UN high-level meetings in 2023

UN high-level meetings on health in 2023

In September 2023, the UN General Assembly will convene three high-level meetings on health, focused on:

• Ending Tuberculosis
• Delivering universal health coverage
• Strengthening pandemic prevention, preparedness, and responses

The UK Government has confirmed it will attend all three events.

This section summarises UK commitments on these issues, and global progress to date.

The sustainable development goals

2023 marks the half-way point for the implementation of the 17 sustainable development goals (SDGs), which were adopted by the UN in 2015 and are intended to be met by 2030. The SDGs include promoting good health and wellbeing, eliminating hunger and poverty, and advancing gender equality.

In April 2023, the UN Secretary General António Guterres warned that “we have stalled or gone into reverse on more than 30% of the SDGs” and called upon all states to “recommit to seven years of accelerated, sustained and transformative action.”

The Secretary General’s report, Progress towards the sustainable development goals: Towards a rescue plan for people and planet (May 2023), will be discussed at the second SDG summit at the UN in September 2023.

UK aid strategy and spending on health The UK’s international development strategy

The UK Government launched a new, ten-year international development strategy in May 2022. It is expected to be supplemented by a further strategy focused on how the UK will help the world achieve the SDGs by 2030.

As set out in section 6 of the Commons Library research briefing on The UK’s 2022 aid strategy, global health is one of the four priorities for UK aid spending.

The strategy includes commitments to invest in vaccines and diagnostics, building stronger health systems and global health surveillance, making investments in Gavi, the vaccine alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and helping to end preventable deaths of mothers, babies and children.

The Department of Health and Social Care and the Foreign, Commonwealth and Development Office policy paper, Global health framework (May 2023) provides more detail on how the Government plans to strengthen global health security and country health systems.

UK aid spending on health

In 2021, health was the second largest sector (13.6%) to receive UK bilateral aid in 2021, totalling £970 million. This was down £620 million (39%) compared to 2020. Part of this decrease was due to reduced levels of spend on the health sector in response to Covid-19, but also reflects wider reductions in the UK aid budget. These spending figures do not include contributions to multilateral organisations, such as the UN.

Spending plans for 2023 have not been announced, though the UK has made some future commitments:

• Gavi, the vaccine alliance: £1.65 billion from 2021 to 2025, up from £1 billion for the 2016 to 2020 period. From 2000 to June 2020, the UK was its biggest funder, providing a quarter of total contributions, totalling £4 billion. Gavi supports regular immunisation and vaccination campaigns.
• The Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria: The UK has pledged £1 billion for 2023 to 2025, down from £1.4 billion for 2020 to 2022. The Global Fund provides 76% of all international financing for TB.
• World Health Organization (WHO): £340 million in core contributions for 2020 to 2024, up 30% on the previous period.

The UK’s work on helping address global health threats was rated “green/amber” by the Independent Commission for Aid Impact (ICAI) in 2018. The ICAI said the UK’s aid programme generally contributed to strengthening disease surveillance and improving the resilience of health systems.

Ending Tuberculosis

Tuberculosis (TB) is caused by bacteria spread through the air when people with the disease cough, sneeze, or spit. It primarily targets the lungs.

SDG 3.3 sets out an aim to eliminate communicable disease including TB, AIDS, and Malaria by 2030.

The WHO states that worldwide, TB is the second cause of death from an infectious disease (after Covid-19, and above HIV/AIDS).

The Covid-19 pandemic reversed many years of decline in the number of cases of TB and deaths from the disease. The latest WHO Global TB report estimated that around 1.6 million people died from TB in 2021. This was higher than the two previous years (1.5 million, 2020, and 1.4 million, 2019). 10.6 million fell ill with TB worldwide in 2021.

The Global Fund notes that drug-resistant TB and the effects of the Covid-19 pandemic are “major challenges” to eliminating TB. WHO analysis suggests a significant fall in TB diagnosis in 2020 and 2021 due to the pandemic and a decline in global spending in essential TB services (from US$6 billion in 2019 to US$5.4 billion to 2021). It says this funding is “less than half of what is needed.”

Section 2.2 of the Commons Library research briefing on UK aid and the Global Fund for fight HIV, TB and Malaria (November 2022) provides more statistics on the incidence of TB and the work of the Global Fund.

Delivering universal health coverage

SDG target 3.8 is for the world to achieve universal health coverage (UHC). This includes financial risk protection, access to essential health care services for all, and access to safe, effective, and affordable medicines and vaccines.

