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IAVI submission to the International Development Committee inquiry on Extreme Poverty and the Sustainable Development Goals

February 2022

About IAVI

IAVI is a non-profit scientific research organisation dedicated to addressing urgent, unmet global health challenges including HIV/AIDS and tuberculosis (TB). Our mission is to translate scientific discoveries into affordable, globally accessible vaccines and other public health tools. As a Product Development Partnership (PDP), we support a network of partner clinical research centres in Africa and India, supported by donors including the UK government, and have our central clinical laboratory, the Human Immunology Laboratory, at Imperial College in London.

  1. The importance of global health

Extreme poverty has many causes, but one of the key drivers is poor health. Decades of research and practical experience have shown that poor health and infectious diseases (including but not limited to HIV/AIDS, TB and malaria) can seriously reduce household incomes, raise healthcare expenditures and debts, increase gender inequality, reduce educational outcomes, increase insecurity and act as a serious brake on economic development. Yet in regions such as sub-Saharan Africa, ill health remains rife: even before the COVID-19 pandemic struck, the WHO estimated that a third of the world’s population had no access to essential health services and almost one billion people were spending more than ten per cent of their household budget on healthcare. To give one specific example: although TB attracts less attention than some other health crises, it still kills the equivalent of over three thousand people every day, with over 90% of illnesses and deaths occurring in developing and emerging economies. The global economic burden of TB is estimated at over $20 billion, including $8.3 billion of TB control costs and $12 billion of lost economic output. Clearly, controlling or preventing the spread of TB would provide a major boost to efforts to reduce extreme poverty. And the same applies for many other infectious diseases. Before the Covid-19 pandemic, the WHO and World Bank already estimated that more than half a billion people worldwide were being pushed into or further pushed into extreme poverty because they have to pay for health services out of their own pockets, and said that the pandemic is likely to make the situation worse. This means that put simply, if we want to alleviate poverty, we need to improve global health.

  1. The need for new tools

There are many ways to improve global health, including (but not limited to) improving sanitation and hygiene, increasing access to clean water, building healthcare infrastructure and facilitating the delivery of things such as bed nets, antimalarial drugs and antiretroviral drugs. However, it is also clear that to sustainably improve global health over the longer term, the world needs to not only increase the supply of existing health technologies but accelerate the development of new tools. In the case of Covid-19, the world has made spectacular progress in developing new vaccines and treatments and rolling these out worldwide at unprecedented speed. However, the same unfortunately does not apply to other diseases: returning to the example of TB; the most widely-used vaccine, BCG, was introduced a century ago and still has serious shortcomings: while BCG has good efficacy in preventing severe TB disease in infants and young children, it does not adequately prevent pulmonary TB, and many lives are lost as a result. The last few years have seen some major breakthroughs in the development of TB vaccines, including the development of a candidate vaccine (M72/AS01E) which is significantly protective against pulmonary TB in HIV-negative adults with latent TB infection, - the first time in almost a century that a new vaccine has been shown to help provide protection against TB disease. Yet because the economic incentives for private sector investment are often limited, TB vaccine R&D remains seriously underfunded. And the same goes for HIV/AIDS, Ebola, Lassa Fever, snakebite and numerous other poverty-related and neglected diseases. Investment, while sometimes significant, does not come close to matching the scale of disease burden. Relatively modest levels of investment in R&D now could be truly transformational in improving global health – and hence reducing extreme poverty.

  1. The role of the UK government

The UK has for decades played a major role in global health, as the home of many leading research institutions and universities; as the host to a vibrant pharmaceutical industry; and as one of the most generous public funders of global health R&D. The FCDO and its predecessors have long recognised that supporting global health R&D, including HIV and TB vaccine R&D, is a powerful and cost-effective way of reducing poverty and accelerating progress towards the Sustainable Development Goals. In the past, serious investments have been made: in 2019, for example, the UK public sector invested a total of £151 million in global health R&D – almost as much as the European Commission, France and Germany combined. This investment has played a pivotal role in accelerating the development of desperately-needed new health tools including new vaccines, helping build clinical research capacity and clinical trials infrastructure in sub-Saharan Africa and elsewhere, training local scientists and improving access to local health services, and helping build resilience against emerging pandemics. Just as importantly, UK funding of large multilateral programmes such as the Global Fund and Gavi has helped accelerate the roll-out of existing drugs and vaccines, generating huge returns on investment. As recent experience with Covid confirms, global health is an area of genuine UK leadership, expertise and comparative advantage.

