IDC Inquiry on COVID-19 response
Written evidence from the Department for International Development on “the current situation and the immediate risks and threats” as part of the ‘Humanitarian Crises Monitoring: COVID-19’ Inquiry.
Date: 21 April 2020.
The Department for International Development (DFID) welcomes the International Development Committee’s inquiry considering the impact of COVID-19 on developing countries and the UK’s response. COVID-19 is the biggest threat this country has faced in decades – and we are not alone. All over the world we are seeing the devastating impact of this invisible enemy – both to global health and economies. As the Committee notes, developing countries – particularly those with on-going conflicts and/or humanitarian crises - face significantly different and difficult challenges in responding to this pandemic.
There has never been a more important time to deliver our UK aid commitment. Just days ago (12 April) we announced £200 million in new funding to slow the spread of COVID-19 in the most vulnerable countries, bringing the total amount of support from the British taxpayers, through UK aid, to £744 million committed so far to fight the pandemic. This makes the UK one of the biggest donors globally and we are at the forefront of the international response, using our aid budget and British expertise to stop the spread of COVID-19, support fragile economies, find a vaccine and save lives around the world - including in the UK.
Our experience tackling the Ebola outbreak shows that stopping the spread of COVID-19 in developing countries will help the world’s most vulnerable and keep Britain safe. We are strengthening fragile health services in the world’s poorest countries where the chance of the disease spreading rapidly is the highest. This will reduce the risk of future waves of infection globally.
We are helping the poorest countries – which represent a quarter of the world’s population - by supporting their economies and access to skills and education. Economic disruption hits the world’s poor the most, and would deepen the global economic consequences, making it harder for all of us to bounce back and prosper.
We are helping countries hosting refugees or those displaced from their homes, because of conflict or humanitarian crises, to get this terrible pandemic under better control. We want to avoid countries already suffering conflict and disasters becoming even more unstable; this would threaten global security, including for us at home. And we are using the best of British expertise, science, businesses, charities and influence for the global response.
We’re not doing this alone. The Prime Minister has called on his fellow G20 leaders to work together in researching a successful COVID-19 vaccine and ensuring that it is available to everyone. The DFID Secretary of State, alongside the departmental Junior Ministers, are working with their counterparts in governments around the world to ensure international support is targeted where it is most urgently needed to stop the spread.
Point 1: The emergence, incidence and spread of coronavirus virus infections and the Covid-19 disease in developing countries.
DFID has been tracking the emergence and spread of COVID-19 through the Research and Evidence Division (RED) Science Cell, which has been embedded in the response structure since the start of the crisis. This includes experts in public health and epidemiology, modelling of infectious diseases, humanitarian contexts, and economics – reporting to DFID’s Chief Scientific Adviser.
The DFID team draws on data and evidence from the SAGE, analysis from Public Health England (PHE) and the World Health Organization (WHO), and modelling outputs from leading UK universities including Imperial College London and the London School of Hygiene and Tropical Medicine. This analysis drives evidence-based decision-making by teams working across DFID and across Government on tackling the COVID-19 pandemic.
The first reported COVID-19 case outside China was in Thailand (13th January) and the first death outside China in the Philippines (2nd February), respectively. In Africa, the first confirmed case was in Egypt (14th February). As of 5th April, 47 countries in Asia and 51 countries in Africa have been affected. Initial cases in Low- and Middle- Income Countries (LMICs) were reported to be imported from South and Southeast Asian countries, including Malaysia, Nepal, and Sri Lanka. Local transmission in these areas followed quickly. Cases in Africa, especially sub-Saharan Africa, were slower to be reported but have steadily increased in the last several weeks. Across the continent, only three countries remain without reported cases.
The progression of the pandemic in LMICs has lagged behind HICs. This is partially due to geographical proximity or travel connections to China, and the risk of importation. However, most evidence also identifies limited capacity in LMICs for outbreak detection and testing as reasons for low case numbers and lagging timelines. This suggests that current caseload is likely heavily underreported in LMICs, and many countries are further along in their epidemiological curve than official data indicate.
