International Development Committee
Humanitarian crises monitoring: Impact of coronavirus
Written submission on behalf of Oxfam GB on longer term issues, implications and lessons to be learned.
7 May 2020
- Oxfam welcomes the opportunity to submit further into this important inquiry on the impact of Covid-19 on vulnerable populations in developing countries. Following our previous input, this submission is structured by the three pillars of an effective response to Covid-19: i) A global public health plan, ii) An economic rescue plan for all, and iii) The humanitarian response, concluding with a case study of the situation in Iraq. This submission will address other important issues related to Covid-19, many of which have not yet gained enough attention, and will focus on longer term issues and implications, as well as lessons to be learned from Oxfam’s response to the 2014/15 Ebola crisis in West Africa and the more recent 2018/19 outbreak in the Democratic Republic of Congo (DRC). Similarly to our first submission, the need for a gendered response to Covid-19 will be referred to throughout.
A global public health plan
- The UK must ensure that a Covid-19 vaccine and any effective treatments, if and when approved, are available to all as fast as possible and free of charge, ensuring that public investments into vaccine development prioritise public health.
- In order to learn from past mistakes and save lives within the response to Covid-19, the UK should look to key lessons learned from the previous Ebola outbreaks in West Africa and the DRC (including the impact of increased health care costs and health system capacity).
An economic rescue plan for all
- The UK (and other wealthy country governments), led by the G20, must urgently upscale their support to poorer nations, include providing cash grants to those who need them and bailing out businesses responsibly, alongside issuing at least US$1 trillion in Special Drawing Rights and the immediate suspension of developing country debt payments.
- In line with the G20 agreement on debt suspension, the UK should pass legislation to prevent any private lender from suing a developing country government for stopping debt payments in the 2020 emergency period.
The emergency humanitarian response
- The UK should review the key lessons learned from the Ebola crises in West Africa and the DRC, in order to learn from past mistakes and save lives within the humanitarian response to Covid-19, ensuring that community engagement with an emphasis on women’s participation is at the heart of the response.
- The UK should take immediate steps to garner international support for the global ceasefire; in response to Covid-19 and increase support to activists and organisations working for inclusive and sustainable peace.
Section 1: A global public health plan
- In our first submission to this inquiry, we set out the urgent need for the UK to increase its investments into public health spending in developing countries and scale up its support in 5 key areas: prevention; health workers; removal of financial barriers; public sector requisitioning of private facilities; and efforts towards a Covid-19 vaccine. This section will provide further information on the steps needed to ensure a Covid-19 vaccine is universally accessible, and present lessons learned from the Ebola crisis that can inform the global public health response to Covid-19.
A Covid-19 vaccine
- To save lives both in the UK and around the world, developing a Covid-19 vaccine must be an urgent priority. Oxfam welcomes announcements from the UK Government on new funding for Research and Development (R&D) of a Covid-19 vaccine. However, without a robust access strategy, there are no guarantees that a new vaccine will be accessible to everyone who needs it – both in the UK and developing countries (especially marginalised groups such as refugees, migrants and people from poor and disadvantaged communities). Everyone must have equitable access to a new vaccine for the global response to Covid-19 to be effective.
- Without safeguards in place, there is a danger that pharmaceutical companies could gain the rights to an exclusive Covid-19 vaccine. This could make the vaccine unaffordable for millions of people and have grave implications on the global spread of this pandemic. This would also create a barrier for researchers hoping to build on new knowledges and technologies.
- The UK must ensure that a Covid-19 vaccine and any effective treatments, if and when approved, are available to all as fast as possible and free of charge.
- The UK should take firm action to ensure that public investments prioritise public health over corporate profiteering.
