New ADB platform aims to help end malaria, TB, and dengue in Asia-Pacific

The Asian Development Bank is working on a new flagship regional initiative to help accelerate the elimination of some of Asia-Pacific’s biggest climate-sensitive diseases. ExCITD, short for Ending CompleX and Challenging Infectious and Tropical Diseases, is expected to involve a mix of concessional loans and grant funding from different partners to help scale solutions to ending diseases such as malaria, tuberculosis, and dengue, which are rising or resurging in different places in the region. The bank hopes the initiative, which will have a strong emphasis on partnerships, will help the region to eliminate these diseases within the next decade. “We want to go together … we want to go faster and stronger to achieve these elimination goals in some of our [developing member countries] over the next decade,” Amandeep Singh, ADB senior sector specialist, said during the bank’s INSPIRE forum held from July 7 to 11. Bank officials emphasized the bank isn’t a traditional donor, and isn’t set up to fill gaps left by significant cuts in grant aid. But they’re hoping they can help revamp the thinking about tackling these diseases by considering them as investment projects. While the initiative is still in the works, officials say it’s an example of how ADB is responding to growing demand for health financing among its developing member countries. Several countries in the Asia-Pacific region are seeing a decline in grant funding, or graduating from support coming from global health initiatives such as Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. During the COVID-19 pandemic, many countries sought help from the bank, particularly to gain access to vaccines, and realized they needed bigger investments beyond grants and technical assistance to improve their health care facilities and systems, said Dr. Akihito Watabe, a health specialist at ADB. The need While a lot of progress has been made in tackling many infectious diseases, billions of dollars are required to reach their elimination, based on expert estimates. Take malaria as an example. The world needs to mobilize $80 billion to $100 billion more to eradicate malaria by 2040, according to estimates presented by Martin Edlund, CEO of Malaria No More and executive director of the Health Finance Coalition, during the forum. The cost of inaction is dire, especially with the threat of climate change. The World Bank estimates that the impact of climate change on health may cost the economies of low- and middle-income countries some $20.8 trillion by 2050. But countries can no longer significantly rely on traditional donor aid. The U.S. government — the world’s largest donor to global health — canceled thousands of grants this year and is proposing massive cuts to global health programs for fiscal year 2026. “It seems clear, and I think we can say now, that the old model of international aid and development is over and it's not coming back,” Edlund said. A new approach Edlund said a new financing approach is needed that combines country budgets, concessional loans, commercial investments, and catalytic grant capital, and that there’s a “big opportunity” to do that with ADB’s ExCITD initiative. With declining donor aid, everyone is “looking for leverage,” he said. During the forum, several development partners from global and local philanthropies, as well as multilateral and bilateral donors, met in a closed-door session to discuss how they could work under the initiative. “My definition of catalytic capital is grant funding that is not used in isolation, but instead it's leveraged 10x to 20x, unlocking on-budget country spending, concessional loans led by partners like the ADB and commercial investment where it makes sense in things like manufacturing,” Edlund told Devex. There is huge interest from organizations such as the Global Fund and Gavi in how they can use their grants to open up more resources for countries. Both multilateral organizations are facing budgetary constraints, especially with the change in U.S. policies. But one element that Edlund said he is “excited to explore” is how to get domestic corporate and philanthropic capital to serve as catalytic grants and unlock these other financing opportunities. “Given how disruptive a disease like dengue is to local business and lives, and livelihoods, we think domestic corporate and philanthropic capital can help to unlock this spending,” he said. “We’re working with partners in Indonesia to look at how they could provide maybe 50% of the catalytic capital needed for unlocking … loans and other spending.”