Sightsavers’ submission to the Foreign Affairs Committee call for evidence on global health security (GHS0022)

About Sightsavers

1. Sightsavers is an international development organisation which works with partners to eliminate avoidable blindness and promote equality of opportunity for people with disabilities in over thirty developing countries. Our programmes also include working to ensure quality inclusive education, strengthen health systems and eliminate neglected tropical diseases (NTDs). Sightsavers leads a number of UK Aid funded health programmes, including the ASCEND programme, which is supporting the delivery of around 400 million treatments to help several countries to reach the elimination threshold for diseases and promote long-term sustainable change[1].
2. We welcome the opportunity to contribute to the Foreign Affairs Committee’s call for evidence on global health security.
3. Our submission focuses on the lessons learned of the COVID-19 pandemic, the role that the FCDO should play in bringing a resolution to the pandemic as well as preventing and reducing the impacts of potential future pandemics. The submission particularly emphasises the need for the FCDO to champion efforts towards incorporation of disability inclusion into global pandemic preparedness and response mechanisms, as well as aligning UK government’s approach to global health security with the 2030 Agenda for Sustainable Development.

Lessons from the COVID-19 pandemic on importance of international collaboration in securing global preparedness and resilience against biosecurity threats

4. The COVID-19 pandemic has left no country unshaken. The pandemic has also revealed fault lines in global preparedness architecture and the vulnerability of states and communities to the impact of public health emergencies. Prior to the pandemic, assessments on national health security preparedness revealed that no country was fully prepared to effectively deal with epidemics and pandemics, and yet little attention was paid to these revelations globally[2],[3],[4].
5. Clearly, no one country, organisation or community can singlehandedly mobilise actions required to prepare their systems to effectively deal with health threats that they confront in a globalised and closely interconnected world of today. Thus, international cooperation is critical for mobilising and sustaining efforts on global preparedness and response[5].
6. One of the ways to strengthen global health security preparedness is by implementing the International Health Regulation (IHR) 2005 nationally by all member states of the World Health Organisation (WHO)[6],[7]. Since the pandemic, it has come to light that implementation of IHR alone nationally is unlikely to result in preparedness levels that put countries in a position to effectively respond to pandemics like COVID-19. More needs to be done internationally to strengthen global preparedness which can only be achieved through stronger international cooperation, co-ordination, and leadership.
7. The need to develop stronger, more resilient health systems across the world has been exposed by the COVID-19 pandemic. In times of crisis, the first responsibility of the health sector is to save lives and provide health care where it is most needed. But this responsibility can only be carried out if health facilities and health services are functioning effectively. In many countries this is often not the case and health systems are weak. In times of crisis, systemic weaknesses and existing inequalities are exposed.

8. This context is relevant for people with disabilities and other marginalised population groups[8] in developing countries who are living in poverty.  The persistent lack of access to reliable quality health care increases people’s vulnerability over time, particularly for people with disabilities and other marginalised groups. Due to high levels of discrimination; inequality; barriers accessing education, employment, and healthcare; vulnerable livelihoods and inadequate social protection schemes, people with disabilities may be highly vulnerable to shocks and crises. This discriminatory context is exacerbated during disasters – which expose existing inequalities[9].

9. It has become clear that this is the case during the COVID-19 pandemic. The World Health Organisation and various other UN agencies have reported that people with disabilities are being disproportionately affected by COVID-19[10]. This disproportionate impact is being shaped by various factors, including the existing barriers that prevent many people with disabilities accessing adequate health care. UNDESA found that among 43 countries, 42% of people with disabilities perceive their health as poor, compared to just 6% of people without disabilities. People with disabilities are often more impacted by low quality or inaccessible health services than others in the population[11]. Inaccessible health facilities, transport networks and high costs can all make accessing adequate health care extremely challenging[12]. These barriers make accessing health care and life-saving information extremely difficult.

10. The issue of discrimination is particularly pressing. Due to discrimination during health emergencies and in contexts with limited resources people with disabilities may be less likely to be prioritised and allocated resources and treatments.[13]. Dangerous narratives have been emerging that people with disabilities cannot contribute to the response to COVID-19, make their own decisions[14] and most worryingly, that their lives are not worth saving compared to others – in direct contradiction of the UN Convention on the Rights of Persons with Disabilities (CRPD)[15] and all other human rights instruments. The International Disability Alliance have already collected reports that various countries are de-prioritising people with disabilities in medical triage and withdrawing life-saving equipment and support[16].

