events that have occurred under the shadow of the pandemic that impact on global health, many of which the effects will not be seen until later down the line.
To read more about the political climate affecting international healthcare systems and individual health, there are some resources below that delve into greater detail.
A special thanks to Emilia Micunovic of the ONE Campaign in aiding with the writing of this article.
Global Fund Website: https://www.theglobalfund.org/
ONE Campaign: https://www.one.org/international/
£1bn, pledge instead of £1.8bn (the required 30% increase), would mean $1.3bn of potential US contributions would be foregone, leading to 1.5 million lives being endangered and 28 million people contracting new infections.