Malaria No More UK Submission to the International Development Committee Inquiry on Extreme Poverty and the Sustainable Development Goals

About Malaria No More UK

Founded in 2009, Malaria No More UK is one of the leading UK organisations working to eradicate malaria worldwide. We work to unite policymakers, private sector actors and public audiences in this fight. We have offices in the UK and Kenya and work closely with our sister organisation Malaria No More US to help coordinate and drive global progress against malaria.

Key points

• The link between malaria and extreme poverty is stark. It impoverishes families, households and national economies. The impact of malaria is especially ferocious on the poorest who are least able to access preventive measures and medical treatment.
• Ending malaria is crucial to achieving a number of the UN’s Sustainable Development Goals.
• In 2020, disruption to malaria services due to the COVID-19 pandemic led to an additional 47,000 malaria deaths and has pushed countless more people into extreme poverty. Investments in tackling malaria also play a critical role in defeating COVID-19 and strengthening the infrastructure needed to improve preparedness for future pandemics. The Global Fund to Fight AIDS, TB and Malaria (Global Fund) is a proven and effective vehicle to channel investments to respond to the world’s deadliest infectious diseases and prepare for future pandemics in low and middle-income countries.
• The UK’s investments in tackling malaria help to lift women and girls out of extreme poverty. The Global Fund is one of the most impactful investments that the FCDO makes in supporting women and girls.
• The UK government plays a key role in shaping policy and practice through its voice and influence on the board of the Global Fund. The Commonwealth continues to be a key forum where the UK can play a role as a convener and work with both donor and endemic countries to drive forwards poverty eradication.
• The FCDO can help to reignite progress against malaria, as a major factor to tackling extreme poverty, by:
1. Making an early and ambitious pledge to the 7th replenishment of the Global Fund to Fight AIDS, TB and Malaria.
2. Investing in strengthening the community health systems to ensure that the poorest and most marginalised communities have access to the tools and treatments they need to fight COVID-19 and malaria, and any new diseases which could threaten global health security.
3. Providing long-term financing for malaria research to ensure the development of new tools needed to prevent, diagnose, and treat malaria.
4. Continuing to use its voice on the board of the Global Fund, and its role as a convener, particularly within the Commonwealth

Introduction

Malaria and the Sustainable Development Goals

The relationship between malaria and extreme poverty is stark. It impoverishes families, households and national economies. The impact of malaria is especially ferocious on the poorest who are least able to access preventive measures and medical treatment. In 2020, malaria claimed the lives of 627,000 people. More than two-thirds of these deaths were children under the age of five. In addition, in 2020, there were an estimated 241 million cases of malaria worldwide.

However, the burden of malaria is not felt equally between countries. The World Health Organisation’s (WHO) African Region[i] carries a disproportionately high share of the global malaria burden. In 2020, the region was home to 95% of malaria cases and 96% of malaria deaths.[ii] Even within a single locality, children of lower socioeconomic status are twice as likely to contract malaria than those of higher status.[iii] Many of these countries are Commonwealth nations, which the UK has long and established ties with.

Ending malaria is a crucial aspect of achieving many of the United Nations (UN) Sustainable Development Goals (SDGs). The following table emphasises the clear links between ending malaria and achieving the SDGs.

The UK’s role in ending malaria and achieving the SDGs

As argued by experts at the World Health Organisation, “there is no question that eradicating malaria would make the world healthier, more productive and more prosperous.”[xi] As the second largest international donor to the fight against malaria, the UK has been at the forefront of efforts that have helped to save over 10.6 million lives and prevent over 1.7 billion cases, over the last two decades.[xii]

However, progress against malaria has stalled in recent years, and the COVID-19 pandemic has emerged as an additional threat to malaria responses worldwide, increasing the risk of a malaria resurgence that could undo years of progress.

