Global Fund: Supplementary Funding

Debate between Charlotte Nichols and Dan Carden

Wednesday 8th March 2023 Commons Chamber

[Dan Carden (Liverpool, Walton) (Lab)]

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.

[Charlotte Nichols (Warrington North) (Lab)]

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.

[Dan Carden]

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”.

[Dan Carden]

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.

[Charlotte Nichols]

Will my hon. Friend give way?

[Dan Carden]

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.