Global Fund chief on COVID-19 funding, global health security

WASHINGTON — Global COVID-19 response efforts need a bolder response, health financing remains difficult, and the way global health security is defined needs to change, according to Peter Sands, the executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Access to COVID-19 Tools Accelerator, or ACT Accelerator, is still short of the funding it needs. What’s needed is the “kind of boldness of response” that wealthy countries have shown in their domestic spending when it comes to accelerating the development of new tools and ensuring equitable access to them, Sands said in an interview at Devex World.

Global health funding

Overstretched development assistance budgets won’t be enough to meet the needs of the COVID-19 response and stretched health systems, but most of the funding for these global public goods is going to come from governments — though it may flow through a number of mechanisms, including grants, International Monetary Fund Special Drawing Rights, or debt relief, Sands said.

The ACT Accelerator needs about $4 billion urgently and about $28 billion through 2021 to meet the needs as outlined by the investment case, he said.

While innovative financing mechanisms aren’t likely to generate massive new sources of money, they can sometimes be useful in addressing particular challenges. The COVAX Facility is a good example of how an instrument has been designed to create a financing solution around a particular problem — in this case, COVID-19 vaccine access and distribution, Sands said.

While immediate funding needs are top of mind, COVID-19 could have a longer-term impact on health budgets and how they’re viewed, he said.

While the fiscal capacity of most low income and middle-income countries has been badly hit by the pandemic, and budgets have come down, COVID has “delivered a very powerful lesson on the interdependence of health and the economy,” he said. While countries will have smaller total budgets, it is important that health gets a larger share and that those allocations are done as efficiently as possible, Sands said.

“I’m hoping that now that people are really looking at the interaction between health and the economy, they don’t just look at the downside risks, but they look at the upside benefits.”

 The Global Fund 

The Global Fund is developing a new strategy and while it is too early to outline exactly what it will look like — the board is in the midst of a series of discussions about it — there is no doubt that COVID-19 has “dramatically changed the context,” Sands said.

Global health is a “very different” arena in the wake of the pandemic and as an organization created to fight the biggest infectious diseases, it will have “big strategic implications” for the organization, not least because of its impact to deliver on its core missions around HIV, TB and malaria, he said.

The pandemic has forced The Global Fund to think about risk and tradeoffs as it has responded and continues to do so, he said. The fund has been acting rapidly and prioritized pace to help health systems contend with the crisis even if it meant sacrificing the “same degree of oversight that we would normally have.”

Vaccines are not likely going to be available in the poorest countries until late 2021 at best, and the economic impact is going to be devastating “unless we can galvanize a different scale of response from the G-7 and G-20,” Sands said. That means continued support for personal protective equipment and mitigation measures will continue to be critical despite vaccine excitement, he added.

Redefining global health security

One of the key issues moving forward is the framing of the debate about global health security — whether it focuses largely on diseases that might kill people in rich countries, which is roughly how it is characterized today, or if it is about how to keep everyone safe from the threat of infectious diseases, Sands said.

“If it is the latter, then it requires us to look a bit differently at, in a sense, the residual pandemics, the unfinished fights against earlier pandemics,” he said. “My view is that we can’t really run with a concept of global health security that is kind of code for diseases that might kill people in rich countries. It is morally untenable and politically not going to fly.”

In the past preparedness efforts to protect against global health threats have struggled to gain traction, particularly in low- and middle-income countries because political leaders found it difficult to invest in more hypothetical needs while people are suffering from TB or malaria. But the two efforts should be viewed as more in line, as evidenced by the fact that much of the disease response is based on the infrastructure and capabilities that have been put in place to fight HIV, TB, and malaria.

“It’s not like global health security is a kind of separable, different thing, it’s intricately linked to the way we’re fighting existing diseases,” Sands said.