Should the Global Fund play a role in future pandemics?

As the board of The Global Fund to Fight AIDS, Tuberculosis and Malaria meets Thursday to discuss the organization’s strategic framework for post-2022, there are calls for the organization to expand its mandate to cover financing for COVID-19 and future pandemics.

Former board members of the Global Fund and other health experts have expressed their support for the fund's role to evolve and address future health threats beyond HIV, TB, and malaria — they argue that it is best placed to do so given its mission to fight infectious diseases and the way it’s structured that allows for community engagement through its country coordinating mechanisms.

The Global Fund also includes a wide array of stakeholders on its board, with civil society and community representatives given voting rights, allowing them to take part in the board’s decision-making.

“The Global Fund has a structure in place that has been purposely developed and deployed for pandemic response,” said Aida Kurtovic, who previously served as chair of the Global Fund board, during a panel session at this week’s International AIDS Society conference.

“Why on earth [would we] consider creating [a] new agency, [a] new global institution however we call it, instead of fusing what we have available, which has already proven that it has wonderful capacity, and it is delivering results,” she added.

There have been numerous calls over the years for the Global Fund to expand its mandate beyond HIV/AIDS, TB, and malaria, as well as arguments in favor of the organization keeping its focus on the three diseases. In open consultations over its next strategy, among the recommendations was for the fund to further engage on global health security, allowing it to have a role in emerging health challenges and future pandemic threats such as COVID-19.

But those recommendations also came with a caveat that expanding the mandate of the Global Fund should come with additional financing, and not take away investments for HIV/AIDS, TB, and malaria. There are concerns that expanding the Global Fund’s mandate would affect these programs for which resources are already limited.

There is already a decline in 13 donor governments’ funding for HIV, according to the latest report by the Kaiser Family Foundation and UNAIDS. The United States is the largest bilateral donor for HIV, but even its funding has remained flat in 2020.

In addition, civil society organizations are concerned the world is still off track in achieving targets for HIV, TB, and malaria, said Loretta Wong, who previously represented the developing country NGO delegation to the board of Global Fund.

“How can the Global Fund stay focused on the three diseases, get back on track, and achieve its original goals if [the] Global Fund is to expand to cover other pandemics?” she asked. “I think the concerns from … civil society should really be … addressed and be heard.

But Chris Collins, president and CEO at the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, told Devex that the Global Fund can be more effective in its work focused on ending HIV/AIDS, TB, and malaria if it takes on an expanded role on pandemic preparedness and response.

“This is an enormous opportunity to advance progress on AIDS, TB, and malaria, identifying synergies between pandemic preparedness, health systems strengthening and ending longstanding epidemics, and avoiding further siloing of global health,” he said.

Emergency response or pandemic preparedness?

Some board members pointed out that the Global Fund is already involved in the pandemic response. Through its COVID-19 response mechanism, the organization is already providing support for COVID-19 response in countries and mitigating the impact of the pandemic on HIV, TB, and malaria programs. Global Fund resources have also been deployed to strengthen health and community systems.

The organization is also part of the ACT-Accelerator and works together with other global health institutions to procure and distribute COVID-19 tests and treatments including oxygen to countries, and personal protective equipment to health workers. It has received support for this work, with the U.S. government’s $1.9 trillion American Rescue Plan including $3.5 billion for the Global Fund’s COVID-19 response — in addition to U.S. annual funding to the organization.

But the future role of the Global Fund when it comes to pandemics — if and when the board decides to expand its mandate — needs to be clarified. During the Global Fund board’s meeting in May, a key consideration was the organization’s role in pandemic preparedness and response. The organization is currently involved in COVID-19 emergency response, but there’s room for it to be involved in pandemic preparedness work.

“I think that the Global Fund mechanism is especially well-situated to respond to the kind of global financing needs that are individual country-driven … investments that need to be made year-on-year in response to country priorities,” said Stefano Bertozzi, who previously represented private foundations on the Global Fund board. “I think of that especially in the area of pandemic preparedness, not so much in the area of emergency pandemic response,” he added.