2023 World Bank analysis on progress towards the SDG target found continuing inequalities in health service coverage. 31 of the 193 countries with data were scoring “high” on the SDG measure, while 16 were scoring “low.” Low-scoring countries were predominantly in Sub-Saharan Africa, as well as Afghanistan and Papua New Guinea. The indicator measures are based on factors including access to a range of services, including for infectious diseases, child health, and reproductive and maternal health.

The World Bank analysis noted that while up to 2017 financial protection when accessing healthcare was “improving,” 1.4 billion people (18% of the global population) had been pushed into or pushed further into poverty by their medical expenses (poverty being defined as US$3.20 per day), and 500 million (7%) had been pushed into extreme poverty (US$1.90 per day). More than half lived in Sub-Saharan Africa.

The proportion of the population spending more than 10% of their annual income on health needs had also increased since 2000, reaching one billion in 2017.

Separate WHO surveys found that the Covid-19 pandemic disrupted essential services in more than 90% of countries at its height in 2021. This included TB diagnosis and treatment services (51% of countries from January to March 2021), reproductive, maternal and child health services (35%) and regular immunisation programmes (34%).

The issue of UHC was considered by Commonwealth Health Ministers in May 2023. They resolved to support the UN meetings in September and pledged to:

• work collectively to monitor progress on healthcare
• share best practices and expertise on strengthening primary health care
• consider a rights-based approach and address gender inequality

Commonwealth ministers also acknowledged “underinvestment in primary health care services, including the continued financial burden of out-of-pocket expenditure is a key barrier in impeding the achievement ouch targets.” They committed to work with finance ministers to increase domestic resources.

Strengthening pandemic prevention, preparedness and response

The first objective of the UK’s Global health framework (May 2023) is to strengthen global health security through improved preparedness and response to future pandemics.

Pledges to meet this objective include the “100 Days Mission,” launched under the G7 presidency. This sets out an aim to make diagnostics, therapeutics and vaccines available within 100 days of a future pandemic. In the UK, the Health Security Agency has responsibility for the mission. The International Pandemic Preparedness Secretariat published its latest annual implementation report in January 2023.

The UK Government is also supporting negotiations for a Pandemic Preparedness Treaty being negotiated at the World Health Organisation. The Government has expressed support for the Treaty and has said it is “actively shaping its design to ensure it improves how the world prevents, prepares for, and responds to future disease outbreaks of pandemic potential”. The Government, however, emphasised that “the key will be to ensure the final text is clearly in the UK national interest”.

A petition calling for the government not to sign a new Pandemic Preparedness treaty without a public referendum received 156,086 signatures in six months, before it closed in November 2022. The petition received a Government response after achieving 10,000 signatures. The Government said that it supported a new legally binding instrument “as part of a cooperative and comprehensive approach to pandemic prevention, preparedness and response.”

The petition was successfully considered for Parliamentary debate after achieving 100,000 signatures, and the debate took place on 17 April 2023.

Negotiations are governed by the Intergovernmental Negotiating Body at the WHO, set up specifically to negotiate this proposed treaty.

The Intergovernmental Negotiating Body (INB) held a series of meetings in March and April 2022 to discuss proposals for the treaty. Further meetings have been held in December 2022, February-March 2023, with more planned throughout 2023. Minutes and proposed agendas of the meetings are available on the WHO INB website.

The Zero Draft of the treaty, known as the Zero Draft of WHO CA+, was published on 1 February 2023, and discussed at the Intergovernmental Negotiating Body’s fourth meeting between 27 February 2023 and 3 March 2023.

Because the Zero Draft is the starting point for negotiations, the substantive provisions and content of the treaty could change.

Alongside the development of the Pandemic Preparedness Treaty, the WHO is also undertaking a review of the International Health Regulations 2005 (IHR). According to the WHO, the IHR is:

… a key international instrument on international health, rooted in the WHO Constitution. The IHR was established to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.

Because the IHR already provides for some of the legal basis for international responses to “public health emergencies of international concern”, the regulations therein are relevant to the development of the Pandemic Preparedness Treaty. As part of this process, more than 300 amendments have been proposed by States Parties. These amendments were subject to a review by the Review Committee regarding amendments to the International Health Regulations.

Further details of negotiations, the UK’s position, and an explanation of how these relate to the proposed amendments to the International Health Regulations, are set out in the Commons Library Research Briefing What is the proposed WHO Pandemic Preparedness Treaty? (June 2023).