The government must choose whether to renew its contribution to fighting disease abroad.
The UK is set to co-host the Global Fund to Fight AIDs Tuberculosis and Malaria’s 8th replenishment summit in Johannesburg on November 21st. The purpose of the summit is for the UK, along with the fund’s other member states and private supporters, to set their contributions to the fund for the next three-year cycle. The fund draws investment from a range of governments, private firms, and philanthropists, and co-ordinates how it is distributed among the most vulnerable communities.
The Global Fund is “open to all voices in how funding is invested” according to Revanta Dharmarajah, who is part of the Developed Country delegation to the Global Fund Board. The board has made it clear to the UK government that they would have a role in determining how any aid is spent.
The fund has suggested that the UK government match the £1 billion investment that the previous government contributed in 2022, which was itself a reduction from the £1.4 billion invested in 2019, but there are concerns that this will be reduced. Dharmarajah warns that “services are now being paused, and we’re going to go backwards” if the Global Fund’s total fundraising goal of $18 billion (£13.68 billion) is not met.
The role of the Global Fund is primarily as “a financing organisation that raises funds every three years, and then distributes that to countries” Dharmarajah explained. This is done in consultation with both the donor countries and representatives of both the recipient countries, and the communities the Global Fund aims to target. Dharmarajah also works as the lead HIV and health financing officer for the UK charity Frontline Aids, who work to implement some of the Global Fund’s schemes.
A recent example of this is the Nadoum programme which was funded by investments contributed during the Global Fund’s 7th replenishment in 2022. This programme aimed to establish community-based services, which would allow local people to manage their own communities’ AIDs treatments, across the Middle East and North Africa. This acted by training staff, across five countries, in harm reduction and providing patients who may be turned away by mainstream healthcare, such as drug users, and homosexual people, with a reliable source of lifesaving medicine. Dharmarajah believes that these efforts are vital to achieving the Global Fund’s goal of eradicating HIV across the world by 2030, and the Global Fund is better placed than national governments to “deliver treatments to communities which are hard to reach.”
The UK’s decision, which may be announced the week before the summit itself, comes in the aftermath of a series of decisions by the UK government to cut investments abroad. The government has already reduced spending on bilateral international aid from 0.7% of Gross National Income (GNI) to 0.5% of GNI since taking office last July and has pledged to reduce it further to 0.3% of GNI by 2027. The UK’s contributions to the Fleming Fund for researching anti-microbial resistance, and Gavi, an international vaccine alliance, have also fallen since 2022.
The USA’s complete withdrawal from the Global Fund in February this year has emphasised the UK’s role as a leader within the fund, according to Dharmarajah. He said that the UK has “always been a strong partner” within the fund, and that any reduction in the UK’s contribution may encourage other countries to do the same, reducing the likelihood of the Global Fund reaching its $18 billion funding goal. Many economists have interpreted Chancellor Rachel Reeves’ pre-budget speech, where she said that “Each of us must do our bit for the security of our country”, as indicating that some combination of tax rises, and spending cuts are likely to be announced. This could mean further reductions in the UK’s contribution to international organisations such as the Global Fund.
An opinion poll conducted in August by the polling agency More in Common suggested that 62% of the British public would support either maintaining the UK’s Global Fund contribution at its current level or raising it. Public discontent over any potential investment cuts is also evident through the attempts of charities such as The Borgen Project to directly lobby MPs on the issue. The charities ONE and Project Everyone are planning to project Yinka Ilori’s artwork ‘We Can End AIDS if We Choose To’ onto parliament and across London, in the week leading up to the government’s decision.
Inside parliament, MPs are also becoming increasingly frustrated with the government over suggestions of a potential funding cut. A debate held in the commons on November 4th saw MPs from Labour, the Liberal Democrats, and the Democratic Unionist Party all speak in favour of renewing the £1 billion investment from 2022. Following the debate, a group of seven Labour MPs wrote to the Prime Minister warning against a reduction in investment and stating that any funding cut would be a “moral failure” by the government. One of the signatories, former minister for International Development under Gordon Brown, Gareth Thomas, told The Guardian that Britain was “moving in the wrong direction, precisely when we must defend international co-operation and multilateralism most vigorously.”
The Global Fund believes that it can prevent 400 million infections and save 23 million lives across a three-year period if it achieves its $18 billion funding goal at the Johannesburg summit. Dharmarajah fears that a 15% cut in UK funding is likely however, and that this will be used to justify similar cuts from other contributors. Other sources have as reported that the government is considering a 20% cut.
Dharmarajah says that the Global Fund recognises the restrictions placed on investors by low economic growth, and high national debt. He said that the fund is “not asking any country to increase (funding), just to continues its commitment to what it believes in.” He insists however, that lives will be lost if the Global Fund’s targets are not met, especially in the most vulnerable communities who are traditionally underserved by bilateral aid programmes.
This is an opportunity for the UK government to showcase international leadership on a crucial public health issue, but it remains unclear what choices they will make.
