Gavi and the Global Fund

Iqbal Mohamed Excerpts

Thursday 15th May 2025 Westminster Hall

[Steve Race (Exeter) (Lab)]

It is a pleasure to serve under your chairship, Ms Jardine. I congratulate my hon. Friend the Member for Milton Keynes Central (Emily Darlington) on securing this debate. I refer Members to my entry in the Register of Members’ Financial Interests.

I am proud to co-chair the all-party parliamentary group on nutrition for development, alongside the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell). Nutrition and immunisation are closely linked. Children with poor nutrition are often those who are most vulnerable to infectious diseases and need protection from vaccines, yet vaccines are less effective in malnourished children and often do not trigger strong immunity.

The children whom specialised immunisation programmes are trying to reach are also the least likely to have access to food and nutrition services. Immunisation has the most impact when it is delivered alongside other interventions and integrated into primary health systems. By addressing under-nutrition and under-immunisation simultaneously, we can significantly improve health outcomes and vaccine efficacy, as well as provide interventions in the most cost-effective way.

I saw this for myself on a recent visit to Isiolo in Kenya, hosted by UNICEF and organised by United Against Malnutrition and Hunger. We saw how in rural areas, nutrition interventions are delivered alongside vaccinations, healthcare education and maternal healthcare, to ensure that people have wraparound healthcare interventions that save lives. That was funded by UK development assistance and delivered by partners including Action Against Hunger. If a woman walks for 20 km or more with her children once a week for nutrition, they are less likely to walk the same distance, at a different time, to a different place, for vaccines. Integrating the services is paramount to good healthcare.

This February, ahead of the Nutrition for Growth summit, I met the chief executive officer of Gavi, Dr Sania Nishtar, to discuss the important role that Gavi is playing in delivering these integrated services. Dr Nishtar spoke about the new $30 million programme to integrate nutrition and immunisation interventions in Ethiopia through the UK-founded Children’s Investment Fund Foundation, as well as UNICEF Ethiopia and Gavi, with support from the UK through Gavi’s matching fund mechanism.

Ethiopia has one of the highest numbers—a staggering 1.1 million—of zero-dose children, who have not received a single dose of routine vaccines. That statistic is exacerbated by the covid-19 pandemic, conflict and displacement. The pilot programme aims to reach around 140,000 of those zero-dose children in areas with the highest dual burden of malnutrition and infectious disease, providing cost-effective and efficient interventions to help children to survive and thrive.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Does the hon. Member agree that even before the devastating cuts to UK foreign aid, there was instability in funding for global vaccination programmes? We have already heard that over 1.5 million children die from preventable diseases. Does he agree that the reduction in UK foreign aid will have a devastating impact on the ability to provide vaccines to these children, and will end up costing lives?

[Steve Race]

I will let the Minister answer that question, but I hope there will be an impact assessment to properly map our interventions in future.

Integration costs money and Gavi cannot do it without financial support. I hope that when the Minister is assessing our contribution to this year’s Gavi replenishment, he will look at including support for nutrition integration. What plans does his Department have to integrate nutrition and immunisations more widely?

I want to touch on one issue briefly. The UK’s contribution to Gavi has not only helped to save lives but contributed to the UK’s health security by reducing the risk of global health emergencies and pandemics. It has brought money into the British economy through reputational research returns, and it showcases the UK’s leadership on the global stage.

In my constituency, the Medical Research Council-funded Centre for Medical Mycology at the University of Exeter works closely with Gavi, carrying out world-leading research into deadly fungal diseases and developing vaccines for some of the most widespread causes of death and disablement in developing countries. Does the Minister agree that the UK’s continued participation in Gavi and the Global Fund not only is the right thing to do because it saves lives around the world, but is strategically sound, as it supports our growth strategy and is an important part of delivering both our industrial strategy goals and our national health goals?

