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‘We have to fight for what counts:’ Why we need to tackle HIV, TB, and malaria


The Global Fund is an organization designed to end AIDS, tuberculosis, and malaria as epidemics. Since its creation in 2002, the Global Fund has helped save 44 million lives and halved the combined death rate from all three diseases.

It has invested more than $53 billion over 20 years. Annually, the Global Fund mobilizes and invests more than $4 billion into programs run by local experts in more than 100 countries to fight all three diseases. The Global Fund and its partners have made tremendous progress tackling these deadly epidemics and saving lives. But in 2020, COVID-19 caused progress in the global fight against AIDS, tuberculosis, and malaria to stall for the first time in two decades.

Andrea Mosca, a ONE Youth Ambassador from Italy, sat down with the Global Fund‘s executive director, Peter Sands, to learn more.

Keep reading to find out.

The COVID-19 pandemic has put pressure on health budgets around the world. To what extent has this pandemic impacted the Global Fund‘s goals, and how did Global Fund react?

The pandemic has had a devastating impact on the fight against HIV, TB, and malaria. In 2020, for the first time in the Global Fund‘s history, key programmatic results for HIV, TB, and malaria declined compared to the previous year.

But the Global Fund partnership‘s rapid and determined response to COVID-19 prevented an even worse outcome. Thanks to generous support from donors, we provided more than $4.2 billion in emergency funding to more than 100 countries to fight COVID-19. Many countries used the same laboratories, disease surveillance, community networks, trained health workers, and supply chains that had been built to fight HIV, TB, and malaria as the foundation for their COVID-19 responses.

But we can‘t stop here. COVID-19‘s deadly global impact has shown that we must increase funding, fight existing pandemics like HIV, TB, and malaria, and prepare for future health threats at the same time.

If we focus on Tuberculosis, we saw an 8.7% decline in spending between 2019 and 2020. We are talking about a curable and preventable disease that killed 1.5 million people in 2020 alone. What should we expect now?

The Global Fund actually increased our spending on HIV, TB, and malaria by 23% in 2020. But even with the increased funding, the impact of the COVID-19 pandemic on the fight against TB has been devastating. It has reversed years of progress in providing essential TB services and reducing the TB disease burden. Because fewer people were also tested and treated for TB in 2020, World Health Organization modeling projections suggest the number of new TB infections and deaths could be much higher in 2021 and 2022.

That‘s why our fundraising target is to raise $18 billion to fund lifesaving HIV, TB, and malaria programs over the next three years. If we reach this target, our total funding for tuberculosis…will increase by 40-50%.

In the last two decades, costs of antiretroviral therapy for one person have come down from $10,000 to less than 66$ per person, per year. This represents a tremendous success, however, access to testing and treatments is still challenging. What is the Global Fund doing in this area?

Indeed, vulnerable groups are still being left behind. HIV incidence, while declining overall, is relatively high and in some places on the rise among key and vulnerable populations, such as men who have sex with men, sex workers, prisoners, transgender women, and people who inject drugs. That‘s why the Global Fund‘s new strategy, launched last year, focuses even more on reaching these vulnerable groups.

For example, we have increased our investments fivefold to fight the gender inequalities that make adolescent girls and young women in sub-Saharan Africa more vulnerable to HIV than their male peers. It‘s working: The number of HIV infections among adolescent girls and young women has dropped by 41% since 2010 in the 13 priority countries.

Business as usual won‘t end malaria.

While we made incredible progress on malaria in the last 15 years, the disruption of health services caused by the pandemic heavily impacted cases and deaths have increased, with Sub-Saharan Africa carrying the 96% of that increase. How do you think the new vaccine against malaria will help counter this situation?

Business as usual won‘t end malaria. We need to build on what we know works, like insecticide-treated nets to protect children and families while they sleep, indoor spraying of homes to kill mosquitos, and seasonal malaria chemoprevention to protect children under 5.

And we need to up our game. We need new innovations, like new nets treated with next-generation insecticide to fight insecticide resistance. We need new medical breakthroughs, too – like the new malaria vaccine we helped fund along with Gavi, the Vaccine Alliance, and Unitaid.

Since 2019, more than 1 million children have been reached with at least one dose of the new malaria vaccine through pilot introductions in Ghana, Kenya, and Malawi. While the new vaccine isn‘t a silver bullet, it is a valuable complement to other innovations and existing tools. By optimizing the deployment of such tools to reflect local circumstances, we can maximize the impact of every dollar in fighting malaria.

We have faced impossible odds before, and we can do it again.

Italy contributed to the 2019 Global Fund replenishment pledge with €161 million, increasing its previous commitment by 15%. However, the current economic situation may restrain governments from contributing to multilateral instruments such as the Global Fund during this year‘s replenishment. Do you have a message for our citizens and policymakers?

Italy continues to be an amazingly strong supporter of the fight against HIV, TB, and malaria, and a critical donor to the Global Fund. But in the face of the catastrophic impact caused by COVID-19 on the fight against HIV, TB and malaria, the choice is stark: we either increase funding, or we abandon the Sustainable Development Goal target of finally defeating these pandemics by 2030.

It‘s that straightforward. We have faced impossible odds before, and we can do it again. When the Global Fund was created 20 years ago, HIV, TB and malaria seemed unbeatable. But we have proven that with science, adequate resources, and effective global collaboration, we can force even the deadliest diseases into retreat. In just 20 years, our partnership has saved 44 million lives and cut the combined death rate from the three diseases by more than half in the countries where we invest. In addition, by investing in the fight against HIV, TB, and malaria, we keep reinforcing the health systems that are needed to respond to current and future pandemics.

This is our fight. Together. We have to fight for what counts.

How do you think youth and civil society can support the Global Fund?

Young people‘s points of views and involvement are crucial in the fight against pandemics. Three years ago, I created a Youth Council of representatives of young people from around the world. They advise me directly about the needs and challenges youth face in relation to HIV, tuberculosis, and malaria and, more broadly, to other aspects of their health and well-being. They are outstanding, dedicated activists who prove every day that they are the future: people like Grace Ngulube, a phenomenal young woman who was born with HIV and who founded Youth Health Connect360 in Malawi to help young people with HIV access youth-friendly services. Or Nana Millers, a determined transgender youth activist and feminist advocating for the rights of young transgender women like her.

Around the world, activists young and old continue to play a crucial role in maintaining global visibility, to ensure we keep everyone focused on doing the right things. We call on young people and civil society groups to join our collective fight. Your leadership, support, advocacy, and your voice calling for others to join us would be extremely powerful. Because if not us, who? And if not now, when? This is our fight. Together. We have to fight for what counts. And we count on you to help us make a step-change towards more equitable health for all.

Want to help support the Global Fund? Add your name to our petition.

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