Health officials, world leaders and donors from around the world met this week at the Global Fund’s Fourth Replenishment Conference in Washington to increase financial support -- and to highlight the progress made in fighting the three diseases. Fund officials aim to raise up to $15 billion for the next three-year funding cycle, 2014-2016. That would represent a $4.6 billion increase over the previous funding period.
The United States has pledged up to five billion dollars to the program.
President Barack Obama also said the U.S. will add $1 for every $2 pledged by donors. France reaffirmed its commitment of US$1.4 billion to the Global Fund for the next three-year period. Japan has pledged $800 million, the United Kingdom $1.6 billion, and Canada $612 million.
Among the participants at the conference, entrepreneur Bill Gates of the Bill & Melinda Gates Foundation pledged up to $500 million for the new funding cycle.
Speaking at a symposium of Global Fund partners, U.S. Secretary of State John Kerry stressed the importance of continued financial support and highlighted the progress made against HIV, malaria and tuberculosis. He said that thanks to the support of the Fund, an AIDS-free generation may be within sight.
"It’s really a stunning story," he said, "that speaks to the extraordinary progress that we’ve been able to make together in our global health efforts. It’s also a story about how the world came together to support a 40-fold increase in people receiving lifesaving anti-retroviral treatment [for HIV/AIDS] during the past decade alone. It’s a story about how the global target of a 50 percent reduction in TB-related deaths by 2015 is now actually within reach. It’s a story about cutting malaria so dramatically in some regions that infant mortality has dropped by a third."
Other participants agreed with Kerry. Nigerian Finance Minister Ngozi Okonjo-Iweala said worldwide, projects supported by the Global Fund have helped save nine million lives from the three diseases.
For many in Africa, that has meant working to curtail the spread of HIV/AIDS.
"On the continent," said Okonjo-Iweala, "we’ve seen new HIV infections have fallen quite dramatically, nearly 40 percent. One million fewer people acquired HIV in 2012, and we had 22 percent fewer AIDS-related deaths between 2001 and 2012."
In Nigeria, she said over a million people are receiving anti-retroviral treatment for the disease, an increase of about seven percent over last year. Also, nearly 700,000 pregnant women have received counseling on how to prevent mother-to-child transmission of HIV.
Nigeria is also making progress against malaria. Health officials have scaled up treatment centers and laboratories, and distributed 57 million bed nets to prevent infection by disease-carrying mosquitos.
But Okonjo-Iweala said recent studies have shown that only 40 percent of children surveyed actually sleep under them. She said policy makers are debating which would be more effective: bed nets or treatments that kill the mosquitoes. Some studies say larvacides are less expensive and equally effective.
Nigeria’s finance minister also said the government is working to improve the effectiveness of treatments, by tracking resource flows and measuring the impact of projects.
As a partner in the Global Fund, Nigeria is also using its own resources for health programs.
"We’ve committed $500 million to this initiative over four years," she said, "and we’re very proud of this commitment because it comes from money saved from the reduction in subsidies for petroleum. When we tried to reduce subsidies, people were out on the streets saying [petroleum subsidies to lower prices] is the only thing they gain from government. But poor people were not getting the subsidies. By taking this chunk, one-third of this money, and putting it directly into these programs, this is our commitment for how [we’ll approach health care]."
Similar progress was noted by another participant at the conference, the first lady of Rwanda, Jeanette Kagame. She's active in global development and public health issues, and is a founding board member of Friends of the Global Fund.
She said thanks to the Fund, Rwanda is on its way to meeting the U.N.-backed Millennium Development Goals of reducing maternal and child mortality. Part of that is due to improvements in reducing malaria, tuberculosis and mother-to-child transmission of HIV/AIDS. She said new infections of HIV have been reduced by half and mortality from HIV has fallen by 80 percent.
"We have emphasized prevention of mother to child transmission of HIV," she explained. "HIV-positive pregnant women and their children have access to services in 85 percent of our health facilities. It costs less to offer an HIV positive woman a full treatment regimen during pregnancy than to care for her infected children for the rest of their lives. The number of HIV testing and treatment sites has increased significantly over the past 10 years during which time 456 out of 502 health centers have been equipped to provide comprehensive HIV services. "
Rwanda’s first lady said there are other improvements in health care. The incidents of malaria, she said, declined by nearly 75 percent between 2005 and 2012. And, nearly 90 percent of all malaria patients are able to get affordable treatment. She said tuberculosis patients receive comprehensive care, with nearly all those infected being treated. Four sites were established to quarantine those with multi-drug resistance to the disease. Also, she said all Rwandans now have access to health insurance.
Secretary of State Kerry said the way forward should include what he called strategic investments based on the latest science and best practices.
"In tight budget environments in almost every one of our capitals, every dollar, every yen, pound, euro, all of them, are going to be competed for in a zero-sum game, and it’s going to be imperative that we come in and show people how we are producing and what we are getting for the value of that currency," said Kerry."
"That’s why we need to continue setting benchmarks for outcomes and put our weight behind HIV prevention… We have to begin to put in practices that stem that tide. And treatment and care interventions that work can make an enormous difference in creating the culture that can begin to do that."
He also said partners need to focus on the impact of HIV/AIDS on women and girls, who represent over half of those infected in sub-Saharan Africa. He said Global Fund partners – both private and public – need to work to improve the effectiveness of anti-retrovirals for the disease, and cooperate in the purchase of the drugs in order to drive down costs.
Kerry said in an inter-connected world, illnesses like drug-resistant tuberculosis are only a plane-ride away, so there’s no alternative to investing in global health.