WRITTEN EVIDENCE BY RESULTS UK TO THE FOREIGN AFFAIRS COMMITTEE INQUIRY ON GLOBAL HEALTH SECURITY (GHS0017)

About RESULTS UK

RESULTS UK seeks to mobilise the public and political will to end extreme poverty. We undertake strategic policy, parliamentary and grassroots advocacy on three key determinants of poverty: economic opportunities, health and education, with a particular focus on child vaccinations, tuberculosis (TB), education and nutrition.

This submission will explore the following points, as outlined in the inquiry’s Terms of Reference:

●        The UK’s current approach to global health security

●        The UK’s role in future pandemic preparedness and prevention

●        The UK’s partnerships with global health multilaterals and how they have bolstered global health security

●        The FCDO’s role in vaccine development, equitable access and routine immunisation

As a member of Action for Global Health, RESULTS UK endorses its submission to this inquiry.

Part 1: International collaboration on global health security

a) What lessons has the COVID-19 pandemic taught us about the importance of international collaboration in securing global preparedness and resilience against biosecurity threats?
 

The international response to the COVID-19 pandemic has and will continue to rely heavily on infrastructures and systems built over decades of investment in global health. Diagnostic infrastructures built as part of international efforts to end HIV/AIDS and TB have been central to COVID-19 testing efforts. Diagnostic platforms, laboratories and staff that ordinarily provide routine HIV/AIDS and TB testing have been redeployed for COVID-19 purposes. Capacity and capability for epidemiological monitoring through disease surveillance networks established through the Global Polio Eradication Initiative (GPEI) have also been critical to understanding the spread of the virus in low and middle-income countries. Healthcare workers trained and employed through funding from multilaterals like the Global Fund to Fight AIDS, TB and Malaria, and the GPEI, have been at the forefront of providing care for COVID-19 patients, maintaining critical health services and running effective community-based public health messaging campaigns that have saved countless lives. Historical investments in global health research, including HIV and TB, have offered researchers working on COVID-19 tools a ‘running start’.

The establishment of the Access to COVID-19 Tools Accelerator (ACT-A) and the global response to COVID-19 builds on the efforts of key global health multilaterals like the Global Fund, which have been able to quickly leverage their investments and infrastructures to support COVID-19 programmes and efforts to mitigate the pandemic’s impact on vital health services. The ACT-A also builds on the efforts of the Global Action Plan for Healthy Lives and Well-being, and underscores the importance of effective coordination between actors in the global health space at the international, regional and national level.  Building on these experiences, the UK should leverage its forthcoming presidency of the G7 to further strengthen the multilateral system and ensure those leading global responses to COVID-19 have the resources they need to deliver their critical mandates.

b) Has the UK effectively used its position in multilateral organisations to promote international collaboration in response to COVID-19 and the global health security agenda?

The UK’s position as one of the largest donors to global health multilateral organisations gives it significant influence over their policy directions, which has placed a spotlight on its role during the pandemic. The UK’s role as host of the Global Vaccine Summit was a remarkable opportunity for major nations to come together and show political and financial solidarity with Gavi, the Vaccine Alliance (Gavi), as they raised US$8.8bn for Gavi to deliver its core 5.0 strategy, as well as their position as one of the key partners of the COVAX facility. Through its position on the board of the Global Fund to Fight AIDS, TB and Malaria, the UK supported grant flexibilities that enabled countries to quickly adapt essential health programmes and respond to COVID-19.

The UK has currently pledged £571 million to COVAX, of which £250 million is conditional on partner countries pledging in kind, with UK Foreign Secretary Dominic Raab announcing the UK would commit £1 for every £4 committed by Canada, Germany, Sweden and the World Bank Group. While we welcome the pledges made to the Vaccines Pillar and Covax, with around 75% of all UK financial commitments focused on vaccines, we urge the UK to ensure equal and fair focus on all of the ACT - A pillars to ensure that we build a holistic response to the pandemic. This includes meeting the ACT-A’s immediate funding need for US$ 4.6 billion as soon as possible, and to fully fund the US $38 billion by mid-next year, as well as closing the financing gap for the Global Fund’s COVID-19 Response Plan. The UK’s leadership of the G7 offers a crucial opportunity to close the funding gap and utilise its diplomatic position to encourage other donors to level up commitments.

c) How effective is the UK’s current approach to global health security?

