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Foreign Affairs Committee inquiry into Global Health Security

Written evidence submitted by the Foreign, Commonwealth and Development Office (GHS006)

Executive Summary

  1. The following submission by the FCDO to the House of Commons Foreign Affairs Committee’s Inquiry into Global Health Security provides answers in response to the Terms of Reference.

 

  1. The impacts of COVID-19 are broad and unequal: the IMF is predicting a 4.4% global economic contraction in 2020; UNESCO reports disruption to the education of up to 1.6 billion students; acute malnutrition is expected to increase by 14% by end 2020; and marginalised groups, including women and girls, people with disabilities, and refugees and displaced populations, are most likely to be disproportionately affected.

 

  1. The UK Government is therefore using the full range of development, diplomatic, national security and prosperity tools to galvanise the international response, in support of the most vulnerable. We are working closely with our international partners to ensure a co-ordinated, global and inclusive response, which enables all countries to build back better. We have announced up to £1.3 billion in UK Aid to counter the health, economic and humanitarian impacts, and to lead the search for a vaccine.

 

  1. The Prime Minister has set out a vision for a new global approach to health security to protect humanity from the next pandemic. This five-point plan focuses on:
      1. A worldwide network of zoonotic research hubs to spot a new pandemic before it begins, by identifying pathogens before they leap from animals to humans;
      2. Increased research and development and manufacturing capacity for treatments and vaccines to ensure tried and tested treatments are ready to deploy against emerging threats;
      3. Improved horizon scanning and early warning systems making best use of data and cutting-edge technology;
      4. Strengthened protocols and guidance for dealing with health emergencies and strengthened ability to share evidence and devise new guidance during a crisis;
      5. Reduced trade barriers that have impeded the COVID-19 response.
  2. The FCDO has a pivotal role to play in enabling the UK to work with others to deliver this vision.  The FCDO combines expertise on global health with diplomatic reach and a major portfolio of global investments. The UK is the second largest governmental donor to global health, investing up to £2bn annually, and our response to COVID-19 has demonstrated how our programmes can pivot to tackle new threats. 

 

  1. The FCDO is working with departments across government, in particular DHSC and Defra, to pool our collective health, research and diplomatic expertise to develop the detail required for implementation and international engagement under each element of the Prime Minister’s plan. The FCDO will continue to use its diplomatic and specialist health advisory networks to build international support for the plan, through multilateral fora including the G7 and G20, and working with key bilateral and external partners, including the Gates Foundation, Wellcome Trust and UK universities.

 

  1. We have grouped the Committee’s questions and our responses under three themes: international collaboration and lessons on COVID-19; research, financing and distribution of COVID-19 vaccines; and Global Health Security and preventing future pandemics.

 

 

International Collaboration and Lessons on COVID-19.

 

How the UK has promoted international collaboration in response to COVID-19 and on the global health security agenda 

  1. COVID-19 has demonstrated the need for a collaborative international approach to tackling pandemics and preparing for future health threats: none of us are safe until all of us are safe. The UK supports a strong and co-ordinated global health response to COVID-19 and the wider global health security agenda. Examples of how the UK has promoted international collaboration include:

 

  1. Supporting an approach of vaccine multilateralism to bring the pandemic under control and support global economic recovery.  The UK has been instrumental in shaping the COVAX Facility, in collaboration with Gavi, the Vaccines Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and World Health Organization. The UK was a founding donor for the COVAX Advanced Market Commitment (AMC) which aims to give low- and low-middle income countries equitable access to vaccines that are developed; supporting countries in tackling the virus and helping halt the global spread of the pandemic, keeping us all safe.

 

  1. Co-hosting an event on Vaccines, Therapeutics and Diagnostics (VTDs) at the United National General Assembly (UNGA) to bring together countries and international partners to showcase multilateral collaboration and commit to ensuring global equitable access to new COVID-19 vaccines, treatments and through the Access to COVID-19 Tools (ACT) Accelerator. Thanks to the UK’s leadership at UNGA, we and bilateral donors committed up to $1 billion to COVAX for low and middle-income country access and the World Bank announced a financing envelope of up to $12 billion for IDA and IBRD eligible countries.

