Foreign Affairs Committee Inquiry: Global Health Security Unicef UK Submission (GHS0031)

Unicef UK

UNICEF, the Children’s Fund, is mandated by the UN General Assembly to uphold the UN Convention on the Rights of the Child (UNCRC) and promote the rights and wellbeing of every child. Together with partners, UNICEF works in over 190 countries and territories focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

UNICEF globally is at the frontline of the humanitarian response to the Coronavirus crisis. UNICEF has a core role to play in the provision of critical supplies; as global lead of the Nutrition and Water, and Hygiene (WASH) clusters and co-lead of the Education cluster; co-lead in risk communication interventions, leader of the child protection sub-cluster; and as a leading member of the UN Crisis Management Team.

As part of its COVID-19 response, UNICEF is playing a leading role in many aspects of the Access to COVID-19 Tool Accelerator (ACT-A) and COVAX facility, as well as the preparation and roll out of COVID-19 tools, especially at the national level. UNICEF is leading efforts to procure and supply COVID-19 vaccines for 196 countries on behalf of the COVAX Facility in what is likely be the world’s largest and fastest ever procurement and supply of vaccines. UNICEF was already the world’s largest procurer of vaccines.

In parallel, UNICEF is working to secure access to safe injection equipment and cold chain equipment, and to support country readiness efforts for roll-out of a COVID-19 vaccine, recognising that securing access to vaccines alone won’t be sufficient to protect those at highest risk of infection such as front line health workers, on whom UNICEF relies on to deliver life-saving health programmes.

UNICEF, together with WHO and other partners, is co-leading global efforts to ensure countries are ready to introduce and deploy the vaccine as soon as it becomes available. This includes helping countries to strengthen their cold and supply chains, training health workers, and working with communities in addressing misinformation and building trust in vaccines and in the health systems that deliver lifesaving vaccines.

Unicef UK is submitting evidence to the Foreign Affairs Committee with the aim of ensuring that the UK Government continues to drive critical investments into the health systems and global partnerships which can help end the pandemic now, prevent future pandemics, and ensure every child has access to the life-saving and essential services they need to survive and have a healthy future.

1. Summary

1.1. COVID-19 has spawned challenges across healthcare systems globally, with even the wealthiest countries struggling to cope with the influx of patients. It has been a wake-up call for the chronic lack of resourcing and prioritisation of primary (PHC) across the globe.1 The poorest countries and those facing emergencies and protracted crises, with weak and under-resourced health systems, are being pushed to the brink of collapse.

1 https://www.who.int/publications/almaata_declaration_en.pdf

1 1.2. Adapting services due to the pandemic will only go so far to reignite services safely, especially for health workers, until a vaccine is widely available. Mortalities caused by vaccine preventable diseases such as measles are rapidly rising,. COVID-19 is threatening to roll back progress made in reducing preventable child deaths in the last three decades.

1.3. At least 80 million children under the age of one are at risk of diseases such as diphtheria, measles and due to COVID-19-related disruptions in routine vaccinations. This is against a backdrop of already stagnating global vaccination coverage rates, leaving nearly 20 million children unvaccinated annually.

1.4. Disruptions to health systems and reduced access to in 118 low- and middle-income countries could result in an extra 1.2 million deaths of children under age five in just six months, in addition to the 2.5 million children under-five who died every six months even before the pandemic. Overall, we are likely to see spiking to levels not seen for 10-20 years. Until the pandemic is under control, the risk to children’s health and their future is high.

1.5. In this context it is vital that the UK Government maintain critical funding to support health systems and uphold its commitment to the world’s children, despite their intention to reduce ODA from 0.7% of GNI to 0.5%.

1.6. In addition, Unicef UK recommends that the UK Government use its Presidency of the G7 to ensure concrete commitments and immediate actions towards strengthening integrated PHC systems. Building this into the Prime Minister’s five point plan to prevent future pandemics will be essential, and ensure that PHC can deliver lifesaving and essential services for all women and children, regardless of where they live and their socio-economic status, and can respond to and manage health emergencies and outbreaks such as COVID-19.

1.7. The features of PHC allow the health system to adapt and respond to a complex and rapidly changing world. With its emphasis on promotion and prevention, addressing determinants, and a people-centred approach, PHC has proven to be a highly effective and efficient way to address the main causes of, and risk factors for, poor health, as well as for handling the emerging challenges that may threaten health in the future.

2. What lessons has the COVID-19 pandemic taught us about the importance of international collaboration in securing global preparedness and resilience against biosecurity threats?

2.1. The pandemic has taught us the value and importance of international collaboration. Where multilateral institutions have been strengthened, supported and financed we have seen historic collaboration. The development of the COVAX facility is a good example of this.

2.2. However, COVID-19 has spawned challenges across global healthcare systems, challenging the resilience of the most solid health systems in the world. It has laid bare the chronic lack of resourcing and prioritisation of PHC across the globe, despite the first commitments on PHC being made 40 years ago in the famous Alma-Ata Declaration.2 For the poorest countries and those facing persistent health emergencies and protracted crises,

2 https://www.who.int/publications/almaata_declaration_en.pdf

2 weak and under-resourced health systems are being pushed to the brink of collapse, and they are where the disruptions are most likely to last.3

2.3. In order to secure global preparedness and resilience, all countries need an minimum foundation of health systems capacity to respond to threats and contribute to global security. UNICEF experience shows that, particularly in countries with low health sector capacity, there is a reliance on coordinated international support so to ensure data and information is shared efficiently and resources priroitised where they are needed most. Ensuring UN agencies are supported to collaborate effectively is important. This includes challenging the public when confidence in these institutions and the expert guidance that they provide is called into question. By providing additional funds and public support to the World Health Oragnization (WHO) at a time of crisis, the UK Government should be commended in doing just that.

2.4. In order to be as effective as possible, international collaboration in response to this crisis demands global leadership in support of multilateral platforms. Without it, political tensions and divergent agendas can obstruct quality collaboration. This was starkly demonstrated as the WHO’s role as technical expert and guide for the world was called into question by governments and guidance.

2.5. Right now, the global response and political attention is focused on COVID-19, but the UK must begin to prepare and build momentum for the moments ahead where even more urgent action is needed to protect child health. COVID-19 provides an opportunity to address the need for strengthened health systems worldwide, and in parallel strengthen the multilateral systems which facilitate that.

3. How effective is the UK’s current approach to global health security?

3.1. The UK has been at the forefront of global health agendas – including on child survival - for over two decades. It has done this directly through UK Aid funding alongside the provision technical expertise and role of the former Department for International Development (DFID). In particular by funding and influencing the strategy of health multilateral bodies, including GAVI, of which the UK has been the largest donor since its inception in 2000. Over the last decade alone, the UK has hosted the Gavi, the Vaccine Alliance replenishment twice, co- led the Nutrition for Growth Summit to tackle malnutrition, and provided global stewardship on AMR (Antimicrobial Resistance) through the O’Neil Review.

3.2. At the UN General Assembly, 2020, the Prime Minister outlined the UK’s new global approach to health security based on a 5-point plan to protect humanity against another pandemic like COVID-19. In addition, the UK has already committed to global health security being one of the priorities for its G7 presidency: the UK’s Health Track will be almost exclusively dedicated to COVID-19, with the Prime Minister’s five-point plan being central to this. And in October 2020, the UK Government pledged up to £500 million (approximately US$ 640 million) to the Gavi COVAX Advanced Market Commitment (AMC). This is in addition to an earlier US$ 61 million pledged by the Government for the COVAX AMC at the Global Vaccine Summit in June 2020, bringing the total contribution from the UK to US$ 701 million.

3 https://data.unicef.org/resources/healthy-mothers-healthy-babies/

3 3.3. However, there are ways in which the UK’s five point plan could be strengthened to align more strongly and sustainably with systems strengthening for pandemic preparedness in the long term, and to accelerate progress towards the health Sustainable Development Goals (SDGs).

3.4. Concrete commitments and immediate actions towards strengthening integrated PHC systems should be an integral part of this plan. This is essential to prevent future pandemics will be essential so that PHC can deliver lifesaving and essential services for all women and children, regardless of where they live and their socio-economic status, and can respond to and manage health emergencies and outbreaks such as COVID-19.

3.5. The features of PHC allow the health system to adapt and respond to a complex and rapidly changing world. With its emphasis on promotion and prevention, addressing determinants, and a people-centred approach, PHC has proven to be a highly effective and efficient way to address the main causes of, and risk factors for, poor health, as well as for handling the emerging challenges that may threaten health in the future.

3.6. In addition, the UK’s five point plan is missing another crucial priority element of pandemic preparedness – healthcare workers – the people who fight disease every day, through prevention and treatment. Governments must ensure that their healthcare workers are protected now, through a consistent supply of PPE, comprehensive training, and the essential resources they need to carry out their lifesaving work, now and in the future.