- In the interests of global public health, the UK Government must impose public funding conditions on all UK funding committed to developing a Covid-19 vaccine. This should include:
- Ensuring the final product is affordable, accessible and available for everyone who needs it, including the UK and other countries (but not limited to low- and middle-income countries);
- Stipulating, as a condition of public funding, that any vaccine or medical product developed is licensed according to the principles of socially responsible licensing, including but not limited to preventing exclusive licensing;
- Ensuring that clinical trials resulting from publicly funded research are shared via a clinical trial registry;
- Committing to full price transparency of any products that derive from UK Government funding;
- Ensuring that R&D costs of any product are publicly available and shared with other Governments and the World Health Organisation;
- Introducing ‘step-in’ rights for the UK Government to issue non-exclusive licenses if a licensing partners fail to comply with the requirements of providing the health technology at an affordable and fair price.
Lessons learned from the public health response to the Ebola crisis
- It is important that lessons learned from previous global health crises are implemented within the global Covid-19 response. For example, during the Ebola crisis, due to existing inequalities (such as access to health services and water) between regions, socio-economic groups and genders in West Africa, the cost of paying for health services increased levels of poverty and inequality. Fees for health services delayed detection and the treatment of disease – dramatically increasing the risk of infection. Those unable to afford health care could only pay for unqualified and/or cheaper care, or not access health care at all.
- The diversion of aid to respond to Ebola heightened pressure on many health centres to increase user fees for other health services in order to sustain their services and provide an income for workers. High user fees during a time of lowered incomes increased levels of poverty and further reduced people’s unequal access to life-saving health care.
- Many health centres, if they existed at all, were unable to provide safely the services required, due to a lack of staff, medicines and health information. During Ebola, health systems were overwhelmed and unable to continue existing services, resulting in a dramatic rise in lives lost from other causes. In Sierra Leone, for example, there were almost as many additional maternal and neo-natal deaths as from Ebola.
- When Ebola struck, many affected countries had little capacity for surveillance, laboratory testing, contact tracing or infection control. Fear, stigma and a lack of trust in health facilities delayed effective responses. Vaccination programmes were suspended, making a million children in the worst affected countries vulnerable to measles.
- Affected countries were unable to contain Ebola within their borders. Unfortunately, the lessons from Ebola did not translate into the required investments in public health systems and pandemic preparedness. Only 3% of international recommendations for financing preparedness efforts have been achieved by the international community, with 50% seeing little to no progress.
- The Ebola crisis also highlighted the failure of the global R&D system. The system depends on monopolies of Intellectual Property, and therefore commercial interest, to incentivise pharmaceutical companies into research for new products. In the meantime, these Intellectual Property monopolies enable companies to dictate high prices for new products. The Ebola crisis illustrates why this system must change so that public health needs dictate the global research agenda and new products are affordable to everyone.
- The UK should review the key lessons learned from the Ebola crisis outbreaks in West Africa and the DRC, in order to learn from past mistakes and save lives within the public health response to Covid-19.
Section 2: An economic rescue plan for all
- As set out in Oxfam's previous submission, analysis shows that unless urgent and drastic action is taken, the economic crisis caused by Covid-19 could push over half a billion people into poverty. This could delay the fight against poverty by up to 30 years in vulnerable regions, including Sub-Saharan Africa, and disproportionately impact women and people of colour.
The economic impact of Covid-19
- Investors have already removed US$83 billion from emerging markets since the beginning of the crisis, which is the largest capital outflow ever recorded and risks millions of jobs and livelihoods. The UNDP has estimated that nearly half of all jobs in Africa could be lost, and globally, workers could lose as much as $3.4 trillion through lost income. The informal sector accounts for 90% of employment in developing countries, with no access to sick pay or other social protections. 400 million Africans already live on less than £2 a day and cannot afford to exercise the social distancing measures needed to keep themselves and their families safe.
