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10 Years of Lives Saved Through the Global Fund
In celebration of the Global Fund’s 10th anniversary, ONE Global Health Policy Manager Erin Hohlfelder reflects on the organization’s accomplishments over the years.
When I was ten, I was busy doing important things like mastering long division, practicing softball and rocking the plastic glasses/bowl cut combo. While I’m proud of those accomplishments, I have to say I’m even more proud today to honor all the incredible things that the Global Fund to Fight AIDS, Tuberculosis and Malaria has achieved in its first ten years of existence. To understand the Global Fund’s impact, it’s important to remember just how bad things were before it existed: Fewer than 50,000 Africans had access to AIDS treatment. Malaria was killing nearly 1 million people annually. Treating TB was considered too expensive for most of the developing world.
In late January of 2002, leaders came together in Switzerland to launch the Global Fund. Built to be what Kofi Annan called a “war chest” to respond to these global health emergencies, it had the backing of donors, public health officials, developing country leaders and NGOs. Intentionally, it was designed to be different than other aid models; it was rooted in having local stakeholders (rather than donors) say what they wanted to do to fight AIDS, TB or malaria, and how much money it would take to get the job done.
Though no aid model is perfect, the Global Fund has clearly been doing something right, because it has delivered incredible results over the last decade:
In delivering these services — often in partnership with aid efforts including PEPFAR and with national health systems — the Global Fund has helped change the global health landscape. Though they each still claim far too many lives, all three diseases are all on the decline globally. Now, the mantra has shifted from a “stop the bleeding” approach to a more hopeful, long term approach characterized by phrases like “we can achieve the beginning of the end of AIDS” and “we know how to end malaria deaths by 2015.” And, just as my own personal style has thankfully evolved from those outdated plastic glasses to contact lenses, the Global Fund has gone through its own strategic reforms in the last 12 months to become an even more targeted, efficient mechanism in the years to come.
SEE ALSO: The beginning of the end of AIDS
Funding — as always — remains a challenge. The Global Fund has said it is currently unable to fund new programs until 2014 due to a roughly $2 billion funding gap. Constricting global budgets, coupled with persistent whispers of corruption, are convenient excuses for donors to pull back on their contributions to these diseases. But the Global Fund has made the changes necessary to ensure that money invested in its programs will be monitored transparently, evaluated rigorously and directed toward specific outcomes. As a result, donors should feel confident that maintaining or increasing their contributions will go toward the achievement of bold new goals: saving 10 million lives and preventing 140 to 180 million new infections between 2012 and 2016.
Of all the aid projects I’ve been able to visit, the one individual who stands out most is a playful little girl named Madeline who I met at a Global Fund clinic in Ghana. She was born HIV-positive, but thanks to the Global Fund, her mother was able to access the antiretroviral treatment that will keep her alive and healthy. I get that 10 million lives saved through the Global Fund seems too overwhelming to conceptualize. So instead, I’d suggest we simply think of Madeline, and then think of all the other Madelines out there who, thanks to the Global Fund, will be able to grow up healthy and one day also master long division and practice softball like me. I just hope they all skip the bowl cuts!
Watch: 10 years of the Global Fund, 7.7 million lives saved
To celebrate 10 years of the Global Fund to Fight AIDS TB and Malaria, they have launched a video celebrating some of their achievements over the last decade:
If you feel inspired, please share!
The Beginning of the End of AIDS
Is it possible that the success Africa has had, in managing and treating HIV/AIDS, reduced the sting of the HIV pandemic on the continent? The fact is, according to UNAIDS’ latest report, there are more people living with HIV today than there were 10 years ago. Approximately 34 million people live with HIV today, up 17% from 2001. In parallel, deaths from AIDS-related illnesses have decreased by 21% since 2005
This is chiefly because there is better access to antiretroviral drugs in sub-Saharan Africa, where 68% of all HIV cases worldwide are found. Gone are the gory images synonymous with AIDS, that often appeared in the 1990s to early 2000s, which left many with the sound conviction that contracting the HIV virus was as good as pronouncing a death sentence.
