TACOMA, Washington — Each year, upwards of 405,000, 690,000 and 1.5 million people die of malaria, tuberculosis (TB) and HIV/AIDs, respectively. This terrible triumvirate infects some 230 million people annually, the vast majority being in the developing world and representing an enormous threat to global health. Fortunately, since 2002, the world’s collective resources and intelligence have been directed towards the Global Fund to Fight AIDS, Tuberculosis and Malaria worldwide. This work has never been more important in order to combat the ripple effects of COVID-19 in the developing world.
Over the past 18 years, the Global Fund has directed more than $45 billion into public health efforts such as testing, treatment, and education. Its contributions have cut the number of lives lost from the three diseases by nearly half, saving 32 million lives. However, COVID-19 places extreme stress on the healthcare systems that the Global Fund has propped up, jeopardizing years of progress. The organization has sprung into action, but donors will need to step up to save the world’s poor from extreme suffering.
Complications of COVID-19 in the Developing World
Typically, the Global Fund employs an intensive process to identify the right way to make needed investments. The organization assembles $4 billion in funding each year, the majority from donor governments but a sizable amount hailing from private donors and foundations. After determining which countries are eligible to receive aid based on income and disease burden, local representatives and experts form a Country Coordinating Mechanism group to determine a plan of attack for the three diseases. Once this plan is reviewed, local partners and operatives use grant money in productive ways within their communities.
Because of the rapid onset of the pandemic, the organization had to adjust quickly. It mobilized $1 billion of funding for over 100 countries to access using two pathways: the COVID-19 Response Mechanism and grant flexibilities. Under the former, countries with existing Global Fund allocations can access a $665 million pool of funds intended for interventions mitigating COVID-19’s effect on HIV, TB and malaria programs, as well as reinforcing general coronavirus responses. Through grant flexibility, countries can reallocate up to 5% of their existing grants from the Global Fund to fight COVID-19 and stop the three target diseases from roaring back.
Examples already abound of countries that have taken advantage of this injection of funds. In Ukraine, which has the second-largest HIV epidemic in Eastern Europe, the Global Fund has supported the work of 100% LIFE, a local community network that delivers antiretroviral therapies and other medicines to people’s homes. Elsewhere, the organization has helped partners ensure that crucial preventative steps are still taken despite the challenges of lockdowns. Community health workers in Benin, supported by the Global Fund, turned out in the thousands to knock on doors and distribute 8 million mosquito nets in just 20 days. Around the world, equipment and technology usually used to diagnose one of the big three diseases is being repurposed for COVID-19, while the Fund acquires new equipment to fill in the gaps.
A Call for Help
Yet the organization can only do so much without redoubled commitments from its donors. In a June report, the Fund projected that most of the $1 billion in flexible funding would be expended by July, and pleaded for $5 billion in additional donations to preserve decades worth of global health strides. If this request is not met, the consequences could be dire: according to projections, COVID-19 could bring about an additional 382,000 deaths from malaria, 534,000 deaths from HIV/AIDs and a whopping 1.4 million deaths from TB.
The coronavirus is sinister in that it does not only expose societies’ vulnerability to disruptions, but it revives the crises of old. The three diseases that inspired the Global Fund’s creation were in retreat across the developing world until COVID-19 hit. No matter how long the pandemic lasts, its knock-on effects on these three killers will be its ultimate, deadly legacy.
– Jack Silvers