United Kingdom - Global health

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The UK is the second-largest donor country to global health

The UK is the second-largest government donor to global health in absolute terms, after the US. ODA to health has risen in recent years. It increased from US$2.2 billion in 2015 to US$2.9 billion in 2019. ODA for health represented 15% of the UK’s total ODA in 2019. This puts the UK above the DAC average of 8% and makes it the third-largest donor to health in relative terms.

The UK provided US$1.2 billion (41% of ODA to health) as bilateral funding and USS$670 million (23%)  as earmarked funding through multilaterals (reported to the OECD as bilateral funding). The UK’s bilateral health efforts focused on medical research (25%), family planning (17%), infectious disease control (12%), health policy and administrative management (10%), and reproductive healthcare (10%).

The UK is a strong supporter of multilateral health initiatives. In 2019, the UK contributed 36% or US$1.0 billion of its ODA for health through core contributions to multilaterals (DAC average: 50%). The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and Gavi, the Vaccine Alliance (Gavi) were the largest recipients of UK multilateral funding for health in 2019, receiving US$472 million and US$237 million, respectively. Based on recent pledges, the UK continues to be the third-largest public donor to the Global Fund (pledging £1.4 or US$1.8 billion for the 2020 to 2022 replenishment) and the largest donor to Gavi (pledging a total of US$2.9 billion for the replenishment period 2021 and 2025 (according to official US$ conversion from Gavi). The UK hosted the Gavi Vaccine Summit in London in 2020 which likely influenced the UK’s sizeable pledge. In addition, the UK is among the largest funders to the Global Financing Facility (GFF).

The UK has played an active role in the global response to COVID-19 and that is expected to continue as ‘Global health and COVID-19’ is one of seven strategic policy priorities for UK ODA in FY2021/22. The UK made early contributions to all product pillars of the Access to COVID-19 Tools (ACT) Accelerator, including US$317 million to CEPI and US$735 million to Gavi COVAX AMC as of April of 2021. The UK increased its funding to the WHO to support its role in coordinating the global response to COVID-19 and strengthening health systems in partner countries, providing a core contribution of £340 million (US$434 million) over the next four years. This represented a 30% increase to existing funding. For FY2021/22, the Foreign, Commonwealth and Development Office (FCDO) allocated £1.3 billion (US$1.7 billion) for global health and COVID-19 focused on continued support to multilaterals (including WHO, COVAX, and Gavi) and through bilateral spending in areas with the greatest needs. The UK will host the CEPI replenishment on 7 to 8 March 2022 in London. Its pledge to CEPI for 2022 to 2026 is US$205 million (£160 million); 37% less than the previous commitment 2017 and 2021. This decline is reflective of the UK’s overall ODA budget in 2021.

The FCDO’s FY2020-2021 Annual Report and Accounts indicates that planned global health spending for FY2021/22 from its Global Funds Department and its Human Development Department (responsible for some of the FCDO’s health spending) will be £916 million (US$1.2 billion). This is a 27% decrease from the outturn of £1.2 billion (US$1.5 billion) in FY2021/22. The Human Development Department budget carries the brunt of the cuts. These departments do not represent the totality of FCDO global health spending and the planned program spending may be revised; however, these cuts have already had an impact. The UNFPA Supplies program had its budget reduced by 85% from £154 million (US$197 million) to £23 million (US$29 million). UNAIDS’ budget has been cut by over 80% from £15 million (US$19 million) to £3 million (US$4 million). GPEI was due to receive £100 million (US$128 million), but funding was cut by 95% to £5 million (US$6 million).

The UK government prioritized global health during its 2021 G7 Presidency with a strong focus on pandemic preparedness. It established a new Pandemic Preparedness Partnership, a private-public partnership that sets out recommendations for cutting the time needed to develop and deploy vaccines for new diseases from 300 to 100 days. The UK committed to delivering 100 million AstraZeneca vaccines to low and middle-income countries by June of 2022, of which 80 million will be delivered through COVAX.  The FCDO has also published in December 2021 two new policy papers  on global health, setting out its agenda on health system strengthening and on ending preventable deaths which will remain core priorities for UK development assistance moving forward. The papers do not, however, set out any financial commitments or specific results targets, except contributing to meeting key UN Sustainable goals.

The FCDO is responsible for global health policy development

The FCDO has created a new global health directorate that pulls together all the teams working on global health within the organization. The directorate reports to the Director General, Americas and Overseas Territories, Vijay Rangarajan, who is also responsible for the global health thematic in the FCDO. The organizational structure of the FCDO is still unclear and there is no formal organigram published to explain how this directorate works with the Department of Health and Social Care (DHSC). From 2016, a global health oversight group with representatives from Department for International Development (DFID) and DHSC oversaw global health policy and programming of spending on areas of mutual interest between government departments, including the cross-government response to global health threats. It is unclear whether this group will be maintained in the future.