- The UN Conference on Trade and Development (UNCTAD) estimates that $2.5 trillion is needed to tackle the pandemic, get poor countries and communities through the crisis and prevent global economic collapse. As outlined in our first submission, this should come from increased aid spending. UNCTAD estimate that it will take $500 billion in aid flows, and Oxfam estimate that the OECD countries should be responsible for $300 billion of this – which will necessitate many more countries meeting their 0.7% commitments. The rest should come from debt cancellation and the issuing of Special Drawing Rights by the IMF. In the longer term, taxation of those who can afford it will be an important part of funding a just recovery. Whilst DFID should not advocate specific forms of taxation to other governments, the ability of developing county governments to effectively tax should be aided by accelerated global action to adopt in a coordinated way minimum corporate taxes set at sufficient and fair levels, on a country-by-country basis, and based on a fair allocation of profits made in every country; to accelerate automatic exchange of information mechanisms for developing countries and publish multinational corporations’ country-by-country reports in order to return the money hidden in tax havens; and to require public country-by-country reporting by all large corporations.
- Due to the severe economic as well as health consequences of the virus, the priority areas for such funds – aid, as well as domestic resources freed up by debt relief etc., should be both public health and social protection, including greater use of cash programming to protect the poorest against loss of income.
Developing country debt payments
- Further to Oxfam’s first submission outlining the need for bilateral and multilateral debt suspension, the UK has an important role to play in the influence it exerts over private debt payments. The G20 Finance Ministers called on private creditors to “participate in the initiative [to offer a debt suspension to 77 vulnerable countries for 2020/21] on comparable terms”. Of bonds owed by the 77 low-income countries who qualify for G20 debt relief, 90% are governed by English law. This means that these countries could be sued in the UK for suspended debt payments because of Covid-19.
- The UK has the power to enable creditor countries to suspend private debt payments as per the G20 agreement without fear of being sued. The UK should pass legislation to prevent any private lender from suing a developing country government for stopping debt payments in the 2020 emergency period.
Special Drawing Rights (SDRs)
- The creation of at least US$1 trillion in new international reserves, or SDRs, would dramatically increase the funds available to developing countries during the crisis. SDRs are an international reserve asset, created by the IMF and defined as a weighted average of five convertible currencies. Although SDRs are not a currency, they are convertible, and by boosting country reserves, they can help free up vital fiscal space for greater health spending and spending to support the economy.
- SDRs have been drawn upon in previous crisis situations. For example, the G20 agreed to allocate $250 billion in SDRs to help bolster the reserves of IMF member countries in response to the global financial crisis in 2009.
- Given the scale of the recession from Covid-19, the G20 should immediately propose an emergency issuance of $1 trillion in SDRs. Approval would require 85% of the votes of IMF members, of which the UK is a leading voice. Rich countries should also agree to lend their currencies in exchange for lower-income countries’ SDR allocations, or a new mechanism could be set up allowing rich countries to lend their SDRs to the IMF and increase its lending capacity.
- The UK should use its global influence and leading voice within the IMF to support the issuance of at least US$1 trillion in SDRs, which would dramatically increase the funds available to poorer countries.
Social protection, cash grants and responsible bailouts
- The funds shored up by governments must be used on immediate and universal social protection, as well as the public health response. Cash grants and other forms of universal social protection are critical in the face of this crisis and can play a huge role in tackling inequality and protecting the vulnerable.
- Oxfam has already provided electronic cash transfers to over 50,000 people in vulnerable communities in Nairobi in response to the crisis. All workers suffering income losses need some form of income replacement, be it wage subsidy, unemployment benefit, sick pay or other benefits. Currently, only one in five of all unemployed people have access to unemployment benefits.
- Where no adequate social protection schemes exist, governments should provide income support through new cash transfers, seeking to include those not yet covered and expanding to all residents, including migrants and refugees. New measures must uphold women’s independent right to social protection and make sure benefits are adequate and reliable, coverage universal, protection comprehensive, financing progressive, and governance accountable. This is the time to take bold steps towards shock-responsive universal social protection.
- Stimulus packages and financial lifelines in response to the pandemic should also go to the most vulnerable – such as workers and small businesses who are least prepared to cope. Sectors that contribute to the climate crisis, such as fossil fuel extraction, should not be bailed out at all. It must also be recognised from the beginning that no bailout is gender neutral, and that the way in which bailouts are organised should aim to close the gap between women and men.
