Global Fund

ONE is embarking on a listening and learning trip to Senegal, Ghana, Mozambique and Kenya with members of our board and other supporters. Christy Turlington Burns checks in:

I met an inspiring woman a few days ago in Accra, Ghana. Her name was Elizabeth*. She is a mother, a widow and she is HIV positive. This may sound pretty grim, but what I learned from spending some time with her is that Elizabeth and her two-year-old daughter Abigail* are getting the care they need here at the Tema General Hospital.

Elizabeth learned about her HIV positive status when she came here to be tested after her husband died a few years ago. She was pregnant at the time, which was actually a blessing, because it enabled her to begin antiretroviral treatment at a critical time for Abigail. Abigail takes a prophylactic drug to prevent infection of the AIDS virus.

I also spent some time with the nurses here who counsel the families who come into the clinic from up to a 15 kilometer radius to be tested. They shared other stories like Elizabeth’s, where women sought them out to be tested and then treated if their results were positive. When mothers have access to ARVs, they use them. And when they use them the chances of vertical transmission (when the virus travels inadvertently from the pregnant mother to her child) are minimal. At Tema, a mere 4% of babies whose mothers have begun treatment test positive. I was told that just a few years ago things were not nearly as hopeful.

Before the Global Fund and (RED) started distributing money to treat and prevent AIDS, there was very little incentive for the poor in Ghana to test because having HIV was a virtual death sentence.

Dr. Patricia Nsamoah, a senior medical officer and HIV focal person at TEMA, told us about the state of the clinic before they received Global Fund (RED) money.

“We’ve been testing HIV for a very long time, but basically people just didn’t know what to do if they tested positive for HIV,” Dr. Nsamoah said. “So when ARVs came, the Global Fund made it possible for us to have access to ARVs. You can at least see a patient, treat opportunistic infections, test for CD4, and at the point when they need the ARVs it is available and you can have a success story. Previously if you were working in the fever unit as the doctor in charge, what you did at the beginning of every morning was to sign death certificates because overnight by the time you came people had just died. But now a lot has changed… I’m telling you the clinic just grows bigger because people do not die.”

Today, Tema serves more than 2,200 people infected with HIV/AIDS in Ghana. These families are thriving and they are hopeful despite all they have endured. Abigail is a beautiful, curious little girl. She is confident with wise eyes that have seen the future.

*Elizabeth and Abigail’s names have been changed to protect their privacy.

Today, the Global Fund to Fight AIDS, Tuberculosis and Malaria released its annual results report, tracking progress in the fight against these three diseases and forecasting future global health progress.

According to the report, “The Global Fund 2010: Innovation and Impact,” programs supported by the Global Fund save at least 3,600 lives every day, and have saved an estimated total of 4.9 million lives since the Fund’s creation in 2002. In terms of funding, the Global Fund has approved $19.2 billion in proposals to 144 countries and disbursed $10 billion so far.

Here is a closer look at the Global Fund’s progress to date in fighting these three diseases:

HIV

• 2.5 million on antiretroviral therapy,
• 790,000 HIV-positive pregnant women provided with treatment to prevent mother-to-child transmission of HIV,
• 4.5 million basic care and support services provided to orphans and children made vulnerable by AIDS,
• 105 million HIV counseling and testing sessions conducted.

Tuberculosis

• 6 million provided with treatment for active TB,
• 1.8 million TB/HIV services provided.

Malaria

• 104 million insecticide-treated nets distributed,
• Indoor residual spraying in dwellings more than 19 million times,
• Treatment for 108 million cases of malaria.

Importantly, more progress is on the way. Financing approved by the Global Fund in the last two rounds (rounds 8 and 9) will reach countries in 2010 and 2011 and deliver with it a significant boost to health outcomes.

The Global Fund projects that if the current scale-up of health investments for these diseases continues or is ideally accelerated, impressive achievements are possible. Executive Director of the Global Fund observed, “A world where no children are born with HIV is truly possible by 2015.” Additionally, the Global Fund predicts that with continued momentum, malaria can be eliminated as a public health problem in most endemic countries and multi-drug resistant tuberculosis (MDR-TB) can be contained.

ONE released a press statement earlier today, highlighting how the Global Fund’s report demonstrates that U.S. investments fighting HIV/AIDS, tuberculosis and malaria and child mortality are working.

In 2007 the German government hosted a replenishment conference for the Global Fund in Berlin. To underline its role as host Germany promised to give €200m annually to the Fund between 2008 and 2010. Right now, the German parliament is discussing the 2010 budget.

We were quite surprised to see that section 23 – the part of the budget that holds most of the funds going to development – foresees only €142m for the Global Fund. The development ministry was quick to clarify that the remaining €58m would come from funds that were not used throughout the year, and that those funds just wouldn’t show up in the budget proposal. But ONE and other NGOs are wondering: Why the hide-and-seek?

