Submission to the International Development Committee Inquiry into the Effectiveness of UK Aid
Malaria No More UK - 13/05/20
Malaria No More UK welcomes the International Development Committee’s Inquiry into the Effectiveness of UK Aid.
As the second largest international donor to the fight against malaria, the UK has been at the forefront of efforts that have helped to save 7 million lives, and prevented more than 1 billion cases since 2000. Despite this progress, the disease still claims the life of a child every 2 minutes, and much work still needs to be done. The UK government has committed to spend £500m per annum tackling malaria until March 2021 and has stated that it is committed to leading the way in eradicating malaria and ending the preventable deaths of mothers, new-born babies and children.[i]
In this submission, we set out evidence for why UK investments in tackling malaria, including those channelled through the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and into R&D for new tools, are highly cost effective and should be continued, and how tackling the disease serves the goals of reducing poverty and inequality, whilst helping to build a safer, healthier and more prosperous world for all.
UK aid spent tackling malaria offers real value for money, delivering $36 of social and economic benefits for every $1 spent.[ii] Current global investments in tackling malaria prevent almost 100 million cases of malaria and save close to 600,000 lives a year. Every pound spent on malaria not only prevents the spread of the disease, but also helps build more resilient health services around the world, which are better able to cope with both existing and emerging diseases.
By helping to strengthen procurement and supply chains, improve data systems and data use, build stronger community responses and systems, and expand the qualified health workforce, investments in malaria promote quality health services of all kinds, and strengthen health systems with a powerful multiplier effect that can improve a community’s overall health status, as well as its economic and social well-being.
Tackling malaria is central to the achievement of the Sustainable Development Goals (SDGs). Malaria is embedded in Goal 3 on health and wellbeing for all, and progress against the disease has positive impacts on other SDGs including those on education and gender equality. For example, malaria is responsible for up to 50% of preventable school absenteeism in Africa.[iii] Reducing the incidence of malaria enables children to attend school regularly and learn more effectively, which significantly improves their performance, and later their capacity to earn a wage. Freeing women and girls from the burden of caring for family members when they fall sick with malaria increases their likelihood of completing school, entering and remaining in the workforce, and participating in public decision-making. Preventing malaria in pregnancy reduces maternal mortality and gives children a healthier start in life.
Reducing malaria is central to the UK’s commitment to ending preventable deaths, particularly of pregnant women and children who are most vulnerable to the disease, and can play a mutually reinforcing role in the delivery of DFID’s broader health strategy. Taking a ‘high burden to high impact’ approach to tackling malaria, as recommended by the WHO[iv], will help to ensure that UK investments have the greatest impact in driving progress and protecting the most vulnerable communities in countries that currently carry the highest burden of the disease.
Research has shown that with the right tools, strategies, and sufficient funding we can eradicate malaria for good.[v] This would not only save millions of lives, but also reduce a significant burden on health systems - in highly endemic countries, efforts to tackle malaria can account for up to 40% of public health spending - and free up crucial resources for use elsewhere, whilst leaving behind a legacy of stronger health systems and innovative tools and approaches that can continue to provide value long into the future.
We encourage the UK to continue its strong investments in malaria, which are highly cost effective, as a central pillar of efforts to strengthen health systems and end the preventable deaths of mothers, new-born babies and children.
The Global Fund to Fight AIDS, TB and Malaria is an innovative partnership that pools resources, consolidates technical expertise and leverages increased investment from both the private sector and endemic countries to accelerate the end of the three diseases.
Since its founding in 2002, the Global Fund has delivered phenomenal results on a global scale, helping to save 27 million lives.[vi] The UK is a longstanding and leading donor to the Global Fund. In June 2019, the UK pledged up to £1.4 billion to the 6th replenishment of the Global Fund, to help save 2 million lives over the next three years.
The Global Fund amplifies UK resources to achieve greater results. It plays a catalytic role in spurring greater investment through leveraging private sector financing and stimulating significantly increased domestic investments in fighting the three diseases. As part of the UK’s pledge in 2019, it committed to aid match private sector support, which since then has raised £100 million towards the Malaria Match Fund.[vii] At least 15% of the Global Fund allocation in each recipient country is provided as a co-financing incentive, which can only be accessed when countries commit to additional domestic investments in health.[viii]
UK investment has also enabled the Global Fund to reduce commodity costs through pooled procurement. With large-scale purchasing power, the Global Fund achieved a 38% reduction in the price of insecticide-treated nets between 2013 and 2016.[ix] The Fund invests about US$1 billion per year in strengthening health systems, making it the largest provider of grants to build health systems among the multilateral institutions.[x]
The Global Fund is a highly effective institution achieving a ‘very good’ rating in DFID’s last Multilateral Development Review in 2016, which described the Fund as ‘achieving exceptional results’.[xi] Publish What You Fund’s 2018 Aid Transparency Index rated the Global Fund ‘good’ and as one of the most transparent organisations in terms of finance and budgeting.[xii]
We encourage the UK to continue its strong support for this highly effective mechanism, alongside its vital bilateral support to endemic countries and investments in R&D.