Today, the fight against malaria is at a precarious juncture, and without immediate and accelerated action further ground may be lost. This submission will outline how the FCDO can help to reignite progress against malaria, as a key contribution to tackling extreme poverty, including by:

• Making an early and ambitious pledge to the 7th replenishment of the Global Fund to Fight AIDS, TB and Malaria.
• Investing in community health systems to ensure that the poorest and most marginalised communities have access to the tools and treatments they need to fight COVID-19 and malaria, and any new diseases which could threaten global health security.
• Providing long-term financing for malaria research to ensure the development of new tools needed to prevent, diagnose, and treat malaria.
• Continuing to use its voice on the board of the Global Fund, and its role as a convener, particularly within the Commonwealth, to accelerate progress against tackling malaria and extreme poverty.

Malaria No More UK welcomes the International Development Committee’s inquiry on Extreme poverty and the Sustainable Development Goals and trusts that the following evidence supports the Committee’s goal of identifying the causes and solutions to ending extreme poverty and helping the UK to meet its obligations to the UN SDGs.

How might the FCDO’s strategy, policies and programmes need to change as the number of people in extreme poverty grows due to the global pandemic or the effects of climate change?

In 2020, disruption due to the COVID-19 pandemic led to an additional 47,000 malaria deaths and has pushed countless more into extreme poverty.[xiii]

COVID-19 has exposed weaknesses in health systems around the world, highlighting the need for countries to allocate more domestic resources to strengthening their public health systems. Equally, it has highlighted the importance of donor country investments to support developing countries to build robust and resilient health systems, both to tackle existing diseases, and prevent against the emergence of future pandemics.

Investments in vital pillars of the malaria fight, including data-informed decision making, functional supply chains, an incentivised workforce, and engaged communities, also play a critical role in defeating COVID-19 and strengthening the infrastructure needed to improve preparedness for future pandemics. Tackling malaria also de-burdens the health system from the strain caused by malaria, thus freeing up resources and capacities to fight COVID-19 and other health challenges. In the immediate term, preventing cases of malaria also allows for more focused and effective diagnosis and response to COVID-19 as the two diseases share the key symptom of fever.

As the number of people in extreme poverty grows due to the COVID-19 pandemic, it is vital that the UK continues to invest in efforts to strengthen health systems to tackle existing diseases and prevent future disease outbreaks which could further hamper progress towards achieving the SDG targets on extreme poverty. 

The Global Fund is the largest multilateral investor in grants for systems for health, investing more than US$1 billion a year to strengthen and build diagnostic tools and laboratory facilities; data and surveillance systems; procurement and supply chains; community systems and responses; and training of health workers.

The Global Fund is a proven and effective vehicle to channel investments to respond to the world’s deadliest infectious diseases and prepare for future pandemics in low and middle-income countries. In 2020 alone, the Global Fund disbursed US$4.2 billion to support countries to fight HIV, TB and malaria and strengthen systems for health, and approved an additional US$980 million in funding to respond to COVID-19, mitigate the impact of COVID-19 on lifesaving HIV, TB and malaria programs and make urgent improvements to health and community systems.[xiv]

Later this year, donor governments, including the UK, will be asked to continue to invest in the Global Fund at its 7th Replenishment Conference, which will be hosted by the USA. The UK has been a leading donor to the Global Fund since 2002 and remains the third largest donor behind the USA and France. These investments have yielded an incredible return and transformed millions of lives around the world.

It is vital that the UK government makes an early and ambitious commitment to the 7th replenishment of the Global Fund and use its influence and convening power to encourage other donors to step up, so the Fund can continue its lifesaving work over the next three years.

How effectively do the FCDO’s strategy, policies and programmes address the needs of women and girls in extreme poverty?

