The ecstatic press releases started even before the conference to replenish the Global Fund to Fight AIDS, Tuberculosis and Malaria officially closed last month in Montreal. The fund, which channels donor money to local programs that fight the three diseases in places where they are the most damaging, especially sub-Saharan Africa, had put out a call for $13 billion for its next three years of programming. By the end of the conference, the fund had raised $12.9 billion.
The bulletins out of Quebec captured the relief of a public health community that has watched its international financing dwindle, even as scientific advances make it increasingly possible to actually end some of the world’s worst diseases. That includes HIV, officially the deadliest epidemic in history, according to the United Nations. The decline in global health funding threatens not just to stymie scientific advances against diseases like HIV, but to actually reverse gains made in the past decade.
That’s why the celebration following the Global Fund’s replenishment was premature, according to health activists. Without bigger, more sustained and more diversified commitments, hundreds of thousands of people will continue to die from diseases that are easily prevented and treated. The situation calls into question the international community’s ability to meet public health threats, even as new dangers continue to emerge.
The United Nations’ Sustainable Development Goals released last year include a long list of targets designed to drive the global agenda on everything from poverty reduction to climate action over the next 15 years. The list includes a call to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases” by 2030.
The deadline is probably unrealistic, but the end result is no fantasy. There are strategies to end AIDS by 2030 and to cut tuberculosis deaths by 95 percent from 2015 to 2035. In his final State of the Union address in January, President Barack Obama underscored the feasibility of ending malaria, too.
Ultimately, decades of research have delivered the interventions necessary to prevent people from falling sick from these three diseases, and many more. When people do get sick, medications exist to treat most patients, or, in the case of HIV—which remains incurable—to deliver them near normal life expectancy.
The humanitarian justification for these efforts is obvious. Ending the HIV, malaria and tuberculosis epidemics would have saved nearly 2.5 million lives in 2014, most of them in the developing world, according to the World Health Organization.
The decline in global health funding threatens not just to stymie scientific advances against diseases like HIV, but to actually reverse gains made in the past decade.
There are other interests at play, though, not least of which are economic. In addition to saving the global donors billions of dollars in aid, ending these epidemics could help spur economic growth in the countries that have been most affected by them, especially in eastern and southern Africa. Conversely, not ending them has the potential to cost significantly more lives and to collapse national health systems.
While they have not reached everyone who needed them, the steady stream of new drugs and improved interventions has saved hundreds of thousands of lives in the developing world, especially of newborns and infants. The result is that there is currently the largest population of young people on the planet in human history, according to the United Nations. But many are living in places where public health services for young people are limited. As they start to become sexually active, that puts them at increased risk of contracting HIV. Once infected and without proper treatment, they are then more susceptible to tuberculosis and other diseases.
The sheer number of people who could fall sick has the potential to overwhelm any response the international community could muster. Global health experts warn that the number of people who could become infected with HIV, alone, could outstrip the totals seen at the height of the global epidemic in the 1990s and early 2000s, when there were the most AIDS-related deaths globally.
All of which has global health advocates asking why there is not more urgency in the push for financial resources. Instead, international donor funding for the global HIV response actually fell more than $1 billion between 2014 and 2015, according to a recent analysis by the Kaiser Family Foundation and UNAIDS.
The Global Fund’s replenishment is unlikely to offset those losses. In fact, Stephen Lewis, the former U.N. special envoy for HIV/AIDS in Africa, organized a side event in Montreal to warn that the fund had set its request far too low in order to not to scare away skittish donors—$20 billion too low, according to his calculations. “The shortfall in funding is astronomic,” he said. “Additional billions are needed, a minimum of $3 billion in this coming year alone.”
In the face of the funding shortfall, the international community has called on the governments most affected by these epidemics to invest more in alleviating them. Officials in places like South Africa, Kenya and Botswana have shown a willingness to contribute more domestic resources. Meanwhile, international donors have been considering strategies to improve the efficiency of their programs and direct the funding they do have to the communities where it is likely to have the most impact.
But these efforts are still likely to fall short of the ambitious targets. As Lewis cautioned, “You’ll never put an end to AIDS, tuberculosis and malaria unless the major donors pull their weight.”
The funding shortfall has broader ramifications. If the international community cannot find the resources to eradicate the diseases it has the tools to, what chance does it have against those it does not? It is a critical question in the era of Ebola, Zika and, perhaps most importantly, anti-microbial resistance. Anti-microbial resistance is what happens when micro-organisms—everything from bacteria to parasites—become resistant to the medications that currently exist to treat them. Outgoing U.N. Secretary General Ban Ki-moon has called it “a fundamental, long-term threat to human health.”
Anti-microbial resistance is happening more and more often, becoming enough of a worry that the U.N. held a high-level meeting to discuss what to do about it at last month’s General Assembly. The meeting ended with a declaration from the heads of state that included a commitment to “mobilize adequate, predictable and sustained funding”—just what they are already struggling to do.
Andrew Green is a foreign correspondent based in East Africa. He writes often from the region on issues of health, human rights and politics, and his work has appeared in Foreign Policy, The New Republic and The Washington Post, among other outlets. You can view more of his reporting at www.theandrewgreen.com.