Why The U.S. Is Pledging $4.3 Billion To The Global Fund

The U.S. has pledged up to $4.3 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria over the next three years. The question is, will it actually make an impact?

If previous data is any indication, the answer is yes. "The Global Fund has a good track record in terms of impact achieved and funding distributed," says Josh Michaud, associate director of global health at the Kaiser Family Foundation, a nonpartisan health policy research group.

The Fund was created in 2002 to address the AIDS, TB and malaria epidemics, which claimed 4 million lives that year alone, mostly in poor countries.

With money raised from both the private and public sector, the Fund gives grants to local NGOs and programs that provide interventions such as bed nets to protect against malaria-carrying mosquitoes or the daily pills that keeps HIV in check. The Fund invests in more than 400 projects in 100 countries, mostly in sub-Saharan Africa and Southeast Asia.

What makes the Fund different from, let's say, the World Bank or governments that give aid, is that local NGOs are part of the governing body, says Michaud. That means they have a bigger say in how money is disbursed on the ground.

Earlier this month, the Fund released its annual report, which draws on data from UNAIDS, other research groups and its own reporting. The report paints a dramatic picture of the world's efforts to tackle the three diseases in the past 14 years — and shows that progress has been made:

• Programs that the Fund supports have helped save 20 million lives from 2002 to 2015 and cut AIDS, TB and malaria deaths by a third — from 4.1 million in 2002 to 2.6 million in 2015.
• The Fund is the world's largest financier against these diseases. It provides more than 65 percent of global dollars to TB programs ($4.9 billion since 2002), 50 percent to malaria programs ($8 billion since 2002), and 20 percent to HIV/AIDS programs ($16 billion since 2002).
• There has been a 45 percent drop in AIDS-related deaths, from 1.9 million in 2004 to 1.1 million in 2015, in countries where the Fund invests. "I find it difficult to say that it was the Global Fund alone who made this impact," says the Kaiser Family Foundation's Michaud of these figures. There have been many powerful players in the global fight against HIV/AIDS, including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), he says.
• The number of malaria cases has declined rapidly, thanks to bed nets and better use of drugs to eliminate the parasite from the body. Cases have dropped by more than 18 percent between 2000 and 2015, resulting in a total of 806 million malaria cases averted globally between 2010 and 2015.
• Diagnosis and treatment for tuberculosis has helped save 38 million lives since 2000.

Tomorrow, the Fund will hold its fifth replenishment conference. Global leaders from the public and private sector will come together in Montreal to decide how much to give the Fund from 2017 to 2019. The Fund hopes to raise $13 billion, which it estimates would save 8 million lives and avert up to 300 million new infections across the three diseases.

It's a lot of money — and that's why the Global Fund should work even harder to quantify its impact, says Amanda Glassman, director of global health policy at the Center for Global Development, a think tank.

Her big issue with the Fund is that some of its numbers are fuzzy. She cites the TB figures as an example: "The Fund supposedly says governments have completed high rounds of treatment. But we're starting to see a lot of multi-drug-resistant TB, which suggests retention isn't as good as the data suggests."

"We would like to see more accountability between the funds disbursed and what's happening on the ground," she adds.