10 Years On, Funding Crisis Threatens the Global Fund’s Effort to End AIDS
Contact: Blair Hinderliter
On January 28, 2012, the world marks the 10-year anniversary of the launch of the most successful global health effort in history — The Global Fund to Fight AIDS, Tuberculosis and Malaria. Each month, 100,000 lives are saved1 through Global Fund investments to-date, and even greater progress is on the horizon, thanks to recent scientific breakthroughs and the achievements of the last decade.
Against the backdrop of success and future promise, however, the Global Fund’s mission is in jeopardy. During the economic downturn that may only now be coming to an end, a number of wealthy countries either cut their pledges to the Global Fund or have failed to deliver the money they promised. Without the necessary resources in hand, the Global Fund was forced to announce on November 23, 2011 — a mere week before World AIDS Day — that it was cancelling its next round of grant-making (Round 11) and would stop making new grants for at least two years.
To understand just how damaging and ironic this stoppage is, we must go back in time a decade to the Global Fund’s creation.
A Decade of Progress and Innovation
10 years ago, the future of the fight against these diseases was bleak. An AIDS diagnosis was essentially a death sentence for those living in poor countries without access to anti-retroviral treatment. Tuberculosis (TB) programs suffered from decades of neglect. And malaria was a largely unchecked killer of children and pregnant women in sub-Saharan Africa.
In response to this emergency, donor countries and poor countries, together with civil society and the private sector, formed a unique partnership. Determined to turn the tide, they created what then UN General Secretary Kofi Annan called a “war chest” to change the future of the fight against AIDS, TB, and malaria.2
What followed was one of the most extraordinary decades in the history of public health. In the past 10 years, the Global Fund has become the largest source of funding for AIDS, TB, and malaria, and fundamentally altered our ability to fight these diseases. The Global Fund now saves an estimated 100,000 lives each and every month.3
Global Fund investments, together with the U.S. PEPFAR program, have helped resurrect African communities on the verge of being wiped out by HIV/AIDS. The Fund provides treatment for 3.3 million people living with HIV/AIDS, with millions more accessing testing and counseling services. The Global Fund has helped detect and treat 8.6 million cases of TB, and TB mortality is on target to be halved by 2015 in comparison with 1990.4 Hundreds of millions of insecticide-treated bed nets have been distributed by Global Fund programs, and malaria deaths have plummeted by 50 percent in 11 African countries.5
The Global Fund has achieved these results by staying on the leading edge of the best practices and principles of effective foreign aid. The countries and people that implement them develop proposals, an independent review panel of experts evaluates them, continued funding is awarded based on performance, and the results — successes and failures — are transparently reported. Moreover, the U.S. is able to leverage its contribution by urging matching contributions from others. Historically, every $1 the U.S. contributes to the Global Fund has been matched with $2 from other donors.6
The End of AIDS is in Sight
In May 2011, researchers announced the results of a breakthrough study, HPTN 052, that proved conclusively what AIDS researchers had long suspected: AIDS treatment can prevent the spread of the virus. Treating HIV-positive people with anti-retroviral therapy (ART) early in the disease cycle dramatically reduces transmission of the virus to uninfected partners. In fact, researchers found that when treatment was initiated early in the progression of the disease, as opposed to waiting for those infected to become sick, there was a 96 percent reduction in the risk of transmission.7 This discovery was named the 2011 "Breakthrough of the Year" by Science magazine.8
The implication of this new finding, along with other breakthroughs in prevention, is that we now have the tools to end the AIDS epidemic.
Early AIDS treatment not only reduces transmission of HIV, it can also protect HIV-positive people from opportunistic infections like TB. The study found that early AIDS treatment reduced the occurrence of TB infection by 67 percent.9 This is critical given that TB is the biggest killer of people with HIV.
This evidence, combined with recent economic modeling by the U.S. Centers for Disease Control and Prevention, which shows that investing more in AIDS treatment and prevention now will not only reduce deaths but will also reduce the cost of the AIDS response in the long run, shows that we can end AIDS if we have the political will.
Moment of Crisis in the Fight Against AIDS, TB, and Malaria
Just as the end of the AIDS epidemic is in sight, and enormous but fragile progress has been made against TB and malaria, donors are scaling back their contributions and failing to meet commitments. This has forced the Global Fund to halt funding for new grants for the next two years. This cancellation of new funding opportunities will be devastating to the fight against AIDS, TB, and malaria.
The Global Fund provides resources for treatment to 3.3 million people living with HIV/AIDS today — half of all those receiving HIV/AIDS treatment.10 It also provides over two-thirds of the external funding for TB treatment for those in need, saving 4.1 million lives11, and has distributed insecticide-treated bed nets to 230 million families.12 By suspending any new funding opportunities until 2014, the Global Fund has essentially told countries not to begin any new people living with HIV on treatment. The cessation of new programs for two years could mean a death sentence for the millions.
Just as science is telling us we can end AIDS within the next generation, and funding for scale-up of treatment is more important than ever, the Global Fund is being forced to shut its doors to new patients for at least the next two years. The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it. Progress against all three diseases is not only in danger of being halted in its tracks, but actually being reversed.
The Way Forward
The U.S. is the largest single donor to the Global Fund and has been instrumental in its success over the past decade. We must do our part to ensure the Fund can reverse its decision to the expansion of programs for two years and instead allow for new funding opportunities before 2014.
