Countries are revising their grants as the Global Fund to Fight AIDS, Tuberculosis and Malaria prepares to cut $1.4 billion in its current funding cycle — a devastating blow to a sector still reeling from the massive funding cuts implemented by Washington.
The cuts vary across countries, although the majority are facing cuts of 10% or more. South Africa is slated for a 16% reduction in its allocation, my colleague Andrew Green reports.
Some argue it’s the responsible thing to do. Several donors have not yet disbursed what they have promised the Global Fund, including the United States, which has so far only contributed $1.8 billion of its $6 billion pledge. The Global Fund’s eighth replenishment is coming up soon, but it’s unclear if it would be able to meet its fundraising goal of $18 billion.
“Given the rapidly evolving changes in our donor landscape, the prospects for full conversion of Seventh Replenishment pledges remain highly uncertain,” a Global Fund spokesperson tells Andrew. “While we continue to pursue full pledge conversion, we still face the risk of a significant gap between current grant commitments and available resources.”
But some advocates say the decision is creating chaos on the ground. While the Global Fund said lifesaving services will be maintained, some are worried it would lead to even more limited resources for community-based work.
Country coordinating mechanisms — which are responsible for overseeing the implementation of Global Fund grants — and principal recipients of the grants are currently working with fund officials on the revision, which is expected to be finalized by the end of September.
Read: Global Fund plans to cut $1.4 billion from grants it has already awarded
The organizations are not alright
U.S. funding cuts are also pushing other organizations to make some tough decisions or resort to emergency measures.
UNAIDS — the joint program composed of a secretariat and 11 U.N. agencies — is facing a major funding shortfall, prompting the secretariat to request board approval to tap into its reserves to sustain activities, including its ongoing restructuring.
ICYMI, UNAIDS is undergoing a major restructuring in response to declining donor funding and calls for changes within the program and the broader U.N. system. This will see the secretariat lose 55% of its staff, downgrade its country offices, and relocate most of its remaining functions outside of Geneva.
That effort, however, comes at a cost — approximately $32.8 million in 2025 and 2026. But UNAIDS expects its balance to shrink down to just $27 million by the end of the year — and who knows what the future will bring in terms of donor funding.
So the board agreed for UNAIDS to use up to $15 million of its reserves, but is asking the secretariat to present a plan on how it will replenish it in December.
Meanwhile, Gavi, the Vaccine Alliance has also cut 24% of its workforce, eliminating 155 full-time positions, according to a report by Geneva Solutions. The organization wasn’t spared from U.S. cuts, with the Trump administration allocating zero funding for it in its 2026 budget request.
A spokesperson said the cuts were made “to align Gavi ’s structure with its strategic goals, enhance efficiency and adjust to a changing environment of pressing resource constraints.”
Read: Board agrees for UNAIDS to use its reserves for restructuring
Background reading: UNAIDS will lose more than 50% of staff in restructuring
Strings attached
But even organizations retaining funding from the U.S. government are finding themselves shifting priorities.
The Stop TB Partnership, which was established to help end the scourge of tuberculosis as a public health problem, is one of the (lucky?) few organizations retaining U.S. funding. However, it can no longer use U.S. contributions for several activities, such as promoting diversity, equity, and inclusion, as well as those related to advocacy and communications, Stop TB Partnership Executive Director Dr. Lucica Ditiu tells me. As a result, the organization is laying off staff working on these activities.
This also means the organization is losing U.S. support for its grantmaking facility for civil society and grassroots networks of people affected by TB that rely on those grants to advocate for financing and policy change to sustain TB programs.
But while the organization is retaining U.S. funding now, the future remains uncertain given the unpredictability of U.S. government policies and, by extension, the global health funding landscape.
Read: Stop TB cuts over a quarter of staff amid shift in US priorities
ICYMI: Stop TB Partnership retains US funds but must revise scope, cut staff
Wins-day
But there was a bit of good news on the global health innovations front.
On Wednesday, the Swiss regulatory authority approved Coartem Baby, the first malaria treatment for newborns and young infants weighing under 4.5 kilograms (9.9 pounds). Its rollout could begin in Africa before the year’s end. In Uganda, the registration process is already underway.
Novartis has committed to providing Coartem Baby on a not-for-profit basis, although there’s no price yet, Andrew reports. Experts don’t expect that to be an issue, given that it’s a reformulation of an existing treatment. They also expect it to be covered by the Global Fund.
Speaking of the Global Fund, on Wednesday, it also announced an access agreement with Gilead Sciences to procure lenacapavir — a long-acting injectable hailed as a potential game changer in HIV prevention. Trials show the twice-yearly shot is highly effective and offers a convenient option for those at risk.
The fund says it’s utilizing private sector funding to make it more affordable to introduce and scale up the shot in countries.
“Our ambition is to have the first shipment and delivery of the products reaching at least one African country by the end of 2025,” according to a Global Fund news release.
Read: First malaria medicine for newborns is approved
Related: Where is the political demand to eliminate pediatric HIV/AIDS? (Pro)
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A new playbook
Utilizing other types of financing is becoming an attractive option for global health organizations as traditional donor aid funding declines.
During a session at this week’s Asian Development Bank health-focused forum titled INSPIRE, several development organizations, including Gavi and UNICEF, shared how they’ve been using co-financing and blended finance over the years to crowd in additional resources for health, whether it’s to address child wasting or reach immunization goals in countries.
For its most recent replenishment, Gavi secured some $4.5 billion in commitments from development financing institutions in support of its immunization work.
Charles Bleehen, head of development finance at Gavi, said it may be helpful to have a co-financing playbook for global health institutions and programs.
“Everybody has their own framework and their own way of doing things, but … as far as I'm aware, there's no common co-financing playbook [for global health],” he said. “I think that could be incredibly helpful in just bringing our sort of less financially literate colleagues along in this process.”
ICYMI: Gavi eyes blended financing in new partnership with AIIB
What we’re reading
Medical groups are suing U.S. health secretary Robert F. Kennedy Jr. for removing COVID-19 shots from the CDC’s recommended vaccines for healthy children and pregnant women, exposing them to serious illness and even death. [NPR]
The U.S. has 1,300 confirmed measles infections across the country, surpassing the 2019 figures. [BBC]
The next phase of the pandemic agreement discussions has resumed in Geneva with the first meeting of the Intergovernmental Working Group, whose task is to negotiate the details of the pathogen access and benefit sharing system that will serve as an annex to the agreement. [Health Policy Watch]
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