Point 2: The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats (particularly relating to countries with existing humanitarian crises and/or substantial populations of refugees or internally displaced persons)
Imperial College’s modelling indicates that, in the absence of interventions, COVID-19 will result in 2.3-3.4 billion infections and 9.1-13.2 million deaths in LMICs this year, where there are already significant weaknesses in health systems as well as higher incidence of people at greater risk due to other medical conditions (such as HIV, TB, and malnutrition). The impact is likely to be ongoing for a significant length of time, with a likelihood of several waves of the pandemic.
If COVID-19 follows the trend of other outbreaks, the secondary impacts (including from containment efforts) of the pandemic on developing countries are likely to be even greater than the risks directly associated with the virus itself. These secondary impacts can be wide ranging. This could see a weakening of institutions, heightened instability, conflict, and interruption in vital social services and the reversal of progress in social sectors such as girls’ education. We may see increasing morbidity and mortality from other medical conditions and instability and insecurity exacerbated in developing countries.
COVID-19 will disproportionately affect countries with existing humanitarian crises, including countries in conflict and those at risk of seasonal climatic shocks. There are risks that disrupted trade and the effects of lockdown measures disrupt markets and affect countries and regions with existing high levels of food insecurity and malnutrition, which could deepen levels of needs. Global supply chains to deliver humanitarian support continue to be significantly disrupted and humanitarian access impacted, notably through hindering the deployment of essential international medical personnel.
Refugees and Internally Displaced People (IDPs) may be at higher risk of infection by COVID-19 and other diseases due to high geographical mobility, living in overcrowded conditions and urban environments, lack of safe sanitation and already poor health outcomes. Many are also in remote or hard to reach areas, whether geographically or as a result of conflict or other obstacles. Refugees and IDPs are also least able to cope with secondary impacts due to: limited access to already overstretched basic services; constrained livelihoods and access to basic assistance; marginalisation, social exclusion and stigma and discrimination that means they are less likely to seek, and be prioritised for, constrained health services.
People traditionally marginalised in society could also be disproportionately affected and COVID-19 risks reinforcing and exacerbating discrimination and inequality, including in access to essential support and services. Women, older people and people with disabilities are all likely to be more exposed to abuses and neglect and could be affected if lockdown measures prevent them from getting the necessary support from their social network. There is also the risk of increased domestic abuse.
In addition, based on previous, comparable responses there is a strong possibility of an increase in the number of Sexual Exploitation Abuse and Harassment (SEAH) safeguarding cases in the aid sector during the COVID-19 crisis and related response, despite strengthened protection and prevention measures introduced across the aid sector since 2018. This is for two main reasons: health and humanitarian are among the highest risk sectors in normal circumstances and both are likely to see a scale-up in programming, even if the safeguarding risk is potentially somewhat offset by limitations on access and movement for staff; and lockdowns and staff drawdowns will make it harder to detect, report and investigate incidents.
Deployment of security forces during outbreaks has previously been associated with an increase in sexual exploitation, abuse and harassment; increased humanitarian response may also heighten the risk of sexual exploitation, abuse and harassment in the aid sector. In countries with recent memories of conflict-related sexual violence committed by armed forces, the deployment of security services during an outbreak can create fear and tension and lead to further trauma for survivors of abuse.
DFID is working to disaggregate data for the pandemic by sex, age, disability status and other relevant characteristics, helping us track outcomes for the poorest and most marginalised to better understand and address differences in exposure, treatment and impact. We will also consult with and support organisations led by affected groups (women’s rights organisations, disabled people’s organisations, context specific excluded groups etc). We will put in place actions to mitigate against an increase in sexual exploitation and abuse and ensure our country preparedness and response plans are grounded in strong social analysis - to understand the current situation and to manage intended and unintended health, social and economic impacts of policies and mitigation measures.
Point 3: The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries.
