Global Fund is facing ‘colliding crises’ when tackling HIV, TB, malaria

Global Fund Executive Director Peter Sands touted the organization’s efforts in 2023 to save millions of lives from HIV, TB, and malaria. But he said the work has become more challenging in the face of “colliding crises.” The Global Fund to Fight AIDS, Tuberculosis and Malaria has saved 65 million lives since its founding in 2002, with the combined death rate for the three diseases slashed by 61%, according to its latest Results Report. The report shows that the organization’s HIV investments over the last two decades have freed up 1.66 billion HIV-related hospitalization days, and averted 1.36 billion outpatient visits, which according to the fund translates to $85 billion in cost savings. The Global Fund also invested $1.8 billion to strengthen health and community systems in 2023 — the highest amount in a given year — and plans to invest $6 billion between 2024 and 2026. But Sands said the communities they are serving are now being hit by climate change, conflicts, and attacks on gender equality and human rights. “The reality is that global health has probably been somewhat eclipsed by climate change and humanitarian responses to conflict in the sort of pecking order of [official development assistance] priorities.” --— Peter Sands, executive director, Global Fund to Fight AIDS, Tuberculosis and Malaria One example is malaria. “Draw a map of the countries with the highest malaria burden in the world. Draw another map of the countries with the greatest vulnerability to climate change. Draw a third map around conflict, and you'll find there's remarkable overlap between those three maps,” he said during a briefing on Wednesday. “Ultimately, we may talk about these as separate crises, but they're impacting the poorest and most vulnerable communities,” he added. Climate change is causing a rise in temperatures, which is contributing to an increase in malaria transmission, including in places previously unaffected by it. It has also been linked to the frequency of extreme weather events, leading to disasters such as flooding that create more opportunities for malaria-carrying mosquitoes to breed. But Sands said conflict, resistance to insecticide, parasite resistance to antimalarial treatments, and a “significant funding gap” are also contributing to the challenges they face in tackling malaria. Progress and setbacks Sands said the Global Fund has secured price reductions for key tests and treatments, including for antiretroviral, or ARV, treatments, now priced at $45 per person per year — a far cry from the $10,000 per person per year cost of ARVs back when the Global Fund started over two decades ago. The Global Fund is also now deploying new HIV tools, such as the dapivirine vaginal rings, a type of long-acting HIV preexposure prophylaxis, or PrEP, for women and girls. Sands said they are also excited with the trial results for the twice-yearly injectable lenacapavir. “We see this as potentially a game-changing tool if we're able to deploy it at scale, which means that it has to be at a price point which makes that feasible,” he said. Sands said the tools need to reach those most at risk of HIV. However, they’ve seen an “erosion” of human rights, and stalled progress on gender equality, both of which have direct implications on HIV prevention efforts. “Even if we have access to and can provide access, in theory, to the best and most innovative tools, if the people who are most at risk can't get access to health services, are scared to reach out because of stigmatization or even criminalization, then it's not going to work,” he said. “The kind of technical and economic side of it around market shaping has to be accompanied with progress on breaking down human rights-related barriers to access.” Future plans Sands said fighting the three diseases will continue to “require significant resources.” The Global Fund will have its next replenishment in the third quarter of 2025. It is currently working on an investment case, which he anticipates will be published in early 2025. Sands acknowledged it’s a challenging environment for fundraising to continue their progress on HIV, TB, and malaria. “The reality is that global health has probably been somewhat eclipsed by climate change and humanitarian responses to conflict in the sort of pecking order of [official development assistance] priorities … and also that donor countries, ODA budgets, many of them, are under acute pressure,” he said. He added that “it's all the more important that we can demonstrate that the money does actually translate into impact, that we use it efficiently and effectively.”