 

  1. Securing agreement between the G20 Finance Ministers and Paris Club creditors to suspend all debt repayments for the poorest and most vulnerable countries until the end of 2020, providing up to $12 billion in additional fiscal space to fund COVID-19 response plans. This has recently been extended for a further six months.

 

 

  1. Looking ahead, the UK will use its 2021 G7 Presidency to ensure a coordinated G7 approach to the core international health and economic issues arising from COVID-19. This will focus on saving lives and protecting livelihoods; supporting a COVID-19 recovery that builds back better for our citizens and the wider world; and delivering positive outcomes for developing countries. 

 

  1. The UK is also looking to our future beyond COVID-19 and is pleased to have co-led the UN Financing for Development workstream on Recovering Better for Sustainability alongside the EU, Fiji and Rwanda. This is a real opportunity for us to shape a recovery that delivers cleaner, healthier, more inclusive, and more resilient health systems, economies and societies, that puts the 2030 Agenda for Sustainable Development and the goals of the Paris Agreement within reach. Our presidencies of the G7 and COP26 next year will allow us to continue to take a leadership role in building back better, demonstrating that we are a global force for good in the world.

 

Which countries have provided good lessons in how to combat COVID-19? What have embassies been asked to do to collect best practice?

  1. The UK remains a strong proponent for improved data and intelligence sharing, including best practice and lesson learning. In April 2020, the FCDO and Cabinet Office established the International Comparators Joint Unit (ICJU) to help maximise our learning from others. The FCDO and Cabinet Office use international data, including from the FCDO's overseas network, to provide timely, relevant and objective analysis of different countries' responses to the crisis. However, we also recognise that while COVID-19 is a global pandemic, no one country or region is alike, so determining causality between specific measures and incidences of COVID-19 is extremely difficult and therefore, there are limitations to the applicability of experiences from elsewhere to the UK.

 

  1. Nevertheless, as part of the COVID-19 response, the UK supports mechanisms for capturing and sharing information from country posts, our science programmes and academia. For example, through our collaboration with the Wellcome Trust funding the Social Science in Humanitarian Action Platform, we have contributed to better understanding the impact of COVID-19 prevention measures on the wider health care system in fragile contexts, the key considerations for home and community-based care, and evidence on the shielding of vulnerable groups.

 

  1. Together with the Bill and Melinda Gates Foundation, we are also supporting the COVID-19 Hygiene Hub, hosted by the London School of Hygiene and Tropical Medicine. This provides free, context specific advice on behaviour change to governments of developing countries and their development partners. They have published over 185 resources, which have been read over 50,000 times since April, provided rapid technical advice to 140 organisations in 59 countries, and delivered ongoing technical support to over 60 projects.

 

  1. The FCDO Chief Scientific Adviser is a member of SAGE and shares this information with the advisory group. This enables the Government to consider international experiences alongside wider evidence to formulate the most appropriate response at that time for the UK.

 

  1. Along with others, the UK supports robust governance structures and independent and transparent reviews of the COVID-19 response so that lessons can be learned and global preparedness enhanced. We are supporting the work of the current Independent Panel on Preparedness and Response (IPPR), led by co-chairs Ellen Johnson-Sirleaf (Liberia) and Helen Clark (New Zealand), due to report in May 2021, and engaging with other review processes underway. The Panel provided an update to the World Health Assembly on 10 November about the approach to the review, and the themes they are addressing. The UK will submit a formal response to the IPPR in due course, and we will engage constructively with thinking shared by other countries as this emerges.

 

 

Research, financing and distribution of COVID-19 vaccines

 

How the FCDO supports research and distribution of a COVID-19 vaccine and COVAX

 

  1. FCDO are mobilising international support for the main multilateral institutions involved such as Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) and supporting the Vaccines Taskforce to ensure that international efforts meet both global and UK domestic needs.