There has never been a more important time to deliver our UK aid commitment and we have so far pledged £744 million of UK aid to tackle the COVID-19 pandemic, making the UK one of the biggest donors to the international response alongside the United States, Japan and Germany. The UK response is tackling the direct and indirect impacts of COVID-19.
The UK is committed to finding a vaccine, tests and treatments for all. Pioneering British scientists and researchers are at the forefront of the global race to find a COVID-19 vaccine, tests and treatments to stop its spread, including within the UK. The Prime Minister pledged £210 million of aid at the G20 leaders call on 26 March to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop COVID-19 vaccines, bringing the UK contribution to £250 million - the biggest donation by any country. And he also announced £40 million for research on new therapeutics and £23 million on diagnostics. He has called on other leaders to help fund the research, and support the international collaboration needed to accelerate the discovery and global availability of vaccines, drugs and diagnostics that are needed to end the pandemic.
We are using the best of British expertise, innovation and business to stop the spread of COVID-19, working closely with leading businesses, such as Unilever, to tackle the virus. Our £100 million partnership (£50 million from DFID) with the firm will tell one billion people around the world about the importance of hygiene and distribute over 20 million hygiene products.
By preventing the virus from spreading in the poorest countries through strengthening fragile health systems and sharing essential supplies we will save millions of lives and reduce the risk of future waves of infection, that could come to the UK. Our most recently announced support (12 April) includes £130 million for UN agencies, including £65 million to the World Health Organization (WHO), which is coordinating international efforts to slow infections and save lives. A further £50 million will support the Red Cross in difficult to reach areas such as those suffering from armed conflict, and a final £20 million will go to NGOs, including UK charities.
Only by working through multilateral organisations can we achieve the scale of action and coordination needed to overcome this global crisis. As a top donor, the UK is using our significant investment and influence within the UN, International Financial Institutions (IFIs), global health multilaterals, and wider international system to push for a strong a coordinated global response to the crisis. We are pressing the UN system and IFIs to coordinate their support in alignment with the WHO-led public health response and the OCHA-led humanitarian response, including effective coordination on the ground. And we are encouraging the IFIs to ensure that they rapidly provide financing and technical support to where the needs and risks are greatest. The UK is a top donor to Gavi, the Global Fund and Unitaid, all of whom are flexing rapidly to support the COVID-19 response.
We are also working to ensure that wider international and in-country responses are based on needs assessments and focused on the needs of the poorest, and encourage inclusive, resilient and sustainable growth - allowing countries to “build back better”. Our country teams are gathering live intelligence on how multilateral agencies are coordinating on the ground.
The UK is also addressing the impacts of COVID-19 on developing countries through intergovernmental forums such as the G7 and G20. Building on G20 Leaders commitment to “further step up coordination of their actions, including with the private sector, to support emerging and developing countries facing the health, economic, and social shocks of COVID-19”, the UK is pressing the G20 to commit to provide immediate resources to the WHO, CEPI and Gavi, the Vaccine Alliance. The UK will continue to work with the G7 and G20 to support the international response and to galvanise a more cooperative global effort in addressing the health, economic and wider impacts, particularly in the most vulnerable countries. We are engaging across government to harness the full range of HMG diplomacy efforts behind our lobbying priorities.
We are preventing the poorest countries – which represent a quarter of the world’s population - from collapse by supporting their economies and access to skills and education. Up to £150 million of UK aid funding will go to the International Monetary Fund’s (IMF) Catastrophe Containment Relief Trust (CCRT) to help developing countries meet their debt repayments so that they can focus their available resources on tackling COVID-19.
The UK has also worked closely with other G20 creditors and the Paris Club to provide a temporary suspension of debt repayments from the poorest and most vulnerable countries that request relief, further boosting countries’ capacity to respond to the crisis.
And we are preventing the humanitarian impact from deepening: As well as our humanitarian aid (DFID provided £1.6 billion in 2018 in response to humanitarian crises) the UK is the largest government donor to Education Cannot Wait, which is supporting children in 16 COVID-19 hit countries through $15 million of emergency grants. And UK aid support is challenging harmful misinformation about COVID-19in South East Asia and Africa before it can spread worldwide and cause damage here in the UK.
