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Effectiveness of UK Aid Inquiry

Reason for Submitting

TB Alliance is a not-for-profit organization with a mission to discover, develop and deliver better, faster acting, and affordable tuberculosis (TB) drugs to those who desperately need them and a long-term partner of DFID. We envision a world where no one dies of tuberculosis. Since our inception in 2000, TB Alliance has led the global search for and development of new TB medicines. TB Alliance is a product development partnership, also called PDP, which has allowed us to foster a unique and global network of 400+ public and private partners with the expertise, skills, resources, and commitment to develop new generations of therapeutics to treat TB patients around the world. We also ensure that our effective pharmaceutical development is coupled with worldwide access and follows our affordability and adoptability (AAA Mandate) criteria.

Over the last 15 years, UK DFID has been a critical resource and strategic partner to TB Alliance – this support has resulted in the development and delivery of the first paediatric TB medicine, impacting the lives of over 1 million children around the world. Thanks to DFID’s investments, TB Alliance became the first not-for-profit organization ever to develop and register a TB drug  (pretomanid) and new short effective treatment for patients with the most severe forms of drug resistant TB. These medical innovations will have lasting impact in developing countries where TB burden is highest; equally, patients in the UK also stand to benefit from the new approved drug treatment against the most severe forms of resistant TB. Such achievements would not have been possible without DFID’s support and leadership in global health research and development (R&D) – a result of the way in which DFID operates independently and delivers aid both effectively and cost-efficiently.

We strongly urge the International Development Committee to consider our recommendations.


  1. Maintain the independence and operational structure of DFID as well as its specialized focus. DFID is the world’s leading development agency; it is highly efficient, effective, and with its specialisation is an asset to the UK.
  2. Maintain the commitment of 3% of funds dedicated to (global) R&D. This R&D funding allocation and mechanism not only provides a major return on investments and impact for development programs worldwide, it also directly supports important national goals in the UK: knowledge economy, access to a global network of innovation, new affordable products and technology that benefit UK patients and the NHS, and a major “soft power” with governments and international bodies around the world.
  3. Continue UK’s participation and leadership through DFID in the Global Fund to Fight TB, HIV and Malaria as well as the European Union (EU) research programs, including the upcoming EU Horizon Europe programs, especially IMI3 and EDCTP3. The UK receives more investment from these programs than it currently puts in and helps maintain a global leadership in the academic sector and the knowledge economy.

DFID’s investments in Global Health R&D have saved lives around the world

The UK government has long invested in global health and R&D, including playing a global leadership role for TB product development. Since 2006, DFID has been among the top two donors of TB Alliance – these investments have come to fruition with major impact and benefits to TB patients around the world and in the UK. As a result of sustained and growing support from DFID over the years, TB Alliance became the first not-for-profit organization ever to develop and register an anti-TB drug (pretomanid) and new short effective treatment for patients with the most severe forms of drug resistant TB. According to an investment case study made by McKinsey, partners for Rockefeller Foundation and TB Alliance, a rapid introduction and adoption of this treatment containing three drugs could reach between ~160,000–240,000 patients until 2023 without needing increased TB delivery budgets. This exhibits a major health impact and reduction in mortality. Furthermore, with the introduction and delivery of new and more effective medicines, UK’s return on current investments in the Global Fund and other global TB programs are magnified! Due to the highly complex, expensive and ineffective options for drug resistant patients, countries had to spend 67% of their TB budgets on the 9-10% of TB patients who are drug resistant to standard treatment. The new treatment containing pretomanid, which is highly effective, shorter in duration and lower cost, will represent a major relief on health care systems whilst saving lives and significantly increasing the quality of life for patients.

Furthermore with UK and European regulatory approval in June 2020, patients in the UK and the NHS stand to benefit from the  new treatment, promising to positively disrupt the drug resistant TB drug market as current treatments for extremely drug resistant TB can be immensely long (up to 20 months), expensive (UKP .5-1 million per patient in some cases) and a major burden on patients, their families and the NHS (contact tracing, hospitalisation, infection control measures, etc).

DFID’s investments have also enabled TB Alliance to develop child friendly TB medicines. Each year, one million children get sick with TB and about 205,000 needlessly die. That's more than 550 children dying each and every day. But until recently, national TB programs relied on outdated, imprecise diagnosis and treatment methods that failed many children. Bitter-tasting pills for adults were the only drugs available for children. Clinicians and caregivers would break them in pieces and estimate the correct dosage for their paediatric and adolescent patients. With support from DFID, in 2016 TB Alliance and its partners introduced a child-friendly TB medicine in correct doses.  These medicines are now included in the WHO Model List of Essential Medicines for children. The impact from our work, thanks to DFID, was also highlighted as the milestone of 1 million treatments of child-friendly TB medicines was announced in June of 2019. The improved paediatric treatments are now used by at least 93 countries, representing over 75 percent of the estimated global childhood TB burden – we can reassure the IDC that British taxpayers money is being well spent, and that the system established to help some of the world’s poorest people is in fact delivering!


DFID’s Development Policies, Priority Setting and Transparency are Hallmarks of Development Assistance Around the World


DFID has a global reputation as a development leader and is considered a benchmark for many other donors. This has allowed the UK to channel its soft power given that DFID is considered as highly specialised, independent and poverty focused. It is internationally viewed as one of the most professional, transparent, and accountable agencies in the world. It is a scrutinised government department, with its own watchdog, an independent commission for aid impact, in addition to a select committee and the national audit office – and it ranks third globally in the aid transparency index.  As a reputable agency, DFID is a thought leader, policy influencer globally, and through its focus and expertise in R&D, a major source of innovation in the global aid community. To a great extent, the UK enjoys its immense influence in the world as a direct result of DFID’s fulfilment of aid target of spending 0.7% of gross national income.


Investments by UK DFID, especially in R&D, have not only resulted in tremendous progress in achieving the Sustainable Development Goals of reducing poverty and reducing the impact of the TB, HIV, and malaria pandemics, it has also had a spill over effect back into the UK, directly benefiting national actors. The UK is the single largest recipient of research funding from the European Union (EU) and thus UK academic institutions have a major competitive advantage, bolstering their quality and experience in global programs on research and medical product development. In fact, UK entities combined receive more funding from the EU for research than the total contribution made by the UK to the EU. As highlighted above, the new treatment for drug-resistant TB also exemplifies that many of the breakthroughs from the investments in global R&D have a direct and significant impact to the UK population and the institutions serving it.


From an operational point of view, UK DFID touts a system of data collection and analysis, reporting, monitoring and evaluation that not only ensures accountability to the UK Parliament and tax payers but serves as a gold standard used by other high and low, middle income countries in support of their own aid efforts. For instance, DFID has conducted several extensive evaluations of PDPs including TB Alliance; the subsequent reports and recommendations from these assessments have been adopted and implemented in full by donors such as IrishAid and Australia Aid.


In many ways, UK DFID is a lynchpin that is vital to the entire global aid enterprise. It’s independence and effective spending is exactly why the world looks to DFID for global development priorities and how to implement them. We appreciate the IDC and Chair to consider the evidence put forth above.

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