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[Iqbal Mohamed]

The hon. Member talks about vaccine inequality in women and girls, but would she agree that the global Gavi programme helps to address the inequalities that people face? During the covid pandemic, it was clearly reported that richer and more affluent countries had priority for vaccines when compared with low and middle-income countries. Gavi is essential to help to perpetuate equality.

[Alice Macdonald]

I totally agree with the hon. Member. In fact, what we have seen with Gavi is that countries that were primarily recipients before have now becomes donors, such as Indonesia. Gavi is a clear pathway for countries to transition into different roles in the global economy as well.

Other Members have mentioned brilliant examples of science and innovation in their constituencies. I want to mention the John Innes Centre at the Norwich Research Park, which is not technically in my constituency, but is in Norwich. It is doing pioneering work, particularly around malaria. As we have heard, that work is helping to save lives internationally, as well as creating jobs at home and generating economic growth.

We need a new architecture for international development. We have to accept the world that we are in, but we also have to challenge ourselves as to why some of the public support for aid has been lost—although, some of the polling shows there is a lot of support for lifesaving interventions such as vaccines. Both Gavi and the Global Fund show us what that new architecture could look like: working together globally through multi- lateral institutions and pooling our resources to maximise our impact.

This is not the time to take our foot off the accelerator. We have made huge progress in this area, both in tackling disease and protecting our own health security. I am sure that the Minister will reaffirm our commitment to improving the health of some of the poorest communities in the world and to delivering a safer and more prosperous future for us all.

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[Monica Harding (Esher and Walton) (LD)]

It is an honour to serve under your chairship, Ms Jardine, and I congratulate the hon. Member for Milton Keynes Central (Emily Darlington) on securing this debate. This year, as both Gavi, the Vaccine Alliance, and the Global Fund conduct their funding replenishments, it is more important than ever that we consider the indispensable value of their work, both for Britain and the world. Since its inception at the beginning of the millennium, Gavi has immunised more than 1 million children and saved in the region of 20 million lives.

The UK was one of the alliance’s founders and has since constituted its largest single sovereign donor. In its short existence, the Global Fund has succeeded in driving down the death rates across AIDS, TB and malaria by 61%, saving 65 million lives. That is close to the entire population of this country and would not have been achieved without British support. That manifested most recently in a £1 billion pledge to the Global Fund’s seventh replenishment. That money is likely to avert around 1 million deaths. We have made so much progress, eliminating many diseases in some countries and reaching the edge of success in others.

However, the work of Gavi and the Global Fund is being placed at risk by short-sighted cuts to international development spending. President Trump has gutted USAID, shattered the fund that fights HIV and AIDS and is poised to eliminate much American funding for global immunisation efforts. Following that playbook, this Government have decided to slash British development spending to 0.3% of our GNI, its lowest level this century.

I, like many others, still remember the optimism of the last Labour Government, who pledged to make poverty history and funded Gavi and the Global Fund when they were created. This Government have rejected so much of the proud 1997 legacy, and they must not do so when it comes to global health. I hope that they put money behind their pledge to prioritise global health and vaccinations. There are so many strong and resonant moral arguments for Britain, but at the same time, the fight against disease serves concrete British interests.

The war against infection is currently facing an alignment of factors that make victory more challenging than ever. Climate change is amplifying disease risk. Higher temperatures are opening up regions to mosquitoes, and the incidence of dangerous weather conditions is on the rise. Pakistan’s catastrophic 2022 floods, for example, have since led to almost 7 million additional malaria cases. At the same time, the disturbing spread and intensification of conflict across the globe is impeding efforts to treat and prevent disease. Increasingly, civilian populations are being deliberately cut off from aid, while healthcare facilities are being not only disrupted, but targeted. Consequently, we are seeing the return of once-controlled diseases like polio and upticks in those like cholera, which emerge from degraded sanitary infrastructure.

