STOPAIDS reaction to the publication of new FCDO position papers

Today the Foreign, Commonwealth and Development Office (FCDO) has published two position papers that outline the approaches towards, and aims of ending preventable deaths and strengthening global health systems. You can view the papers here:

FCDO Health Systems Strengthening for Global Health Security and Universal Health Coverage

Ending Preventable Deaths of Mothers, Babies and Children by 2030: Approach Paper

STOPAIDS welcomes the adoption of these papers that come at a critical time for global health. We hope renewed efforts to end preventable deaths and build health systems will reignite the UK’s leadership in the HIV response. After COVID-19, AIDS-related illnesses are the leading cause of death of women of a reproductive age and HIV transmissions disproportionately affect marginalised communities.

Considering the systemic barriers in the fight to end AIDS and for all communities to realise their right to health, it is welcome to see the papers’ emphasis on human rights, country leadership and the importance of strong, resilient health systems.

Even before the COVID-19 pandemic, at least half the world’s population were lacking access to essential health services. In order to properly address this, these papers must be followed through with Government action that urgently returns to the 0.7% spending commitment and repairs the damage from the catastrophic funding cuts made earlier this year.

Earlier this year STOPAIDS, the APPG on HIV & AIDS and Frontline AIDS released a joint report highlighting the impact of UK Government cuts to Overseas Development Assistance (ODA) on HIV and AIDS worldwide. The report paints a worrying picture of progress in jeopardy, out of step with our Government’s rhetoric, commitments, and strong historic political and financial leadership; cuts of over 80% have been made to key multilateral organisations for the HIV response including UNAIDS, UNFPA, and Unitaid. These cuts will undoubtedly affect the international community’s ability to get the HIV response back on track, as well as disproportionately affect already marginalised communities.

STOPAIDS welcomes how the Health Systems Strengthening paper recognises the importance of reducing out of pocket expenses and ensuring that people are not pushed into poverty because of the costs of health services. This follows a report on 12 December from the WHO and the World Bank that more than half a billion people have been pushed or pushed further into extreme poverty due to health care costs. But the Government must recognise how some of their ODA investments through the CDC Group – the UK’s development finance institution – into private healthcare potentially risk fuelling this. Considering the risks around using ODA being channelled to the private sector for health-care delivery, FCDO must ensure aid-funded private sector engagement in global health does not undermine public healthcare provision or a country’s ability to achieve UHC. 

It’s encouraging that the Ending Preventable Deaths paper makes reference for the UK planning to continue to support the large-scale prevention and treatment of HIV, TB and malaria through the Global Fund. 

Action on the three preventable diseases and health system strengthening through The Global Fund is critical for delivering the FCDO’s new strategies. The Global Fund is the largest multilateral provider of grant support to strengthen health systems. In its 20 years of transformational impact, the partnership has saved 44 million lives – more than 3 million of these saved thanks to UK Aid. To deliver on the FCDO’s new commitments, it’s critical that there is a full and timely disbursal of the current Global Fund pledge, and an early and ambitious pledge to the 7th replenishment in 2022. 

Lastly, STOPAIDS is pleased to note the step forward of the FCDO committing to use research and innovation to improve equitable access to safe, affordable technologies such as medicines, vaccines, tests and other products. However, it is disappointing that there is no mention of how the UK Government will help increase local production capacity of essential medical tools in low- and middle-income countries as a way of ensuring sustained, stable and affordable supplies. 

The stark inequity in COVID-19 vaccine (and diagnostics) access must compel FCDO into re-thinking the market shaping approaches that have been used to address vaccine inequity in this pandemic. The message from UNAIDS, echoed by the majority of countries in the global South, is to ‘Lift patents, share vaccine technology and let developing countries make their own vaccines’. The FCDO should heed this message and develop a strategy for how it will map and monitor intellectual property barriers of essential medical tools and use its influence to push for pharmaceutical companies to actively engage in technology transfer with potential manufacturers. One way this can be achieved is for there to be stronger conditions attached to UK Government funding for biomedical R&D so that products are openly licensed, research and data is publicly available and all investments are transparent. This will create the ‘end to end’ approach that FCDO have committed to taking; by ensuring new products, technologies, and innovations are affordable and accessible to all through the health systems.