 

  1. Challenges and opportunities

Unfortunately, however, the UK’s role in improving global health, and in accelerating R&D, is now being seriously undermined. The first major problem is simply that the scale of the challenges in global health is growing rapidly. The current Covid pandemic has had a catastrophic effect on health and poverty rates many countries. As the Committee itself has noted, some estimates suggest that over 88 million people could fall into extreme poverty because of the pandemic. In 2020, the then Development Secretary (Anne-Marie Trevelyan) told the Committee that “a health crisis, a humanitarian crisis and an economic crisis … threaten to undo thirty years of international development work, … [with] secondary impacts which will be felt for years to come for the poorest.” She was right. UNAIDS has warned that disruptions to the delivery of antiretroviral therapy could cost more than 500,000 extra deaths from HIV/AIDS in sub-Saharan Africa in 2020-21, while global efforts to end TB risk being set back by five to eight years. Research compiled by the World Health Organization and the World Bank in December 2021, meanwhile, has shown that Covid is likely to halt two decades of global progress towards achieving Universal Health Coverage. An already very difficult job has got much harder.

Secondly, the UK government is unfortunately less well-placed to improve global health now than it has been in the past. This is partly a straightforward issue of funding: although recent years have seen blockbuster levels of investment in some multilateral initiatives such as the Global Fund, support for smaller bilateral initiatives such as R&D funding has been cut sharply. Funding for HIV vaccine R&D, for example, has been cut from an average of £9 million per year from 2007 to 2012, to £1.2 million from 2013 to 2017, and zero since then. Generally, the government had also (until Covid) deprioritized the development of new drugs and vaccines to fight poverty-related and neglected diseases, replacing sizable R&D funding lines open to competitive tender with smaller bilateral grants concentrated on a smaller number of recipients. To its credit, the government has sometimes attempted to compensate for these shifts and cuts by creating new cross-departmental  R&D funding initiatives such as the Newton Fund and Ross Fund, but these have had a different focus: the Ross Fund, for example, focused on neglected and emerging diseases and antimicrobial resistance, but did not cover existing serious pandemics such as HIV/AIDS and TB – and was eliminated in March 2021 anyway. Ongoing cuts to the Overseas Development Aid (ODA) budget also mean many organizations working on global health and global health R&D are now likely to have their budgets cut further. Furthermore, the merger of DFID with the Foreign Office seems to have weakened ministerial oversight of R&D issues, with expertise being lost and a narrower portfolio of R&D initiatives supported. DFID had built up decades of experience in managing projects directed at tackling diseases in low- and middle-income countries, and was well-placed to ensure global access was guaranteed, but the departmental restructuring means this focus on helping the poorest has been weakened. The government’s overall strategy with respect to global health remains unclear. Ironically, at a time when global interest in health R&D is at an all-time high, government support for many kinds of R&D has withered.

  1. Policy recommendations

As described above, there is much to commend about the UK’s track record when it comes to alleviating extreme poverty through improving global health. The government’s leadership in supporting Covid vaccine R&D is welcome and provides an opportunity to reinvigorate support for health R&D across the board. However, there is also a serious risk that increased funding and attention for Covid-related in initiatives will come at the expense of other global health initiatives, setting the fight against another diseases back by several years. Given the UK’s strategic strengths, and the continued desire to reduce extreme poverty, underinvestment in global health R&D in particular represents a missed opportunity. IAVI recommends that the government should boost its efforts to tackle extreme poverty by:

As the number of people in extreme poverty grows, it is increasingly important that the government behaves proactively rather than reactively; and focuses on delivering sustainable long-term solutions to crises rather than quick fixes which offer only a temporary improvement in outcomes in global health. A clearer strategy for global health, including sustained investment in R&D, can be a powerful way of achieving broader goals around economic development, gender equality and reduced poverty.

 

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