Vital Global Health Programs Shouldn’t Fall Victim to Economic Crisis
March 02, 2009
Impoverished people in developing countries share no blame in the current financial crisis, but they are the ones who could bear the consequences — perhaps with their lives — of mistakes made by Wall Street investors.
World TB Day (March 24) arrives this year with uncertainty as to whether the wealthy nations of the world will keep their commitments to global health. As deficits climb — fueled by large bailouts of financial institutions — pressure mounts on the administration and U.S. Congress to curtail spending. But it would be both shameful and foolhardy to shortchange one program in particular: The Global Fund to Fight AIDS, Tuberculosis and Malaria.
As the threat of multidrug-resistant tuberculosis (MDR-TB) grows, the work of the Global Fund becomes ever more critical. Providing two-thirds of international funding for TB programs, the Global Fund enables high-burden countries to scale up efforts to detect and effectively treat TB.
Last year, 1.7 million people died from TB, a disease that's been curable for more than half a century. Of the 9 million people who developed active TB, nearly half a million cases were MDR-TB. More worrisome is the emergence of extensively drug-resistant tuberculosis (XDR-TB), which has a mortality rate of 85 percent and has been found in 35 countries, including the U.S. Left unchecked, XDR-TB has the potential to turn the clock back to the pre-antibiotic era in which TB was synonymous with death. In many parts of the world, it still is.
Thanks to the Global Fund, however, we've made progress in fighting the scourge of TB — as well as AIDS and malaria. The Global Fund, financed with contributions from the world's wealthiest countries, solicits grant proposals for health programs in poorer nations to combat these three deadly diseases. If the proposals are deemed worthy by an independent technical review panel, the Fund grants the money to launch and sustain these programs. Since it began, the Fund has disbursed $7.2 billion for programs that have saved an estimated 3.5 million lives.
The Global Fund board and G8 leaders agreed in 2007 to potentially triple the yearly amount of resources it would grant, scaling up to $6 to $8 billion by 2010 if countries crafted high quality proposals. Countries responded with a dramatic increase in the ambition and number of proposals submitted. The Global Fund, in turn, approved a three-fold increase in funding for 2008 programs over previous rounds, counting on donors to live up to the 2007 agreement to fund the increase. But the additional funding has not come from the U.S. and other donors, which has created a "crisis of success" for the Global Fund, with some approved grants not yet able to be funded, critical new grant rounds pending, and the Fund now projecting a need for $8 billion in 2010. Without full funding this year and next, life-saving proposals will be put on hold, and plans to scale up programs will have to wait. This means that lives will be lost and developed nations will have broken a promise.
Congress and the Obama administration have a chance in the coming supplemental appropriations bill to fix this by increasing 2009 funding. This would meet urgent needs, set the Global Fund on an upward trajectory and show the world that they are committed to multilateral, results-driven global health funding. In addition, the Obama administration and Congress should work together to provide the U.S. fair share of the $8 billion need of the Global Fund for 2010: $2.7 billion.
To put it in perspective, the funding needed is less than 0.5 percent of what G8 countries have approved to bail out failing banks in the last three months and could save over 2 million lives. Unlike financial institutions that came asking for help because of bad decisions, the Global Fund has succeeded, beyond expectation, in its mission, which is to bring badly needed health services to the poor. It should be rewarded, not punished, for that success.
Background on Global Fund and TB
The Global Fund to Fight AIDS, TB and Malaria was launched in 2001. To date, it has committed US$14.9 billion in 140 countries to support large-scale prevention, treatment and care programs against the three diseases. Global Fund-backed programs have produced these results:
- HIV/AIDS: More than 2 million people on anti-retroviral therapy. 62 million HIV counseling and testing sessions were done. 3.2 million orphans were provided with medical services, education and community care.
- Tuberculosis: 4.6 million people treated under DOTS (Directly Observed Treatment, Shortcourse).
- Malaria: 70 million insecticide-treated bed nets distributed. 74 million people treated.
What some of the projects approved in the last funding round would do:
- 4.5 million people tested for HIV in Nigeria.
- 30 million bed nets distributed to reach every household in the Democratic Republic of the Congo
- Cutting-edge drug-resistant TB diagnosis and treatment for every person in need in Lesotho
- One-third of the world's population is infected with the TB bacteria. With most, the disease remains dormant, but a small percentage - almost 9 million - develop active TB each year.
- The drugs to treat TB can be purchased for as little as $20.
- TB is the biggest killer of people living with HIV/AIDS.
- People who are HIV-positive and infected with TB are 50 times more likely to develop active TB in their lifetime than people who are HIV-negative and infected with TB.
- Multidrug-resistant TB is a form of TB that is difficult and expensive to treat and fails to respond to standard first line drugs.
- Extensively drug-resistant TB occurs when resistance to second-line drugs develops on top of multidrug-resistant TB. It is virtually untreatable.
Comments on the Global Fund:
It couldn't be more clear. This is the most successful institution that we have in the world for addressing the most horrific epidemics that the world faces. We have explicit policy pledges. We have validated national plans. We have a clear commitment that all valid plans will be fully funded. We've already broken that pledge to the world's poorest people. We're delaying programs. We have a massive gap, and it is the responsibility of world leaders to face up to this.
— economist Jeffrey Sachs, director of the Earth Institute at Columbia University
Barack Obama, Joe Biden, and Hillary Clinton are champions of Global Health - last year in the Senate they all helped pass the landmark bill that reauthorized U.S. global AIDS, TB and malaria leadership. Now they have an opportunity to take this administration forward in support of multilateralism and programs that work. If the U.S. leads, the world will follow — I urge the administration to fully fund the Global Fund so it can continue to save lives and show what accountable, results-driven development can look like.
— Joanne Carter, executive director of RESULTS
In just the last two or three years, programs that the Global Fund has supported have shown enormous declines in malaria cases in childhood deaths. For example, in Rwanda, in a program largely funded by the Global Fund, we saw a 66% drop in malaria deaths in one year. In Eritrea, I think it was an 80% drop in deaths in 5 years. . . . I think what we're seeing is that malaria programs led by funding from the Global Fund are showing some of the greatest results in the public healthcare sector.
— Peter Chernin, president and COO of Newscorp and chairman of Malaria No More