Why does this matter for Britain? It is because, as we have heard, disease does not respect borders. Since covid, we are all only too aware that disease can reach our shores, putting both our NHS and our health security at risk. Resistance, particularly in strains of TB and malaria, is also an increasing threat. Both Gavi and the Global Fund are working on the development and deployment of new generations of TB vaccines, even in the face of these new headwinds. Existing interventions for fighting malaria are also seeing their efficacy decline in the face of insecticide and drug resistance. Better, sharper tools have been developed. The challenge now is getting them to where they are needed, and for that we need the Global Fund.

[Iqbal Mohamed]

Before I came to this place, I worked in the pharmaceutical industry in safety, efficacy and regulatory compliance. Does the hon. Member agree that the leadership role that the UK has played to date is not just limited to financial contributions and support, but has ensured that the vaccines that are rolled out in third world and low and middle-income countries are as safe as they can be?

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[Iqbal Mohamed]

Gavi relies heavily on philanthropic foundations,  notably the Gates Foundation, but there are concerns that they may have a disproportionate influence on setting the priorities for global vaccine programmes. Does the right hon. Lady agree that any reduction or pulling back of the UK’s support of those programmes could exacerbate those concerns?

[Wendy Morton]

The hon. Gentleman is absolutely right that Gavi has the ability to pull in many different donors, but perhaps the specific questions following the ODA cut should be directed to the Minister. Gavi is a good example of how partnership can deliver for the benefit of the most vulnerable.

Conservative Governments made significant interventions that contributed to the UK’s reputation as a global health leader. In 2015, we pledged £1.44 billion to Gavi over five years, and in 2020, when we hosted the global vaccine summit, we committed a further £1.65 billion. During the last two Global Fund replenishments, we pledged £1 billion in 2022 and £1.46 billion in 2020. Those pledges to Gavi and the Global Fund were just one part of our leadership and efforts to strengthen global health, and an incredibly important one at that.

I note from responses to my written questions that Ministers are often quite keen to highlight our record on global health, but I would like to take this opportunity to ask some questions about the Government’s record to date. Following the reduction in ODA to 0.3% of GNI, I ask the Minister: what does global health now look like from the strategic level of the Foreign, Commonwealth and Development Office? It would be helpful to know where the priorities are and whether the Government plan to continue the emphasis on multilateral NGOs such as Gavi and the Global Fund, or whether other models are to be considered.

Although the approach to global health may be changing under this Labour Government, the replenishment periods for Gavi and the Global Fund are rapidly approaching—in fact, Gavi’s is literally weeks away. I would therefore welcome some clarity from the Minister on the discussions he has had with representatives of both funds and other donor nations. I want to press him a little about the absence of any UK pledges to date. I have previously had no luck getting an answer on that through my written questions, so I will have another go today. Has he considered the impact of the UK’s apparent delay in pledging on our international reputation and our standing as a leader in global health?

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[Stephen Doughty]

I absolutely will. It is referenced throughout my briefings because of the important partnership and contacts that we have with Unitaid. I have seen its work as well.

We are delighted to be co-hosting the Global Fund’s eighth replenishment with South Africa. We aim to attract and deepen investor engagement, sustain collective investments, and collaborate with the private sector on financing, innovation and supply chain support. We will do everything possible to ensure the success of that replenishment. Last month, the Children’s Investment Fund Foundation made an impressive first pledge of $150 million, a fivefold increase of its previous investment. That extraordinary commitment underscores the significant role of private philanthropy in advancing global health equity and highlights the power of partnership. As countries work to increase domestic financing, we must stand together and strive for success in those replenishments. We know this is an incredibly important moment for all these issues.

Many Members have rightly asked me about financial commitments—I have heard the voices around this room. Members will understand that we cannot make any financial commitments for the next replenishment until after the spending review is complete, but I assure them that we will continue to champion the Global Fund and Gavi and the people they serve, as well as the issues that have been raised today. Members’ voices and those of their constituents have been heard. None of us want to make decisions about cuts to the ODA budget, not least because of our record of success on these issues, but when I look at some of the things I do every day, I can say that they are the right choices, although difficult. We remain committed, however, to international development and particularly to global health. The number of interventions on these issues have made that very clear across the House.