Much credit goes to Africa’s people, its governments and our international partners for sustained efforts in the relentless fight against HIV in Africa. A good example of such leadership among others is the government of South Africa — they are now financing as much as 80% of the antiretroviral medication for its people through its own health budget, bolstered by technical support from donors. Botswana achieved universal access to treatment in 2008, and since then has begun to see a further decline in new infections. The percentage of children born HIV-positive to mothers living with HIV in Botswana also declined from 21% in 2003 to 4% in 2010 — impressive progress thanks in part to sustained political leadership.
Today, 22 countries in sub-Saharan Africa have reduced new HIV infections by more than 25%, data shows that an HIV-positive person on treatment is 96% less likely to pass HIV on to others and clinical trials have proven that voluntary male circumcision reduces the risk of new HIV infection in men by roughly 60%.
These numbers tell a great story, but there are other numbers that could put to risk the great progress made by African governments, development partners and the private sector. UNAIDS statistics show that the availability of funding to combat HIV is generally on the decline while funding needed to fight the pandemic is increasing. According to UNAIDS, at the end of 2010 around US$ 15 billion was available for the AIDS response in low- and middle-income countries. Yet donor funding has been reduced by 10% from US $7.6 billion in 2009 to US $6.9 billion in 2010, and the Global Fund recently had to cancel Round 11 of grant-making due to insufficient or delayed donor funds.
This begs the question: How do you put millions of people on treatment, give them renewed hope, and then back off, knowing full well the catastrophic implications of such action?
We still have nearly 9 million HIV positive people who are still in need of treatment, 1,000 babies born with HIV everyday, and nearly two new people are infected for every one person put on treatment. This reminds me of what remains an indelible statement by Dr. Kihumuro Apuuli, director general of the Uganda AIDS Commission who said, “You cannot mop the floor when the tap is still running on it.”
For all the commitment and investment our governments and development partners have made much remains to be done if we are to make this period in history become the beginning of the end of AIDS. So what does this mean? Well, at ONE, we believe that, it means reminding ourselves to recommit to measurable goals. They include:
- Virtually eliminating mother-to-child transmission by 2015
- Accelerating access to treatment for 15 million people by 2015
- Implement innovative prevention techniques to drastically reduce new infections by 2015.
These goals are by no means new. World leaders have already committed to them in various international forums. If these commitments — including commitments to the Global Fund — are renewed, together, we can really begin to see the end of this pandemic.
A wake-up call in the fight against AIDS
An uneasy sensation, of the pit-of-the-stomach kind, spread among the activists and donors supporting the fight against AIDS this week. The Global Fund, the international partnership that channels money to fight AIDS, TB and malaria, announced it has been forced to delay applications for new programmes due to insufficient funding from donors. Instead it will have to focus its efforts on maintaining the current programmes. After a decade of huge leaps forward in the fight against AIDS, it is hugely concerning that progress may stall.
New figures from UNAIDS this week showed that in just one year we have added 1.4 million people to treatment. In 2003 only 100,000 people had access to life-saving antiretroviral treatment, now more than 6.6 million people do. This is in large part thanks to the work of the Global Fund which is responsible for a sizeable chunk of the global response to HIV and AIDS.
Despite this progress, nearly 8 million others are still waiting for life saving drugs and the number of new HIV infections remains high. And while effective treatment to prevent mothers passing on the virus to their babies is available, less than half of HIV positive women have access to it. A major push is still needed in order to turn the corner in this epidemic.
This year, for the first time, evidence shows us that it is possible to end AIDS within a generation. New research found that an HIV-positive individual on antiretroviral treatment is up to 96% less likely to transmit the virus to others. This news should give us reason to be more hopeful than ever that the fight against AIDS is one we can win. But this hope is being undermined by donors who are not meeting their promises to the Global Fund. In the past all pledges made to the donor fund have been delivered, but now this record is slipping. Some donors are not keeping their promises and others are delaying pledges. Now is the worst possible time for delays and broken promises.
There have been concerns about the Global Fund. It is true that the Fund identified a very small proportion of funds being lost. But the Fund has a zero tolerance policy for corruption. Suspected corruption is pursued aggressively, corrupt officials go to jail, steps are taken to reclaim funds and new safeguards are put in place. The Fund has also introduced a pro-active plan of action to address any remaining issues. The openness of the Global Fund and its commitment to deal with concerns head-on is something worth celebrating. And reforms agreed this week will make the Global Fund not just a life-saving global health institution but also a leading example of smart aid and transparency in practice. If donors had doubts, they should now have confidence.
