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On 7 July 2022, the House of Lords is scheduled to debate the following question for short debate:

Lord Trees (Crossbench) to ask Her Majesty’s Government, further to the Kigali Summit on Malaria and Neglected Tropical Diseases on 23 June, what assessment they have made of the effect of current reductions in Official Development Assistance on the global control of (1) malaria, and (2) neglected tropical diseases.

1. What is official development assistance?

The Organisation for Economic Cooperation and Development (OECD) defines official development assistance (ODA) as “government aid that promotes and specifically targets the economic development and welfare of developing countries”. It is often referred to as ‘overseas aid’.

The OECD said that total global ODA was $178.9bn in 2021, its highest level ever and a 4.4% increase in real terms compared to 2020.

2. How has UK ODA spending changed?

In November 2020, the then foreign secretary, Dominic Raab, announced that the government would reduce ODA spending from 0.7% of UK gross national income (GNI) to 0.5%.

In 1970, the United Nations set a target for countries to spend 0.7% of their GNI on overseas aid. The UK first met the target in 2013. The International Development (Official Development Assistance Target) Act 2015 enshrined the 0.7% target in legislation.

The UK continued to meet the target until 2020. Following the November 2020 announcement, ODA fell to 0.5% in 2021. The government described this as a “temporary measure” in response to the fiscal pressures resulting from the coronavirus pandemic. At the time, there was discussion about whether the reduction required further legislation. In July 2021, the government said that it did not.

In July 2021, the chancellor of the exchequer, Rishi Sunak, set out the fiscal circumstances that would need to apply in order for the government to return to spending 0.7%. In March 2022, the Office for Budget Responsibility (OBR) said that, based on its forecasts at the time, these conditions would be met in 2023/24. This would imply that ODA returned to 0.7% of GNI the following year, in 2024/25.

In 2021, nine countries spent a higher proportion of their GNI on overseas aid than the UK, of which six countries met or exceeded the UN target of 0.7%.

3. What are malaria and neglected tropical diseases?

3.1 Malaria

The World Health Organization (WHO) described malaria as a life-threatening disease spread by mosquitos. The WHO said it was both preventable and curable. Nevertheless, the WHO stated that, in 2020:

  • there were 214mn cases of malaria worldwide
  • there were 627,000 deaths, an increase of 69,000 compared to 2019
  • 96% of malaria cases occurred in Africa
  • 80% of deaths from malaria in Africa were in children under the age of five

The WHO has published a ‘global technical strategy for malaria’. It set goals that included reducing malaria cases and deaths by 90% between 2016 and 2030 and eliminating malaria in at least 35 countries by 2030. The strategy stressed the importance of prevention, diagnosis and treatment, but also of high-quality surveillance data in order to react quickly and effectively to developments.

3.2 Neglected tropical diseases

The WHO described neglected tropical diseases (NTDs) as “a diverse group of 20 conditions that are mainly prevalent in tropical areas”. The organisation said that they mostly affect impoverished communities and disproportionately impact women and children. The WHO said they cause “devastating health, social and economic consequences to more than one billion people”.

The WHO has published a ‘road map for neglected tropical diseases 2021 to 2030’. The road map aims to “prevent, control, eliminate or eradicate” the 20 diseases. It argued that action against NTDs was “one of the ‘best buys’ in global public health, yielding an estimated net benefit to affected individuals of about $25 per $1 invested. The strategy included actions in the areas of diagnostics; monitoring and evaluation; access and logistics; and advocacy and funding.

4. How does overseas aid address malaria and tropical diseases?

In November 2020, when announcing the cut in the aid budget, Mr Raab set out five priority areas for future aid spending. One of these included promoting “international health security”.

Statistics on UK aid show that “health” was the sector that received the largest amount of bilateral aid in 2020. In 2019, prior to the pandemic, health had received the second largest amount of bilateral aid.

4.1 Global Fund to Fight AIDS, Tuberculosis and Malaria

The government has stated that the “majority” of its spending on malaria prevention and treatment is through the Global Fund to Fight AIDS, Tuberculosis and Malaria (the ‘Global Fund’). The Global Fund raises money on a three-year cycle, which, it states, provides “longer term predictability” to its work in fighting the diseases.

The most recent ‘replenishment’ of funding was in 2019, when the UK government pledged £1.4bn. The government stated this made it the second largest donor. The next replenishment will take place later in 2022. The UK government has recently said that it was currently reviewing the “replenishment investment case” in light of the new international development strategy (see section 5.2 of this article).

4.2 Other UK aid initiatives

Other announcements or commitments relating to UK aid work on malaria and NTDs include:

In 2019, the government established the ‘accelerating the sustainable control and elimination of neglected tropical diseases’ (ASCEND) programme to control and eliminate NTDs in 12 countries. More recently, however, the UK has withdrawn from this programme as part of the cuts to ODA.

5. Government policy announcements

5.1 Preventable deaths approach paper

In December 2021, the government published a paper setting out how it would meet its commitment to end preventable deaths of mothers, babies and children by 2030. In relation to malaria and NTDs, measures included:

  • dispensing preventative treatment to pregnant women in areas of high malaria transmission
  • supporting the Global Fund, which has initiatives such as providing mosquito nets, anti-malarial indoor sprays and preventative treatment for women
  • continuing to use research and development to fight disease; for example, the paper said the UK had supported the development of seven new drugs for malaria and more than 20 diagnostics for malaria and other diseases
  • ensuring that programmes to combat malaria also support countries’ broader health systems
  • combatting climate change, which the paper said increases the risks posed by malaria

5.2 May 2022 strategy for international development

In May 2022, the Foreign, Commonwealth and Development Office (FCDO) published a new strategy for international development.