So ONE and 10 other NGOs, among them Oxfam and Medicines Sans Frontiers, published an open letter addressed to the five parliamentarians that report to the budget committee about section 23 of the budget in which we call on the Bundestag to include the full funds that were promised in the 2010 budget. We’ll keep you posted on further developments!

Please welcome the newest addition to our policy team, Erin Hohlfelder. Erin is the Policy Manager for Health and will primarily focus on AIDS, TB, malaria, and NTDs. We’re very excited for her contributions to the ONE Blog! -Chris

As a new member of ONE’s team, it was exciting to see Bill Gates name ONE as a key partner of the Foundation in his Annual Letter. But it was perhaps even better to see him use the letter as a platform for some of our organization’s top health priorities—the work of the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria—as well as other important initiatives including polio eradication.

Gates is clear that in his work with Melinda at the Foundation, they have not set out to only fund projects that are “safe”; indeed they have been innovative and at times even risky in their investments, with the ultimate aim of real progress in the fight against diseases across the developing world. The Foundation played a key role ten years ago, for instance, in establishing GAVI—a unique program working with governments in developing nations to build sustainable immunization programs and to ensure access to affordable vaccines. Through market-shaping mechanisms and the availability of new vaccines, GAVI has delivered huge returns on partners’ investments: over 4 million child deaths have been averted since 2000 and over 250 million children have received a basic package of immunizations and vaccines.

The Global Fund, too, has been a key mechanism in the fight against global disease. Gates notes that the Fund’s work in both HIV/AIDS and malaria has been invaluable. Alongside PEPFAR, the Fund has taken the lead on scaling up ARV therapy delivery to those who are HIV+, and it has used its grants to sizably increase the delivery and usage of bednets to ward off mosquitoes that transmit malaria. Bill and Melinda Gates have both been vocal advocates for the highly-ambitious goal of malaria eradication; if we want to make this a reality, the Global Fund must continue its important work of partnering with countries and members of civil society to deliver sustainable solutions.

Critically, 2010 is a key replenishment year for both GAVI and the Global Fund. Gates rightly highlights that “improvements in…health have relied heavily on the generosity of rich countries,” and that is cause for concern amidst the financial crisis and growing budget deficits across the board. At ONE, we urge our members to use their collective voice to push their elected officials for their support of proven health interventions, in spite of the challenging economic environment. Robust funding for GAVI and the Global Fund is not just a Gates Foundation priority but a global imperative if we truly hope to reduce poverty and improve health in Africa.

In 2007, Germany pledged €600 million between 2008 and 2010 for the Global Fund at its own replenishment conference here in Berlin. ONE repeatedly praised Germany for this commitment. For us it came as a shock when we learned that the Government´s budget proposal for 2010 however does not follow through: GF contributions were reduced by €58m to €142m in 2010. This would have meant that the host of the last replenishment breaks it own promise in a year of the next replenishment – a really bad move.

This Tuesday, the Ministry of Development Cooperation reversed the cuts. The shortfall of 58 million Euro will now come from unspent 2009 money and the “planning reserve” (financial reserves for unexpected expenditures) in the 2010 budget, we and others were told by the Deputy Minister. This money will not be taken away from other budgeted programs as far as we know.

The Financial Times Deutschland on Wednesday reported on the protests against the cuts, using the headline: “Cuts of Anti-Aids-Support Causes Protests” / “Development Ministry back pedals after criticism”. The FTD mentions the organization ONE (“who is supported by Rockstar Bono”…) along with our NGO-friends DSW criticizing the Government for breaking its promises.

The Economist today takes stock of the state of global health innovation and how new advances are being funded worldwide. Our friends at GAVI and The Global Fund are singled out as displaying progress in “clever fund-raising, cautious spending and the precise measurement of outcomes.”

You can read the full piece here.

As well as appealing to the charity of ordinary people, agencies are finding new ways to raise money from lenders. A trail has been blazed by the GAVI alliance, a public-private partnership that funnels money towards vaccines for neglected diseases in the poor world. It has raised more than $1 billion in short-term financing by issuing bonds backed by sovereign pledges of aid money in future years. By making a big sum available today, rather than promising a trickle over a long period, the project has helped to create the economies of scale that make widespread vaccination possible. The Global Fund also has new ideas; this year it will launch its own exchange-traded fund—based on an index of firms investing in health and development—aimed at both traditional investors and “socially responsible” ones.