Historically, the UK has been an international leader in global health security. As a leading donor, the UK enjoys strong relationships with global health multilaterals such as the Global Fund, the GPEI and Gavi and is able to directly influence their direction, policy and practices. These partnerships enhance the impact of UK aid in responding to global health emergencies and building pandemic preparedness. Not only do these partnerships maximise the UK’s impact in responding to global health challenges but they also complement the UK’s bilateral work with governments to build more resilient, sustainable and accessible health systems around the world.

The COVID-19 outbreak is an urgent reminder of the need to increase investment in building health systems that reach everyone, prioritising the most marginalised and vulnerable, and building strong international partnerships. The presidency of next year's G7 provides the UK with an opportunity to build on this further by bringing together the international community to develop a sustainable and holistic response to COVID-19 and bolster pandemic preparedness. A strong, well-coordinated and fully funded global health infrastructure is integral to improving global health security, strengthening health systems and responding to any future pandemics.

The UK’s approach to transitioning countries away from donor support is an important element of the UK’s current approach to global health security that requires improvement. Over the past decade, the investment approaches of multilateral and bilateral donors such as the UK, have largely been driven by a core determination of eligibility based on gross national income (GNI) per capita, as opposed to health and inequality indices. If a country becomes a middle-income country (MIC) donors often begin to reduce their funding and narrow the range of programmes they support. Economic growth can hide great inequalities in recipient countries, with some of the worst performing countries in health development indices often in the MICs category. For example, Ghana, which has become one of West Africa’s wealthiest countries after two decades of economic growth, has inaccessible and poor-quality healthcare services, which is worsened by its deep regional inequalities[1]. At present, health indicators are not given sufficient consideration in donors’ assessments of countries’ potential transition away from Official Development Assistance) ODA. The withdrawal of support before countries are ready to take ownership of their health systems, as well as the lack of coordination between donors on the transition planning, significantly weakens the ability of these countries to respond to pandemics, and leaves them vulnerable to future outbreaks and health crises.

RECOMMENDATIONS

1)      When assessing a partner country’s ability to transition, donors like the UK must consider contextual indicators such as the country’s poverty rate, public health, disease burden or education, which are the most effective criteria to evaluate countries’ capacity to reach the most marginalised and vulnerable populations. As part of this, coordination and communication between donors during transition assessments is essential.
 

2)      Use the UK’s upcoming G7 presidency to strengthen multilateralism and ensure sustainable health systems strengthening and investments in global health research are viewed as integral to the immediate response to COVID-19 and global efforts to build back better.
 

3)      The UK needs to use its influence and position on the boards of global health multilaterals to ensure alignment and coordination between key global health stakeholders on strengthening pandemic response, recovery and preparedness through comprehensive approaches to health systems strengthening.
 

4)      Encourage increased collaboration between global health stakeholders with the aim of reducing child mortality and progressing against commitments under the Global Action Plan for Healthy Lives and Well-being.
 

5)      The UK should ensure that the Global Fund’s COVID response mechanism remains fully funded, as it seeks to mitigate the secondary impacts of the pandemic and ensure health systems are strengthened.

Part 2: The UK, vaccine development and routine immunisation

d) What should the FCDO be doing to support research and distribution of a COVID-19 vaccine?

