Memorandum by the Department for International
1. Infectious diseases are a major threat
to global health, prosperity, social stability and security. Infectious
diseases account for more than 40 per cent of the global disease
burden, causing millions of deaths in the world each year.
2. Globalization has had a number of major
effects, as people, money and goods have become more mobile. The
consequence of rapid and wide scale population movement is a global
opportunity for disease; a reality dramatically underscored by
the AIDS pandemic, the spread of antimicrobial drug resistance
and the recent swift spread of severe acute respiratory syndrome
3. Globalization also provides significant
opportunities to harness new information and technologies to share
skills and knowledge, leading to better ways to tackle new challenges
leading to improved health outcomes.
4. The Department for International Development
(DFID) is committed to international poverty reduction and recognizes
that the health and well-being of the world's poor requires international
action. DFID is working hard to strengthen the international effort
to combat diseases of the poor, with a greater focus on communicable
diseases, including the development of new drugs and vaccines
and improving the effectiveness of national health systems.
5. This international effort is underpinned
by national and global surveillance that tracks disease trends
and identifies new infectious disease threats and outbreaks. This
information acts as the critical foundation for designing effective
national and global strategies to tackle diseases, management
of resources and systems, developing new tools such as drugs and
vaccines, monitoring control measures ad shaping public opinion.
ORGANIZATION (WHO) AND
6. DFID works in partnership with developing
country governments and key international institutions, including
WHO, UNAIDS, UNFPA and the World Bank to tackle infectious diseases.
7. WHO, in its role as the world's leading
technical agency on health, has an essential part to play in setting
norms and standards at a global level, and helping its member
states to tackle the major burdens of disease, whatever their
cause, and to strengthen their health capacities and infrastructures.
8. DFID, Department of Health (DH) and Foreign
and Commonwealth Office (FCO) share an interest in shaping a strong
WHO, recognizing its potential in support of both national and
international health. The Departments engage collectively with
WHO on strategic and technical levels, as the world's leading
health agency has a major contribution to make in promoting health,
development and poverty reduction. The agenda to tackle poverty
was established during Dr Bruntland's term as Director General
of WHO (1998-2003) and more recently re-emphasised by the Director
General nominee, Dr J W Lee, who states that "we (WHO) must
focus our work on these global commitments (to the MDGs) to sustaining
development and eliminating poverty". WHO is a key agency
with which the UK, through DFID, engages to support our joint
9. On a technical level, WHO has developed
surveillance systems for infectious diseases and continues to
support pandemic preparedness. The Global Outbreak Alert and Response
Network is a collaboration of existing institutions and networks,
coordinated by WHO, pooling human and technical resources for
the rapid identification, confirmation and response to outbreaks
of international importance.
10. WHO's global alert and response activities
and the Global Outbreak Alert and Response Network represent a
major pillar of global health security aimed at the detection,
verification and containment of epidemics. In the event of an
intentional release of a biological agent, these activities would
be vital for effective international containment efforts.
11. WHO takes a lead role in establishing
the International Health Regulations (IHR) to address serious
diseases that have potential for cross border spread. Revisions
to the regulations have been made in accordance with the epidemiology
of infectious diseases and by the growth of international travel
12. DFID has contributed significant financial
and technical support to international partnerships, such as the
Global Fund to fight AIDS (200 million US dollars over five years),
TB and Malaria (GFATM), Roll Back Malaria (RBM), Global Alliance
for Vaccines (GAVI) and STOP TB. DFID has also funded public private
partnerships to generate new public goods in health for developing
countries, such as drugs, microbicides, diagnostics and vaccines,
for example our £14 million contribution to the International
AIDS Vaccine Initiative. Through effective global action, we are
on the verge of eradicating the unnecessary death and suffering
due to one disease, polio.
13. Access to medicines is central to achieving
health outcomes. DFID is working on a range of mechanisms to improve
affordability of medicines, improving health systems delivery
and fair trade rules. DFID has worked closely with DH on access
to medicinesLord Hunt was on the UK High Level working
group and we have been working closely with them at official level
to take the agenda forward with other stakeholders. The UK Government
is engaged in negotiations through the World Trade Organization
(WTO) on trade-related aspects of intellectual property rights
(TRIPS) and Public Health, revolving around developing countries
with insufficient manufacturing capacity and their inability to
make use of the compulsory licensing flexibilities in TRIPS to
meet their public health needs.
AND THE DEPARTMENT
14. DFID is actively engaged with Department
of Health in critical areas of international health. DFID supports
the Government's strategy "Getting Ahead of the Curve".
This sets out to:
describe the scope and nature of
the threat posed by infectious disease to the health of the population
and establish the priorities for
action to combat the present, as well as possible future, threat
posed by infectious disease.
15. The strategy recognizes that UK health
and global health are inextricably linked and in order to safeguard
UK health, international action and cooperation is required. DFID
welcomes the opportunity to contribute to the strategy and will
continue to play a role in its implementation. However, the nature
of our engagement will need to take account of the following context.
Our objective and strategies for working to improve the health
of populations in developing countries are to meet development
objectives in those countries. It would be contrary to the International
Development Act (2002) for the UK government to engage in these
countries to primarily safeguard UK health.
16. DFID would, however, value closer opportunities
for aligning UK and international agendas. The UK's influence
internationally is as much related to the quality of our domestic
policies as to the quality and scale of our policy dialogue with
our country and donor partners. There are areas of domestic policy
development where we may be seen to be promoting different policies
at home than with our development partners. For example, the UNGASS
Declaration of Commitment is a key document providing a blueprint
for the global response to HIV/AIDS. DFID strongly endorses this.
All countries are asked to provide an annual response outlining
the activities they have undertaken to fulfil their commitments.
This year, 2003, will see the first substantial report on achievement
of baseline objectives, and a full day of this year's General
Assembly will be devoted to this. The UK Government has not submitted
it's contribution to the report. It is difficult for us to emphasise
the importance with our development partners where we are not
17. There are disease specific examples
of cooperation. The Strategy recognizes tuberculosis as an infectious
disease priority. DFID has been invited to participate in the
UK national panel on tuberculosis, which will convene following
the development of the new action plan to address tuberculosis.
18. More people are dying of TB in the world
today than at any other time in history. In the UK, progress made
in reducing tuberculosis in boroughs of London has been difficult
to sustain, emphasising the importance of a cross boundary response.
In response to the global threat of tuberculosis (92 per cent
of cases and deaths occur in low income and lower middle income
countries) the international community needs to adopt a similar
cross boundary approach by providing increased resources, improved
surveillance and more support for the global programmes aimed
at controlling TB.
DFID VIEWS ABOUT
VARIOUS UK HEALTH
19. Public Health Laboratory Service (PHLS)
Specialist agencies, and its Communicable Disease Surveillance
Centre, provide expertise in informing policy, in co-ordinating
surveillance activities and in the investigation of outbreaks
and epidemics. The Communicable Disease Surveillance Centre (CDSC)
is responsible for surveillance, sharing information in this country
and across the world.
20. DFID recognize the importance of a new
National Infection Control and Health Protection Agency combining
the existing functions of the Public Health Laboratory Service
and three other national bodies (the National Radiological Protection
Board, the Centre for Applied Microbiology and Research, and the
National Focus for Chemical Incidents) to provide an integrated
approach to protecting the health of the public against infectious
diseases as well as chemical and radiological hazards.
21. Technical skills within the National
Health Service are part of an international resource pool that
builds capacity within developing countries. Examples include
the support to health systems and management skills in Bolivia
and public health expertise to address Ebola in Uganda.