 

  1. The UK, along with many other countries, funds CEPI, an innovative global partnership working to develop vaccines against pandemic threats, including the largest portfolio of coronavirus vaccines. CEPI’s COVID-19 vaccine investments are guided by speed of development, scalability of vaccine production and equitable access. CEPI is committed to ensuring appropriate vaccines are first distributed to populations when and where they are needed, regardless of ability to pay. The FCDO has committed up to £210 million of UK Aid to CEPI and DHSC has provided an additional £40 million. The UK is asking all governments to contribute to this important global initiative.

 

  1. As set out above, in June 2020 the UK hosted the Global Vaccine Summit mobilising US$8.8 billion for Gavi, the Vaccine Alliance. This will enable the implementation of Gavi’s 2021 – 2025 strategy to strengthen immunisation systems and vaccinate over 300 million children against vaccine preventable diseases. Gavi will also play a vital role in recovering immunisation coverage levels in the post-COVID-19 period, which have been disrupted by COVID-19 control measures, particularly lockdowns.

 

  1. During the Global Vaccine Summit, the COVAX Advance Market Commitment (AMC) was also launched. The UK is a founding donor for the AMC, committing £48 million repurposed funds at the Summit. In September, the UK announced an additional commitment of up to £500m, of which £250m is conditional match funding, being unlocked as other donors confirm financial commitments to the facility. As of 16 November, the UK has unlocked 80% of its match funding target of mobilising $1 billion this year.

 

  1. The UK has also played a leading role in shaping the COVAX self-financing facility, in collaboration with Gavi, CEPI and WHO. Working closely with the Vaccine Taskforce, the FCDO continues to support the development of COVAX to ensure it is successful. The FCDO plays a key role as the UK representative on the Gavi Board and other Gavi governance structures that will provide strategic oversight for COVAX.  The FCDO also represents the UK on the board of CEPI, and is a key donor partner, along with DHSC, of the WHO.

 

  1. The FCDO suggested and shaped the World Bank commitment of up to $12 billion to support COVID-19 vaccines, therapeutics and diagnostics (VTD) access. This funding in loans and grants is aligned with and can support upper-middle-, lower-middle- and low-income countries engage with COVAX to co-finance procurement and vaccine delivery. FCDO is also working with regional development banks, including the Inter-American Development Bank and Asia Development Bank, to secure their support for their member countries to access COVID-19 vaccines, therapeutics and diagnostics.

 

Challenges to worldwide distribution of a vaccine and the role of the FCDO in ensuring cooperation in vaccine distribution

  1. COVID-19 vaccines will play an important role in ending the pandemic and supporting the global economic recovery. The international effort to develop and distribute them will however be shaped by geopolitical forces as well as global health requirements. 

 

  1. The UK believes that a transparent, rules-based, multilateral approach to vaccines is the most effective way to bring the pandemic under control as quickly as possible. However, there are multiple barriers to overcome to implement this approach. These include:
  1. The operational challenges of distribution, including cold-chain issues. For example, vaccines that need to be kept ultra-cold throughout the supply chain make deployment at scale to remote areas and areas with limited infrastructure very challenging.
  2. Ensuring that only safe and effective vaccines are used. This requires that robust and transparent regulatory pathways, quality assurance and oversight mechanisms are in place for countries with stringent regulatory authorities and those without.
  3. Information-sharing on vaccine trials, including on potential adverse events. The involves cooperation on information and data sharing, and testing and regulations, including surveillance and pharmacovigilance mechanisms during trials.
  4. ‘Vaccine nationalism’, a more unilateral approach taken by some countries in handling the pandemic. Countries only focusing on domestic vaccines needs and increasing population coverage as quickly as possible (before others can vaccinate highest risk groups) may limit the potential to have greater impact on the pandemic. Modelling by North Eastern University suggests that an equitable distribution of a first 2 billion vaccine does to high-risk populations globally could avert 62% of COVID-19 deaths, compared to only 33% of deaths averted if focused on only high-income countries.
  5. Vaccine hesitancy can also reduce vaccine uptake. This can be driven by local mistrust about vaccines, as well as deliberate hostile state narratives on vaccines risks. The spread of mis- and dis-information can inhibit public health responses, create confusion, distract governments and undermine public trust.