The UK government has committed over £474.5million to the Research and Development (R&D) of potential future COVID-19 vaccines, diagnostics and treatments. Furthermore, the UK has contributed £260 million for the Coalition for Epidemic Preparedness Initiative (CEPI) towards international vaccine research efforts for infectious diseases.[2] With millions of pounds of public money going into the R&D for future COVID-19 medical technologies, it is critical that the final products are sold “at cost”, and that pharmaceutical companies do not profiteer from public funding when governments are required to buy back the products that they initially funded the development of. In addition, there is a critical need to scale up geographically diverse manufacturing capacities, in particular in Low- and Middle-Income Countries (LMICs), so that the necessary quantities of final products can be produced on the scales needed to meet demand once they are approved. There is currently no clear policy from the UK public funding agencies to request that their grantees ensure effective technology transfer, open-sharing or licensing of COVID-19 medical technologies to facilitate diversified and sustainable follow-on development and manufacture globally, especially in LMICs.

The government has refuted the need to attach any safeguards on R&D funding into COVID-19, but is instead merely relying on the policies and practice of the institutions that a significant proportion of their R&D funding is channelled through. The UK Government needs to work alongside institutions like Gavi and CEPI, both key institutions of ACT-A, and take action to tackle intellectual property barriers that could lead to high prices or obstruct large scale global manufacturing, as well as ensuring that Gavi remains fully financed by adhering to pre–existing commitments. There is also a need to ensure that measures are in place to ensure affordability of final prices within their agreements with pharmaceutical companies to ensure every dose is allocated in line with the World Health Organization’s (WHO) Equitable Allocation Framework. If necessary, the government should not relinquish its responsibility to introduce stringent public interest conditions on their funding to ensure equitable access, in line with the majority of the UK public’s desire to see equitable access to COVID-19 technologies established[3].

RECOMMENDATIONS
 

It is critical that the UK government ensures that publicly funded R&D contributions ensure equitable access to COVID-19 medical products by attaching the following conditions to R&D funding:
 

1)      Final products are sold “at cost”, and are accessible to all, including low and middle income countries.
 

2)      Recipients of R&D funding are transparent about their costs, prices and data (see recommendations below).
 

3)      Exclusive rights are not granted for the final products, in order to facilitate production.
 

4)      Supply and ensure affordability. All products should have worldwide non-exclusive licensing and the right to use, produce and supply. This should be done through mandating health products that have received public funding to share Intellectual Property (IP), research and know-how with the WHO’s COVID-19 Technology Access Pool (C-TAP).
 

5)      Companies could voluntarily share IP, research and know-how through the C-TAP mechanism.

e) How can the FCDO ensure that COVAX is successful? What are likely to be the main challenges associated with worldwide distribution of a vaccine?

The worldwide distribution of a vaccine is complicated by the numerous candidates being developed by various pharmaceutical partnerships across the world, in which there exists a large diversity of requirements. For example, the vaccine developed by Pfizer and BioNTech (not yet part of the COVAX Facility, but has expressed an interest in a possible supply deal) requires a cold chain of -80C, whereas the vaccine being developed by Moderna can be stored in normal freezers (-20C) and can survive in a fridge for up to a month before its use. The diversity of requirements for each vaccine clearly displays the huge challenges associated with equitable distribution.

For COVAX to be a success fully funded health systems will be essential. That will require the UK to maintain the commitments to health multilaterals like Gavi, the GPEI and the WHO, to ensure there is sufficient capacity to enable the roll out of COVID-19 vaccines whilst not compromising the continued delivery of routine immunisation. With severe disruption to routine immunisation services due to COVID-19 (with at least 80 million children under age of one set to miss routine immunisation services and the WHO and UNICEF launching an emergency appeal due to the severity of polio and measles outbreaks), there is an urgent need to ensure that routine immunisation services are intensified and restored.  

Another essential tool in the fight to ensure the effective distribution of a vaccine is through the sharing of technologies, to ensure wide scale up manufacturing. The UK is well placed to ensure transparency and facilitate information sharing between actors in the private sector.
 

The FCDO can ensure that COVAX is successful in using its diplomatic network to raise awareness of Gavi’s investment case, which needs US$5bn for 2021.

