Every three years, the Global Fund to Fight HIV, Tuberculosis and Malaria holds a Replenishment Conference. The pledges thus received are used primarily to finance its various programmes. Notwithstanding the progress made over the past 20 years, the Fund is currently facing a health emergency that threatens to irreversibly divert the path towards eradicating these pandemics. In this context, “moving forward to keep saving lives” is the challenge to be met by the Fund’s 7th Replenishment scheduled for 2022 in the United States. The challenge is particularly critical for Africa, which is the continent most affected by the three pandemics. This column aims to illustrate this point.
Actually, the COVID-19 pandemic has caused significant disruption and setbacks in the implementation of key Global Fund programmes. Preliminary data from the Fund’s indicator tracking survey shows a causal link between COVID-19 and the decline in HIV, TB and malaria programme performance. In 2020, the number of people treated for drug-resistant TB in countries where the Global Fund to Fight AIDS, Tuberculosis and Malaria has invested declined by 19% and the number of people on treatment for multidrug-resistant TB decreased by 37%.. In 2020, the number of people treated for drug-resistant TB in countries where the Global Fund to Fight AIDS, TB and Malaria has invested declined by 19% and the number of people on treatment for multidrug-resistant TB decreased by 37%. This is a difference of almost one million people who were not treated in 2020 compared to 2019. The number of tests for suspected malaria cases also decreased compared to 2019. As for 2021, data suggest that we are heading towards a further decline in the indicators for the three diseases.
The global picture broadly presented above is further compounded when special attention is paid to the African continent. The emergence and persistence of the COVID-19 pandemic has exacerbated existing inequalities, led to the reallocation of essential resources, hindered prevention and treatment activities, and overexposed vulnerable populations to health risks. According to a recent study published in the Lancet Global Health, low- and middle-income countries could see deaths from HIV, TB and malaria increase by as much as 36% over the next five years due to disruptions in healthcare services caused by COVID-19.
But actually, what looks like unpleasant warnings is driven by the need to act urgently. While the hope of ridding humanity of these three pandemics by 2030 has been somewhat dampened, strained or even shattered by the disastrous effects of Covid-19, it is important to bear in mind that the battle is not lost. And in any case, giving up cannot be an option. The world cannot simply wait until the storm over. It must continue to overcome its disasters, which means learning to dance in the rain. In this sense, the urgency of the situation calls for action. If nothing is done in the next few months, the tremendous progress made before the COVID-19 pandemic could go up in smoke and pave the way for a global hecatomb that no moral conscience would wish to see.
It is against this background and for many other reasons which cannot be contained by this short column, that the Global Fund’s Board adopted a new, innovative and ambitious strategy for the 2023-2028 period at its 46th session in November 2021. The paradigm shift is not a minor one. It will involve concurrently developing integrated and people-centered health systems to achieve greater impact, resilience and sustainability; increasing community engagement and leadership; and maximising equity in health, gender equality and human rights. On a broader level, this strategy also aims to more efficiently prevent new pandemics or health emergencies.
During this session, the SC also changed the disease split of its key programmes. The aim is to provide more funding for TB programmes, while protecting HIV and malaria programmes. And with good reason! Since the launch of the Global Fund’s allocation model in 2013, the split has remained at 50% for HIV, 18% for TB and 32% for malaria. However, almost a decade later, the stakes have changed. The proportion of TB-related deaths has increased. “About 10 million people are affected by TB each year, resulting in about 1.5 million deaths. This contrasts with the 38 million people living with HIV with about 680,000 deaths each year; and the 220 million cases of malaria per year with over 400,000 deaths. Added to this, as mentioned above, are the adverse effects of the COVID-19 pandemic on the control of these three diseases.
With this in mind, the SC decided that: “1. all funds available for country allocation up to and including US $12 billion will be distributed as follows: 50% for HIV/AIDS, 18% for TB and 32% for malaria. 2. Any additional funds available for country allocation above US$ 12 billion will be allocated as follows: 45% to HIV/AIDS; 25% to tuberculosis; and 30% to malaria.
An innovative strategy and efficient allocation of resources is half the battle. The other half consists in raising the necessary financial resources. Hence, the importance of the 7th Replenishment Conference.
In fact, the success of this Replenishment is crucial for the implementation of the Fund’s new strategy and the allocation of financial resources. The Fund’s actions are totally dependent on this Replenishment. However, more than a simple replenishment, the current context requires a broadening of the resource base. And to understand what is at stake here, just think of a 26 cm pie or pizza. If the aim is to offer larger and more consistent portions to those who will eat it, then, changing the distribution of the portions will not change anything ultimately. The solution is to order a larger pizza (40 cm). Mutatis Mutandis, raising additional funds is essential to meet the new challenges related to HIV, TB, malaria and COVID-19. It is the impetus for a realistic utopia.
For Africa, the continent most affected by these diseases and a battleground, the 7th Replenishment is of vital importance. Because, although we are all deeply affected, experiencing vulnerability at the same time and collectively facing tragedy, the conditions for fighting HIV, TB and malaria are not identical. Not all continents are equal in the face of these pandemics, and even less so in the face of the health crisis that the entire world has been experiencing for almost two years now. While it is true that these diseases can potentially affect everyone, the means to deal with them always depend on the resources available. Africa’s resources to date are insufficient. Sadly.
In fact, if greater financial resources are not mobilised, if decision-makers run the risk of shutting themselves in denial, a sort of veil of unreality, then thousands of lives that are essential to the development of the African continent would be sacrificed, harassed, handicapped, weakened and destroyed after a long agony. The point here is not to sell a misleading argument of sponsored lobbyists or to draw an exaggerated conclusion from excessively alarming assumptions. The pages of many reports and studies are full of gloomy projections, the emotion of which can be felt just by reading them.
It is perhaps worth remembering that mobilising funds for the fight against HIV, tuberculosis and malaria is not an expenditure, but an investment. Indeed, there is no need to be the oracle of Delphi to know that the cultural, sporting, religious, economic and creative potential of humanity is always impoverished when thousands of people are prematurely snatched from life. At the same time, fundraising challenges our ability to stand together. It invites us to rediscover the beauty of human solidarity, that is, the need to forge links in order to create resilient and sustainable systems for health. In other words, there is a world narrative to be reinvented or revitalised around a global policy of solidarity. The success of the 7th Global Fund’s Replenishment would be a great step in this direction. Let us reenchant the bright side of our common humanity.
 https://www.theglobalfund.org/fr/covid-19/news/2020-06-17-global-fund-survey-majority-of-hiv-tb-and-malaria-programs-face-disruptions-as-a-result-of-covid-19/ (Consulté le 15 novembre 2021).
 Le Fonds mondial, Rapport sur les résultats 2021, p. 5.
URL :https://www.theglobalfund.org/media/11305/corporate_2021resultsreport_report_fr.pdf (Consulté le 22 septembre 2021).
 Alexandra B. Hogan and others, “Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study” in The Lancet Global Health, 13 July, 2020, URL: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30288-6/fulltext (Consulté le 20 novembre 2021).