I will reply briefly to some specific points made. My hon. Friend the Member for Milton Keynes Central spoke about the wider benefits not only to the economy, but in terms of our research and the links to the covid vaccine research. I saw some of the pioneering RNA vaccine research in visits with the all-party group years ago. To then see that expertise used to combat a deadly pandemic was extraordinary.

The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell)—my successor on the all-party parliamentary group on HIV, AIDS and sexual health—rightly talked about this being investment, not charity. I think there is a consensus across the House on the proven track record of the Global Fund, Gavi and Unitaid.

My hon. Friend the Member for Exeter (Steve Race) mentioned his visit to Kenya and the links with nutrition as well. He knows the Government’s commitment to the global compact on nutrition and the work that was done around the summit and indeed the research in his own constituency. I thank the hon. Member for North East Fife (Wendy Chamberlain) for her contribution. Her constituency is a place I know well, having done my masters at the University of St Andrews. Important work is being done at that university and at many institutions across the UK.

My hon. Friend the Member for Norwich North (Alice Macdonald) asked important questions about women and girls. I can assure her that women and girls remain at the heart of our global health work. Gavi supports countries with vaccines that directly benefit girls and women, for example those against HPV, which we know is one of the leading causes of cervical cancer. Shockingly, over 85% of cervical cancer deaths are in low-income countries, and it is the main cause of death among many young women in Africa. Women and girls therefore remain at the heart of these partnerships going forward.

The hon. Member for Strangford (Jim Shannon), who is no longer here, as ever spoke passionately on the issues. My hon. Friend the Member for Ashford (Sojan Joseph) spoke about the importance of work on TB. We are absolutely committed to this, whether through the Global Fund, Stop TB Partnership or our work with the TB Alliance. We are doing many pieces of research and operations work.

My hon. Friend the Member for Macclesfield (Tim Roca) spoke about malaria, as did others. On that, there is really remarkable process being made on vaccines. Some of the early findings from the malaria vaccine implementation programme show that an additional one in eight children can be prevented from dying if they receive vaccines in combination with other malaria interventions. We are carrying on the important work on anti-malarial bed nets and other interventions.

My hon. Friend the Member for Gedling (Michael Payne), another of my successors in the APPG on HIV/AIDS, again spoke of the importance of the Global Fund, and I completely agree with him.

My hon. Friend the Member for Gravesham (Dr Sullivan) spoke about her experience working at the Francis Crick Institute, another leading institution doing incredible work. We should be very proud of our academics and researchers in this country for what they do.

My hon. Friend the Member for Bishop Auckland (Sam Rushworth), a powerful voice for his constituents, also spoke of his own personal experiences in sub-Saharan Africa.

[Iqbal Mohamed]

Will the Minister give way?

[Stephen Doughty]

I will not, because we are about to run out of time and I need to leave time for my hon. Friend the Member for Milton Keynes Central to wind up.

The shadow spokespeople raised a number of choices. I do have to gently say to the hon. Member for Esher and Walton (Monica Harding) that we are not in 1997. We are in a very different set of world circumstances. That is tough, but I believe in being honest with this House about the challenges we face. That does not mean we lose our commitment to development or global health, as is clear from what the Government are setting out, and I have listened carefully to what Members have said today.

Not only did the right hon. Member for Aldridge-Brownhills (Wendy Morton) serve as the Minister; we also served on the International Development Committee together. She rightly talks about the important role that IFFIm and others can play—I might write to her more specifically on the plans on IFFIm. She asked me lots of questions about the spending review. I would love to be tempted into answering her, but I cannot, so I refer her to my previous answers.

The UK will continue to champion global health at a critical moment. We will work hard, together with our partners. We have heard about some fantastic work we have been responsible for and about some fantastic organisations. I can assure Members that the Government hear all of those voices, and they will be contemplated as we make some challenging but important decisions over the weeks and months ahead.