Germany has responded to this development by releasing a commitment of $100m to support the Global Fund. Other donors now need to follow. And donors must commit to serious planning for an ambitious scale-up of efforts over the next couple of years, to ensure the Global Fund can reach many more people who need its help. We cannot afford to lose ground just when the beginning of the end of AIDS is in sight.
When the Global Fund was first established Kofi Annan said “the war on AIDS will not be won without a war chest”. That is still true today. The world needs the Global Fund and we need to fund it. This would be the worst time to falter.
This article first appeared on the Huffington Post UK website.
The Global Fund: Zero tolerance for corruption and misuse of funds
Over the weekend, the Associated Press filed a story about corruption involving a small number of grants made by the Global Fund, an international partnership that channels funds to fight AIDS, TB and malaria from donors to some of the poorest countries in the world. It’s always interesting to me when stories create news with misused facts and salacious headlines. So I thought it might be useful to have a little background and perspective from someone who’s spent a lot of time with the Global Fund.
The AP report was correct in saying that the Global Fund’s Inspector General has taken an aggressive approach to rooting out and publicizing incidents of fraud and abuse, but the story erred by extrapolating the findings in a few countries to tarnish the entire grant portfolio. Let’s put this to rest: there is absolutely no evidence that there is widespread fraud or corruption of Fund grants. On the contrary, of the $13 billion disbursed by the Global Fund to date, only a portion has been audited by the Global Fund’s inspector general, and of that only a relatively small amount — US $43 million — has been rescinded.
Now just because the percentage of grants found to be misused is relatively small doesn’t mean it’s okay — just the opposite. That’s still a lot of money, and it should piss off anyone who cares about the world’s poorest. We should not rest until all taxpayer supported programs can report no misuse of funds — including those administered right here at home.
While I was thinking about this over my morning coffee, I spied a New York Times front-page article that started, “Since the [US] government took over Fannie Mae and Freddie Mac [the country's largest mortgage lenders], taxpayers have spent more than $160 million defending the mortgage finance companies and their former top executives in civil lawsuits accusing them of fraud.” Now I’m willing to bet that all those gloating over the Global Fund stories won’t get nearly so exercised about this kind of pervasive corruption.
I also don’t want to fall into the trap of denying there are problems. We will undoubtedly hear about other instances of abuse. So I’m thankful that the Global Fund and its partners, especially the countries that desperately need the money, take this all very seriously.
There’s already lots of work underway to continue to make improvements. The Fund is pursuing suspected corruption aggressively, usually in close cooperation with local authorities: corrupt officials are going to jail, funds are being returned, new safeguards are being put in place. At the same time, the Global Fund is working hard to strike a balance, continuing its policy of zero tolerance for corruption while not becoming so risk adverse that it can’t get its job done.
So in the end what’s the conclusion? We should celebrate the openness of the Global Fund, even the information it provides can be abused. We should fight hard to support programs that improve global health AND governance and transparency — fighting for funds needed to save lives and at the same time to build robust systems and checks and balances needed to guaranty their effective use. And we should feel proud that we’ve helped the Global Fund weather this storm and continue its amazing work to save lives.
This post is also featured at the Huffington Post.
Positive start for Global Fund replenishment, but more is needed
At a meeting this week in New York high-level representatives from governments and private sector organisations gathered to reaffirm their commitment to the work of the Global Fund and announce their funding pledges for 2011 to 2013.
At the meeting the European Commission announced that it will increase its contribution to the fund by 10%, which is a step in the right direction for full replenishment. The US has committed to a 38% increase and France to a further 20%.
We look forward to the UK contributing its fair share once its multilateral aid review finishes early in the new year.
Whilst these numbers are encouraging, more is needed to save lives and prevent the spread of disease. In particular the commitments made do not put us on track to meet 2 major health goals by 2015: the virtual elimination of mother-to-child transmission and the end of malaria deaths.
The Global Fund is one of our most powerful tools in the fight against AIDS, Tuberculosis and Malaria. Since its creation in 2002, it has become the dominant financier of programs to fight AIDS, tuberculosis and malaria, with more than 600 programs in 145 countries. To date, programs supported by The Global Fund have saved 5.7 million lives by providing AIDS treatment for 2.8 million people, anti-tuberculosis treatment for 7 million people and the distribution of 122 million insecticide-treated nets for the prevention of malaria.