In the strategy, the government said that its health goals would be achieved by investing both bilaterally, with individual countries, and through multilateral initiatives such as: Gavi, the Vaccine Alliance; and the Global Fund. However, the strategy also announced a shift from multilateral funding to bilateral funding. It said this would allow the government to “focus funding on UK priorities and control exactly how taxpayers’ money is used to support these”. The FCDO said its target was for around three-quarters of FCDO aid to be spent bilaterally by 2025. This compared to 66% of overall aid spending in 2020 (including some aid spent by organisations other than FCDO).

The FCDO also stated that initiatives would include using big data and artificial intelligence to help predict the spread of new diseases.

6. Kigali summit

The Kigali summit on malaria and neglected tropical diseases took place on 23 June 2022, alongside the Commonwealth Heads of Government Meeting in Rwanda. The WHO said that it brought together “some of the most influential voices in global health, including world leaders, leading WHO figures, philanthropists, scientific experts, global influencers and community champions”.

6.1 Summit outcomes

The outcome statement from the summit said that progress against these diseases had stalled and even reversed in some countries. The statement attributed this to “disruptions of essential services and supply chains during the Covid-19 pandemic and plateauing of funding, rapidly increasing population and widespread biological challenges such as insecticide and drug resistance”. The statement stated that attendees committed to financing essential programmes and treatments and to backing “the scientific innovations that are crucial to the ending of malaria and neglected tropical diseases”.

The summit announced over $4bn in new funding for malaria programmes, together with donations from pharmaceutical companies of 18bn tablets for preventing and treating NTDs. Rwanda, as hosts of the summit, called for the 2022 replenishment of the Global Fund to raise at least $18bn.

6.2 Declaration on neglected tropical diseases

The Kigali summit also launched the Kigali declaration on NTDs. The declaration aims to deliver the targets in the WHO’s road map for NTDs and to secure commitments to achieve the UN’s third sustainable development goal, which relates to health and wellbeing.

The UK signed the Kigali declaration at its launch. In support of the declaration, the government emphasised the importance of continuing to invest in research and innovation in new drugs and diagnostic techniques for diseases, including NTDs. It described the government’s ‘product development partnerships’, which are “public-private partnerships for developing health technologies such as vaccines, therapeutics and diagnostics”.

7. Commentaries

The House of Commons International Development Committee has taken evidence on the future of UK aid and the impact of the reduction to 0.5% of GNI. The committee described this as an “ongoing inquiry”, and it has not published a report. However, a summary of the evidence included views from organisations working in the development sector that said the government’s approach to administering the cuts to aid spending had been “chaotic”.

The committee also received evidence from the malaria campaign organisations Malaria No More UK (MNMUK) and Medicines for Malaria Venture (MMV). They stated that the UK had been at the “forefront” of efforts to tackle malaria since 2000, but that the aid reductions put the UK’s strategy at risk, particularly in Nigeria. The organisations said that cuts to broader health programmes would also have “significant knock-on impacts” for malaria, as the disease “thrives where there are gaps in basic health services”. Similarly, they argued that malaria prevention and pandemic control are mutually reinforcing.

MNMUK and MMV also expressed concern about cuts to the UK Research and Innovation agency (UKRI) as a result of the reductions in ODA. They cited examples of UK research programmes in the area of infectious disease control that were no longer able to obtain funding.

More recently, in their response to the new international development strategy, MNMUK and a group of other organisations welcomed the strategy’s aim to build global health security. However, they argued that the reduction in multilateral funding would be likely to lead to “huge cuts to life-saving programming”. The organisations said that the FCDO must ensure that “sufficient funding remains on the table” for the Global Fund, which they described as “cost-efficient and powerfully effective”.

In response to the new international development strategy, Baroness Sugg (Conservative), a former minister in the Department for International Development, argued there was a “realistic prospect to end malaria this generation—if there is the political will and investment to do it”. However, she suggested that progress on the disease was at risk, particularly as a result of the impact of the pandemic on health services. Baroness Sugg called on the government to contribute to the 2022 Global Fund replenishment in a way that “bucked the trend” from multilateral to bilateral aid. She said the fund was a “highly efficient mechanism for fighting existing disease”.

Commenting on the UK withdrawal from the ASCEND programme, the WHO has said that there was “no obvious alternative source of funding”. The international charity Sightsavers, which ran ASCEND in west and central Africa, has been reported as estimating that the reductions to UK aid will have caused nearly 72 million people to miss out on treatment for NTDs between October 2021 and April 2022.

The UK Coalition Against NTDs has said that it is “gravely concerned” by the cuts in ODA. The coalition argued that several countries are on the “brink of disease elimination” and that jeopardising this progress could lead to greater reliance on donor aid in the long-term.

However, a November 2020 opinion poll for YouGov reported that two-thirds of Britons supported cutting the foreign aid budget. Previously, the academic Sebastián Edwards stated that some economists believed foreign aid spending was ineffective and has actually caused harm to poorer countries. They argue it can create dependency, foster corruption and lead to over-valued currencies.

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Cover image from Malaria No More UK