The UK aid response to COVID-19

The World Health Organisation (WHO) declared the COVID-19 outbreak to be a global pandemic on 11 March 2020. Since then, the virus has spread rapidly to almost every country in the world, triggering a global public health crisis on an unprecedented scale. As of 27 September 2021, there had been more than 231.5 million confirmed COVID-19 cases around the world, with nearly 4.7 million deaths. It is estimated that, by the end of 2022, COVID-19 will have reduced the global economy by $3 trillion (approximately £2.2 trillion), the largest global recession since the Second World War (estimated to be more than 3.5% lower than projected before the pandemic).

This rapid review explores the UK’s international aid response to the COVID-19 pandemic. It assesses how well the UK government prioritised and redirected its aid resources in the first 16 months of the global response, including at the central level and in three country programmes (Pakistan, Sudan and Zambia). It also looks at the UK aid response to COVID-19 in two thematic areas: violence against women and girls (VAWG) and health. As a rapid review, it is unscored and is intended to inform Parliament and the public about the choices made by the UK government in its aid response to COVID-19 and the rationale behind them. Forthcoming ICAI reviews will explore particular elements of the UK’s aid response to COVID-19 in more depth.

Relevance: How credible has the UK aid response to COVID-19 been so far?

The UK’s aid response during the early months of the pandemic was credible and appropriate. It demonstrated a commendable level of flexibility and a robust approach to risk management, allocating £733 million in central funding by mid-April 2020.

The World Health Organisation (WHO) declared the COVID-19 outbreak to be a global pandemic on 11 March 2020. Since then, the virus has spread rapidly to almost every country in the world, triggering a global public health crisis on an unprecedented scale. At the time of publication, there had been more than 231.5 million confirmed COVID-19 cases around the world, with nearly 4.7 million deaths. It is estimated that, by the end of 2022, COVID-19 will have reduced the global economy by $3 trillion (approximately £2.2 trillion), the largest global recession since the Second World War (estimated to be more than 3.5% lower than projected before the pandemic).

For many of the world’s poorest countries, the pandemic is reversing development gains made over the past two decades. Up to 97 million additional people were pushed into extreme poverty in 2020 and 2021. The UN estimates that 235 million people (1 in every 33 people worldwide) are in need of humanitarian assistance in 2021, through the combination of COVID-19 and other crises. In 2020, the UN launched an unprecedented global appeal for $10.3 billion (£7.6 billion) to respond to the COVID-19 pandemic, covering 63 countries. The global economic crisis has also led to loss of income and sharp rises in debt for developing countries, limiting their ability to invest in their recovery.

The UK was quick to identify that the pandemic would require a significant reprioritisation of the UK aid programme. On 24 January 2020, the UK government started planning its response on a ‘reasonable worst case scenario’ basis – that is, faced with a high level of uncertainty, it assumed the most pessimistic among the range of plausible scenarios. On 15 March 2020, the former Department for International Development (DFID) decided that it would need to reprioritise a significant quantity of the UK’s aid efforts towards the response. By the end of April 2020, £733 million had been allocated from central funds to support the international response, and country offices and spending departments set about redirecting resources from existing aid programmes to address the impacts both of the virus and of measures taken to control its spread in developing countries.

Further reprioritisation of the UK aid programme took place later in 2020, linked first to the contraction of the UK economy in 2020 and then to the reduction of the 2021 aid spending target to 0.5% of gross national income (GNI). The COVID-19 response continued to be a priority for the UK government, alongside ‘bottom billion’ poverty reduction, climate change, girls’ education and Britain as a force for good. In September 2020, the UK government merged DFID and the Foreign and Commonwealth Office (FCO) into the Foreign Commonwealth and Development Office (FCDO). This was a major undertaking that has taken up a lot of staff time.

This rapid review assesses the UK’s international response to the COVID-19 pandemic. It looks at how well the UK government prioritised and redirected its aid resources in the first 16 months of the global response, examining how the UK allocated its resources at the central level and in three of its country programmes (Pakistan, Sudan and Zambia). It also looks at the UK aid response to COVID-19 in two thematic areas: violence against women and girls (VAWG) and health.