The commitments made in New York are a positive step in the right direction but much more is needed. Rest assured that we at ONE will be working with governments to improve this life saving investment in the weeks and months ahead.
How do you prevent mother-to-child transmission of HIV?
From online petitions to angry baby protests, it’s hard to miss ONE’s focus on the Global Fund and our goal to ensure that virtually no child is born with HIV by 2015. But throughout this campaign, many of you have rightfully asked, “How does this exactly work?”
It’s a miracle of modern medical technology that we’re able to prevent the mother-to-child transmission of HIV (PMTCT).
An HIV-positive mother can pass HIV on to her baby any time during pregnancy, labor, delivery and breastfeeding, so the transmission of the virus must be blocked at each stage. The 2010 World Health Organization guidelines recommend that HIV-positive pregnant mothers should go on a regimen of three antiretroviral drugs (ARVs) as soon as possible — and stay on these drugs until their infant is born and breastfeeding has concluded.
As soon as the infant is born, the baby should take nevirapine — a very inexpensive drug — daily for six weeks. The infant should be formula-fed rather than breastfed if possible, but it’s recognized that formula feeding is both expensive and difficult to do safely in resource-limited settings, so the mother is recommended to breastfeed her child exclusively for six months while continuing to take ARVs. In a recent study conducted by Harvard University in Botswana, mothers who adhered to this regimen reduced transmission of HIV to their babies by an amazing 99 percent.
These prevention guidelines have evolved over the years as scientists have learned more about how to most effectively reduce the risk of transmission while also working to minimize drug resistance for our most effective treatment tools. Many policymakers stress that access to effective contraception to prevent unintended pregnancies is also important for women who are HIV-positive.
For more details on the PMTCT process, including a chart that maps which drugs are used when and in what settings, visit AVERT’s handy guide. Also, be sure to check out WHO’s global strategic vision for 2015.
The Motherland Tour
When it comes to African musicians, Yvonne Chaka Chaka is about as big as they get. Born in Soweto and growing up during apartheid, Yvonne shot to stardom as a singer in her native South Africa in the late 80s and has since risen to become a superstar across sub-Saharan Africa, known as the Princess of Africa and hailed by Nelson Mandela as a “national icon”. I was very proud, therefore, to be able to attend the world premiere in London of her film The Motherland Tour – A Journey of African Women, organised by our friends at Malaria No More UK. The film, like much of Yvonne’s work, was inspired by her desire to influence and educate people on the dangers of preventable and treatable diseases.
Yvonne, who has worked closely with ONE in the past, met a number of strong and inspirational women who are engaged in educating themselves and others in the prevention and treatment of diseases like malaria and HIV, or training to be nurses and midwives so that maternal mortality need not be such a regular tragedy on the continent (In the United States a woman’s chance of dying in childbirth is 1 in 4,800, in sub-Saharan Africa it’s a shocking 1 in 22).
One of the film’s most touching stories is of Hupa, a mother in Zambia whose 3 year old son died of malaria. “In the past,” she explains, “we relied on traditional methods” whilst holding up some straw and cow dung. “At the time I was not even willing to accept my child was sick. I did not know.” She is devastated, knowing now that simple precautions, better education and access to treatment could have saved her child.
Hupa is now a member of a project funded by the Global Fund where, after working in the fields each day, she helps educates others about the causes and means of preventing malaria. Armed with insecticidal mosquito nets and the knowledge she has been given by the Global Fund, she is a vital source of information and resources for her community.
The film is full of stories of women like Hupa, too many to mention here.
The showing was attended by a number of dignitaries from sub-Saharan African countries, and they were implored by Yvonne to listen to the messages in the film, and write to their governments and leaders to ask them to pressurise those charged with replenishing the Global Fund to do what was necessary to help continue the fight against HIV, malaria and TB around the world.
I spoke with Diarmaid McDonald, Campaign Coordinator for STOP AIDS who had a message for governments:
“We work a lot with Malaria No More and we believe we are close to seeing the end of paediatric HIV and seeing the end of malaria as a global killer. That is why we are pushing hard for a $20 billion replenishment of the Global Fund in October.”
