Britain Slashes Foreign Aid: ‘You Couldn’t Pick a Worse Time’

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Global Health

The nation is often the second-largest donor to groups working in poor countries to prevent and treat infectious diseases, and to provide reproductive health services to women.

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By Apoorva Mandavilli

Britain, among the leading donors to the poorest nations, has slashed its foreign aid contributions, imperiling global progress against infectious diseases, famine and climate change, as well as efforts to improve girls’ education and sexual and reproductive health.

Since 2020, the country has cut its human rights work by 80 percent, funds for some global health programs by more than 80 percent and humanitarian aid to Yemen, Syria and other nations by 60 percent.

The consequences, especially for the struggling post-Covid economies of many low-income countries, have been catastrophic, experts said. The pandemic, a deepening debt crisis and the war in Ukraine are all undermining the capacity of many low- and middle-income nations to invest in health and endangering millions of lives, according to a new report by the United Nations program for H.I.V. and AIDS, UNAIDS.

"We’re just seeing many more people on the brink of starvation," said Joe Cerrell, the Bill & Melinda Gates Foundation's managing director for global policy in Europe, the Middle East and East Asia. "You couldn't pick a worse time to be pulling back."

The latest blow is expected by the end of this month, when Britain will announce its contribution to the Global Fund, which finances the majority of campaigns against H.I.V., malaria and tuberculosis.

Leaders of the Group of 7 nations pledged their support to the fund at an event hosted by President Biden last month. But Britain, one of the fund's founders and its second-largest donor after the United States, was notably absent.

"I strongly disagree with the cuts in the budget," Tony Blair, a member of the opposition Labour Party who served as prime minister from 1997 to 2007, said in an interview.

Mr. Blair's government established the Department for International Development and committed 0.7 percent of the gross national income to overseas development aid. (By contrast, the United States spends less than 0.2 percent of its gross national income on overseas aid.)

Britain's retreat from international development began in June 2020, when Boris Johnson, then the prime minister, announced that the department would be folded into the Foreign and Commonwealth Office, diminishing the department's influence.

Then, in November 2020, Mr. Johnson's government, citing an economic crisis precipitated by the pandemic, said it would cut overseas development aid to 0.5 percent from 0.7 percent of gross national income, effectively shrinking the budget to 12 billion pounds (about $13 billion) from 16 billion pounds.

Earlier this year, Prime Minister Liz Truss, then the foreign secretary, said the aid budget would be prioritized for housing refugees and asylum seekers from Ukraine and elsewhere, trimming the funds available for other programs by roughly another £4 billion.

As a result, "it's very difficult to find room to continue supporting things like the Global Fund," said Mark Lowcock, who led the Department for International Development from 2011 to 2017. "When you add it all up, it's clear that there's a very substantial loss of life arising from these sets of decisions."

It's "the wrong thing to do to balance the books on the backs of the world's poorest people," Mr. Lowcock added.

The Foreign, Commonwealth and Development Office said in a statement that Britain spent more than £11 billion in aid in 2021 and to date has invested £4.4 billion to fight H.I.V., tuberculosis and malaria around the world.

"We will continue to support this vitally important work and will make our pledge after informing Parliament," the office said.

H.I.V., tuberculosis and malaria together kill nearly three million people each year. The sustainable development goals of the United Nations include ending the three diseases as public health threats by 2030.

But the pandemic set back progress against all three.

"If the Global Fund doesn't have enough money, it means less treatment for tuberculosis, less treatment for people with H.I.V., less bed nets for malaria — it's as simple as that," said Dr. Peter Piot, a special adviser to the president of the European Commission and a former assistant secretary general of the U.N.

South Africa, India and Nigeria bear the greatest burden of H.I.V., tuberculosis and malaria, respectively. All three countries are members of the Commonwealth, Dr. Piot noted.

"You’re the leader of the Commonwealth, and then that brings not only privileges but also responsibilities," he said of the British government.

The British Foreign Office's own assessment estimated that the cuts since 2020 might result in 250,000 more maternal and child deaths, 14.6 million unintended pregnancies, 4.3 million unsafe abortions and 700,000 fewer girls receiving an education.

The Global Fund, by its own estimate, has saved 50 million lives since its launch in 2001. With $18 billion from donor countries, it could save another 20 million lives over the next three years, said the fund's executive director, Peter Sands.

"You have to have some pretty good reasons not to do that," he said.

Other G7 countries may be able to make up for some of the shortfall in multilateral programs like the Global Fund, but Britain was the sole supporter of many programs for girls’ education; sexual and reproductive health; and neglected tropical diseases.

Those donations have been easier to scale back than others that are tied up in contractual obligations to the World Bank or the International Monetary Fund.

In May 2021, for example, Britain abruptly ended a £1 million annual donation to a program that provided treatment for trachoma — a bacterial eye infection — to 1.7 million people in Zambia. The program had just one month to line up alternative funding, said Nicholas Mutale, the executive director of Lions Aid Zambia, a civil society group that helps the Zambian government disburse treatments.

Although the Bill & Melinda Gates Foundation provided some money as a stopgap, the trachoma program had to cancel about 2,000 planned surgeries. "About half of them may have lost their sight by now," Mr. Mutale said. "The effect of the disability is, of course, quite, quite, quite grim."

Given its limited resources, the Zambian government has to prioritize "mainstream" diseases that result in loss of life, like H.I.V., over neglected diseases like trachoma, he said.

"We all have to look out and begin to see how we could stand on our own two feet to try and support our own interventions," he added. "But before we get to that, it would be nice for those that are standing to try and share the little that they have."

The British government is under growing pressure to reduce spending in the face of an economic crisis. On Monday, Ms. Truss was forced to reverse almost all of a package of planned tax cuts that had provoked turmoil in the financial markets. She has promised other measures in two weeks’ time to close a budget gap still estimated at tens of billions of dollars.

A previous reduction in the aid budget faced strong opposition inside the governing Conservative Party, but it may prove easier to cut again than already strained domestic spending.

For now, the country continues to support refugees and migrants and, at 0.5 percent of the gross national income, its contribution to global aid is still significant, noted Ian Mitchell, a senior fellow at the Center for Global Development in Washington, D.C.

But Britain's economic troubles cannot fully justify its withdrawal of development aid, Mr. Mitchell said. The country "seems oblivious to the fact that everyone else is having these problems as well," he said.

In an interconnected world, funding global health is also a matter of self-interest. Last year, Britain cut its contribution to the Global Polio Eradication Initiative by 95 percent for at least five years.

"Lo and behold, we’re seeing polio re-emerging, indeed in London," said Sarah Champion, a Labour member of Parliament and the chair of a committee that monitors the government's aid spending.

The current trend also erodes Britain's standing as a world leader, she said. "It's as heartbreaking as it is humiliating, to be quite honest."

Peter Robins contributed reporting from London.

Apoorva Mandavilli is a reporter focused on science and global health. She was a part of the team that won the 2021 Pulitzer Prize for Public Service for coverage of the pandemic. @apoorva_nyc

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