Continued innovation and research is vital to progressing the fight against malaria, particularly given the dual imperatives of the growing threat of drug and insecticide resistance and innovation needed to end the disease for good.
The UK is a world leader in health, with its research in the bio-medical and life sciences underpinning industrial strategy. It has a long track record of tackling malaria, stretching back to the discovery of the malaria parasite by British scientist Sir Ronald Ross in 1897, which laid the foundation for efforts to combat the disease. To this day, cutting edge British science is saving lives, from the development of new insecticides by the Innovative Vector Control Consortium (IVCC) in Liverpool, to the development of the world’s first vaccine against malaria by GSK, which is currently being piloted in areas of Kenya, Ghana and Malawi.
In addition, UK support for Product Development Partnerships (PDPs) is enabling the pharmaceutical industry to invest more in R&D for diseases of poverty such as malaria because the costs and risks are shared. These partnerships include the IVCC and the Medicines for Malaria Venture (MMV) with whom GSK have developed tafenoquine – a radical new cure for relapsing malaria.
The UK’s support for the Global Fund and GAVI also provides the pharmaceutical industry with the confidence that when they invest in R&D for malaria treatments and vaccines, then any products which are successfully developed are more likely to reach the people who need them.
We encourage the UK to continue its support for malaria R&D and PDPs with long-term financing in order to ensure there is a steady stream of new tools that will be needed to end malaria for good, and that they can reach the right people, in the right places, at the right time.
First and foremost, UK aid spending must reflect its core purpose of poverty alleviation, sustainable development and commitment to ending preventable deaths.
As the COVID-19 pandemic has shown in recent months, the health of people globally is interconnected, and can only be overcome through global coordination and cooperation. Diseases do not respect borders. Therefore UK support for tackling malaria and building strong and resilient health systems which are better equipped to deal with pandemics of the future, is something that benefits the poorest and most vulnerable around the world, but also helps keep people safe in the UK.
Malaria destroys lives and livelihoods and can hold back a country’s GDP by as much as 1.3% per annum.[xiii] Cumulatively year on year this has a catastrophic impact on a country’s economy and the lives of its whole population. Maintaining a focus on the goal of malaria eradication will help reduce poverty experienced by the world's poorest people, and unleash untapped economic potential in malaria affected countries.
Countries affected by malaria make up 14% of the global economy and are responsible for UK trade worth around £57 billion a year.[xiv] Driving progress towards a malaria-free world will address a significant barrier to economic development and expand opportunities for global trade and foreign investment.
We encourage the UK to maintain its life-saving aid commitments to the poorest people, including by renewing its long-standing and smart financial investment in tackling malaria, which in turn helps to build a safer, healthier and more prosperous world for all. In addition to leading by example in helping to fill key global financing gaps, we encourage the UK to use its diplomatic convening power to help build the global case for malaria reduction, including for pandemic preparedness, particularly at the forthcoming G20, UK hosted G7 in 2021, and Commonwealth Summits.
About Malaria No More UK
Founded in 2009, Malaria No More UK is one of the leading UK organisations working to eradicate malaria worldwide. We work to unite policymakers, private sector actors and public audiences in this fight.
[i] Conservative Manifesto, 2019 https://www.conservatives.com/our-plan
[ii] Copenhagen Consensus, 2015 http://www.copenhagenconsensus.com/post-2015-consensus
[iii] RBM Education Fact Sheet https://endmalaria.org/sites/default/files/RBM_Education_Fact_Sheet_170915.pdf
[iv] High burden to high impact: a targeted malaria response, WHO, 2018 https://www.who.int/malaria/publications/atoz/high-impact-response/en/
[v] Malaria Eradication Within a Generation: Ambitious, Achievable and Necessary, 2019 http://www.malariaeradicationcommission.com/
[vi] Global Fund Results Report 2018 https://www.theglobalfund.org/en/impact/
[vii] UK aid backs private sector to fight malaria, 2019 https://www.gov.uk/government/news/uk-aid-backs-private-sector-to-fight-malaria
[viii] Sustainability, Transition and Co-Financing, 2018 https://www.theglobalfund.org/en/sustainability-transition-and-co-financing/
[ix] Deal on Mosquito Nets to Yield $93 million in Savings, 2016 https://www.theglobalfund.org/en/news/2016-01-18-deal-onmosquito-nets-to-yield-usd-93-million-in-savings/
[x] Ending epidemics and building health systems, 2018 https://www.theglobalfund.org/en/blog/2018-10-12-ending-epidemics-and-building-health-systems/
[xi] Raising the standard: the Multilateral Development Review 2016, DFID https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/573884/Multilateral-Development-Review-Dec2016.pdf
[xii] Publish What You Fund, Aid Transparency Index, 2018 https://www.publishwhatyoufund.org/the-index/2018
[xiii] The economic burden of malaria, Gallup and Sachs, 2001
[xiv] Global Britain and Ending Malaria: The Bottom Line, 2017 https://www.malarianomore.org.uk/file/2192/download?token=NLusQJ-m