 

  1. The FCDO is involved in a range of activities that helps to address and mitigate the impact of these challenges. For example:
    1. To overcome the operational challenges, the UK supports and finances organisations with the expertise and history of delivering effective immunisation campaigns to support countries in preparing for vaccine distribution and deployment in 2021, including the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance
    2. Monitoring the World Health Organization’s Allocation Framework which will support evidence-based country allocation. The framework will operate in COVAX  through the Allocation Mechanism to ensure that all countries that participate in COVAX agree their National Deployment and Vaccination Plans (NDVPs) to vaccinate priority health, social care and other key workers and over time expand coverage to other priority groups to maximise the public health and socio-economic impact of vaccines.
    3. Through our position on governing boards and policy engagement at HQ and posts, we will ensure coordination between COVAX, WHO and multilateral development banks at both international and country level to support coherence on regulatory, financing and vaccine introduction and delivery planning and implementation. For example, the Gavi Board has approved the allocation of US$ 150 million from core resources for initial funding to prepare the 92 AMC economies to deliver COVID-19 vaccines, focusing on urgent technical assistance and cold chain needs with priority for 56 Gavi-eligible economies and others on a case by case basis.
    4. Supporting the key role of WHO Pre-Qualification, WHO SAGE and stringent regulatory authorities in approving vaccines that are procured or delivered by UN agencies and funded by multilateral development banks.
    5. To counter mis- and dis-information and ensure people in developing countries have access to accurate information on COVID-19., the FCDO’s has invested £1.1 million to support the Humanitarian-to-Humanitarian (H2H) Network to counter misinformation on the virus in 13 countries. Our Counter Disinformation and Media Development programme also supports networks that expose disinformation, including on COVID-19.

 

  1. Through the UK’s international engagement in forums such as the G7 and G20 and its role in global governance structures such as Gavi, CEPI, and the World Bank, the FCDO has promoted multilateral approaches to research, development, scaled-up manufacturing, procurement and distribution of vaccines. Gavi has raised $1.8 billion out of the $2 billion required by the end of this year to secure the necessary manufacturing capacity to provide 1 billion doses to the AMC during 2021.  Along with DHSC and others, we are championing equitable vaccine distribution, promoting the needs of developing countries and vulnerable communities, and ensuring that international organisations coordinate effectively on downstream delivery.

 

  1. The FCDO also promotes WHO’s role in providing robust technical guidance on specific COVID-19 vaccine use strategies to ensure maximum public health and wider impact. FCDO has a role in advocating for national, regional and global actions that will accelerate vaccine availability globally and especially in low- and middle-income countries. These include streamlining regulatory processes, product liability and indemnification and support for early country immunisation planning and preparation.

 

Global Health Security and preventing future pandemics

 

The role of the FCDO in bringing about a resolution to the COVID-19 pandemic and preventing future pandemics

 

  1. The Foreign Secretary set out HMG’s international response to COVID-19 at the outset of the crisis: secure a strong and co-ordinated global health response, particularly for the most vulnerable countries; accelerate the search for a vaccine, new drugs, treatments and diagnostics; support the global economy, keeping trade open and securing critical supply chains; and support British nationals overseas, including helping them to get home safely.

 

  1. The FCDO continues to work across Government to implement this plan and bring about a resolution to COVID-19, working particularly closely with DHSC as lead on global health security and the UK’s relationship with WHO. HMG is using the full range of development, diplomatic, national security and prosperity tools to respond to the impact of COVID-19 in vulnerable countries. We have so far committed up to £1.3 billion of UK Aid to counter the health, humanitarian, and socio-economic risks, and to support the global effort to find and distribute a vaccine, and to bring this pandemic to an end as quickly as possible.

