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Global Fund: Supplementary Funding

Volume 729: debated on Wednesday 8 March 2023

Motion made, and Question proposed, That this House do now adjourn.—(Fay Jones.)

It is a pleasure to have secured the Adjournment debate this evening on supplementary funding of the Global Fund, a subject that I am passionate about, and one that I know the Minister responding is, too. I want to start by paying tribute to the organisations that work tirelessly and diligently on these matters, including Malaria No More and STOPAIDS, which have advocated throughout the replenishment period for the UK to meet the Global Fund’s funding target.

I would like to begin by describing the work of the Global Fund and highlighting its impact in saving lives across the countries that it operates in. In 2002, the Global Fund was created to fight what were then the deadliest pandemics confronting humanity: HIV and AIDS, tuberculosis and malaria—diseases that are all treatable and preventable; diseases of poverty and inequality; diseases which at that point seemed truly unbeatable. Bringing together civic society organisations, the private sector, Governments and local communities, the Global Fund has proven that, with collaboration and the correct investment, action can be taken to improve lives.

The results have been stark. In the 20 years following the initiation of the fund, 50 million lives have been saved. The number of deaths caused each year by AIDS, tuberculosis and malaria has decreased by 70%, 21% and 26% respectively since 2002. Yet those numbers alone paint only a partial picture, because the fund helps to better the livelihoods of families and communities around the world. Every dollar invested for the Global Fund’s seventh replenishment will yield an astonishing $31 in health gains and economic returns.

The Global Fund targets countries in the greatest need. Countries in Africa receive about three quarters of the Global Fund investments, and Commonwealth countries receive about half. The Global Fund promotes gender equality, strengthens health systems and allows children to gain an education. It is perhaps the most successful initiative the Foreign, Commonwealth and Development Office supports, and it demonstrates to the international community our efforts to end AIDS, tuberculosis and malaria epidemics in line with UN sustainable development goal 3.3. Its success was highlighted by the Independent Commission for Aid Impact, which praised the fund for its low operating expenditure, saying that it represents the best “value for money” of any UK development assistance initiative. Indeed, the Minister himself said that the Global Fund is “brilliantly effective.” In his time as a Back Bencher, the Minister urged the Government to ensure that we are as generous as possible on the replenishment of the fund and he is now in the perfect position to ensure that the Government are as generous as possible. He knows the Global Fund can only be as effective as it is if it is properly funded.

I want to highlight one example of the programme in action. I would like to speak about Krystal. Krystal is a field entomologist in Uganda. Her story is particularly relevant on International Women’s Day, as malaria has a disproportionate impact on women and young children, and in particular on pregnant women. She collects mosquito samples, which are then studied to develop genetic technology that can interrupt malaria transmission. Krystal’s fight against malaria is not just professional, it is personal. She remembers the horrors of having malaria as a child, her little brother convulsing with the disease, and her mother struggling to afford the treatment for her children. When Krystal and her two brothers were growing up, their mother worked to support the family. When one of her children got malaria, she was left with the impossible decision of whether to stay home to care for her sick child, or go to work to earn the money to look after her family and pay for treatment. Krystal says that the Global Fund’s arrival in Uganda was a game changer. She said:

“I remember what it was like when the Global Fund came to Uganda. They brought free malaria treatment to hospitals, free mosquito nets that protected children and their families, and funded village health teams.”

In Uganda, deaths from malaria fell by almost two thirds between 2002 and 2020, while the percentage of people using long-lasting insecticidal nets almost doubled over the same period. In 2020, almost every person in Uganda with suspected malaria received a test. That accomplishment was only possible with the intervention of the Global Fund and Krystal’s story is one example of the outstanding work the Global Fund carries out. There are many more.

I would like to share another example. I was recently in Kenya on a delegation with STOPAIDS. At the Ngong Sub-County Hospital just outside Nairobi, I met Abigail, a two-year-old child. Her mother was HIV-positive and had been supported through a programme funded by the Global Fund which provides what are called Mentor Mothers. That meant her mum got peer support for two years—not only for the period of her pregnancy, but until Abigail was two—to make sure she was taking her antiretroviral tablets and her daughter was taking the prophylactic treatment that was needed because her mum was breastfeeding. Now, as a two-year-old, Abigail is HIV-free, despite being born to a mother who was HIV-positive and who had not been complying with treatment earlier on. Does my hon. Friend agree that the Government can put a cost on these sorts of interventions, but they cannot necessarily put a value on them? They are hugely important.

I am very grateful to my hon. Friend. I am glad she had the opportunity to get that on the record.

