1.54 pm, 10 October 2019: The Global Fund announces it has reached its US $14 billion target! Congratulations to everyone who has contributed to this amazing result!

Earlier in the day, Rachael Hore, RESULTS UK’s Policy Advocacy Officer (TB) explained why achieving this is so important.


Today is the eagerly awaited test of the world’s resolve to end the epidemics of HIV/AIDS, tuberculosis (TB) and malaria. The total amount pledged at a pledging conference in Lyon will mean the difference between life and death.

1. It’s time for world leaders must put their money where their mouths are

In September 2018, world leaders attended the first UN High-Level Meeting (UNHLM) on TB and signed a political declaration. Commitments in the declaration include fully financing the global response to TB including through mechanisms such as the Global Fund to Fight AIDS, TB and Malaria. Today is an opportunity to deliver on this commitment. The Global Fund hopes to raise at least US $14 billion to carry out its operations in the next 3-year period.

The Global Fund’s activities are the cornerstone of the global TB response, providing 69% of all international financing for TB. If US$14 billion is pledged to the Global Fund, it will help deliver on the other commitments made at the UNHLM on TB such as the commitment to successfully diagnose and treat 40 million people with TB by 2022. For example, with a full replenishment the Global Fund estimates that, in collaboration with partners, it could reduce the number of people falling ill with TB by 22% and the number of people dying from TB (excluding people with HIV) by 46% by 2023.

Not only will a fully-funded Global Fund help deliver on the commitments made during the UNHLM on TB, but also the Sustainable Development Goal target to end the epidemics of HIV, TB and malaria by 2030 – a target that at current rates of progress will not be achieved for at least another 150 years. The Global Fund’s activities on HIV, TB and malaria also include strengthening health systems and addressing human rights-related barriers to accessing services, which will make its work a trailblazer on achieving Universal Health Coverage (UHC).

Replenishment conference

Image: Twitter, IsDB Group https://twitter.com/isdb_group/status/1181934976436183041. Peter Sands presenting at the replenishment conference in Lyon, 9 October 2019. A graph showing the difference in mortality rate predictions between a successful Global Fund replenishment or business as usual.

2. It’s time for equity

The Global Fund’s “Breaking Down Barriers” initiative provides support and funding to 20 priority countries to tackle human rights barriers to health care, particularly among vulnerable populations such as men who have sex with men, sex workers, prisoners, transgender people and people who inject drugs. This includes carrying out assessments and using the results to create policy change. For example, in June 2019, South Africa used the assessment and subsequent consultations to launch a new three-year plan to tackle gender inequality and human rights barriers to HIV and TB health services.

Currently a large barrier to successfully tackling the TB epidemic is that around 40% of people with TB are not diagnosed, notified or treated each year. The reasons so many people are “missed” range from poor access to health services to unavailability of TB services in their local facility or a lack of health workers. The Global Fund plays a key role in finding and treating these “missing” cases. This includes its “catalytic funding” investment in 12 countries that account for 55% of the all “missed” people with TB and drug-resistant TB to expand the most successful approaches in finding them. These include adding screening to routine check-ups; developing more effective ways for private providers to refer and report people to public systems; supporting community health workers to find people with TB and support them throughout treatment; and reaching vulnerable people in high-risk areas such as prisons and urban slums.

Community health worker Kenya

Catherine is a community health volunteer in Kathonzweni, a division of Makueni County, Kenya. Catherine is paid a stipend by the Global Fund (through Amref) per person with TB she visits. Community health volunteers in Kenya are chosen by their communities and are therefore trusted by the communities they serve. This can be especially important for spreading awareness about the signs and symptoms of TB and the importance of getting a diagnosis and treatment, rather than self-medicating at a pharmacy or referring themselves to a herbal practitioner. They also help to address stigma around the disease within the community, for example, dispelling myths and disseminating facts. An important part of their role is on health education on topics including the importance of taking the correct doses of treatment for the recommended length of time, the importance of all contacts being tested for TB, and for children to start on isoniazid preventive therapy (IPT).

3. It’s time to strengthen health systems

The Global Fund also focuses on health systems strengthening. It is the largest multilateral provider of grants to support sustainable systems for health, investing more than US $1 billion a year on improving procurement and supply chains, strengthening data systems and data use, training qualified health care workers, building stronger community responses and systems, and promoting the delivery of more integrated, people-centered health services so people can receive comprehensive care throughout their lives.

Strong health systems are essential for sustainability and global health security. For HIV, TB and malaria, drug-resistance poses a huge threat to global health security, and to the gains made against the three diseases so far. For example, TB is the only drug-resistant infection that is airborne, and is responsible for one third of all deaths related to antimicrobial resistance. The Global Fund will play an instrumental role in containing and tackling the threat of drug-resistance.

Makueni brothers Kenya

The “Makueni Two Brothers” are community health volunteers for TB attached to the Makuenni County Referral Hospital in Kenya. As well as screening in the hospital, they conduct community outreach to raise awareness of TB, to find people with TB through contact tracing, to follow up with people with TB who have not attended their scheduled appointments, and to conduct health education among people with TB and their families/households. 

4. It’s time for innovation

The Global Fund helps to increase access to the best tools to diagnose and treat TB. Newer and better tools exist, such as ‘GeneXpert’, to rapidly diagnose TB including whether the strain is resistant to any drugs, and newer drug regimens for drug-resistant TB that do not include the older, toxic injectable drugs. These innovations will be worthless if they do not reach the people who need them. The Global Fund plays a vital role in helping the best tools reach those who need them.

The Global Fund also promotes innovation in financing from other actors. For example, Global Fund’s multi-country grants for malaria have raised nearly twice as much in additional investment in the 2017-2019 period, including an expected US $100 million in domestic financing. This includes increased investment to tackle drug-resistant malaria, thereby increasing investment in global health security and fostering coordinated efforts between partners and countries. Multi-country grants help to expand access to malaria services, especially for under-served populations such as mobile and migrant populations.

Lab worker

Image: Tom Maguire. Lab worker looks at sputum samples at 6 Mile Health Clinic, Port Moresby.

5. It’s time to step up, not slip back

The gains made against HIV/AIDS, TB and malaria have been slow and are fragile. They are threatened by increasing rates of drug-resistance across the diseases, entrenched gender inequalities and human rights-related barriers, and wavering political commitment and funding.

While the Global Fund needs to be fully financed in order to carry out its essential activities and to address existing gaps in the responses, it is also necessary that the financial burden of the responses is not shifted to countries unless they have capacity. The Global Fund, alongside other multilateral donors such as PEPFAR and bilateral donors, request the countries they support to progressively increase investments in HIV and TB programmes including recurrent costs such as purchasing medical supplies and paying staff. While in principle this shift is intended to lead to greater country ownership and financial independence, it should be informed by rigorous assessments of countries’ readiness in terms of their financial and technical capacity, in order to avoid putting people’s lives at risk if service provision declines or is disrupted, and to ensure a stable supply of affordable and high-quality treatment.

The Global Fund’s replenishment should be seen as one building block in the global health response. The replenishment will be followed by the replenishments of the Global Polio Eradication Initiative (November 2019) and Gavi, the Vaccine Alliance (June 2020), and the financing moment at the Nutrition for Growth Summit (late 2020). As countries pursue UHC, it is essential that these moments are seen as part of a holistic approach to the health response. Nutrition, immunisation and infectious disease programmes complement one another, and greater impact can be achieved through closer collaboration. Their individual impact is drastically reduced if one is neglected; but together, they can deliver sustainable, resilient and equitable health and well-being for all.

The clock is ticking and the world is watching.