Another approach is to encourage firms to pool patents, which lowers the cost and accelerates the pace of drug development. Clever researchers at modest institutions may benefit from knowledge gained in more prestigious places. Under pressure from the WHO and anti-poverty activists, the drugs industry has started to relax its patent-protection policy. GlaxoSmithKline (GSK), a British drugs giant, said early in 2009 that it was ready to share certain patents (but not those for HIV). GSK and Pfizer, an American rival, then announced they would combine their patents for HIV into a joint research effort, called ViiV. In December UNITAID launched its own plan to create a global pool for HIV patents. The agency’s board will hold a final vote on this in February; Mr Douste-Blazy expects ViiV and some other big firms to take part.

On Friday, eight US senators sent a letter to President Obama asking him to fund global AIDS programs in 2011 at levels consistent with the Lantos-Hyde HIV/AIDS, TB and Malaria Reauthoration Act of 2008.

This is the concluding paragraph of the letter.

“America has, with bipartisan support from Congress, made tangible gains in saving lives in many impoverished countries and demonstrated our compassion to the world. This leadership must continue. As such, we urge you to support funding for global AIDS programs, including U.S. bilateral programs and the Global Fund, consistent with the Lantos-Hyde Act.”

 
It is signed by U.S. senators Boxer, Isakson, Casey, Lautenberg, Cardin, Durbin, Gillibrand and Kaufman. You can read the full letter here.

It’s not just the holiday season, it’s budget season — when President Obama makes critical decisions impacting the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

That’s why we’re asking him to give “A Global Gift” and include $1.75 billion for the Global Fund in his Fiscal Year 2011 budget.

Click here or on the card below to send President Obama a holiday card reminding him how important it is for the US to invest in the global fund and the lifesaving work it does in the struggle against these deadly, but treatable diseases.

When you send President Obama a holiday card you’ll be reminding him that since 2003 the Global Fund has:

* Helped get lifesaving antiretroviral drugs to more than 2.5 million people and palliative care and prevention services for millions more;
* Placed 6 million people on tuberculosis treatment; and
* Provided 104 million bed nets to prevent malaria.

Add your voice and help keep this critical work going.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) recently announced impressive new results on their impact in fighting disease around the world.

Since its creation in 2002, the Global Fund has supported:

• 2.5 million people on antiretroviral treatment for AIDS
• Detection and treatment of 6 million cases of infectious tuberculosis
• Distribution of 104 million bed nets to protect families from malaria

Since its launch in 2003, PEPFAR has supported:

• Life-saving antiretroviral treatment for over 2.4 million people.
• Direct care for nearly 11 million people affected by HIV/AIDS, including 3.6 million orphans and vulnerable children.
• Prevention of mother-to-child transmission programs that allowed nearly 340,000 babies of HIV-positive mothers to be born HIV-free.

Please note that there is overlap in these numbers due to concurrent efforts on the part of these mechanisms (e.g., the total number of those on antiretroviral treatment for AIDS is not 2.5 million plus 2.4 million), and we will not know the new global total for a couple months.

On November 11, the Global Fund to Fight AIDS, Tuberculosis and Malaria wrapped up its 20th Board meeting in Addis Ababa, Ethiopia. Dr. Michel Kazatchkine, Executive Director of the Global Fund, reviewed the progress of the Global Fund, noting that it has disbursed $8.8 billion to more than 620 grants in 138 countries. In 2009 alone, the Global Fund has:

• Placed 600,000 people on ARV treatment
• Supported prevention of mother-to child transmission services for 537,000 pregnant women
• Provided multi-drug resistant (MDR) tuberculosis treatment for 20,000 people
• Treated 90 million cases of malaria

At the meeting, the Global Fund Board approved $2.4 billion in its ninth round of funding, making it the second-largest round to date. In total, 85 proposals were approved, representing just over half of all eligible proposals. Beyond the traditional disease-specific grants, funding was approved for the first wave of National Strategy Applications (NSAs), which ensure that countries develop comprehensive national plans to address the three diseases. The approved proposals will be asked to make 10% efficiencies (cuts in total requested funding) to accommodate decreased funding resources.

Funding for the Affordable Medicines Facility-malaria (AMFm) pilot was also approved. The AMFm is an innovative financing mechanism designed to expand access to the most effective treatment for malaria, artemisinin-based combination therapies (ACTs), and to help reduce the use of less-effective and potentially harmful treatments. The AMFm does this by negotiating a discounted price for effective malaria treatment, and brings the price down further for those in malaria-endemic countries through a co-payment.

The Board also recognized the need to increase effectiveness and simplify the Global Fund’s operating model. The Board decided to transition the grant portfolio to single streams of funding to simplify support. This means that the Global Fund will consolidate grants supporting a program to fight HIV/AIDS, tuberculosis or malaria into one grant agreement (a “Single Stream Agreement”). Additionally, the Board resolved to immediately discontinue the Rolling Continuation Channel (RCC), which allowed expiring grants to be renewed. The Board is set to meet again early next year to determine priority areas for further changes in its operating model.