The world’s poorest will go without vaccines unless we help fund healthcare systems

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Chancellor Rishi Sunak will be engaging this week with the annual meetings of the International Monetary Fund and the World Bank, virtually unfolding in Washington DC, followed by preparations for the G20 summit of leading industrialised nations at the end of the month. These international meetings will be dominated by the need for increased support from the world’s richest countries for global pandemic recovery.

But Sunak will be in a tricky position; he is sticking with plans for a drastic 30 per cent cut in the UK’s international aid budget, and is now under fire from members of his own party for plans to pad the reduced numbers with recycled new International Monetary Fund borrowing rights that are supposed to boost global pandemic support.

We might therefore expect to see British officials instead stressing more positive messages – including the high-profile commitment to donate 100 million doses of the Covid-19 vaccine to countries in need.

But even if the UK does make good on these promised donations, what good are vaccines if there’s no functioning public health system to deliver them? In too many parts of the world, the health infrastructure – the medical staff, the clinic and pop-up facilities, the backup public information campaigns – is too often not in place.

Uganda, for instance, is trying to vaccinate 22 million people, or half its population by year-end. But outside the capital of Kampala, distribution has been hampered by factors including the lack of the ultra-low refrigeration needed to store Pfizer and Moderna jabs. President Yoweri Museveni warned in a national television broadcast in late September that 67,000 vaccine doses were about to expire.

That’s why it is absolutely vital that Sunak and the UK government deliver the missing pieces – by providing the necessary financing for the infrastructure that will deliver vaccines to people. And there’s a clear and proven way to do that – through continued British support for a little-known part of the World Bank, the International Development Association (IDA), which has a critical role to play in the current global public health emergency, and where Britain has been a global leader.

IDA is the world’s largest provider of concessionary loans and grants to the world’s poorest countries, in areas including education, water and sanitation, and health. In the past decade, it has helped governments vaccinate 400 million children and provide primary healthcare to a billion people. 

Since the crisis broke last year, IDA has committed more than $53bn (£38.7bn) in grants and zero-interest and low-interest loans, including support for the health infrastructure and vaccine programmes needed to get shots out of warehouses at the airport, and into arms. Its funds come not only from national governments, but from private sector loans that are raised against its equity – quadrupling the impact of every dollar contributed by its member states.

For its last three-year funding drive, covering the years from 2020-2023, the IDA raised a total of $82bn (£59.8bn). But Covid-19 saw the IDA step up the disbursement of funds, hitting around $35bn (£25.5bn) a year, rather than the expected annual $27bn (£19.7bn). So it is now going back to its donors seeking another round of three-year funding commitments.

African governments are urging an increase in funding commitments to $100bn (£73bn), which would allow the IDA to maintain its funding at around current levels.

In addition to enabling countries to respond to the current pandemic, the health infrastructure that IDA helps to build can help create new, permanent health systems capacity that can help countries address other issues as well, from maternal and child healthcare to reproductive health to addressing key diseases like malaria. 

So what will the government of Boris Johnson’s Global Britain do? Britain has been a leading supporter of IDA for the last several funding cycles – it made the largest contribution ($3.8bn (£2.7bn)) to the current three-year cycle. As a result, the UK has helped shape development policy at the World Bank, ensuring that the bank’s priorities reflect the British people’s interest in combatting climate change, advancing gender equality, and ensuring all children have the basics of a good education and proper healthcare.

At the very least, Sunak should commit to continuing British support at the previous levels – signalling to the assembled global finance ministers there is no greater priority for Britain and the world than defeating Covid-19. In addition, and particularly if commitments from national governments fall short, Britain should support expanding IDA’s capacity to augment its funding by borrowing from commercial markets, which it has been doing since 2017. And, crucially, Britain should ensure its contribution is additive, and avoid the temptation of cutting the aid budget elsewhere. These additional funds are desperately needed now to prevent years of development gains from being lost.

Mark Malloch-Brown is president of the Open Society Foundations and a former United Nations deputy secretary-general