If Western governments are serious about tackling disease in Africa and tapping into the potential of Africa’s women and girls then a full replenishment of the Global Fund would be a very good place to start.
Photo courtesy of Malaria No More
New rotavirus vaccines significantly reduce child deaths
Photo credit: Bill and Melinda Gates FoundationWe’ve dedicated a lot of space on this blog to rotavirus — a disease that is the most common form of childhood diarrhea.
Diarrhea is something we often think of as gross or annoying, but it’s easy to forget that diarrhea is deadly, causing nearly 500,000 deaths each year primarily in Asia and Africa.
We’ve also dedicated a lot of blog posts to the GAVI Alliance, because among other things, they’ve been a driving force behind an effort to accelerate access to a vaccine for rotavirus to children in the developing world, alongside partners like Merck, GlaxoSmithKline, PATH, the World Health Organization and the Centers for Disease Control and Prevention in the United States.
But developing a new vaccine for resource-limited settings is a challenging process that takes years of hard work and a lot of money — and it’s a process that’s certainly not guaranteed to work. Which is why we’re celebrating big news out of medical journal The Lancet: two sets of clinical trials in Asia and Africa showed that new rotavirus vaccines can significantly reduce child deaths.
The Asian trial took place in Bangladesh and Vietnam, testing the efficacy of the vaccine (essentially, how well it protects against disease) in more than 2,000 infants. The study showed that the vaccine had 48.3% efficacy against severe disease. When combined with other efforts to improve child survival — oral rehydration salts, zinc, exclusive breastfeeding and improved hygiene and sanitation — diarrheal deaths could be reduced even more.
The African trial, which took place in Ghana, Kenya and Mali, also demonstrated that the rotavirus vaccine offered significant protection for young children. In fact, vaccination reduced severe cases of rotavirus by 64% in the first year of life. These findings were consistent with those from a previous study conducted in Malawi and South Africa.
While the percentages from the studies may not seem overwhelmingly high (We’re using a vaccine that works only half to 60% of the time?), the vaccine actually represents a critical tool that will help control one of the major killers of children around the world. Even with these lower efficacy rates, we have to remember that the rotavirus vaccines will still have a huge impact on reducing severe disease in Africa and Asia because so many more children are dealing with disease there than in the United States or Europe.
But how well a vaccine prevents against disease doesn’t tell the whole story, either, because the health care systems in the developed and developing world are vastly different. If a child gets diarrhea in Europe or North America, a parent can easily access medicines to treat him or her and — in worst case scenarios — take their child to the hospital for emergency care. But because medicines and health facilities are tough to access in much of the developing world, rotavirus vaccination can be a child’s only chance at survival against diarrhea in Africa and Asia.
Major congratulations are due to all who have worked on rotavirus vaccine development and studies to date, and an additional debt of gratitude is owed to the parents who volunteered their children for the trials. We’re thrilled at the news and for what it means for the health of children and families across the developing world. We’ll keep you posted with more on the vaccine and efforts to deliver it in the field in the coming months!
More great news on the Global Fund
If you remember back in March, when we met with global leaders in The Hague, the Global Fund released some impressive reports detailing their work to combat HIV/AIDS, tuberculosis, and malaria. Now, just a few months later, they’ve released new data, and the results are astounding:
- 2.8 million people on life-saving AIDS treatment
- 7 million people treated for TB
- 122 million bednets distributed to protect families from malaria
Those are increases of 22%, 30%, and, 39% respectively just since June 2009! Additional results showed that 930,000 HIV-positive pregnant women have received treatment to reduce mother-to-child transmission of the virus; 120 million HIV counseling and testing sessions have been conducted; and 4.9 million basic care and support services have been provided to AIDS orphans and vulnerable children since the Global Fund started financing grants in 2003.
These new statistics are living proof that investments in the Global Fund are working; in fact, the Global Fund now estimates that it has saved 5.7 million lives.
But just throwing out statistics – even if they are impressive – can often be less impactful than the power of one person’s story. Watch how investments in the Global Fund saved the life of one young man in Cote D’Ivoire, and how he has since been inspired to give back to his community:
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The International ONE Blog is a daily log of the anti-poverty movement. The site is operated by ONE staff, with guest contributions from ONE volunteers, members and allies.
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TAGS: Global Fund, HIV/AIDS, ONE, Policy News