This rapid review used a mixture of methods to provide robust answers to our review questions and ensure a sufficient level of triangulation. The methodology encompassed five intersecting components:

1. Annotated bibliography: We reviewed evidence on the expected impacts of the COVID-19 pandemic in developing countries, including both direct and secondary impacts, and explored global evidence on how to prepare for and respond to pandemics, including relevant learning and evidence from SARS, Ebola and H1N1. We also explored the multilateral response and other bilateral donor responses to COVID-19. The annotated bibliography is published as a separate document.22
2. Strategy review: We reviewed the policies, systems and guidance put in place to support the UK aid response to COVID-19. This included a review of UK government architecture, processes and decisions in response to COVID-19, a mapping of financial flows and an assessment of the evidence used to inform decision making.
3. Key informant interviews: We interviewed UK officials at the centre of the aid response to COVID-19, including current FCDO staff and former DFID and FCO officials, one minister and implementing partners (including multilaterals, bilateral organisations and civil society organisations).
4. Light-touch country and thematic case studies: We looked in detail at the UK aid response to COVID-19 in three countries (Pakistan, Sudan and Zambia) and two thematic areas (violence against women and girls (VAWG) and health). Interviews were held with current and former UK officials, national country partners, other donors and implementing partners. The country case studies were selected to reflect different geographical and operational contexts, including low- and middle- income countries and fragile contexts, and included Sudan as one of only three country programmes to receive an increase in UK aid in 2020. The thematic case studies were selected to explore how UK aid sought to respond to secondary impacts of the COVID-19 pandemic.
5. Academic roundtable: A roundtable discussion was held with experts from academic institutions and think tanks working in the field of global health and development. This provided an opportunity for independent reflection and discussion on the UK aid response to COVID-19 so far.

The COVID-19 pandemic has had unprecedented global impact

On 11 March 2020, the World Health Organisation (WHO) declared the novel coronavirus (COVID-19) outbreak to be a global pandemic. Its impact around the world has been unparalleled in modern times: over 4.7 million people have lost their lives, while the measures taken to reduce transmission have resulted in vast social and economic disruption (often described as secondary or indirect impacts).
The World Bank estimates that the pandemic has pushed an additional 97 million people into extreme poverty, exacerbating inequality. The United Nations Development Programme (UNDP) also estimates that global human development, a measure that includes education, health and living standards, could fall as a result of the COVID-19 pandemic for the first time since 1990, when the measure was first introduced.

The UN has reported that the pandemic has set back progress across the Sustainable Development Goals (SDGs), including the loss of the equivalent of 225 million full-time jobs in 2020, the first increase in child labour in two decades, and an additional 101 million children falling below the minimum reading proficiency level. Gains in gender equality have also been set back by the pandemic, with women bearing a disproportionate share of job losses. In March 2020, analysis by the former Department for International Development (DFID) identified that COVID-19 was likely to increase the risk of domestic violence, workplace violence in the health sector, and racial and sexual harassment. This has indeed occurred: the UN secretary-general, António Guterres, has described lockdowns as causing “a horrifying global surge in domestic violence” and UN Women has identified violence against women and girls (VAWG) as a “shadow pandemic”. As reported by the International Development Committee, the COVID-19 pandemic has also had a severe impact on health systems globally. An April 2021 WHO survey of member states found widespread disruption to routine immunisations (57% of respondent countries), antenatal and paediatric care (56% and 52% respectively) and intimate partner and sexual violence prevention and response services (39%). Access to education and other basic services has also been severely impacted, with potential long-term consequences. In August 2020, the UN reported that 1.6 billion learners in over 190 countries had been affected by COVID-19, exacerbating existing educational disparities. The UN estimates that an additional 23.8 million children will drop out of school in 2021, with long-term impacts not only on learning but also on access to food and work.

Global humanitarian and financial institutions have mobilised significant levels of support

Early in the pandemic, the international community recognised the importance of supporting the COVID-19 response in developing countries to mitigate both immediate and longer-term impacts. The UN launched an unprecedented global appeal for $2 billion (£1.4 billion) to support the humanitarian response to the pandemic in March 2020. This was later revised upwards to $10.3 billion (£7.6 billion), covering 63 countries. In May 2020, the International Red Cross and Red Crescent Movement also launched a collective global appeal, for $3.2 billion (£2.3 billion). As outlined below in Table 2, the UK provided unearmarked contributions to both of these appeals. Initial estimates from the Organisation for Economic Co-operation and Development’s Development Assistance Committee (OECD DAC) indicate that DAC donors spent $12 billion on COVID-19-related activities in 2020, including both new spending and funds redirected from existing development programmes. While this was a substantial mobilisation of aid, it is a tiny fraction (0.07%) of the $16,000 billion spent by governments globally on stimulus measures to protect their own economies.

In this section, we assess the relevance, coherence and efficiency of the UK aid response to the COVID-19 pandemic over the period from January 2020 to May 2021.

Relevance: How credible has the UK aid response to COVID-19 been so far? The UK government set clear objectives for its international COVID-19 response

The UK government did not have a strategy or blueprint in place for an aid response to a global pandemic. However, the UK response benefited from a range of prior investments in preparing for global health threats. Over the period from 2015 to 2018, the UK had developed a strategy – Stronger, Smarter, Swifter – to guide preparations for future health emergencies. It had also created a cross-government EpiThreats group, to link up its scientific and operational capacity. As we concluded in our 2018 review, that strategy drew on learning from the Ebola epidemic in West Africa from 2014 to 2016 to provide a relevant and well-balanced framework for action, supported by a strong strategic rationale.

