The U.K. government’s decision to cut the aid budget has undermined its G-7 global health security agenda, according to experts.
The government's first policy priority for its presidency of the group of leading industrial nations is to “build back better” from COVID-19 by “leading the global recovery from coronavirus while strengthening our resilience against future pandemics.”
Global solidarity was a strong theme of the speech, with Hancock twice saying, “We are all human.” But some global health experts questioned whether the government’s rhetoric matched its actions.
“How does this fit with cutting the aid budget and getting rid of DFID?” asked Robert Yates, director of Chatham House’s global health program and former health adviser at the Department for International Development. “A lot of that was about health system strengthening and helping countries build up their health system, and isn’t that being undermined by slashing the aid budget?”
“If there is this perception that all the great words about ‘collaboration’ and ‘sharing’ just go [only] so far, but when the stuff is discovered that can save people’s lives, it’s like, ‘Thank you very much, we’ll have first dibs on this,’ that's not right.”— Robert Yates, global health program director, Chatham House
DFID was folded into the Foreign & Commonwealth Office last year. The Foreign, Commonwealth & Development Office now controls the bulk of the U.K. aid budget, but the government will not be meeting its legally mandated target of spending 0.7% of national income on development assistance. While it is unclear where the reductions will fall, bilateral budgets, often used to support national health systems in lower-income countries, are expected to take a significant hit.
Hancock’s “emphasis on global solidarity was really at odds with the aid cuts,” said Tom Hart, research fellow at the Overseas Development Institute. He described this as “the real weakness” of the United Kingdom’s G-7 health agenda.
The health secretary’s announcement consisted of four pillars: health security “for all,” including the launch of a New Variant Assessment Platform to analyze genetic viral mutations; improving the coordination and standardization of clinical trials and information sharing; fighting antimicrobial resistance; and developing digital health care.
These objectives appear to put U.K. needs ahead of those of lower-income countries, according to Pete Baker, a policy fellow on the Center for Global Development’s global health policy team. He said the focus on a New Variant Assessment Platform and digital health care, “in combination with [aid] cuts … worries me.”
Along with the New Variant Assessment Platform, Baker said his “main worry” is that “it looks like a U.K.-focused, high-tech approach to global health security, almost like they started with what is interesting and useful for the U.K. and then rolling it out to the world, rather than … starting with the priorities of the security of low-income countries and supporting them.”
Low-income countries often lack basic data collection and epidemiological resources, which are needed for pandemic response and also to understand dangerous viral mutations, according to Baker. With an estimated 4,000 COVID-19 variants in existence, Baker questioned whether advanced genomics is the priority for low-income countries.
He also urged caution on handling genetic material taken from people. During the 2014 Ebola outbreak in Sierra Leone, blood samples returned to the U.K. for testing “went down terribly badly amongst the population and media in Sierra Leone,” Baker said. “All kinds of colonial themes reemerged. The U.K. needs to be careful.”
Yates welcomed the principles behind the U.K. agenda but said its implementation — whether the policies would be applied equitably — is key. “So many things [Hancock] was mentioning objectively are good ideas, but they have to get to everyone quickly,” he said. “This is where you are seeing a mismatch between the words about things being available to all and the actions, particularly around access to vaccines.”
Yates added that “if there is this perception that all the great words about ‘collaboration’ and ‘sharing’ just go [only] so far, but when the stuff is discovered that can save people’s lives, it’s like, ‘Thank you very much, we’ll have first dibs on this,’ that's not right.”
As the U.K. seeks to be a global health leader, it may struggle to defend its credibility.
Having suffered one of the worst COVID-19 death tolls in the G-7, the U.K. by Thursday had given at least one vaccine dose apiece to 10 million of its 67 million people, and the country plans to work down through the age groups of its population with its order of 407 million doses. In contrast, Guinea — the only low-income country in Africa to provide COVID-19 vaccines — had administered shots to just 25 people as of late January, according to the World Health Organization.
Implementation was also a key point for Ilona Kickbusch, a global health consultant, who said the G-7 needs to hone in on the “health security for all” pillar of its platform. “What’s really critical is: What is the political message the G-7 is going to send on global health at this point in time?” she told Devex. “The G-7 had better show how it is a responsible global actor.”
Hancock’s speech was also a missed opportunity to highlight global health’s intersection with other areas in which the U.K. is taking a leading role, according to Hart.
Challenges such as the wildlife trade and deforestation “cut through all” major international events in 2021 and “are important to a global health security agenda, so it would be good to see that all brought together,” he added.
A U.K. government spokesperson said: “The UK will use the G7 Presidency to champion support for the poorest nations and to promote development as part of our global health agenda. This means a stronger, more collaborative and effective global health system, not just in fighting the Covid-19 pandemic, but to ensure the international community is better prepared for future threats.”
Update Feb. 8, 2021: This article has been updated to include the U.K. government’s response.