Why the Global Fund pledges matter

Imagine you are infected with HIV. Imagine you have been in very poor health for many months but, since you have been on antiretroviral (ARV) treatment, you have regained a normal healthy life without the risk of transmitting the virus to your partner or children. As long as you take your pills every day, you live a normal life in terms of work, love and children.

Now imagine Covid-19 arriving. The pandemic makes it difficult for you to continue your treatment. Your health centre is now closed, the health workers ill or absent, the supplies of medicines have become irregular.

Your transport to town is suspended, with movement confined during lockdown. With the last of your available pills getting closer, worries grow. 

You might take a pill every two days, maybe you borrow some pills from other patients, maybe you pay very expensive ones on the market. But in the end, you might have to interrupt your treatment.    

Your treatment might become available again eventually but it takes time for the health system to get things sorted out. Meanwhile, the virus has started to circulate again in your body, attacking your immunity. You’re again at risk of infecting others. But your health centre has neither the tests to detect this nor the drugs to treat your tuberculosis (TB) or other opportunistic infection quickly enough. 

If you live in a low-resource context, your health and your life will depend on international donors and, in particular, the Global Fund for HIV, tuberculosis and malaria. In many countries, the Global Fund is the main, and often only, financial source for the prevention and treatment of these three diseases. 

Today, countries are expected to announce their pledge to replenish the Global Fund. The Global Fund and the technical agencies calculated that a minimum $18 billion is needed for three years (2024-2026). That implies the necessity for a 30 per cent increase in pledges. 

Reaching this target will determine to a great extent what can be done in the fight against HIV, TB and malaria. It will also determine how far it will be possible to mitigate and to recover from the losses caused by the Covid-19 crisis. Who can restart his/her treatment before Aids, TB and death win the race? What losses can be regained, and which ones will remain standstill or backslide?  

Many donor countries are slow to make their pledge and many fail to go beyond flatlining their pledge of three or six years ago, which, in practice, corresponds to reduced pledges. Kenya is both a contributor to the Global Fund and an implementer of its programmes. In the sixth replenishment, covering the 2020-2022 period, Kenya pledged $6 million but contributed $4 million. 

The hesitation of donor countries makes it uncertain if even the Global Fund replenishment minimum target of $18 billion is reached. Positive announcements have come from the United States, Japan and Germany but pledges from many other high-income countries are still missing. 

However, the US condition their contribution to one-third of the total amount—meaning that, if other countries fall short of the requested 30 per cent increase, the US will also reduce its current $6 billion pledge. A shortfall thus carries a double whammy risk—or a double responsibility, if you will. 

In the global discourse on pandemic preparedness and response, the focus lies mostly on future outbreaks of emerging diseases with risks to high-income countries. Little attention goes to people’s needs due to prevailing pandemics—such as HIV, TB and malaria. Should the Global Fund’s replenishment fall short, it’ll be very hard to take the current claims about pandemic awareness seriously.

Now imagine that the Global Fund is broke. Imagine what will happen if donors do not pledge according to the needs of the Global Fund. Imagine your country failing to pay the expected donor contribution to the Global Fund, breaking the promise of worldwide solidarity to fight HIV, TB and malaria. 

MSF teams don’t need to imagine. In several countries, they already see the consequences of funding shortfalls. They describe what gaps in essential care exist and what impossible dilemmas are created: Who should be short-changed or what services need to be rationed? 

MSF has published a briefing paper to explain how these shortfalls in funding for sufficient HIV and TB tests block the timely start of treatment, how health providers cannot provide care according to the quality standard, how patients are excluded or driven into poverty to obtain live-saving drugs, and how essential malaria interventions had to be cancelled. Imagine.

Rolland Kaya is the general director of MSF Eastern Africa. www.msf.or.ke