- Bailouts represent a huge opportunity to change incentives and business models permanently to help build a more human and sustainable economy where workers are treated fairly and our environment is protected. The UK and other governments have the power and the responsibility to act now and set in course profound changes to make our economy more just and fit to address the climate emergency, keeping the chance of limiting global heating to 1.5°C alive.
- The UK should champion an immediate increase in funding for cash programming where needed and in the medium term facilitate and champion a massive increase in universal social protection benefits, providing mass cash grants to enable people to survive and subsidies to workers to keep businesses afloat.
Section 3: The humanitarian response
- In our first submission to this inquiry, Oxfam set out six priority recommendations for humanitarian responses to the Covid-19 pandemic. These focused broadly on resourcing and shaping the response, including committing to its fair share of the Global Humanitarian Response Plan (GHRP) and ensuring that funding for pre-existing humanitarian needs continue to be met. It is important that the Covid-19 response is locally-led, gender- and conflict-sensitive, and recognises women’s leadership.
Lessons learned from the global humanitarian response to the Ebola crisis
- Lessons learned from Ebola outbreaks are also relevant to fragile and conflict affected contexts. Putting the community at the centre of treatment and prevention was a hard-won lesson during Ebola. However, this remains challenging to implement, as the need to respond rapidly and at scale can easily result in a top-down approach to communities.
- Community engagement has historically been deprioritised in the fight against diseases, including Ebola, which initially prioritise biomedical and militarised responses. Experience shows that this can deepen mistrust between communities and responders (even leading to violence), and undermine the uptake of public health messages which slows prevention and recovery.
- In fragile and conflict-affected contexts, trust in public authorities is often low. Decades of neglect and abuse of power, and lack of trust in the Government and authorities severely hindered the Ebola response in DRC. Health workers, burial teams and quarantine centres were all subject to attacks. There are indications that security-led lockdowns in response to Covid-19 in some places are already causing tensions.
- Early, accurate and transparent information is critical in helping people to understand and manage risks during disease outbreaks. However, if getting public health messages to people is prioritised, other vital actions can be missed, including listening, getting feedback, taking opportunities to identify information gaps, understanding barriers to behaviour change and building trust with communities.
- As set out in our first submission and emphasised by the lessons learned from Ebola, gendered vulnerabilities to the impacts of Covid-19 must be recognised and integrated into the humanitarian response. The important role of women as frontline responders must also be acknowledged and context-specific gender analysis should be the cornerstone of any response.
- A review of gender mainstreaming in Oxfam’s West Africa Ebola Response had the following findings:
- Be bold and creative in approaches to meaningful participation of women, particularly in top-down militarised responses;
- Responses should create women-only spaces, help raise women’s voices, engage with women’s organisations and ensure women are invited to share their experiences and opinions;
- Community engagement can help to bridge the gap between high-level decision makers, (male) community leaders and women, providing targeted information and communication opportunities for women;
- Supplement top-down standardised messages with targeted messaging. Women and girls (as well as other traditionally marginalised groups) do not have the same access to information as men. Including women in campaign design can improve outreach and uptake.
- However, just gender mainstreaming is not enough, and Oxfam’s experience of working in crises has shown the importance of maintaining stand-alone gender programming. This includes funding and support for programmes supporting survivors of gender-based violence, particularly support to frontline responders running refuges and shelters; continued support for sexual and reproductive health services; and tailored support to women and girls in response to the pandemic.
Funding & the Structure of the Response
- Similarly to the current situation, funding for the recent Ebola response in DRC was largely channelled to UN agencies. This left implementers (national and international NGOs) struggling to respond at speed and scale, as well as reinforcing the top-down nature of the response.
- Oxfam’s experience in responding to Ebola highlights the danger of unilateral and medicalised responses. There are indications that some of these lessons are already being learnt in the global response. However, Oxfam remains concerned that the absence of humanitarian perspectives can undermine response effectiveness and stifle the development of multi-disciplinary solutions. There are also concerns that gender and protection will be de-prioritised in the second Global Humanitarian Response Plan (GHRP).
