Smart investments save lives

Eliminating HIV, tuberculosis and malaria is within reach, but getting there requires concerted action – and more money, says Peter Sands, executive director, Global Fund to Fight AIDS, Tuberculosis and Malaria

Is there a better investment than one that saves millions of lives? We know how to prevent people from being infected and killed by the three biggest infectious diseases afflicting humanity: HIV, tuberculosis and malaria. In many parts of the world we have already proven that we can end these epidemics. We have a plan for building on this progress and ridding every community of the burden of these three diseases by 2030. But to get there we need more innovation, better collaboration and more rigorous implementation – and more money.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is a proven mechanism for maximising impact by acting as a catalyst to end epidemics. Programmes supported by the Global Fund, and led by local experts in more than 100 countries, have saved more than 27 million lives since the fund was established in 2002. It’s a smart investment.

On 10 October 2019, we face a critical moment. French president Emmanuel Macron will host the Global Fund’s Sixth Replenishment conference in Lyon to secure funding for the coming three-year period. Our target is to raise at least $14 billion. With this level of funding we can get back on track to end the three epidemics by 2030, spur domestic investment of $46 billion in health programmes and save 16 million more lives over the next three years. Such funding will also support efforts to tackle inequalities in health, including gender- and human rights-related barriers to access, by working with partners including civil society and affected communities to build more inclusive health systems that leave no one behind.

In January, we published an investment case setting out why it is smart to step up the fight against the three epidemics. That should not be seen as a choice, but as the fulfilment of a promise. Every member state of the United Nations committed to the Sustainable Development Goals in 2015, pledging to deliver health and well-being for all, to achieve universal health coverage, and to build a more prosperous, equitable and sustainable world. Success or failure in achieving the SDG target of ending the epidemics of HIV, tuberculosis and malaria by 2030 will be one of the clearest tests of that commitment.

The need for external support

While governments and communities must take the lead in fighting the diseases and building inclusive health systems, those countries suffering the greatest disease burdens and lacking financial resources and capacities need external support. With the support of all partners, the Global Fund can significantly contribute to accelerating progress against HIV, tuberculosis and malaria. Adolescent girls and young women are a high priority. If teenagers, particularly girls, are not informed and empowered to avoid getting infected with HIV, the massive increase in the youth population in Africa could lead to more new infections than there were at the height of the epidemic in the early 2000s. If we do not tackle the stigma and discrimination that fuel the epidemic among marginalised key populations, we will never succeed in stopping new infections.

Getting back on track across all three diseases will require all the actors involved, including multilateral and bilateral partners, governments, civil society and the private sector, to raise their game, increasing innovation, coordinating and collaborating more efficiently, and executing programmes more effectively. More innovation is needed in diagnostics, prevention, treatment and delivery models. Only through innovation can we stretch every resource to maximise impact.

We need greater collaboration. The World Health Organization–led Global Action Plan’s commitment for the key multilaterals to ‘align, accelerate and account’ together must be translated into concrete actions. We must extend this drive for more coordinated action to encompass key bilateral partners, and to include governments, civil society, communities affected by the three diseases and the private sector. Only through intensive collaboration can we defeat the epidemics and deliver universal health coverage.

We need a relentless focus on improving execution, using more granular and timely data. With better data we can identify the most effective interventions and target programming more effectively, implementing stronger controls to manage costs and risks, adopting best practices in patient-centred care and community engagement, and leveraging economies of scale by scaling up proven interventions rapidly. By pooling resources and engaging a diverse set of actors, the Global Fund has scale, flexibility and leverage. Such advantages of scale are powerfully demonstrated by the hundreds of millions of dollars of savings the Global Fund achieves through pooled procurement.

More investment will save millions more lives, accelerating the end of epidemics and reinforcing the trajectory towards universal health coverage. We must step up the fight.