In 2010, the U.S. made a three-year, $4 billion pledge to the Global Fund.13 Fulfilling this pledge will be critical to the Global Fund's ability to continue to scale-up progress against the diseases. The multilateral Global Fund is also an essential partner to U.S. bilateral global health efforts, and a platform on which U.S. programs are built. Congress and the Administration must each do their part to ensure our U.S. Global Fund commitment is fully met.
The U.S. can lead not only by meeting its commitment, but also by pushing other donor countries to do more. Last month in a speech on World AIDS Day, President Obama called on other countries to keep their promises, and urged countries that had not yet contributed to do so. The President should follow up this call by convening an emergency donors' conference to encourage other donors to give more and new donors to come on board, in order to fill the resource gap. U.S. funding is essential, but so too is American leadership and diplomacy.
The Global Fund has a decade-long track record of progress and innovation in the fight against AIDS, TB, and malaria. But these diseases won't wait around for the world to sort out its financial challenges. If we are not advancing against these epidemics then we are moving backwards.
The U.S. can lead in moving the world closer to the end of these diseases by ensuring that the Global Fund has the resources it needs right now to continue to fund the expansion of effective, high-impact, life-saving programs. U.S. leadership — in fulfilling our pledge to the Global Fund and convening an emergency donors meeting this spring — will determine the future of the fight and the futures of millions of people.
Recent Quotes on the Global Fund and the Fight Against HIV/AIDS
And on this World AIDS Day, here’s my message to everybody who is out there. To the global community — we ask you to join us. Countries that have committed to the Global Fund need to give the money that they promised. Countries that haven’t made a pledge, they need to do so. That includes countries that in the past might have been recipients, but now are in a position to step up as major donors [...]. To Congress — keep working together and keep the commitments you’ve made intact. At a time when so much in Washington divides us, the fight against this disease has united us across parties and across presidents. And it shows that we can do big things when Republicans and Democrats put their common humanity before politics.
— President Barack Obama, Remarks on World AIDS Day, 12/1/11
There is no greater priority — and this is something our American citizens must understand and our government must understand — there is no greater priority than living out the admonition “to whom much is given, much is required.” We're a blessed nation in the United States of America, and I believe we are required to support effective programs that save lives.
— President George W. Bush, Remarks on World AIDS Day, 12/1/11
This kind of progress deserves our support. The United States is the largest individual contributor to the Fund, and the Obama Administration has made our country’s first multiyear pledge to it. Some donors are, unfortunately, considering reducing their contributions. Some emerging powers and nations that are rich in natural resources can afford to give, but choose not to. To sit on the sidelines now would be devastating. It would cost lives, and we would miss out on this unprecedented opportunity. When so many people are suffering, and we have the means to help them, we have an obligation to do what we can.
— Secretary Hillary Clinton, Remarks on “Creating an AIDS Free Generation,” 11/8/11
As the author of the Global Fund Bill [...] in the United States Senate and someone who worked with the president on PEPFAR to deal with the issue of AIDS in Africa, I believe it is absolutely essential. Africa was [...] on the brink. On the brink of complete meltdown and chaos, which would have been fertile ground for the radical Islamists to be able to get a foothold [...] It’s important for us to use all the assets we have. Promote our values. America is that shining city on the hill. It is — it is the city that comes to the aid of those in trouble in America — in the world. We have done more good for America in Africa and in the third world by the things that we’ve done. And we have saved money and saved military deployments by wisely spending that money not on our enemies but on folks who can and will be our friends.
— Rick Santorum, CNN National Security Debate, 11/22/11
The Global Fund: Then and Now
Within a decade the Global Fund stopped the terror that was draining the life out of societies, cultures, and economies around the world. Below are facts and figures that highlight the Global Fund’s successes and encourage critical reflection on global efforts to eradicate diseases of poverty.
2 Annan, Kofi (2001). Address to the African Summit on HIV/AIDS, Tuberculosis and Other Infectious Diseases. <http://www.un.org/News/Press/docs/2001/SGSM7779R1.doc.htm>
3 The Global Fund to Fight AIDS, Tuberculosis and Malaria (2012). URL: <http://www.theglobalfund.org/en/about/diseases/>
4 The Living Proof Project (2009). Progress Against Tuberculosis: Winning the Fight Against a Deadly Disease. <http://www.gatesfoundation.org/livingproofproject/Documents/progress-against-tb.pdf>
5 United Nations Secretary-General’s Special Envoy for Malaria (2010). WHO Report Announces Decline in Incidence and Mortality [press release]. <http://www.rbm.who.int/docs/2010/st2010-12-14chambers.pdf>
6 The Global Fund to Fight AIDS, Tuberculosis and Malaria (2007). US Congress Approves Record Support for the Global Fund <http://ht.ly/8EOfi>
10 The Global Fund to Fight AIDS, Tuberculosis and Malaria (2012). <http://www.theglobalfund.org/en/about/>
11 The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). World TB Day: Partners Call for Increased Commitment to Tackle MDR-TB [press release]. <http://www.theglobalfund.org/en/mediacenter/pressreleases/2011-03-23_World_TB_Day__Partners_call_for_increased_commitment_to_tackle_MDR-TB/>
12 The Global Fund to Fight AIDS, Tuberculosis and Malaria (2012). <http://www.theglobalfund.org/en/about/>
13 Congressional Research Service (2011). The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Issues for Congress and U.S. Contributions from FY2001 to the FY2012 Request. <http://fpc.state.gov/documents/organization/168096.pdf>