Let me turn to the UK’s most recent funding contribution. At the seventh replenishment in 2022, the UK Government pledged £1 billion to the Global Fund—a significant 30% cut to the UK’s 2019 pledge of £1.4 billion. The US, Japan, Canada, Germany, the European Commission and several other contributors met the Global Fund’s request for a 30% increase from 2019. France increased its contribution by 23% and Italy by 15%. However, the UK—alone—went in the opposite direction. The UK was the only G7 member to cut funding in 2022. Mike Podmore, the director of STOPAIDS, said that it was a “disastrous decision” that risks the lives of 1.5 million people and

“over 34.5 million new transmissions across the three diseases, setting back years of progress”.

I congratulate the hon. Member on securing the debate. Is not the point precisely that the kind of interventions that the Global Fund make are preventive spends? If those lives are not saved or if people continue to contract those diseases and there is not further research into them, in the longer term it will cost more to deal with the consequences of not reducing the infection rate. It is a false economy. The Government talk about making their diminishing aid budget work smarter and harder. Surely, that kind of preventive spend is a smart and hard way of working?

Absolutely, I agree. We know what is needed. Analysis has calculated that $18 billion is required to get the world back on track towards ending HIV, tuberculosis and malaria, to build resilience and sustainable health systems and to strengthen pandemic preparedness. The Global Fund is more than $2 billion short of reaching that $18 billion target. At the sixth replenishment, the UK was the second biggest donor. Now, the UK’s reduction in funding is the biggest contribution to the shortfall.

Now is possibly the worst time to be cutting funding following the coronavirus pandemic, which had a drastic impact on the ability to test for infectious diseases. In 2020, for the first time in the Global Fund’s history, we witnessed declines in key outcomes across all three diseases. Decreases in testing led to increases in infections, undoing years of progress. That is exactly what the statistics tell us: HIV testing fell by 22% and prevention services by 11%. In 2020, TB deaths increased, fuelled by a surge in the number of undiagnosed and untreated cases. The number of people tested for drug-resistant TB dropped 19%, and the number of people treated for TB fell by more than 1 million. Malaria testing fell by 4%. Now is not the time to reduce our commitments to the developing world; it is the time to redouble our efforts.

I am not sure how much time I have, so I will carry on to get through what I want to say.

As co-founder of the Global Fund with permanent representation on the board, the UK is uniquely placed to direct policy and act as a leader in the field. We should do everything we can to strengthen that position, not undermine it. I ask the Minister, who is a champion of the Global Fund, to continue to be both vocal and resolute in his calls to his Cabinet colleagues.

Let me turn to the reasons that the UK decreased its contribution to the fund at the most recent replenishment. We were made aware in the autumn statement that the Chancellor had decided that the aid budget would not be restored to 0.7% of gross national income until “the fiscal situation allows”. The Government have been unclear on when the international aid budget will be increased again, if at all. The Home Office is now appropriating funds to host refugees, and only 0.3% of GNI is being spent on official development assistance—a smaller percentage than before 1997. That means less funding for the UK’s long-standing international aid commitments such as the Global Fund.

No other G7 country used the economic impact of the covid-19 pandemic to reduce its contribution to the Global Fund, but that is exactly the action that the UK Government have taken. Will the Minister share with the House what discussions he has had with Treasury colleagues about the urgent need to return the aid budget to 0.7%? What conversations has he had with FCDO, Treasury and Home Office colleagues about increasing the transparency of the aid budget spending that is allocated domestically? I have written to the Treasury on that point, but I hope his discussions have been more productive than mine.

The development budget—the pot of money we put aside to help the world’s poorest people—is being squeezed from every angle. Not only was it slashed by almost a third, but other Departments are now able to use the fund to cover shortfalls. The Minister should consider whether it is accurate to say that we are spending even 0.5% on international aid, when such a huge proportion of the pot is being spent domestically rather than on helping people facing enormous hardship across the world. I hope that ahead of next week’s Budget he has been lobbying hard for more money. The bottom line is that the UK was the only major donor that failed to deliver the same level of funding as in the previous replenishment, let alone the increase that was requested.

As we have seen in recent years, marginalised communities will suffer the most as a result of UK ODA cuts. These decisions have a drastic impact on infections and deaths from HIV, TB and malaria. We must explore what our country can do to ensure that our international obligations are met. Although of course those obligations involve replenishing the Global Fund, I remind the House that they must extend further.