11. Another lesson is on data and surveillance systems to detect and report emergence and re-emergence of health threats. Disease surveillance, including, virus reporting and monitoring of viral mutation, is a IHR core capacity and should be a multilateral undertaking. As such sharing of surveillance data and information across countries and with multilateral organisations like WHO becomes crucial. However, as noted by the WHO in recent reviews of global data and surveillance systems, there are a few challenges that undermine the rapidity, robustness, continuity, and freedom of surveillance data sharing across borders and with multilateral organisations[17]. These challenges stem from ambiguities in data sharing criteria and lack of common approaches in surveillance modalities across countries[18].

12. Furthermore, surveillance and data systems are not designed to generate information on disability during epidemics and limited data exists on disability before and during health emergencies. The lack of evidence on the inclusion of people with disabilities in responses to previous diseases outbreaks, such as Ebola, means that the evidence base to build effective responses from is limited[19]. This impacts on the ability of governments and development actors to determine the impact, and identify appropriate responses, for people with disabilities[20].  Addressing these challenges requires international collaboration in articulating harmonised guidance and standards for health data terminology, disaggregation, and exchange[21].

13. These issues are mainly because of the exclusion of people with disabilities and other marginalised populations from mainstream pandemic preparedness mechanisms and health system strengthening policies and approaches. Existing global instruments for pandemic preparedness and health systems strengthening are not strong in mainstreaming disability inclusion. This is not limited to certain countries or settings and thus requires global recognition, attention, and international cooperation in addressing the issues.

Recommendations:

14. Working closely with people with disabilities and their representative organisations, the FCDO should take the lead in raising awareness and addressing these issues around disability inclusion and global pandemic preparedness and response mechanisms, to ensure all pandemic preparedness and response efforts account for their needs, and ensure diverse representation on all decision-making bodies.

15. Social protection measures are key to a successful pandemic response. The FCDO should support efforts to strengthen social protection systems globally which can be leveraged upon during pandemic response. Working with national governments and multilateral organisations, it is important that the FCDO supports efforts to incorporate social protection measures into global pandemic preparedness and response mechanisms. These must specifically be designed and deployed in a manner that ensures support for people with disabilities and other marginalised groups are sustained – and improved where required – during and after a pandemic.

16. Global health policy makers and leaders, including the FCDO, must ensure that the rights of women and girls with disabilities are embedded into all preparedness and response efforts to address the gendered impact of public health threats and emergencies.

17. Working with the WHO and other relevant multilaterals, the FCDO should lead efforts to support the strengthening and harmonisation of global surveillance and data systems for health security for ease of data sharing and reporting. This should also include collection of evidence and research on the impacts of health emergencies on people with disabilities, including supporting the disaggregation of monitoring and surveillance data by disability. The tools to collect better data on disability – such as the Model Disability Survey and Washington Group Question Sets – do exist, but are currently under-used, leaving large gaps in available data on which to act on before, during and after crises. Disability disaggregated data will help actors understand impact and allocate resources equitably – to effectively strengthen pandemic preparedness, response, and recovery mechanisms.

Increasing the effectiveness of the UK’s approach to global health security

18. The UK is recognised as a global leader in infectious disease control. This was clearly articulated in the development and implementation of the well-articulated strategy on Health is Global[22]. In addition, the UK has been influential in developing capacity and governance for responding to infectious disease across the world and playing a leading role in the WHO’s Global Outbreak Alert and Response Network (GOARN)[23].

19. Since the pandemic, it is commendable that the UK government has taken steps to continue to lead on issues relating to global health security including ensuring continuous funding to the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) amongst several other initiatives, hosting of the global vaccine summit and financially recommitting to Gavi, the Vaccine Alliance[24],[25].

20. While these efforts are a welcome development, it is important to make sure that these efforts are consistent with the principle of the 2030 agenda of leaving no ne be behind[26]. With people and countries facing more climate related shocks, the threat of major epidemics, the re-emergence of diseases, and anti-microbial resistance (AMR), it has never been more important that health systems are inclusive, resilient and responsive to protect the health of populations[27].