A number of existing DFID bilateral programmes are also being adapted to support communities affected by COVID-19 in partner countries. For example, the UK is making a significant contribution to government-led efforts to prevent and respond to cases of COVID-19 in South Sudan, including support for infection prevention and control as well as water, sanitation and hygiene activities. In Bangladesh, British support is providing a package of assistance which includes help to maintain essential humanitarian services and support Rohingya and host communities for COVID-19 preparedness in the Rohingya refugee camps.
DFID is working closely with our partners across Government, with a dedicated Hub supporting coordination and join-up. We work particularly closely with FCO teams on areas of joint policy, including on multilateral and bilateral coordination, and on wider international strategy; and in February established a joint DFID/FCO COVID International Taskforce to assess the longer-term impacts of COVID-19, and planning for the UK and global recovery from the outbreak.
We are working closely with bilateral development partners to coordinate an effective international response to COVID-19 and mitigate its effects on developing countries. We have ongoing engagement with partners on supporting vulnerable countries, with recent Ministerial and senior official contact with the G7, G20, World Bank Group, other Multilateral Development Banks and wider bilateral partners, including US, Canada, France, Germany, Sweden, Norway, Netherlands, Australia and the Bill and Melinda Gates Foundation.
Point 4: The impact of the outbreak on DFID’s operations (staff absences or reassignments, the impact of travel restrictions and other risk mitigation measures).
DFID is managing the same impacts that many organisations face, with illness in our workforce, and the need of staff to care for families and dependents. We have conducted detailed business continuity planning to ensure that essential functions continue in the UK and overseas.
Current staff absence rates remain low, with less than 2% of staff recording as absent on 6 April. Effective measures are in place to ensure continuity of critical operations, including ensuring core staff are trained on a broad range of activities so they can cover if someone was unable to, plus teams across the department that can be surged to support where necessary. DFID already had strong remote working systems in place, and the vast majority of staff are able to work remotely, with only essential staff remaining in DFID’s UK offices.
As of Monday 6th April, DFID staff in 35 overseas locations were in mandatory drawdown because of HMG concerns that we would not be able to provide adequate duty of care to the staff and dependents posted there (including provision of medical care, security and access into or out of the country). Of the 392 DFID Home Civil Service (HCS) staff in those locations, 74% have already or are planning to come back to the UK. These staff are working remotely as part of the country team from their accommodation in the UK. Meanwhile, 100 HCS staff are scheduled to remain in mandatory draw down countries alongside 560 Staff Appointed In Country (SAIC). In the process of drawing down HCS staff, DFID was successful in retaining health and humanitarian advisers at post in most countries to spearhead our country programme response to COVID-19. We are keeping capacity in drawn down locations under review in coordination with the FCO.
Point 5: Lessons identified and learned/applied from previous experience with infectious diseases (for example, Ebola); the implications for DFID’s policy on a global heath strategy.
COVID-19 presents different challenges to Ebola and we recognise that lessons may not always be applicable or directly transferable. However, there are a number of lessons from the Ebola response in Eastern DRC that may have relevance to wider infectious disease outbreaks, including COVID-19. These include the importance of using and strengthening existing systems where possible, rather than creating parallel ones.
To deliver this integrated response, it is important to ensure effective coordination and empowered UN leadership; a robust political economy analysis and conflict analysis as appropriate; and a sustainable response that contributes to recovery, preparedness for future threats (including climate change) and building back better. The Ebola response was driven by research and technological improvements – including trials of a new vaccine and use of randomised control trials and social science research to inform responses – which should also be replicated in other public health responses.
DFID is also drawing on lessons learned from such previous experiences with global health emergencies to help us pre-empt and mitigate the secondary impacts of COVID-19 on other priorities, such as the provision of essential health services including for other infectious diseases and sexual and reproductive health and rights. During the 2015-16 Ebola outbreak, for example, preventable deaths from malaria increased by around 50% in each of Liberia, Sierra Leone and Guinea. The number of additional deaths from malaria (around 10,623) is comparable with the total number of deaths from Ebola during the outbreak (around 11,325).
