Advocating for COVID-19 vaccine equity and UK aid funding for LMICs

Lifebox co-signs letter to the UK government highlighting the need for vaccine equity across the world.

Dear Secretary of States,

We write with considerable concern about the current situation regarding essential healthcare and the pandemic in Zambia, Kenya, Uganda and other low and middle-income countries (LMIC), and urge the UK government to actively increase its support in managing this through ensuring increased global access to COVID-19 vaccines and in reversal of the recent loss of significant UK aid funding.

We are a royal college, professional associations, and charities representing UK anaesthetists working in the NHS. UK anaesthetists have a long history of supporting the development of safe surgery and critical care overseas. Through international partnerships, anaesthetists have been using their knowledge and skills to support pandemic management worldwide.

As we write, many LMICs globally have recently experienced their highest daily positive COVID-19 cases and mortalities since the pandemic began1, including Zambia, Uganda and Kenya. In many countries, multiple hospitals including COVID-19 centres report they are unable to take any further admissions, there are no remaining critical care beds nationally, oxygen capacity and delivery devices are depleted, and mortuaries are full. Colleagues have reported that young patients including pregnant women and healthcare workers seem to be at greater risk of death than seen previously. The strain and surge has debilitated hospitals, suggesting that there is a real risk of a complete collapse of multiple health systems.

Despite these vulnerabilities, high-income country engagement in COVAX and other initiatives to provide vaccine access in LMICs has been insufficient for effective vaccination programmes to have been implemented2,3. Large outbreaks lead to new variants, often more transmissible and virulent, and resulting in higher numbers of critically unwell patients. We have already seen these variants of concern reach the UK causing local outbreaks and again greater pressure on the NHS.

We are also gravely concerned about the impact of reduction in overseas development aid. It is reported that funding from the UK for international development has fallen by 65% to Africa, and similar amounts to other global regions4 . The abrupt withdrawal of current UK Aid programs has already reduced the capacity of health systems to provide essential care and will result in global regression against the UN sustainable development goals, of which the UK are a member state.

Pandemic management in the UK requires every country in the world to be able to effectively manage outbreaks and case numbers. This in turn needs strong, resilient health systems able to provide COVID-19 vaccination programmes, successful public health information, and deal promptly and effectively with outbreaks. Health systems must also be able to provide essential hospital care in a way that does not increase the risk of hospital-acquired COVID-19 infection for patients and staff. It is these healthcare systems, at risk following loss of UK Aid funding, which we in the UK are depending on to ensure global outbreaks are well managed.

The UK has a significant role to play in preventing the emergence of new variants and ending this pandemic globally. We urge the government to provide more doses of the COVID-19 vaccine to low- and middle-income countries, to urgently reverse the decision to cut UK aid funding, and to use its position on the international stage to improve collaborative working with LMIC governments in the management of this pandemic. Until every country in the world has vaccination programs and systems able to manage outbreaks, the health of the people of the United Kingdom continues to remain at greater risk from COVID-19.

Yours sincerely

Professor Ravi Mahajan, President, The Royal College of Anaesthetist

Dr Ann Harvey, Chair, International Relations Committee, Association of Anaesthetists

Dr Dylan Bould, Chair, Global Anaesthesia Development Partnerships

Ms Kris Torgeson, Global CEO, Lifebox

Mr Julian Gore-Booth, CEO, World Federation of Societies of Anaesthesiologists

Dr Tom Bashford, President, World Anaesthesia

Dr Roger Eltringham, Founder and Medical Director, Safe Anaesthesia Worldwide

Dr Phil McDonald, Medical Director and Trustee, Operation Smile UK

Dr Reema Patel, President, Global Anaesthesia, Surgery and Obstetric Collaboration

Dr Sophie Morris, Chair Brighton- Zambia Anaesthesia Partnership, Treasurer, Brighton-Lusaka Health Link

Dr Mark Thomas, President, Association of Paediatric Anaesthetists of Great Britain and Ireland

Dr Chris Elton, President, Obstetric Anaesthetists’ Association

Professor Alan Macfarlane, President, RA-UK


1 WHO Coronavirus (COVID-19) dashboard. Available at:

2 Ghebreyesus TA. I run the WHO and I know that rich countries must make a choice. The New York Times, 2021. Available at:

3 Harman S, et al. BMJ Global Health 2021;6:e006504

4 African Countries facing 66% cut in aid, UK charities say, The Guardian, 2021. Availability at: