Over the past two decades, the world has witnessed extraordinary advances in global health: tens of millions of lives have been dramatically saved and life expectancy has increased dramatically even in the poorest countries.
However, the context has changed. The executing countries want to take the initiative. The communities demand more prominence. The model responsible for so many achievements will not be the one that allows us to continue moving forward.
To adapt to this new reality, we must make the global health ecosystem more efficient and innovative, more responsive to countries’ needs, and more integrated.
The Global Fund partnership was created just over 20 years ago to fill a glaring gap in the system. By combining government capabilities with the passion of communities, civil society outreach, and private sector pragmatism, this unique public-private partnership has proven extraordinarily effective in saving 70 million lives and reducing the combined AIDS mortality rate by 63%.
Now it’s time to reinvent ourselves once again: get the most out of every dollar, support countries on their path to self-sufficiency, and contribute to the overall transformation of the global health ecosystem.
Maximize the impact of every dollar
Maximizing the impact of every dollar means ensuring quick, affordable access to life-saving innovations. This is a new 100% effective and long-acting injectable tool to prevent HIV. For the first time in history, a new HIV prevention drug is being deployed in low- and middle-income countries and high-income countries at the same time. The first deliveries will arrive in Africa this month. A generic version will soon follow suit, further reducing the cost.
We have taken this same approach with the latest generation of mosquito nets to fight malaria, which are 45% more effective than traditional ones and only cost 70 cents more, as well as with AI-assisted digital x-rays, which facilitate advanced tuberculosis screening in some of the most complex and remote environments.
By collaborating with our partners we can move even faster. When we talk about delivering life-saving innovations, time translates into lives. Scale translates into impact. We cannot afford to spend years piloting programs or slowly rolling out products.
But innovations only improve health outcomes if they reach those who need them most. The weakness of health systems, stigmatization and discrimination remain relentless obstacles. Overcoming them is not only a matter of health equity and human rights, it is an epidemiological and economic imperative. If innovations do not reach those most at risk, we lose impact and waste resources.
Maximizing the impact of every dollar also means dismantling silos of specific diseases and health products. A more integrated, people-centred approach, tackling infectious diseases alongside other non-communicable conditions and mental health, can achieve better outcomes and save money, when executed properly. Integrating capabilities to address multiple pathogens into specific disease interventions also strengthens our first lines of defense against new health threats. These changes have big implications for the Global Fund. We must collaborate with our partners to redefine program design and development without diverting attention from outcomes around the three diseases.
Maximizing the impact of every dollar means ensuring quick, affordable access to life-saving innovations. This is what we are doing with lenacapavir, an injectable antiviral to prevent HIV
It is also essential to continue improving efficiency. With an operating expense of just 6% of donor funds, the Global Fund is already highly efficient. However, technology, including AI, is allowing us to continue simplifying and automating processes, thereby reducing costs by an additional 20%, easing the burden on partner countries.
Accelerate the path to self-sufficiency
External pressures highlight the urgent need for countries to accelerate their path towards self-sufficiency. However, this is a journey, not an immediate change. Too abrupt a transition can undo progress and cost millions of lives. Preparation for the transition varies greatly from country to country.
The Global Fund will work with countries to accelerate the path towards self-reliance through support, incentives and, ultimately, getting out of the way.
For this reason we have reformed transition planning and co-financing. With some countries, we will agree on transition periods so that this three-year subsidy cycle is the last. For others, the path to transition may take two cycles. In all but the poorest and most conflict-affected countries, we will work with governments to develop robust transition plans.
To support the transition, we are stepping up our support to countries to strengthen their public financial management systems and explore new sources of financing. We have already carried out 14 Debt2Health exchanges (debt cancellation in exchange for the country investing that amount in health programs) and 14 mixed financing transactions. In several countries, we are directly funding the development of national health insurance plans.
We can also help countries maintain access to affordable, quality-assured medicines by allowing them to use our Joint Procurement Mechanism with their own money. Countries in transition often pay higher prices and incur significant transition costs, although they can avoid these by using our global digital procurement platform. By offering financing advances and the ability to work with regional procurement platforms, we put more options at your disposal.
For the first time in history, a new HIV prevention drug is being deployed in low- and middle-income countries and high-income countries. The first deliveries will arrive in Africa this month
Of course, in some countries, the combination of economic hardship, conflict and weak governance, coupled with the scale of the disease burden, make the transition to self-sufficiency a longer-term prospect. Now, even in these contexts, we must focus more on sustainability and help build systems and capabilities that lay the foundation for the future.
Health development assistance remains essential to defeat the deadliest diseases, support countries on their path to self-reliance, and strengthen global health security. Countries that have benefited most from globalization also have a responsibility to invest in global public goods such as health, not only as an act of generosity, but also in their own interest. However, we must be smarter in how we combine subsidies, national fiscal resources and private capital to create pathways to self-sufficiency.
Transform the global health ecosystem
The Global Fund was born as a turning point with the conviction that established methods were too slow, bureaucratic and far from the front line. That same groundbreaking energy is what should drive us now.
Faced with the need to adapt to new realities, the Global Fund is committed to adopting big changes: reducing our costs, simplifying our operations and better responding to countries’ needs. We also know that the global health ecosystem must transform as a whole and that we must play a role in making this happen.
Despite all the advances, global health has become too complex and fragmented, and duplication and bureaucracy create challenges for countries and undermine impact. We must rationalize the architecture, merge or close agencies where appropriate, clarify functions and change the way we work together and with countries.
The Global Fund, as the largest multilateral funder of global health for both the three diseases and health systems in general, has assets that could be leveraged on a larger scale, such as our ability to influence the market, our global procurement platform, or the unique role we play in strengthening community systems for health. However, how the Global Fund’s mandate and priorities evolve should not be defined in isolation, but as part of an overall vision for the future of the global health ecosystem, which also includes WHO, Gavi, disease-specific agencies such as UNAIDS, product development associations such as Unitaid and CEPI (Coalition for Epidemic Preparedness Innovations), and the World Bank and other multilateral development banks with which we collaborate.
We must strengthen our multilateral system, but only if we are prepared to make difficult decisions. Because resource constraints are inevitable, we must be rigorous in determining where external funding brings the most value and how best to allocate functions among different agencies based on their comparative advantages. And the way we do it matters. The transformation of global health cannot be dictated from Geneva or New York, but rather we must reflect the leadership of countries and communities, as well as regional bodies such as the African Union.
From being a turning point to reinventing itself
Global health progress over the past two decades demonstrates what the world can achieve when we come together. At a time when skepticism, nationalisms and more transactional approaches dominate the narrative, the facts – tens of millions of lives saved, dramatic drops in mortality, dramatic increases in life expectancy and enormous economic benefits – remind us that with great ideas and collaboration we can achieve extraordinary results.
However, the model that has worked until now must evolve. The advances of the last 20 years are one of humanity’s greatest achievements in public health. The next 20 years will test whether we can be as bold in reinventing the system as we were when we created it.
The decision is not easy: reinvent yourself or die. We must adapt to new realities with courage, protecting what has made success possible, but without clinging to the past. Above all, we must continue to pursue our goals: saving lives, ridding the world of the deadliest infectious diseases, and building health systems that care for and protect us all. When humanity comes together, no challenge is impossible.