RECOMMENDATIONS

1)      The UK should ensure that existing financial commitments made to Gavi and the GPEI are disbursed in full to ensure sufficient capacity for the rollout of COVID-19 vaccines whilst ensuring minimal disruption to routine immunisation services.
 

2)      The UK Government should ensure full transparency of stakeholder negotiations, production, price and stockpiling to permit accountability and responsibility of all countries and organisations involved.
 

3)      Use the FCDO’s strong diplomatic network to raise awareness of the COVAX investment case and emphasise the importance of ensuring it is sufficiently funded.

Part 3: Looking forward: The UK’s role in supporting global health system strengthening and resilience to future pandemics

f) What role should the FCDO play in bringing about a resolution to the COVID-19 pandemic and preventing future pandemics?

The UK has already demonstrated considerable leadership in its support for ACT-A’s work on developing and distributing an effective COVID-19 vaccine globally. However, this level of ambition has not been mirrored in its support for the diagnostic and therapeutic pillars, or the health systems connector. It is important to recognise that while a COVID-19 vaccine offers hope for a post-COVID world, the production and distribution of a vaccine to billions of people, including many in resource limited settings, will take many months even in best-case scenarios. In order to avoid the collapse of health systems and millions of preventable deaths in the meantime, sufficient investments in diagnostics, therapeutics, and health system components of the ACT-A are critical. To ensure the effectiveness of the UK’s response and set a vital precedent for other countries during its G7 presidency, the government should urgently mobilise additional resources in this vein. Given the unprecedented nature of the crisis, its impact on all areas of human development, and the profoundly negative implications of a failure to control COVID-19, it is reasonable to mobilise these funds from outside the traditional ODA budget.

Furthermore, bringing a resolution to the COVID-19 pandemic does not only require controlling the virus, but also addressing the many secondary impacts that are likely to cause greater levels of morbidity, mortality, and economic loss than the virus itself. In the case of TB, for example, WHO has projected that for every three months in which case finding is significantly reduced, we can expect to see an additional 0.2-0.4 million deaths this year alone, and many of the highest burden countries are now entering the 7th month of severe service disruption.[4] With the most critical infrastructures supporting the response to COVID-19 having been built through historical investments in multilaterals like the Global Fund and non-profit Product Development Partnerships, developing new tools to tackle global health challenges, pandemic preparedness, sustainable health systems strengthening and substantial funding for global health R&D must be seen as sides of the same coin. There is an enormous opportunity in ensuring current investments in COVID-19 and future investments in pandemic preparedness do “double duty” in strengthening our capacity to respond to emerging global health threats while also delivering on the government’s manifesto commitment to end all preventable deaths.

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

Similar lessons must also be applied to any efforts to strengthen global pandemic early warning systems. By establishing pandemic monitoring systems isolated from current global health challenges would result in a system unable to effectively monitor different populations’ vulnerability to pandemics or the interventions that could make a substantial contribution to increasing their resilience to outbreaks. For example, the rate of malnutrition can be understood as a risk for exposure to and deaths from infectious diseases and targeted nutritional support programmes could be critical in enabling outbreak control measures to be effective. Similarly, the government would be missing out on critical efficiencies that could be gained by failing to ensure that investments to strengthen diagnostic and monitoring capacity also support efforts to control established infectious diseases like TB which, despite the lack of public awareness, resulted in a staggering 1.4 million deaths in 2019 alone[5].

RECOMMENDATIONS

1)      Balance the UK investment in the global response to COVID-19, by leveraging additional resources in support of the diagnostic and therapeutics pillars and health system connector of the ACT-A.

2)      Mitigate the secondary impacts of the pandemic by channelling additional resources into critical initiatives like the Global Fund’s COVID-19 Response Plan, Nutrition for Growth, and the Global Polio Eradication Initiative.

3)      Ensure investments in the COVID-19 response and pandemic preparedness, including improved pandemic monitoring systems, are not siloed and make a tangible contribution to strengthening health systems and ending preventable deaths in non-pandemic contexts.

December 2020