Introduction

The UK Government’s 2025 Spending Review has struck another blow to global health research. Beyond the reduction of the Overseas Development Assistance (ODA) budget to 0.3% of Gross National Income, it has introduced a new prioritisation in what is funded: activities related to global health security and ODA contributions to multilateral institutions. This has meant some multi-million-pound projects, which had already been approved for funding, have received notice that they can no longer go ahead.

But should research in global health security be seen only as activities aimed at preventing, detecting, and responding to infectious disease outbreaks and other health threats that can spread across borders and endanger populations? For some populations, serious health threats are everyday matters, not major outbreaks. Working towards eliminating preventable causes of poor health, chronic suffering and early death that arise from lack of access to health services might also be seen as global health security. The trouble is some conditions, that are not obvious threats to life, will never be seen this way.  Deafness is a case in point.

Deafness is not an infectious disease

Early deafness profoundly impacts a child’s linguistic, cognitive and social-emotional development prompting a range of interventions to ameliorate its effects.  But let us be clear; deafness is not an illness.  In fact, from the perspective of many Deaf signers and communities around the world it is a marker of cultural-linguistic identity — a source of pride and shared belonging. There are over 300 sign languages around the world used by an estimated 700 million people.

Deafness is one of the world’s most prevalent ‘disabling conditions’ affecting over 1.5 billion people worldwide, but it does not threaten borders, does not appear on pandemic dashboards, and most crucially, it rarely kills — at least not directly. When funders must choose between addressing conditions that cause immediate mortality and initiatives that improve lifelong health and equity, projects focused on deaf lives tend to fall through the cracks.

Therefore, it was with enormous pride and anticipation that we celebrated the news in late 2024 of a successful £2.1 million award from the NIHR Global Health Research Groups programme. The project — a collaboration between SORD, University of Manchester, Monash University Malaysia, and Deaf-led organisations across Malaysia — aimed to improve healthcare access and reduce preventable mortality among deaf Malaysians. The design was bold and unprecedented. Alongside fundamental research, it offered mentorship opportunities from leading post-doctoral Deaf academics in the UK (a rare group in themselves), first time scholarships for Deaf people to enter the academy in Malaysia, and the involvement of over 500 Deaf citizens across Malaysia in improving health access and health outcomes.

The UK Spending Review

Our ambitious 4-year study had been reviewed as reaching the highest levels of scientific quality and in December 2024 we received an ‘intent to fund’ letter and started the contracting arrangements.  And then the UK Spending Review happened.  We were aware of the cuts to ODA funding proposed and its likely impact on future research funding, but we had a letter of intent to fund.  We thought the government would honour its commitment to projects it had already decided were of a quality to fund. Then in July we received a formal letter saying that we would not be funded.  We did not fall within the new priorities.

We can do nothing to challenge this decision and on one level prioritising funds to reduce pandemic risks and boost countries’ resilience to disease outbreaks is logical given limited resources. However, being Deaf and living in a LMIC makes someone much more vulnerable to disease and death than the average citizen given the lack of health literacy, poor access to health care, and late diagnosis of serious illnesses all of which are created by lack of information and services in a signed language. Although our project was aiming to improve public health resilience for Deaf Malaysians, it was not recognised as contributing to global health security. Perhaps the link was not obvious enough or perhaps Deaf citizens were not considered important enough.

Conclusion: Global health security or global health equity?

So, yes — deafness is not an infectious disease. But global health security cannot be built solely on the containment of viruses. It must also be about access, dignity, and equity. Deaf people in LMICs experience higher risks of preventable harm precisely because of systemic neglect. Projects that aim to redress these inequities through culturally and linguistically accessible research must be recognised as essential, not just to public health, but also to global health security.

Authors Alys Young, University of Manchester (UoM) and Uma Devi Palanisamy Monash University Malaysia (MUM) were the co-PIs of the intended project who along with Katherine Rogers (UoM), Celia Hulme (UoM) and Vanlal Thanzami (MuM) led pre-project development work. Young, Rogers and Hulme (UoM) have extensive research backgrounds in health and social care issues affecting Deaf signers. Palanisamy and Thanzami (MUM) have lead research in health equity in Malaysia.

Competing interest:  None

Handling Editor: Neha Faruqui