3.7. Presently, a lack of basic resources and infrastructure for hand hygiene and waste management in healthcare facilities is putting healthcare workers and patients at extra risk of infection, ultimately undermining pandemic preparedness and response. This also includes cold and supply chains which ensure that essential medical supplies, including vaccines, reach every community.

3.8. The UK’s approach to global health security is therefore not currently as effective as it could be and could be improved by investing in healthcare workers, WASH in healthcare facilities and essential cold and supply chains as part of their pandemic preparedness plans and efforts to make PHC a reality for millions more children and communities.

4. What role should the FCDO play in bringing about a resolution to the COVID-19 pandemic and preventing future pandemics?

4.1. Investments are needed now to urgently prepare all countries for the roll-out of COVID-19 vaccines, therapeutics and diagnostics. Community engagement will be crucial as vaccine misinformation has flourished under the pandemic, with false information on social media creating a parallel ‘infodemic’. This increases hesitancy and reduces public demand for routine immunization – and potentially for a COVID-19 vaccine. The UK should take a lead in fighting the spread of misinformation and rebuild trust in vaccines ensuring that strategies to tackle vaccine hesitancy are better integrated across its domestic and international vaccination work.

4.2. In addition, investments should not be standalone but use this once in a lifetime opportunity to build vaccines infrastructure as the backbone to PHC. While budgets are tight, governments and donors should look for ways in which new investments can have a wider and lasting impact on stretched services and look for opportunities where new innovations,

4 partnerships and support can help systems recover from the pandemic. The improvement of storage facilities and cold and supply chains are a few examples of changes which can help solve existing vaccination bottlenecks.

4.3. Efforts and investments to control the COVID-19 pandemic, could leave a lasting impact on the systems needed to prevent another outbreak at any time. By strengthening PHC, expanding cold chains and expanding healthcare worker capacity, countries will be better able to identify, treat and reduce the spread of further outbreaks. Similarly, in addressing vaccine misinformation and setting up structures to manage the 'infodemic' such as the Vaccine Demand Observatory being set up for COVAX, we are putting structures in place that will tackle COVID-19 while addressing wider vaccine hesitancy after the pandemic.

5. Has the UK effectively used its position in multilateral organisations to promote international collaboration in response to COVID-19 and the global health security agenda? What should the FCDO be doing to support research and distribution of a COVID-19 vaccine?

5.1. The UK has been at the forefront of global health agendas – including on child survival - for over two decades – particularly through the technical expertise and role of the former Department for International Development (DFID) in funding and influencing the strategy of health multilateral bodies, including GAVI, of which the UK is the largest donor since its inception in 2000.

5.2. The UK government has also been a prominent supporter in the global emergency response tackling the effects of the COVID-19 pandemic. In particular, it has supported efforts to develop and prepare for distribution of a COVID-19 vaccine, and is set to become the second largest state donor to the WHO.4

5.3. As the new FCDO takes form, the UK should utilise its role on global health multilateral boards, such as the Global Fund to Fight AIDS, Tuberculosis and and GAVI, as well as the World Bank, to ensure the inclusion of health systems strengthening as a priority objective of the response to the pandemic. It should also influence its’ multilateral partners to ensure countries and communities are supported to adapt, prioritise and integrate vaccination with other primary healthcare services.

5.4. In 2021, UNICEF will deliver 2 billion vaccines, 245 million therapeutics and 500 million tests to low and middle-income countries in a safe and equitable way. Funding will be needed for the costs of leading end-to-end supply chain engagement – spanning procurement, international freight, logistics and supporting country readiness, as well as in- country delivery. We will also need to work with governments and communities in support of training, community engagement and communications, helping with vaccine hesitancy and misinformation to ensure the vaccines, tests and treatments reach those in need.

5.5. This year, the UK Government has an opportunity to renew partnerships and demonstrate its leadership. From the G7 to COP26 and through its influential role in multilateral fora, the UK can and must be at the forefront of efforts to respond to the worst impacts of the pandemic. It has the opportunity to harness its soft power and use its unique resource and capacity to set an agenda that can build global health security in a sustainable way.

4 https://www.theguardian.com/world/2020/sep/25/uk-to-become-whos-largest-state-donor-with-30-funding-increase

5 6. How can the FCDO ensure that COVAX is successful? What are likely to be the main challenges associated with worldwide distribution of a vaccine?