Unless anticipated and mitigated appropriately, the secondary impacts of COVID-19 (including some control measures) will contribute to health systems being overwhelmed. This may lead to them being unable to manage the pandemic, as well as reducing access to essential health services for care and prevention (e.g. immunisation) and potentially reversing progress on reducing cases and deaths from preventable diseases, during pregnancy and childbirth, and other health issues. Countries may restrict access to family planning and safe abortion services, affecting women’s health and rolling back sexual and reproductive health and rights.
Based on lessons learned from previous emergencies, DFID is taking action to support countries to: continue to strengthen health systems to provide essential health services, in a way that protects patients and health workers from being infected with COVID-19; prioritise prevention services as far as possible for both COVID-19 and other diseases; plan for disruptions to some immunisation services and treatment for chronic diseases; and think ahead to build back stronger health systems once the peak of the COVID-19 pandemic is over.
DFID’s immediate priority in terms of our global health strategy is supporting low- and middle-income countries in responding to the current COVID-19 pandemic with sustainable responses that also support recovery and preparedness for future threats: Building Back Better, ensuring that girls receive 12 years of quality education and working towards our commitment to end the preventable deaths of mothers, newborn babies and children by 2030. Prior to the current response, we were already working well across DFID, the Department for Health and Social Care (DHSC) and other departments to ensure a strategic approach to global health leadership and investment, including with strategic decision making and oversight through a senior level committee (the Global Health Oversight Group). We will consider the implications of the pandemic on cross-government global health security once the situation is more settled.
Point 6: Whether there are particular risks of transfer of the coronavirus from conflicted and fragile environments to other countries.
Global health experts have identified the weakness of developing countries’ healthcare systems as one of the biggest risks to the global spread of the virus. A ‘second wave’ of the pandemic emanating from the developing world would impact countries who are only just recovering and undermine current efforts to stop the spread of COVID-19 and protect vulnerable people. Typically, health and other systems in Fragile and Conflict-Affected State will be least able to cope with or respond to the additional impact of COVID-19.
Public health interventions in such contexts face additional challenges including low trust in state and public health institutions, weak communications, limited access to communities under the control of armed actors, and the manipulation of the response to serve political or criminal ends. Any response may be highly politicised and risks exacerbating pre-existing tensions and grievances, and there are also risks that responses are perceived to be politicised or unfair, further dividing societies and emboldening conflict actors.
Refugees and Internally Displaced Persons may be at higher risk of infection by COVID-19 and other diseases as a result of poor living conditions or limited access to services. Migrants are also exposed to many of the same vulnerabilities as other citizens, often to a greater extent, and are more likely to be in overcrowded households or employed in short-term, or precarious work with limited provision for sick leave. Any secondary or onward movement from these groups increases the risk of further transmission, including across borders.
We are helping refugees or those displaced from their homes because of conflict or humanitarian crises to access medical supplies and sanitation to prevent the humanitarian disaster that mass infections among refugees would bring. Existing DFID support such as hygiene, clean water and health programmes are already helping to reduce the risk and spread of COVID-19 in refugee and IDP situations and we are working with agencies on the ground to adapt programmes as needed to address specific risks.
Point 7: The risks of negative national or local behaviours arising from perceived risks of cross-border re-infections.
There are a number of risks both from states’ own management of risk and spread, and from perceived risks of reinfections. The capacity and ability of aid agency and international staff to protect and monitor has already been severely depleted and restricted as a result of movement controls linked to COVID-19. That means humanitarian operations will have less ability to deliver, to monitor aid delivery and ensure no diversion, and to be able to monitor protection issues, including for vulnerable populations and groups such as detainees, placing them at greater risk. Any response that is not sensitive to the local political context - working with local leaders, delivering in local languages and being considerate of local customs - will erode trust, undermine efforts to contain COVID-19 and in some cases result in resistance and conflict. Further, some parties to conflicts may use COVID-19 as a pretext to limit humanitarian access.
