A $12 Billion Turnaround: Thoughts from the Global Fund Fourth Replenishment

Posted on by Gabriella Meltzer

After two days of meetings in Washington, DC, for its fourth replenishment session, the Global Fund for AIDS, Tuberculosis and Malaria announced that donors committed $12 billion over the next three-year cycle. Although this number falls short of the stated $15 billion target, this is the Fund’s most successful replenishment to date, and the largest amount ever committed to fighting AIDS, tuberculosis (TB), and malaria.

This week’s successful replenishment is all the more surprising considering the last two year’s turbulence at the Global Fund. In January 2011, the Fund was mired in a corruption scandal, causing several major donors to pull funding. This forced a massive restructuring of the organization, beginning in September 2011, which included the creation of a new funding model for grant-making, and the appointment of a new executive director, Mark Dybul, who took the reins in January 2013.

For a while, the Global Fund seemed to be on its last legs, but the response from donors this week—in the form of pledges and this record-breaking commitment—demonstrates that the Fund has not only been successful in its restructuring, but has also been able to rebuild a crucial trust within its partnerships. There were several forces at play, encouraging this dramatic turnaround and ultimately inspiring donors to so generously open their wallets.

First, the Global Fund, in spite of its hardships, has been successful in taking steps to fight these diseases. Overall HIV/AIDS prevalence is decreasing globally, and there are decreasing numbers of cases of TB and malaria. But as Mark Dybul said at a panel at the Woodrow Wilson Center, “It’s not just looking back at all of the results, but looking forward at what’s possible…. For the first time in history, we can actually see how we can end HIV, tuberculosis, and malaria as epidemics.”

Because of recent scientific advances, experts are optimistic that the beginning of the end of these epidemics is within reach. In the case of HIV/AIDS, the advocacy organization ONE, in its 2013 AIDS report, estimates that the number of infected individuals put on anti-retroviral treatment could surpass the number of newly diagnosed people as early as 2015, based on the recent trends. This inflection point has already been reached in sixteen sub-Saharan countries, such as Ghana and Malawi. Similarly, strategy, knowledge, and tools are available to end the malaria and TB epidemics. As Secretary of State John Kerry said, “It would be almost criminally negligent to turn our backs on the knowledge we have gained, the capacity we have built, and not go out and try to complete the task.”

 Secretary of State John Kerry at the Global Fund Fourth Replenishment (Photo by Maxine Builder)

Secretary of State John Kerry at the Global Fund Fourth Replenishment (Photo by Maxine Builder)

That optimistic tone and continued leadership from the United States—as exemplified by Secretary Kerry’s address at the conference’s Partnership Symposium and President Barack Obama’s speech to commemorate World AIDS Day—were crucial elements in fostering this commitment. In an unprecedented move, the president announced a pledge of up to $5 billion to the Fund from the United States, in a 2-to-1 matching scheme. For every $2 that other donors raised, the United States would donate $1. In Obama’s speech, he set out a clear challenge: “Don’t leave our money on the table.” The United Kingdom and France donated $1.6 billion and $1.5 billion respectively, with representatives from each nation making comments about the friendly rivalry over who would donate the most. CanadaKorea, and Japan all also followed the United States’ lead, increasing their contributions to the Fund.

Recipient countries were not left out, however, and another recurring theme was the importance of strengthening domestic investments and fostering self-reliance. “The era of paternalism in development is over,” said Dybul. It was frequently acknowledged at the conference that successes in fighting AIDS, TB, and malaria could not have been achieved without resilient partners in the field, and recipient countries with strong national health plans were most likely to see these dramatic results. There was also an understanding from recipient countries that responsibility needed to be shared, and that the only successful plans would be those in which they also invested, as demonstrated by Namibia’s $750,000 commitment and Nigeria’s $1.5 million pledge. Although small in comparison to the amounts raised by other countries and even private foundations (such as the Gates Foundation’s $500 million commitment), these pledges from recipient countries demonstrate a commitment to moving away from total reliance on donors in the long term.

The Global Fund’s Fourth Replenishment Conference, overall, fostered an optimistic outlook, in spite of only achieving 80 percent of the total fundraising goal. But there is still time to reach the full $15 billion; President Obama’s challenge is good until September 2014, and there remains $1 billion on the table. Although the politics and the partnerships are important, the sense of hope comes from the fact that the science does exist to end these epidemics. The beginning of end may be near, and with this replenishment, the Global Fund is well positioned to make this dream a reality.