The UK’s response benefited from experience gained during earlier disease outbreaks, particularly Ebola (as mentioned above), H1N1 and SARS.65 Drawing on this experience, UK aid staff in key positions in the UK, Geneva (where the WHO is headquartered) and Department for International Development (DFID) country offices were able to assess the potential consequences of the unfolding crisis for developing countries and identify options for the UK aid response.

In March 2020, an International Ministerial Implementation Group was set up to coordinate the UK’s international response, including through the aid programme. The UK identified at an early stage that the multilateral aid system should be the primary mechanism for responding to COVID-19, not least because of the scale of resources required to respond to the social and economic impacts of the crisis. This objective was affirmed in the government’s May 2020 COVID-19 recovery strategy, which included a section on the international response, with a strong statement of intention to position the UK at the forefront of a coordinated global response. From February 2020, UK officials in Geneva and Washington began engaging with their multilateral counterparts, and DFID’s permanent secretary met with World Bank and International Monetary Fund (IMF) officials to encourage and support their pandemic response.

The UK’s use of aid during the early months of the pandemic response was credible and appropriate. It demonstrated a commendable level of flexibility and reflected emerging evidence on the likely impacts of the crisis on vulnerable populations. While there was no plan or strategy in place for responding to a global pandemic, the response drew on knowledge and experience gained during previous health crises, particularly Ebola and SARS. It also benefited from past investments in preparedness for health emergencies, including coordination structures, international partnerships and funding mechanisms that could be scaled up.

The UK was able to use its large network of ODA-funded research institutions to collect data and analysis on the emerging effects of the pandemic. The information collected was detailed, tracking emerging risks and vulnerability at national and global levels across a range of areas, including health, education, VAWG and livelihoods. Processes were put in place to manage the large volume of information and ensure it was fed into decision making. The adoption of a ‘no regrets’ approach to decision making in the early stages of the pandemic allowed substantial funds to be committed rapidly in the face of considerable uncertainty.

Overall, we found that the positive actions taken within the UK aid programme in response to the pandemic, including the rapid allocation of £733 million in central funds (by mid-April 2020) and the repurposing of existing programmes in our case study countries, were well considered and appropriate, based on the information available at the time. The UK also made an important contribution to the international response through its support for vaccine development and its timely provision of unearmarked funding to multilateral partners leading the global humanitarian response.

Over the course of 2020, much of the UK’s in-country aid programming was repurposed to support the pandemic response. In most instances, this was done by pivoting existing programmes to respond to the direct and secondary impacts of COVID-19 and suspending activities that could not be delivered in a COVID-19 context. This approach helped to minimise the impact of reprioritisation on already vulnerable populations. In our case study countries, UK officials demonstrated a good level of flexibility and adaptability during the early period of the crisis. This was facilitated by the high level of delegated authority to country teams.

The UK made an important contribution to global efforts to develop COVID-19 vaccines, which was acknowledged and appreciated by international partners. The UK clearly contributed significantly to an unprecedented level of international cooperation. It is not clear, however, how much of this investment will eventually qualify as ODA. Plans for the distribution of vaccines have also been disrupted by production and rollout challenges and benefits to developing countries have so far been modest. We find that the UK’s decision to invest in the COVAX facility alongside other organisations was a sound one at the time, but believe that urgent action, backed by ODA, will be necessary to ensure that the facility delivers vaccines at scale to developing countries in the immediate future.

The UK’s strong initial response to the pandemic, seeking to reduce the severity and length of the crisis, mitigate its long-term damage and deliver cost-effective long-term development efforts has been undermined following the decision to reduce the aid spending target to 0.5% of GNI. We have seen evidence of programmes that would have mitigated the long-term damage of the crisis being reduced and good long-term investments being ended. We found evidence in some cases that this had increased the burden on partner countries and other funders, potentially placing vulnerable groups at increased risk. At the time of writing some funders had stepped in (for instance on neglected tropical diseases).118 However, the speed of decision making did not allow other funders to be enlisted in a considered and structured way. Final spending decisions were taken by decision makers away from where programmes were delivered and did not always reflect the detailed risk and vulnerability data that had been assembled to guide the pandemic response. Looking forward, the reduced aid budget and reduced autonomy for the overseas network within the new FCDO appears likely to reduce the ability of the UK aid programme to respond flexibly to the evolving pandemic. There is also concern on the part of officials and partners that the timing and nature of the UK ODA reduction will undermine the UK’s ability to shape the continuing international response to COVID-19.

NB Data provided to ICAI by FCDO country offices in March 2021.

Table 1: Funds repurposed to address COVID-19 within existing project-level budgets in Pakistan