Governments which use ineffective or repressive measures to control the spread of COVID-19 may threaten human rights, state legitimacy and stability. Moreover, experience shows that disinformation campaigns around the crisis for political gain can create mistrust in the health response, reducing compliance with health advice and further exacerbating conflict.
There is a risk that minorities, including refugees and migrants, may have limited access to or be actively excluded from service provision, stigmatised, and may even be scapegoated and targeted. There is also the possibility of increased exploitation of those already at risk of modern slavery, forced and child labour and human trafficking as well disruption to longstanding and ongoing anti-slavery and anti-human trafficking efforts at national, regional and global levels (whether through the virus’ spread or as a consequence of measures to combat it).
Initial evidence indicates that COVID-19 is also likely to increase domestic violence and violence against women and girls: Police reports from China show domestic violence tripled during the epidemic. As well as experiencing the distressing effects of witnessing intimate partner violence, children are also at risk of increased domestic abuse, which may remain hidden as quarantine is enforced and will face particular protection risks when separated from their caregivers. DFID is working to ensure that the response delivers equitable and accessible COVID-19 health services, and prevention and mitigation measures; supports governments and partners to maintain and scale up social protection systems including social safety nets and humanitarian cash transfers; and that we scale up Violence Against Women and Girls (VAWG) prevention and response services and put in place actions to mitigate against an increase in sexual exploitation and abuse.
Point 8: The impact of the outbreak, and consequential mitigation measures, on fund-raising by UK-based development charities/NGOs.
We recognise the important contribution that charities, NGOs and wider civil society and community groups have to play in preparing for and responding to crises such as the COVID-19 pandemic. That applies at both a local and national level in developing countries but also to the crucial role that UK-based development charities and NGOs have to play in delivering more effective and safer responses.
We also appreciate that this is a difficult time for all such organisations, with concerns about their financial position and restrictions on their abilities to fundraise and to operate often coupled with an increased demand for their services and support from vulnerable beneficiaries. Civil society is a vital partner for DFID and we are committed to working in partnership with civil society organisations to meet the challenge of responding to COVID-19.
In line with the government’s overall approach, DFID’s approach to grant funding affected by COVID-19 is to work collaboratively with our partners to find flexible solutions that maintain delivery of essential programmes as far as possible. Ministers are in regular discussion with charities and NGOs to support them through the financial shocks COVID-19 has created.
Point 9: The impact of the outbreak on UK aid funding in the longer term.
As DFID responds to the challenge of COVID-19, we will need to adapt and prioritise existing programming planned for 20/21. Alongside our comprehensive COVID-19 response, which includes programmes in health, humanitarian support, financial aid and economic support, vaccines, and preparations for the recovery phase, work on other DFID priorities will continue.
More broadly, the impact of COVID-19 on UK Gross National Income and implications for the actual amount that 0.7% of GNI may reduce by in 2020/21 are as yet unknown. We are working closely with HM Treasury and will be getting information from the Office for National Statistics on this, which will allow us to make informed projections. But DFID has well established systems in place to ensure that we can deal with in-year changes, while maintaining a focus on good value for money.
We are clear that this response again demonstrates that the UK’s commitment to 0.7% - and the aid that we provide to the poorest and most vulnerable people in response to crises around the world - is also demonstrably in the UK’s own national interests. Diseases are global threats that have no respect for national borders and that put all of us at risk. By supporting developing countries with fragile health systems to properly respond to suspected cases of COVID-19, UK aid can help prevent the spread of the outbreak and reduce the risk of future waves of infection spreading around the world, including to the UK – ultimately saving lives in this country too.
By developing tests, treatments and vaccines for COVID-19 we increase the number of tools available globally and for our NHS in the UK to tackle the virus. What’s good for the global effort to tackle COVID-19 is good for the UK. And helping to reduce the economic disruption caused by the pandemic in developing countries makes it easier for us all to bounce back globally. The reality is that no one country is safe until every country is safe, and DFID will do all it can to help achieve that.