MNMUK welcomed the recent publication of the FCDO’s approach paper on the UK’s commitment to help end preventable deaths of mothers, babies and children under 5 by 2030, and was encouraged to see that malaria was highlighted as a key threat to pregnant women, and a major cause of child deaths.[xv]

Around one third of all pregnant women in sub-Saharan Africa suffer from malaria, putting them and their baby at risk. In 2020, malaria led to around 10,000 maternal deaths and 819,000 children being born with low birth weight.[xvi] Currently, less than a third of women receive the recommended three or more doses of preventative malaria treatment during their pregnancy. This is partly due to the low availability of quality medicine, but also because the treatment tends to be delivered primarily in healthcare facilities during antenatal care visits, and pregnant women from rural areas who do not have the means for transportation often miss them. In older children malaria episodes can cause anaemia which reduces children’s ability to learn and thrive. Girls are particularly affected as they bear the brunt of caring responsibilities which can result in missed school days. If malaria eradication was achieved by 2040, the number of school days gained for girls in agricultural households between 2018 and 2040 would be approximately 762 million.[xvii]

MNMUK was also pleased to see the FCDO’s approach paper recognise the importance of UK-backed research and development and Product Development Partnerships (PDPs) in tackling malaria and ending preventable deaths of mothers and children. UK government investment in Medicines for Malaria Venture (MMV) is helping to bring forward more effective treatments for pregnant women and children under 5 years of age and working with partners to establish new delivery channels involving community health workers to increase coverage and protect as many pregnant women as possible.[xviii]

Furthermore, UK investment in the Global Fund has supported the development of the world’s first malaria vaccine, which was developed by British company GSK, and has been approved for use in children by the World Health Organisation. Using this vaccine on top of existing  tools to prevent malaria could save tens of thousands of young lives each year.[xix]

The FCDO’s strategy and support in the life sciences sector must also be accompanied by long-term investment in academic research, both overseas, and here in the UK, which needs to be done in close partnership with the Treasury and BEIS. The strength of the FCDO’s strategy and policies for women and girls in this sector requires cross-departmental strategic vision.

MNMUK was also pleased to see a broad statement of support for the Global Fund in the FCDO’s Ending Preventable Deaths Approach Paper. Funding for the Global Fund is widely recognised as one of the most impactful investments that the FCDO makes in supporting women and girls. Since being founded 20 years ago, the Global Fund has saved 44 million lives.[xx] In 2020 alone, in countries where the Global Fund invests, 11.5 million pregnant women received preventative therapy for malaria.[xxi] The Global Fund also amplifies UK resources to achieve even greater results for women and girls. It plays a catalytic role in spurring greater investment through leveraging private sector financing and stimulating significantly increased domestic investments in fighting malaria.

It is vital that the FCDO’s new approach paper on ending preventable deaths is now operationalised and supported with targeted financial investments, including in research and development, PDPs, and the Global Fund.

How effectively does the FCDO review the outcomes of the projects and programmes it funds that tackle extreme poverty?

In 2016, the UK made a 5-year commitment to spending £500 million per annum tackling malaria. Progress against this commitment was input focused, and the FCDO reported each year how much money had been invested in tackling malaria.

Now that this overarching financial commitment has come to an end, it is unclear how the FCDO plans to track progress on malaria moving forwards.

Malaria No More UK would welcome the inclusion of a malaria focused outcome indicator, for example, as part of any FCDO framework for tracking progress against the Ending Preventable Deaths approach. For example, this could be lives saved or cases averted as a result of the FCDO’s projects and programmes that tackle extreme poverty.

What effect have the cuts in UK ODA had on the FCDO’s ability to address extreme poverty?

The cuts to UK ODA have had an impact on efforts to tackle malaria and address extreme poverty. For example, the cuts to the UK Research and Innovation agency (UKRI) as a result of the reductions in ODA have had an impact on key malaria research. A research programme led by Imperial College London and partners across Africa, focusing on the development of point-of-care diagnostics for malaria, is no longer able to apply for their next round of funding from UKRI, putting research into a critical area of infectious disease control in jeopardy. At the London School of Hygiene and Tropical Medicine (LSHTM), a four-year malaria research project exploring the increasingly important issue of malaria drug resistance has been cut by two thirds for the next 12 months, with knock on impacts for the researchers in developing countries who partner with LSHTM.

