Funding crisis threatening Global Fund’s fight to end AIDS calls for Canadian leadership

This week, the world marks the 10-year anniversary of the launch of the most successful global health effort in history - the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Nearly eight million lives have been saved through Global Fund investments to date, and even greater progress might be on the horizon, thanks to recent scientific breakthroughs and the achievements of the last decade. Yet this anniversary will be marked by protest marches in Zambia, and by similar activities in Nairobi and around the world. Why?

Because against the backdrop of success and potential promises, paradoxically, the Global Fund’s mission is in jeopardy. Faced with a tough fiscal situation, wealthy countries have put a limit to their pledges to the Global Fund which will stop any further progress. Without the necessary resources in hand, the Global Fund was forced to announce on November 23, 2011 - a mere week before World AIDS Day - that it was cancelling its next round of grants (Round 11) and would stop all new grants for at least two years.

To understand just how damaging and cruelly ironic the cancellation of future grants is, we must go back in time a decade to the Global Fund’s creation.

Ten years ago, the future of the fight against these diseases was bleak. An AIDS diagnosis was essentially a death sentence for those living in poor countries without access to essential anti-retroviral treatment. Tuberculosis (TB) programs suffered from decades of neglect, and malaria was a largely unchecked killer of children and pregnant women in sub-Saharan Africa.

In response to this emergency, donor countries and implementing countries, together with civil society and the private sector, formed a unique partnership. Determined to turn the tide, they created what then UN secretary general Kofi Annan called a “war chest” to change the future of the fight against AIDS, TB, and malaria.

What followed was one of the most extraordinary decades in the history of public health. In the past 10 years, the Global Fund has become the largest source of funding for AIDS, TB, and malaria, and fundamentally altered our ability to fight these diseases. The Global Fund now saves an estimated 100,000 lives each and every month.

Global Fund investments, together with the US PEPFAR program, have helped resurrect African communities on the verge of being wiped out by HIV/AIDS. The fund provides treatment for 3.3 million people living with HIV/AIDS, with millions more accessing testing and counselling services.

The Global Fund has helped detect and treat 8.6 million cases of TB, and TB mortality is on target to be halved by 2015 in comparison with 1990. Hundreds of millions of insecticide-treated bed nets have been distributed by Global Fund programs, and malaria deaths have plummeted by 50 percent in 11 African countries.

In May 2011, researchers announced the results of a breakthrough study, HPTN 052, that proved conclusively what AIDS researchers had long suspected: AIDS treatment can prevent the spread of the virus. Treating HIV-positive people with anti-retroviral therapy (ART) early in the disease cycle dramatically reduces transmission of the virus to uninfected partners. In fact, researchers found that when treatment was initiated early in the progression of the disease, as opposed to waiting for those infected to become sick, there was a 96 percent reduction in the risk of transmission. This discovery was named the 2011 “Breakthrough of the Year” by Science magazine.

The implication of this new finding, along with other breakthroughs in prevention, is that we now have the tools to end the AIDS epidemic.

Early AIDS treatment not only reduces transmission of HIV, it can also protect HIV-positive people from opportunistic infections like TB. The study found that early AIDS treatment reduced the occurrence of TB infection by 84 percent. This is critical given that TB is the biggest killer of people with HIV.

This evidence, combined with recent economic modeling showing that investing more in AIDS treatment and prevention now will not only reduce deaths but will also reduce the cost of the AIDS response in the long run, shows that we can end AIDS if we have the political will.
Moment of crisis in the fight against AIDS, TB, and malaria.

Just as science is telling us we can end AIDS within the next generation, and funding for scale-up of treatment is more important than ever, the Global Fund is being forced to shut its doors to new patients for at least the next two years. The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it. Progress against all three diseases is not only in danger of being halted in its tracks, but actually being reversed.

These pandemics won’t wait around for the world to sort out its financial challenges. If we are not advancing against these epidemics then we are moving backwards. The Global Fund needs resources right now to continue to fund the expansion of effective, high-impact, life-saving programs.

Canada can lead in moving the world closer to the end of these diseases by ensuring that the Global Fund has the resources it needs right now to continue to fund the expansion of effective, high-impact, life-saving programs. Canadian leadership—in fulfilling our pledge to the Global Fund and supporting an emergency donors meeting this spring—will determine the future of the fight and the futures of millions of people around the world.

• Jean-Francois Tardif is executive director of RESULTS Canada.
• Nicci Stein is executive director of the Interagency Coalition on AIDS and Development.