6.1. There is a very real risk that ‘vaccine nationalism’ will deprive the poorest countries with the weakest health systems of COVID-19 vaccines and treatments. Protecting high-income countries alone will not end the pandemic and will leave those most vulnerable to the impact of COVID-19 still at high risk, elongating the impact on children’s health and rights. The whole world will remain vulnerable to the virus until countries with the weakest health systems are protected from it. The FCDO must ensure Governments work together to ensure any COVID-19 vaccine is affordable and accessible to all countries.

6.2. A COVID-19 vaccine alone will not a silver bullet to end the pandemic. Investments in diagnostics and therapeutics are essential to diagnose and treat COVID-19 patients. Further, without comprehensive investment in the systems to deliver COVID-19 tools to all countries who need them, the response will be inequitable, slowing the end of the pandemic. The FCDO must ensure Governments must prioritise support for all elements of the COVID-19 response and ensure an equitable and comprehensive pandemic response for all countries.

6.3. The COVAX response should not be a short-term intervention that allows us to go back to normal after. It has to be a stepping stone towards stronger systems tomorrow. Currently, ACT-A has an 18-month mandate. However, there is growing support for building on the ACT-A model and turning it into a long-term global platform for pandemic preparedness and response - the Access to Pandemics Tools (APT). This would be an effective approach to capitalize on a promising global initiative to address global gaps in pandemic preparedness and response focusing on global collaboration and market dynamics.

6.4. In addition, even before COVID-19, misinformation and a lack of trust in vaccines were growing challenges. As we look forward to the roll out of COVID-19 vaccines, confidence in vaccination overall is critical, both for control of the pandemic and for the negative impact that mistrust could have on wider vaccination services. The FCDO must unite Governments to fight the spread of misinformation and build confidence in the COVID-19 vaccines, leveraging this to improve overall trust in vaccines, prevent vaccines preventable outbreaks, and improve routine immunisation rates.

6.5. In order to ensure the relevant political interest and commitments are realised for solutions and to drive continued progress to end the pandemic, the FCDO should focus on tackling: . Country readiness and preparedness for delivery of COVID-19 tools when they become available. . Lack of demand and uptake of new tools. Possible reasons for this include a lack of planning, inadequate resources, not being ready and lack of training for healthcare workers. . A lack of support for country working groups to plan, react and roll out COVID-19 tools. The need here is especially urgent in complex and humanitarian settings.

7. Unicef UK’s Recommendations

7.1. In order to strengthen Global Health security, the UK must continue to drive critical investments into the health systems and global partnerships which can help end the pandemic now, prevent future pandemics, and ensure every child has access to the life-

6 saving and essential services they need to survive and have a healthy future. This must be maintained as the Government pursues their intention to reduce ODA from 0.7% of GNI to 0.5%. Specifically, the UK Government must:

1. Build on the Prime Minister’s commitment to global health security at the forthcoming G7 to catalyse a movement towards strengthening PHC systems within the G7 2021 presidency. As part of this, ensure that there are concrete commitments and immediate actions towards strengthening integrated PHC systems – including healthcare workers.

2. Support countries to ensure that financial risk protection is expanded as part of moves towards Universal Health Coverage, minimising out-of-pocket payments that drive women and children away from services.

3. Publish a cross-government global health strategy covering all UK Government health ODA spend, ensuring this will strengthen global health security and SDG 3 while delivering against related goals such as WASH (SDG6) and nutrition (SDG 2).5

4. Finalise and publish the Health System Strengthening Position Paper, in collaboration with civil society partners.

5. Utilise its role on global health multilateral boards, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI to ensure that the inclusion of health systems strengthening as a priority objective of the response to the pandemic.

6. Ensure investments in the Access to Covid-19 Tools Accelerator (ACT-A) and broader Covid-19 response retains a strong focus on strengthening health systems and builds additional capacity for child health interventions, including the delivery and catch up of vaccination programmes.

7. Take a lead in fighting the spread of misinformation and rebuild trust in vaccines ensuring that strategies to tackle vaccine hesitancy are better integrated across its domestic and international vaccination work.

8. Ensure every child, young person, and adult, wherever they live, has equitable and affordable access to COVID-19 diagnostics, treatment and vaccines by through a comprehensive financing package for the Access to Covid-19 Tools Accelerator (ACT- A).

December 2020

5 https://img1.wsimg.com/blobby/go/07abcea5-60b9-431e-be69-1422d65b7cd5/Website%20Stocktake%20Review.pdf

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