 

  1. The FCDO has also adapted over 300 bilateral programmes and identified centrally managed programmes to channel resources to the response, to tackle both the direct and secondary impacts of COVID-19. For example:  
  1. In Ethiopia, the UK has worked with the Ministry of Health and other donors to protect funding for essential basic health services. Ethiopia was the first country in Africa to safely deliver a supplementary measles campaign during COVID-19, successfully immunising over 14 million children.
  2. FCDO is repurposing £8.5 million of existing spend for our ASCEND programme which tackles neglected tropical diseases, so that we can use this programme’s infrastructure and resources to support the national COVID-19 response efforts across 21 African countries. 
  3. Our funding to the Global Fund and Gavi keeps essential activities going. It has provided door-to-door distribution of long-lasting insecticidal nets to avoid large crowds at fixed distribution points; more than 200 million nets are on track to be distributed in 2020. The Global Fund has also allocated US$201 million of COVID-19 Response Mechanism for the provision of personal protective equipment.

 

  1. To set out the UK’s approach to preventing future pandemics, the Prime Minister announced a five-point plan at the UN General Assembly in September 2020. This plan represents a new approach to strengthening global health security.

 

  1. FCDO is working with DHSC and other departments to develop the detail required for implementation and international engagement under each element of the plan, using our public health expertise and our diplomatic network. The UK will use our G7 Presidency, our work with WHO and the other Tripartite agencies (the Food and Agriculture Organisation and the World Organisation for Animal Health), and wider multilateral and bilateral engagement, to collaborate with others to strengthen the global health security system in line with these five points.

 

  1. As part of preventing future pandemics, we will work with others to ensure lessons are learned from the international response to COVID-19, including those from the Independent Panel for Pandemic Preparedness and Response (IPPR) and the reports of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme, and the International Health Regulations Review Committee, which are due to be presented and discussed at the World Health Assembly in May 2021.

 

  1. WHO itself has an important role to play in continuing to lead the international health response, and supporting the world to prepare for and respond to all health emergencies. The UK has long been an advocate of reform in the WHO to ensure it is flexible and responsive to new global challenges and will continue to be so.  Our recently announced new £340m core contribution to WHO, for four years, will help to strengthen and further reform the organisation, including its work around future outbreaks and pandemics.

 

  1. The coming months are critical to WHO reform. Ahead of the G7, the UK will work with a wide coalition of countries to reform and strengthen WHO, including a number of Member States who are advancing positions on WHO reform and where areas of alignment are emerging. Key stakeholders include the EU, in particular with Germany and France; the US with Brazil; Japan; Chile; and Switzerland with Oman and Botswana.

 

The effectiveness of the UK’s approach to Global Health Security (GHS)

 

  1. The UK has a strong record in Global Health Security (GHS) through partnering and supporting others to prevent, detect and respond to health threats, as set out in the International Health Regulations (2005) (IHR). We champion the ‘all hazards approach’ to address infectious diseases, environmental, chemical, radiological and other hazards, and are committed to strengthening a ‘One Health’ approach, to work across sectors to manage the risks to human health of the interactions between humans, livestock, wildlife and the environment.
  2. The most recent assessment of the UK’s approach to Global Health Security – the Independent Commission for Aid Impact’s learning review on the UK Aid response to global health threats in January 2018 – was broadly positive, delivering a score of ‘green/amber’. The review found that “the UK government responded rapidly to address weaknesses in the international response system exposed by the Ebola crisis, developing a coherent and evidence-based framework for addressing global health threats and establishing a portfolio of relevant and often pioneering programmes and influencing activities”. The assessment recognised our influence on WHO reform and our success in securing global policy commitments on Antimicrobial Resistance (AMR).