The cuts have also impacted the UK’s bilateral programming. UK ODA has made significant contributions to alleviating the malaria burden in Nigeria in recent years. The 2008-2016 Support to the National Malaria Programme in Nigeria (SuNMaP) was highly successful in targeting and planning effective intervention and saw national malaria prevalence among children aged 6 to 59 months decrease from 42% to 27%. As a result of the ODA cuts, the follow-up, SuNMaP 2 programme which began in 2018, was ceased with almost immediate effect three years before the programme’s planned end. This was an example of a programme that not only saved lives from malaria, but also increased the capacity of disease surveillance in Nigeria, which strengthened the ability of the health system to manage and treat other diseases in tandem. Malaria programmes such as these are vital for strengthening the infrastructure needed to detect and prevent future pandemics, including rapid diagnostics, disease surveillance, and supply chains that ensure essential tests and treatments are available everywhere.

Last year, Malaria No More UK welcomed assurances that the government would continue to fulfil their 2019 pledge of £1.4 billion to the 6th replenishment of the Global Fund. As we look ahead to the 7th replenishment later this year, it is vital that the UK continues its longstanding support for the Global Fund and makes an ambitious pledge. In addition, it is critical that the UK continues to invest in R&D to find new solutions to tackling malaria and other diseases which lead to extreme poverty. Much of this research is British led, from the development of new malaria vaccines by British company GSK and the Jenner Institute at Oxford University, to the next generation insecticide treated bed nets that have been pioneered by the Liverpool based Innovative Vector Control Consortium (IVCC). Finally, the UK should also look to protect investments in strengthening community health systems to ensure that the poorest and most marginalised communities have access to the tools and treatments they need to fight malaria and can combat emerging new diseases which could threaten global health security.

How can the FCDO play a more effective part in the eradication of poverty as a convener, thought leader and investor?

The UK government plays a key role in shaping policy and practice through its voice and influence in the multilateral platforms that make up the global health financing landscape. By doing so it is able to extend its reach beyond the countries in which it has direct bilateral engagement and plays a crucial role in global policy review and dissemination.

In particular, the UK plays a key role as a board member of the Global Fund. The Global Fund is an innovative partnership that pools resources, consolidates technical expertise and leverages increased investment from both the private sector and endemic countries. The UK should retain this position and continue to have strong influence as the Fund implements its new strategy.

Ahead of the 7th replenishment of the Global Fund, the UK also has the opportunity to help leverage financial support from other donor countries, including the US, and European partners like Germany and France. An early and ambitious pledge to the Global Fund would be a signal to other donors to step up, including the US, who has consistently been the largest donor. Given the Fund’s critical role in strengthening health systems and in pandemic preparedness and response, this replenishment would be a great opportunity for the UK to work with our US and European allies to build global health security.    

In 2018, as Chair-in-Office of the Commonwealth, the UK played a key role in convening both donor and endemic countries across the Commonwealth to unite behind a commitment to halve malaria by 2023 at the Commonwealth Heads of Government Meeting. In the same week, the UK government also co-hosted the Malaria Summit London, which resulted in financial, political and scientific commitments totalling £2.9 billion. The Commonwealth continues to be a key forum where the UK can work with both donor and endemic countries to drive forwards poverty eradication.

The UK government has also stated its ambition to become a science superpower. To achieve this ambition, it is critical that the UK continues to invest in science and innovation to tackle global challenges, including malaria and extreme poverty. British science has played a crucial role in the malaria fight. From the discovery of malaria transmission by Sir Ronald Ross in 1897, to the development of pioneering new vaccines and next generation insecticide treated nets, as mentioned above. Not only do these investments save lives, but they also demonstrate the UK’s scientific and manufacturing prowess on the world stage, lending significant weight to our diplomatic relations, and opening new business and trade opportunities to British entrepreneurs and researchers.

More information

For further information, please contact charlotte.dixie@malarianomore.org.uk

Witnesses

The following people would be happy to give oral evidence.

• Mr James Whiting Chief Executive, Malaria No More UK
• Miss Victoria Fowler Head of UK Advocacy, Malaria No More UK

We work with a range of partners and so would be happy to also connect you with other experts in the malaria field, including research scientists, community care providers, MNMUK Board members and a wide range of academics.

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