WHY THE GLOBAL FUND MATTERS

By PAUL FARMER
Published: February 1, 2012
Ten years ago, the heads of the G-8 countries met in Genoa, Italy, to back the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria — a new funding mechanism that dramatically increased resources available to fight preventable, treatable diseases stalking the poor and depleting developing economies around the globe.

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In 2001, very few people — almost none, really — living with H.I.V. in Africa had access to antiretroviral medicines. Today, more than 3.3 million people — more than half of those on treatment worldwide — are on treatment supported by the Global Fund: A true victory for the global community. The fund and the U.S. international AIDS program, Pepfar (the President’s Emergency Plan for AIDS Relief program), are the most ambitious global health endeavors in generations.

Now, 10 years since its founding, the Global Fund is facing a serious financial shortfall, and the fund’s board voted recently not to accept new grant requests until at least 2014. Bill Gates’ announcement of a $750 million contribution to the fund in Davos last week was welcome news — the Bill & Melinda Gates Foundation has been among the greatest supporters of the Global Fund since its inception — but will not change the board’s decision. They knew of Gates’ donation before they canceled the current round of grant-making.

This funding deficit hit right when the end of AIDS became plausible: Last year, scientific breakthroughs provided conclusive evidence that putting more people on treatment earlier can significantly reduce incidence of H.I.V. Treatment is prevention.

Beyond AIDS, the Global Fund is currently the largest donor in the world for tuberculosis and malaria programs. Operating in 150 countries, it has treated more than 8 million cases of tuberculosis and distributed 230 million insecticide-treated nets. Deaths from malaria are down nearly 40 percent in most of Africa. The question is not whether the Global Fund works, but how to ensure it keeps working for years to come.

In my mind, there are four reasons this is imperative:

First, the world needs to expand, not contract, access to health care because of the sheer burden of disease. It is unconscionable that, in 2012, we are still living in a world where millions of poor people die of preventable and treatable diseases.

Second, the Fund doesn’t simply give handouts; it takes the longer road of investing in and working with health ministries. In doing so, it seeks to build (or rebuild) local health systems, develop platforms for transparency and accountability, boost local procurement and improve supply chains, and help train civil servants and health professionals.

This approach has had profound spillover effects on other health and development priorities. In central Haiti, for example, establishing effective treatment programs for AIDS, tuberculosis, and malaria has raised the standard of care for chronic conditions like major mental illness, heart failure and several forms of cancer.

Third, the Global Fund proves how much multilateral organizations can accomplish. While the usual players — the G-8, say — bear the greatest financial burden, I would urge some of the recipient countries to consider themselves partners of and contributors to the fund. In today’s global economy, countries like India, Russia and China play meaningful roles as donors and as recipients of grants. Gabriel Jaramillo, a Brazilian banker who last week was named the fund’s general manager, will surely strengthen these links and reinvigorate its leadership. The Global Fund is a truly multilateral organization, and stronger for it.

Fourth, a recession is a lousy excuse to starve one of the best (and only) instruments we have for helping people who live on a few dollars a day. Most marginalized populations around the globe have always faced economic contraction; “financial crisis” has been ongoing for them since the day they were born. It would be a great mistake to allow one of the world’s most effective global health institutions to fail because we need to get our own fiscal house in order.

Along with Pepfar, the Global Fund has, without question, helped turn the corner on AIDS. It has also helped realize substantial gains against TB and malaria that must be maintained. We need to summon the funding and political will, now, to protect the hard-fought progress of the past decade.

Simply put, if we allow the fund to fail, many people will die, and we will forfeit the chance at the “AIDS-free generation” that U.S. Secretary of State Hillary Clinton called for in November. This is no time to step back.

Paul Farmer is chairman of the department of global health and social medicine at Harvard Medical School and a cofounder of Partners in Health, which has received support from the Global Fund in Haiti, Lesotho and Russia.
A version of this op-ed appeared in print on February 2, 2012, in The International Herald Tribune.