“We must demonstrate that solidarity and collective action are stronger than division.” These were the words of the South African president, Cyril Ramaphosa, guest of the Global Fund meeting held on Friday in Johannesburg, in which the funds that the entity will have at its disposal in the period 2027-2029 to defeat malaria, tuberculosis and AIDS were announced.
In front of him, in a packed room, were heads of government and ministers from numerous donor countries, representatives of the private sector, multilateral institutions and philanthropic organizations. All have pledged to contribute a total of 11,340 million dollars (9,852 million euros).
At a time of severe cuts to cooperation, in which multilateralism is in difficulty, this is an important figure, but the Global Fund’s objective was 18 billion dollars (15.6 billion euros) to save 23 million lives between 2027 and 2029 and reduce the mortality rate of the three diseases by 64% by 2029 compared to 2023 levels. That is, to go from 2.3 million deaths in 2023 to 920 thousand in 2029.
“We are grateful, because it is a strong result in a complicated context. Furthermore, it is not a definitive result because there are key donors who could not announce their figure today,” Françoise Vanni, director of External Relations and Communications of the Global Fund, told this newspaper. “Our ambition remains the same. We know what we need to achieve what we want to achieve,” added the manager.
These reductions are not a surprise in the current context, but the positive thing is that no donors are leaving, they remain committed to investing in health within a multilateralism that works
Françoise Vanni, Global Fund
The Global Fund, created in 2002, is the largest multilateral provider of funds to help countries reduce the impact of AIDS, tuberculosis and malaria. The supported health programs managed to save 70 million lives and reduce the combined mortality rate of the three diseases by 63%.
In the previous replenishment of funds, in 2022, the institution managed to raise a record amount of 15.7 billion dollars. But the world today is different. The cuts to development aid funds suddenly decreed by the United States, but also by other countries such as Germany, the United Kingdom or France, undermine the progress of recent years and move away from the United Nations goal of “ending epidemics such as HIV, tuberculosis and malaria” by 2030.
“Let us choose solidarity over abandonment. Let us choose action over complacency. And let us stop at nothing to build a safer, healthier and more just world for all,” Amina Mohammed, deputy secretary-general of the United Nations, asked on Friday.
Shared responsibility
Diseases know no borders nor do they need visas to move from one country to another, those present in Johannesburg recalled. Folding them is therefore a “shared responsibility” and also an investment. Amina Mohammed recalled, for example, that every dollar invested in global health produces a return of 19.
Peter Sands, executive director of the Global Fund, called for “boldness” at a time when funding is being reduced and cited the need to transform the global health architecture to improve an organization that is too fragmented, where too many entities overlap. “If in three years the system is still the same, it will mean that we have failed.”
For his part, Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO), insisted that “countries need support in their transition to self-sufficiency” in the health sector.
Countries need support in their transition to healthcare self-sufficiency
Tedros Adhanom Ghebreyesus, WHO
Countries such as Canada, Sweden and Norway contribute significantly to the Global Fund, but the efforts of countries in the Global South, such as Ivory Coast, Nigeria and Namibia, also stand out. “It’s a question of global solidarity,” underlined the government of Namibia, a low-income state, announcing that it would contribute one million dollars to the entity.
The United States, the Global Fund’s largest donor, announced a contribution of $4.6 billion on Friday, less than the $6 billion in the previous period. Jeremy Lewin, undersecretary for foreign aid and humanitarian affairs, recalled that the country is “reevaluating” its support for all organizations and distributing resources more “prudently” and that every dollar of American taxpayers must be accounted for.
Additionally, the United Kingdom announced a contribution of $1.1 billion (15% less than three years ago) and Germany will provide $1.1 billion up from $1.3 billion in 2022.
“These reductions are not a surprise in the current context, but the positive thing is that no donors are leaving, that they remain committed to investing in health within a multilateralism that works,” Vanni said.
In the case of Spain, which also contributes to the Global Fund, last June the government announced that it would contribute 145 million euros, a figure that represents an increase of 11% compared to the previous period.
“Spain was one of the first to intervene and announce its contribution and I think this impressed other donors, who imitated it and also increased their contribution,” estimated Vanni.
The numbers speak clearly of the results achieved thanks to multilateralism in the health field. In 2024, 79% of people living with HIV (about 40 million worldwide) were receiving antiretroviral therapy, up from 22% in 2010. Treatment coverage for tuberculosis reached 75% in 2023, the highest level on record, and the proportion of the population with access to long-lasting insecticide-impregnated nets reached 61% in 2023, up from 29%. in 2010.
Countries such as Zambia, for example, had a life expectancy of 43 years in 2002 and in 2021 it has increased to 58, thanks largely to declines in deaths from Aids, tuberculosis and malaria, according to the entity.
“In the next few years we will be able to control or eradicate some of these diseases. There is no better investment,” said Bill Gates, whose Foundation, the largest private donor to the Global Fund, will contribute $912 million.
No vaccines, diagnoses or screenings
The collective financial effort also allows the latest medical advances to be put into practice in countries with few resources. “I come from Swaziland, where this week we saw the first delivery of doses of lenacapavir,” celebrated Peter Sands, referring to the recently approved revolutionary injectable that offers close to 100% efficacy in preventing HIV.
The Global Fund reached an agreement with the American Gilead, manufacturer of this drug, to distribute two million doses in low-income countries, and announced in July that it would begin distributing it in at least one African country before the end of the year.
But on the other end of the scale, funding cuts provoke other types of images: closed offices, disappearance of screening, lack of treatments or vaccines.
There are countries that have lost 70% of their funding overnight. What is plan B? Well, prioritize, decide what I do and what I don’t do. Put on the patches. And this causes a lot of pessimism
José Domínguez, tuberculosis researcher
In African countries this lack of funds already causes very painful decisions. José Domínguez, tuberculosis expert and researcher at the Foundation German Institute for Health Sciences Research Trias i Pujol (IGTP), in Barcelona, underlines, for example, that there are states with great dependence on these external resources “where a certain number of tests are carried out and it is decided who will have them done and who will not”. “It’s happening in Nigeria, for example,” he says in an interview with this newspaper from Copenhagen, where the largest annual conference on tuberculosis, sponsored by the Union, was held this week.
The researcher points out that the problem with these funding cuts is the abrupt way in which they have been carried out, leaving countries with no room to maneuver to prepare and with uncertainty about how long they will last. “There are countries that have lost 70% of their funding overnight. What is plan B? Establish priorities, decide what to do and what not to do. Put in patches. And this causes a lot of pessimism,” he estimates.
This week, a new study from the Barcelona Institute for Global Health (ISGlobal) predicted that 22.6 million people will die between now and 2030 if the sharp decline in official development assistance (ODA) continues.
A study also presented at the tuberculosis conference in Denmark this week estimates that in 26 countries with a high incidence of the disease, these funding cuts could lead to more than 2.2 million deaths over the next five years.