If we are to ensure that the poorest countries have the resources to fund healthcare fully for their populations, we need to end the crippling debt crisis faced by more than 50 countries worldwide. As agencies such as the Catholic Agency for Overseas Development are warning, debt levels for low-income countries are at their highest for 20 years. Countries are being forced to choose between spending on debt servicing and spending on healthcare. The focus of this debate is the Global Fund, but let us not forget that there are actions that the UK Government can and must take to tackle the growing debt crisis. If we want to increase financing for healthcare in the poorest countries, action on debt is essential.

Let me return to the Global Fund. In the current resource-limited setting, it is vital that the UK ensures value for money and capitalises on the match-funding arrangements with the US for the seventh replenishment, under which the US will provide a 50% match for every additional £1 that the UK contributes. Supplementary funding to the Global Fund has the potential to unlock significant matched funding from the US and drive the delivery of the UK’s international development strategy, so the Government should be exploring the allocation of additional funding to the Global Fund in the upcoming Budget and beyond. I urge the Minister to listen to this call.

Finally, it is International Women’s Day. It is important to recognise that women and girls continue to be disproportionately affected by ill health as a result of AIDS, TB and malaria. AIDS-related conditions are the leading cause of death for women of reproductive age globally, and approximately one third of all pregnant women in sub-Saharan Africa suffer from malaria. Thanks to the Global Fund’s investments, more than 85% of pregnant women living with HIV now have access to medicine.

I congratulate the hon. Member for Liverpool, Walton (Dan Carden) on securing this debate. It is a pleasure to respond on behalf of the Government. Let me say at the outset how much we appreciate the work of the Global Fund’s executive director Peter Sands and his team, whom I saw recently in Geneva. He, along with others, has significantly reformed the Global Fund, with which I was involved 10 years ago. It is now going from strength to strength. As the hon. Gentleman said, this spending is among the very best of the development expenditure that the British taxpayer generously provides.

Given the impacts of the pandemic and Russia’s barbaric attack on Ukraine, the UK’s aid budget currently sits at about 0.55% of gross national income. That equated to more than £11 billion in 2021, and we are proud to remain one of the world’s biggest aid donors. Over the past 18 months, the UK has acted decisively and compassionately to help the people of Ukraine and Afghanistan to escape oppression and conflict and to find refuge in the UK. We report all aid spending in line with the OECD rules, which allow funds to be spent on food and shelter for asylum seekers and refugees during their first year in the UK. That point was raised by the hon. Gentleman.

This support has put significant pressure on the aid budget, which is why the Treasury has agreed to provide an additional £2.5 billion of official development assistance over two years. Even with that extra money, we are having to make difficult decisions to manage our aid spending this year and next. Our decisions and approach to spending are guided by the international development strategy. That means focusing our work on the priorities set out in the strategy, including women and girls and global health, both of which the hon. Gentleman cited with approval. We will do this in a way that maximises the positive impact we can have, and our ability to respond to crises.

Organisations such as the Global Fund remain essential partners for the achievement of our goals. The UK joined with others to create the Global Fund because we refused to accept the loss of millions of lives every year to AIDS, TB and malaria— diseases that are both preventable and treatable. The fund’s achievements are nothing short of extraordinary. Over the last 20 years, it has saved 50 million lives, cut the death rate from those three diseases by more than half, invested billions in healthcare systems, and played a crucial role in the protection of key populations and women and girls—a point made by the hon. Gentleman towards the end of his speech.

The UK is an important partner in the Global Fund’s success. We are its third largest donor. We have contributed more than £4.5 billion to the fund to date, and we continue to back its vital, life-saving work. In November, I announced our significant contribution of £1,000 million to the fund’s seventh replenishment. This will support critical programmes through to 2025, helping us to get back on track to end AIDS, TB and malaria. The UK’s pledge will help to save an estimated 1.2 million lives, while preventing 28 million new cases and infections. Not only will that funding help the diagnosis, treatment and prevention of those three diseases, but it will boost work to tackle the stigma and discrimination that are driving the epidemics, reaching 3 million people in key populations through prevention programmes. It will help community workers to find those at greatest risk, and it will be used to invest in innovative research and development work. That includes tackling the growing resistance to drugs and insecticides that threatens the fight against malaria.

We have invested about £400 million in product development partnerships, harnessing the best of British scientific excellence to fight diseases of poverty, and our £500 million investment in Unitaid supported innovations that cut the cost of the best paediatric HIV medicines by 75%. As I made clear in the international development strategy, we will continue to push for multilateral reform, including greater collaboration between health agencies at global, country and local level. The UK remains a determined leader, not only through our financing but through our valuable country partnerships, our expertise and our power to convene others. We are pleased that the Global Fund and Unitaid have been building on their partnership.