21. There is a meeting point between the COVID-19 pandemic and ongoing environmental disaster and climate crisis. It would be much more effective to tie together UK approach to global health security and climate change policies, while also ensuring a mainstreaming of disability inclusion and protection of the rights of people with disabilities[28].

Recommendations:

22. The UK government should continue to prioritise efforts to strengthen health systems to deliver Universal Health Coverage (UHC) globally, remove barriers experienced by people with disabilities in accessing affordable, quality health care, water, sanitation and public health information during and after the pandemic. FCDO should play a leading role in ensuring investments in health system strengthening efforts incorporate disability inclusion.

23. The FCDO should lead on ensuring the UK government’s approach to global health security, particularly for strengthening global pandemic preparedness mechanisms aligns with the 2030 Agenda for Sustainable Development and is consistent with DFID’s Strategy for Disability Inclusive Development published in 2018[29].

24. DFID’s Strategy for Disability Inclusive Development is currently being updated to be made relevant for the FCDO. Given the context of COVID-19 and the disproportionate impact it has had on people with disabilities, who already experienced worse health outcomes, health should be a core component of this strategy.

25. FCDO should endeavour to work with local health partners to ensure decision making is guided by human rights standards and respect to WHO guidance that decisions taken on allocating resources must never be taken based on pre-existing impairments or medical bias against people with disabilities[30].

FCDO’s role in ending the pandemic and preventing/reducing the impact of future pandemics

26. One of the ways to bring about a resolution to the pandemic is ensuring lessons learned so far are effectively used to reconfigure on-going response efforts as well as strongly incorporated into global pandemic preparedness and response mechanisms for future health emergencies.

27. Strengthening international collaboration is very much needed. The UK government has set a good example in strengthening international cooperation which is really needed to advance global health security outcomes.

Recommendations:

28. The FCDO should lead on efforts to compile lessons learned during the COVID-19 pandemic and ensure these are shared widely with global health actors.

29. The FCDO should facilitate a review of global pandemic preparedness mechanisms and ensure lessons from the COVID-19 pandemic inform the review process.

30. Following the review process, the FCDO should work with global health actors and multilaterals to develop a global pandemic mechanism that incorporates lessons learned from the COVID-19 pandemic and informed by other available evidence.

31. Within the new global pandemic preparedness and response mechanism agreed upon by global health leadership and actors, the FCDO should align and develop a cross-government Global Health Strategy to deliver the UK government’s investment priorities and policies for global health. The strategy should clearly articulate the UK government’s approach to global health security, and how it intends to address the current bottlenecks and gaps in the global pandemic preparedness and response architecture.

32. The UK should continue to work in partnership with UN agencies and other multilateral institutions, including by continuing current funding levels to the WHO to strengthen international cooperation on global health security.

FCDO’s role in ensuring COVAX success

33. For COVAX to be successful, there is a need to ensure that the vaccine deployment component of the COVAX facility is strengthened to guarantee optimal uptake of the vaccine at country level. The UK government already plays a prominent role in promoting international collaboration on global COVID-19 vaccine development and deployment evident by the critical contributions the government has made and pledged, including the decision to commit up to £571 million to COVAX[31].

34. It is important that the FCDO uses its global influence to facilitate equitable distribution of COVID-19 vaccine so that those in greatest need are not left unreached. It is critical to specifically prioritise deployment of targeted approaches to reach people with disabilities, as they face numerous barriers in accessing health interventions and often having higher healthcare needs.[32] Furthermore, FCDO should increase support for strengthening epidemic preparedness and response systems, as part of its overarching UHC and health system strengthening portfolio.

Recommendations:

1. It is important that the FCDO support developing countries to make sure marginalised groups, including people with disabilities, are reached by vaccines. Due to increased risk from COVID-19, and the discrimination they experience as outlined above, people with disabilities should be considered a priority population for vaccine roll out. Targeted approaches need to be developed and implemented to reach people with disabilities with COVID-19 vaccine.

2. Furthermore, working with recipient countries, the FCDO should ensure the organisations of people with disabilities (OPDs) are involved in vaccine deployment activities at the country level in order to ensure specific barriers to reaching people with disabilities are comprehensively addressed.

For more information about this submission please contact Tosin Adeyemo, Senior Policy Adviser for Health (oadeyemo@sightsavers.org) or Lauren West, Parliamentary Adviser (lwest@sightsavers.org)

December 2020

8