 

  1. The learning review made four recommendations: (i) for HMG to develop a refreshed approach to global health security with a focus on strengthening country health systems, a broader set of research priorities and clearly defined mechanisms for collaboration; (ii) for the Department of Health (now DHSC) and DFID (now FCDO) to strengthen and formalise cross-government partnership and coordination mechanisms for global health threats; (iii) for DFID (now FCDO) to ensure sufficient capacity to coordinate UK global health security programmes and influencing activities in priority countries, including around the objective of strengthening national health systems; and  (iv) for DFID (now FCDO) and the Department of Health (DHSC) to work together to prioritise learning on global health threats across government.

 

  1. The Government’s response to these recommendations has included:
  1. Expanding membership of the cross-government Global Health Oversight Group to include all government departments and agencies involved in delivering HMG’s objectives on global health security;
  2. Strengthening investment in research and development of new products and tools to combat infectious diseases including those with epidemic potential and establishing new partnerships to provide better evidence about outbreak diseases, to inform more effective preparedness and response activities.
  3. Strengthening the FCDO’s Epidemic Threat (EpiThreat) Group which identify when an issue requires cross-HMG communication or escalation.
  4. Cross-departmental and agency collaboration on the two Ebola outbreaks that have occurred in DRC since the ICAI review, including through use of the pre-SAGE mechanism; 
  5. Recruiting new roles across FCDO and DHSC to enhance capacity and support coordination of cross-HMG working in Africa on GHS; enabling programmes such as the Tackling Deadly Diseases in Africa Programme (TDDAP) effectively to provide up to £20 million to the Africa Union’s COVID-19 Response Fund, making the UK the largest donor to the regional fund. 

 

  1. The COVID-19 pandemic has reinforced the importance of key elements of the UK’s approach to global health security, while also showing that we need to do more. Strengthening country health systems with integrated public health functions, as highlighted by the 2018 ICAI, remains vital. But the global system for ensuring countries are investing in preparedness and health security also needs to be strengthened, and the UK will adapt our approach in line with this. The five-point plan to protect humanity from future pandemics announced by the Prime Minister at the UN General Assembly in September 2020 provides the framework to work together to strengthen global health security.

 

What should a ‘global pandemic early warning system’ look like? What role should the UK Government play in its creation?

  1. The UK is taking forward discussions with key partner countries and organisations on how we can strengthen early warning systems for pandemics and other health threats – building on what already exists but ensuring we have a more robust system for the future, which incorporates a cross sectoral One Health approach. The Independent Panel for Pandemic Preparedness and Response (IPPR) and International Health Regulations Review Committee will also both consider this issue, and we look forward to their recommendations which will provide a sound basis for reform. We are considering issues such as: implementing the Intermediate Public Health Alert already under discussion at WHO to create a more graded warning system ahead of a Public Health Emergency of International Concern; increasing join up across human and animal health; and maximising the usability of platforms where data is accessed.

The role of FCDO removing tariffs on COVID-critical products and how FCDO can encourage further information sharing between countries

  1. As part of the COVID-19 response, the Government is balancing the need to develop domestic resilience in some critical supply chains, with a vision for the UK as a champion of free trade. The UK seeks diverse international supply chains and trading partners. Breaking down barriers to trade, particularly through free trade agreements, can encourage business to diversify their supply chains, which builds resilience. We are also supporting developing country governments to make proportionate, evidence-based trade-offs between containing the virus and maintaining open trade. Through programmes such as Manufacturing Africa, FCDO is funding support to governments to help them understand how their economies are being affected by COVID-19 and to shape their policy response. In the G20, we have succeeded in supporting developing countries by securing commitments on open supply chains.

 

  1. FCDO is also working to complement the activities of other government departments, inducing the Department for International Trade and the Department for Business, Energy and Industrial Strategy, to ensure that trade barriers are minimised to support the efficient and equitable distribution of future vaccines and COVID-critical products and consumables.

 

 

 

 

December 2020