The Global Fund is key to our strategy to end the preventable deaths of mothers, babies and children. The majority of its investment is in Africa, where a child dies every minute of malaria and where one in three pregnant women risks catching malaria, putting them and their baby at risk. It also invests in strong and inclusive health systems. One third of the UK’s contribution to the Global Fund will help to support and strengthen formal and community health systems, improving data tracking, getting medical supplies to clinics in remote areas and helping community health workers to meet the needs of their local communities.

Building on the experience of the fight against covid-19, the Global Fund supports work to prepare for and respond to pandemics. For example, it invests in building laboratory networks that were the bedrock of the covid-19 testing programmes. The fund raised $5 billion in two years to fight covid, leading work in lower-income countries on diagnosis and treatment. But this is about more than money to fight diseases; it is about addressing wider global challenges, from conflict to climate change.

The Minister and I agree that the Global Fund is a very good thing. We have had two years of progress, increased testing and reduction in diseases, and in the end we are hopeful of eradicating those diseases for good. Will the Minister continue to watch that progress? At the minute, statistics suggest that we are sliding backwards—something we cannot afford to do. If that is what the evidence suggests this year and next year, will he push for more funding? Will he also touch on the point about the United States’ match funding, which makes this such a good investment for the FCDO?

The hon. Gentleman is absolutely right to point out the huge benefits of the generous offer from the United States, which, along with Britain, has been one of the two core countries for the Global Fund. On his request that I keep this spending and the results under review, he may rest assured that I certainly will.

The Global Fund has kept health services going in conflict zones from Afghanistan to Ukraine. It has provided $25 million in emergency funding to Ukraine, which has been used to deploy doctors and mobile clinics. It has supported healthcare for those suffering from climate-related disasters in Pakistan and Somalia.

Addressing gender and human rights barriers is an integral part of the Global Fund’s strategy for the next five years, ensuring that life-changing services are available for all, regardless of gender, age, sexual orientation or income. Some 60% of the Global Fund’s investments go towards protecting women and girls. The UK continues to champion those values in all our work. As the hon. Gentleman indicated, today we celebrate International Women’s Day, and this morning we published our strategy, which puts women and girls at the heart of pretty much everything the Foreign Office does. We will stand up for them at every opportunity, work with our partners who do the same and counter any rollback in women’s rights and freedoms around the world.

I am very sorry, but I am about to run out of time.

We are increasing our ambition, because threats to gender equality are mounting and because women and girls continue to be at particular risk from diseases such as HIV and malaria. Over the next year, global leaders will come together for UN high-level meetings on universal health coverage, tuberculosis, and pandemic preparedness and response. The Global Fund is an important partner to the UK in helping to advance those priorities.

To conclude, we have no doubt of the huge importance and value of the work of the Global Fund. We will fulfil our sixth replenishment pledge. This is an outstandingly successful partnership, which is why the Foreign Secretary, the Chancellor and I very carefully considered our £1,000 million pledge to the seventh replenishment, for all the reasons that the hon. Member for Liverpool, Walton has set out so eloquently.

We balance the needs of the fight against AIDS, tuberculosis and malaria against the many other demands on the aid budget, guided by the priorities of the international development strategy. We can all be proud of our commitment and the difference this pledge will make to millions of people around the world, helping to end those three diseases that shatter lives and to build a better, safer world for all.

The hon. Gentleman asked me about the discussions on transparency with the Home Office. A new cross-Whitehall committee, co-chaired by myself and the Chief Secretary to the Treasury, will bear down on the quality of ODA spent throughout the Whitehall system. He asked about discussions with the Treasury on these matters and on ODA generally. I assure him that, short of camping under the Chancellor of the Exchequer’s bed, I could not lobby more than I am.

Finally, I shall give way to the hon. Lady, because there is one minute left.

The Minister has outlined brilliantly all the great things the Global Fund does, but as we have cut our replenishment funding, has the Department made an assessment of what that loss will mean, in terms of the inability to meet some of this need?

We look incredibly carefully at the results our taxpayers are buying with their contribution. The contribution we have made of £1,000 million is a significant one, given the constrained circumstances that we and others around the world find ourselves in. We have made a contribution at that level for precisely the reasons set out by the hon. Lady and the hon. Member for Liverpool, Walton, in what I think you will agree, Madam Deputy Speaker, has been a most interesting and illuminative debate.

Question put and agreed to.

House adjourned.