Just a few days ago, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the largest international organisation involved in the fight against pandemics) published an annual results report which, prior to the arrival of Covid-19, conveyed a certain sense of optimism: 38 million lives saved since 2002; significant progress in the fight against the three pandemics; the largest amount of funds raised in its history… However, the Global Fund now warns that Covid-19’s arrival could wipe out years of tremendous progress – especially in lower income countries that are generally the most affected by these diseases.
Today, we spoke with Françoise Vanni, the Global Fund’s director of external relations, who discussed the report with us and told us about the challenges and the requests that the Global Fund is making to the international community to work together to tackle pandemics – including Covid-19.
Françoise, at first glance, the Global Fund’s Results Report gives cause for some optimism. Was there reason to be happy?
This year’s Results Report shows what can be done when working collectively, in a coordinated way and with the participation of communities. On the other hand, however, it says that we need to mobilise now if we are not to lose all that progress within a matter of months. Six million lives were saved in 2019 alone – a 20 percent increase over the previous year. Furthermore, in 2019 extraordinary progress was made tackling some of the greatest challenges in the fight against the three diseases.
Can you give some examples?
For example, in reducing the very high rates of HIV infection among adolescent girls and young women. Progress has also been made in finding people with previously undiagnosed tuberculosis. The longer a person lives without being diagnosed, and the later treatment is started, the more likely it is that the infectious disease will spread to others and lead to people dying. Similarly, human rights and gender-related barriers to health services have been addressed – particularly for the most vulnerable and stigmatised populations. And the cost of drugs has been drastically reduced, allowing us to save more lives.
But there is also another reality in the report – even before taking into account the arrival of Covid-19. In recent years, not enough was being done by the international community to achieve the Sustainable Development Goals – signed by the United Nations – by 2030. Were we getting back on track? Or were we still a long way off?
We still had a long way to go, even before the impact of Covid-19. However, we ended 2019 with plenty of reasons to be optimistic. At the Lyon donors’ conference, the world pledged more than US$ 14bn – the largest amount ever raised by the Global Fund, and the largest amount ever raised for global health. This success meant that we were able to increase country allocations by 23.4% for the next three-year grant cycle – a major step that would have put us on track towards the goal of ending all three epidemics by 2030.
And then Covid-19 arrived…
…and everything changed. The side effects of Covid-19 threaten to derail decades of progress in the fight against HIV, tuberculosis and malaria. We can’t let that happen. The world must urgently invest to defend our collective progress, fight Covid-19, and save lives.
Are there estimates of the damage this pandemic could cause to the fight against other pandemics?
Recent models from WHO, UNAIDS and the Stop TB global consortium indicate that deaths from HIV, TB and malaria could even double in the coming year due to the fall-out from Covid-19. Our studies indicate that the volume of HIV testing has been reduced by 50% in some places and notifications of new TB cases have dropped by up to 75%, which could lead to an increase in new infections. Prevention programmes have also been affected. In addition, many countries have been forced to delay campaigns to distribute bed nets, leaving unprotected those who are most vulnerable to malaria (such as children and pregnant women). Medical and laboratory staff have been reassigned to combat Covid-19.
To tackle this, what is the Global Fund asking for? How would those resources be used? The report clarifies that if this continues, the organisation will run out of emergency funds as early as this month…
To protect the gains we’ve made in the fight against HIV, tuberculosis and malaria whilst preventing Covid-19 from destroying everything, last June the Global Fund estimated its financial needs at US$ 5bn. Since March, more than $700m have been invested in response to the Covid-19 crisis. However, now at the end of September we are running out of funds and more money has to be put on the table because the pandemic is costing the world trillions. Without additional funding to combat diseases, countries will not be able to continue to: provide adequate services for HIV, TB and malaria programmes; purchase personal protective equipment for their health workers – which would put their lives at risk and contribute to the continued transmission of the virus; or purchase additional testing or treatment for Covid-19 which are critical to combating the virus and saving lives.
And is it possible to mobilise all those resources in such complex times as these?
High-income countries have allocated billions to help their economies and health systems combat Covid-19, but low- and middle-income countries do not have those same resources. Just 1% of rich countries’ national rescue plans would help combat Covid-19 in the poorest and most vulnerable countries and save millions of lives. If we do not defeat Covid-19 everywhere, we risk it becoming another “residual pandemic” that we will continue to fight in the world’s poorest countries for years to come. No one is safe until we are all safe. Investing in resolving it is the best investment the world can make to avoid the cost that all countries are incurring as a result of this crisis – both developed countries as well as the poorest.
The report insists that only a global effort by the different actors involved has the potential to help finance the gap that may be left by Covid-19 and continue saving millions of lives. Does some kind of commitment by the international community already exist?
The global response to Covid-19 must be dramatically increased. The global partnership known as ACT Accelerator (which seeks to accelerate the development, production and equitable access to coronavirus tests, treatments and vaccines as they become available) needs $38bn over the next 12 months, of which less than $3bn has been raised – just 6% of the amount needed.
And how would those funds be used? What is the strategy?
The best strategy we have for fighting Covid-19 today is to test, track and isolate. To do this, we urgently need more tests, more materials to protect health workers, and to track new infections. In regards to malaria and tuberculosis, it is essential that community health workers can continue to go door-to-door with information, diagnostic tests, mosquito nets and medicines. If they do not have adequate protection, then either they will not want to go or they risk getting ill if they do go. This is where action is needed immediately. If health workers get ill and die, the system collapses completely. We are therefore strongly emphasising that it is not all about technology in the end; it is about having men and women providing these preventive health services.
What if the vaccine comes? The major powers are securing supplies, but what about other countries?
We must ensure that the world, and particularly the poorest and most vulnerable countries, are ready when a vaccine becomes available. This means having strengthened health systems (protecting health workers as well as supply and data systems). It is also important to bear in mind that a vaccine will always need to be accompanied by diagnostics and treatment. Therefore, action must be taken on all fronts at the same time. When the vaccine becomes available, equitable distribution must be ensured. It is much fairer, and also much more efficient, to vaccinate key people in all countries than to vaccinate all people in some countries. This is why we are part of ACT-A and why we always work closely with our global health partners such as GAVI and others.
Finally, thinking of our home country: Spain had not donated to the Global Fund since 2011, but at the latest Donor Conference it pledged 100 million for the next 3 years along with a strong commitment to improve health systems in countries where the Fund operates. What is expected from Spain’s return to the Fund? Can it involve strategic aid, not just financial support?
Spain has been, and is, one of the most important historical donors. The Global Fund’s commitment to international cooperation and inclusiveness in public policy, placing rights at the centre and working against inequalities, is very much in line with the Spanish agenda. We are very proud to have a partner like Spain and we look forward to strengthening our collaboration in the months and years to come.