Yesterday, the UK Government announced a pledge of £1.25 billion for Gavi, The Vaccine Alliance. This is brilliant news. The UK was one of the co-founders of Gavi and has been a strong partner in its work, recognising the importance of vaccinating children to saving lives, strengthening health care systems, driving economic growth, and protecting the UK from future pandemics – boosting safety and security for all. Gavi has now vaccinated over 1.1 billion children, stopped deadly diseases from spreading around the world, and saved almost 19 million lives. 

Last week I wrote a blog for Bond arguing that this could be a turning point in the funding of global health multilaterals. So, what does this announcement tell us?

Firstly, that the UK is still a strong supporter of Gavi and vaccinations. This is both great news and something that, in this period of repeated cuts to the UK’s Official Development Assistance (ODA) budget, cannot be taken for granted. It shows that – at least in relative terms – the Government has chosen to protect the global health budget. This has been a very challenging time for the Foreign Commonwealth and Development Office (FCDO). The Government’s spending priorities are of course a political decision. Civil servants do not decide how much money is spent on ODA and they weren’t warned about the cuts, which also led to the resignation of the International Development Minister. So the fact that they have been able to maintain this level of contribution is a big win.

That Foreign Secretary David Lammy chose to attend the summit in person is also significant. He has not made many statements about international development, so personally delivering a speech that he could have delegated matters. 

Secondly, the UK announcement shows that public pressure and campaigning works, particularly when done in partnership with African civil society organisations and leaders. We know that all of the letters sent by grassroots campaigners, all of the contacts with MPs, the letters from politicians in implementing countries, and the steady stream of parliamentary questions that the Minister is still having to answer, have made a difference. Without that demonstration of support and continued pressure, it would have been easy for the UK to make further cuts.

While this announcement gives us some answers it also raises a number of other questions.

What does this mean for the rest of the ODA budget?

The FCDO made it very clear even before the cuts that they would consider all potential spending commitments holistically. This inevitably means that a commitment for one area means a smaller pot for others. We have also heard that announcements are unlikely to be made before the autumn, which means that some organisations will have been in limbo regarding a contribution from the UK for over a year. What this means in practice varies across programmes but it will have significant impacts on their work. Everything from maintaining disease surveillance and responding to outbreaks can be put at risk. Engaging with survivors and people directly affected by diseases could also be impacted, preventing innovation and improvements to services. 

Also, while we are grateful that global health has been protected at least to some extent, the news that global education work may be deprioritised is obviously very alarming. We know that to end poverty, we all need access to health, education and economic opportunity. Cutting any one of these elements limits the life chances of millions of people and traps them in poverty.

What is the breakdown of the investment?

We now know the overall figure of the UK’s investment in Gavi but, famously, the devil is in the detail. It is very likely that at least some of this figure (and contributions from other countries) will include money that had previously been given by the UK to COVAX but was not spent.

The COVAX facility was a mechanism set up during the COVID-19 pandemic to ensure equitable access to vaccines. Once COVAX was wound down in 2023 there was an underspend, but deciding how that money could be used was legally complex and varies from country to country. One way for the UK to boost the Gavi investment despite the current ODA constraints would be to use ODA spending from previous years such as the COVAX underspend. However the ‘investment opportunity’ – the document that sets out what Gavi thinks needs to be done in the next five years and how much it costs to do it – focuses on the new money required to fund this work. So there could still be challenges and potential cuts ahead if the level of new money is low.

We also need to know how much of the investment is going through the International Financing Facility for Immunisation (IFFIm). This uses vaccination bonds to ensure that Gavi can receive the money when it is pledged, but the government can pay later. This has been a very important part of Gavi’s funding and makes it possible for governments to make commitments in constrained financial circumstances where they know they can’t give the money immediately. The UK helped to create IFFIm so some of the investment will definitely be spent there, but understanding the level of that investment has broader impacts on what ODA spending is still possible.

Gavi-supported HPV vaccination, Bangladesh, October 2023. Credit: Gavi/2023/Ashraful Arefin

Who will decide how this money can be spent?

Some countries place restrictions on what the money can be used for. The USA, for example, is placing constraints on what their limited spending on international development can be used for. This is very damaging for a number of the issues we work on.

Usually UK funding commitments can be spent as the organisation sees fit, as long as it is in line with the work that the UK has agreed to fund. However some people are arguing that in this constrained fiscal environment, this is something the UK should do as well. If the UK is truly committed to empowering national governments and affected communities, then they should not restrict how the money is used to implement the strategy.

What are the UK’s priorities for Gavi’s work?

We are still analysing the different commitments that have been made to Gavi. In the event that its new strategy is not fully funded, and some work has to be dropped, what areas will the UK be fighting for? The new malaria vaccine? Reaching ‘zero dose’ children who have not received any vaccinations? Work on climate change? Obviously all of the work that Gavi had proposed is important and necessary, but if there is not enough money then something will have to go and fewer children will be vaccinated. There is a two day retreat before most Gavi board meetings and we expect that there will be some kind of prioritisation exercise before their July board meeting. The UK is a member of the Gavi board so have a say in what areas of work stay and which are dropped.

Is the focus on the countries’ national interest shortsighted?

The rise in right-wing populism around the world, including in the UK, has made many politicians anxious about expressing support for international development. Increasingly they rely on messages that show why ODA is in the national interest to justify spending on global health and education. They talk about the importance of funding vaccinations to protect the UK and the NHS, or about how it boosts the UK’s economy because of the strength of our research and development work. These are both strong arguments. However, there is also a strong case to be made for saving lives even if it didn’t benefit our national interests.

Recent polling data shows that 76% of the UK believe that protecting vulnerable children from deadly diseases improves millions of lives across the world. We need to be talking to our better selves as well as recognising the need for pragmatism in difficult financial and economic circumstances. There is a real risk that in downplaying the moral arguments in favour of funding international development, we play into the hands of populists who would like to scrap ODA entirely.

Will 2025 be the end of this type of replenishment campaign?

David Lammy’s speech suggests that the UK clearly hopes so. Each country announcing a contribution to Gavi at the event highlighted different themes. The President of Greece linked the increase in their pledge to the NATO conference and demands to increase defence spending. In what was the most powerful speech of the night, the President of Ghana spoke about the experience of his brother contracting polio, and the ripple effect that has had throughout their lives. David Lammy focused on the need for reform of global health institutions such as Gavi. He said there were too many different organisations and their work was too siloed. This is not new. It is something that people working in international development have been talking about for many years. Often the people most passionate about multilateralism are also the ones also calling for change. Dr Sania Nishtar, the Chief Executive of Gavi has already set out her reform agenda which she calls the Gavi leap. 

However, calling for reform in that setting felt very pointed. There are expectations that the UK will host an event bringing leaders together to explore reform but it is not clear what that will look like yet. It is clearly something that will be a priority for the UK and an area where they hope that their ongoing commitment to Gavi will help win over allies.