- As discussed above, the economic impact of Covid-19 is already being felt. In many places, the current pandemic is additional to other crises. The World Food Programme’s report on Global Food Crises in April 2020 warned that the number of people on the brink of starvation could nearly double from 135 million to 265 million as a result of the pandemic. On top of this, millions more could suffer from hunger and food insecurity. Women are especially vulnerable to food insecurity.
- Communities have told Oxfam that they expect to die of hunger before getting sick from Covid-19. Localised shocks to food systems are already occurring, as movement restrictions of both people and goods disrupt global supply chains. Supply shocks, export restrictions and hoarding are increasing the price of food at a time when many people are earning less. This will hit vulnerable communities and individuals the hardest.
- The UK should consider how funding can be channelled most effectively to frontline responders, and in line with Grand Bargain commitments on localisation which commits donors and aid organisations to providing 25 per cent of global humanitarian funding to local and national responders.
- The UK should review the key lessons learned from the Ebola crises in West Africa and the DRC, in order to learn from past mistakes and save lives within the humanitarian response to Covid-19.
A triple-nexus approach
- Covid-19 offers an opportunity to strengthen a “triple-nexus” (humanitarian, development and peace) approach. This would allow a response to Covid-19 that addresses the underlying causes of conflict and inequality, and mitigates the impacts of a humanitarian-only response on long-term development.
- Need and vulnerability should be the primary criteria for access to rights-based assistance, ensuring that no one is left behind, and minimising the potential for competition and conflict between groups, particularly in areas already affected by conflict or with large refugee or displaced populations.
- The UN Secretary General’s call for a global ceasefire has highlighted the impact of conflict and armed violence to tackling Covid-19. We welcome the UK’s endorsement of the global ceasefire call. This is an opportunity for the UK to lead an ambitious and united diplomatic initiative to achieve a truly global ceasefire.
- The response to this pandemic requires public trust. However, many governments may be unable or unwilling to respond to this new crisis in an inclusive, transparent and accountable way. With pre-Covid-19 governance challenges remaining unaddressed and driving new and resurging conflicts, governmental and inter-governmental responses must take political economy analysis into consideration in order to be conflict-sensitive.
- To maintain public trust, it is particularly important that UK aid follows international best practice in ODA and is principled, rights-based and conflict-sensitive, reaching the most vulnerable. Aid spending should not exacerbate pre-existing tensions.
- The UK should turn its endorsement of the global ceasefire into action, by taking immediate steps to garner international support (including at the UNSC which has yet to endorse it), suspending arms sales that are fueling conflicts; and increasing support to activists and organisations working for inclusive and sustainable peace.
- Donors, including the UK, should provide rights- and community-based humanitarian assistance, whilst removing barriers between humanitarian, development and peace actions, and emphasising resilience building and good governance.
Country case study: Iraq
- Alongside conflict, Iraq is in political crisis and sits close to the regional Covid-19 epicentre of Iran. Since October 2019, Iraqi protesters have challenged the current political system. Humanitarian space and civic space is an increasing concern for international and national civil society voices. National and sub-national power is often contested, including on issues around the state budget. Oil revenue has decreased, leaving Iraq to seek out potential IMF bailouts, as the state budget has to cope with managing simmering conflict, violence, social tension – and now Covid-19.
- To combat inequality and discrimination against women and those with perceived affiliation with terror groups, principled humanitarian action must be maintained while engaging a broad and decentralised national set of stakeholders along the development and peace agendas. Communities of displaced and/or disenfranchised people are already struggling to support vulnerable people in a society where inequality is a constant strain on social cohesion.
- In order to ensure that aid to Iraq is conflict-sensitive, the UK must boost the UN pooled fund to ensure aid is local and flexible; addresses gender and related inequality gaps in policymaking; is complementary and addresses underlying drivers of failed governance and recurring conflict. The UK should work to ensure that relevant aid and trade (including private sector engagement) agreements with Iraq do not cause unintended harm by further exacerbating social tensions around inequalities in access to services and livelihoods.