By Deb Derrick, President of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
I’m not what you would call a sports fanatic by any means. But in the midst of the Olympics — and not too long after the Super Bowl — it’s hard not to get caught up in the energy and enthusiasm for great personal and team performances. It’s a reminder that a critical component for these achievements is bringing the best possible team to the field (or slopes; or rink). A great team is capable of achieving things never thought possible. And that is no less the case with respect to global health.
Winning the fights against the world’s most challenging global health threats — including HIV/AIDS, tuberculosis and malaria — requires an unmatched team, with players who each bring different, but equally valuable skills to bear.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is an integral part of this team. The world’s largest public health financier, the Global Fund supports programs that save 100,000 lives per month. Created in 2002 to help provide resources to win the battle against the three diseases, which were collectively killing 6 million people annually, the Global Fund now provides:
• More than 20 percent of global funding for HIV/AIDS;
• More than 50 percent of international financing for malaria; and
• The overwhelming majority of international funding for tuberculosis.
What is most exciting is that, today, defeating these three diseases is a real possibility. Only a few years ago, we could not have made that statement. In the last 20 years, tuberculosis deaths have decreased by more than 40 percent. In the last decade alone, HIV incidence rates have gone down 33 percent and the number of malaria cases has been reduced by 26 percent.
But defeating these diseases is the fight of a generation and the Global Fund isn’t doing it alone. It was conceived as a partnership model, relying on donor and implementing countries — those receiving grants from the Global Fund — as well as the private sector, among others, to mobilize resources and conduct life-saving work on the ground.
Last December, the Global Fund hosted what, in the sports world, might be considered its “big game.” At its Fourth Voluntary Replenishment Conference, donors from around the world came together and pledged $12 billion to Global Fund programs, the largest amount ever committed to fight AIDS, tuberculosis and malaria and a 30 percent increase over the 2010 pledges of U.S. $9.2 billion. This achievement was the result of the generosity of 25 donor countries, as well as corporations and foundations, high-net-worth individuals and faith-based organizations. Some implementing countries also pledged to contribute more resources.
Far from December being the end of resource mobilization, though, the Global Fund continues raising funds for its life-saving mission. Since then, more countries have added their names to the pledge list: Switzerland, for example, pledged $68 million to the Global Fund in mid-December, nearly tripling its past contribution – a commitment that “unlocked” additional funding from the United States and United Kingdom.
Then, on Super Bowl Sunday, one of the most watched programs of the year also served as a call to action in the fight against AIDS. In a commercial that aired during halftime, U2 performed its song, “Invisible,” which, through a partnership with (RED) and Bank of America (BOA), was available for free for 36 hours on iTunes. For every download, BOA donated $1 to the Global Fund. Although originally only planning to match up to $2 million, Bank of America generously continued donating through the following Monday night for a final tally of more than $3 million. BOA’s partnership with (RED) and U2 intends to deliver a total of $10 million to the Global Fund that, with matching contributions from the Bill & Melinda Gates Foundation, the multinational software company SAP and Africa’s Motsepe family, will add up to another $22 million.
It’s worth noting, though, that the Global Fund’s partnerships extend beyond mobilizing resources to doing more with the resources it already has. Nowhere is this more clearly illustrated than in recent changes related to procurement. For example, a unique partnership to procure quality nets to combat malaria — leveraging the collective purchasing power of the Global Fund, the United Kingdom’s Department for International Development, the U.S. President’s Malaria Initiative and the United Nations Children’s Fund – will result in a projected $140 million in savings over two years. That is money that can then be used to save more lives. Similar reforms are underway in the procurement of antiretroviral drugs, prevention and diagnostic tools in partnership with the President’s Emergency Plan for AIDS Relief and the South African government.
Unlike sports teams, there is no cap on the number of players who can join the fight against AIDS, tuberculosis and malaria. And, in fact, the more players we have — bilateral partners, traditional donor and implementing countries, the private sector and passionate individuals — the better our odds of beating these three diseases.
There is no question that the athletes that took part in the Super Bowl and those competing in Olympic events are world class. But the world’s best team may not necessarily be found on a field, slope or rink. It may be the one on the global stage conducting the fight of a generation against these three deadly diseases.
Global Fund Observer Newsletter Issue 236: 06 February 2014
Regional outreach to migrants to complement service delivery in five Southeast Asian countries
A $100-million grant to avert the spread of artemisinin resistance in five malaria endemic countries in the Greater Mekong sub-region has been signed by a full complement of stakeholders, signalling the successful achievement of a first regional application under the Global Fund’s new funding model (NFM).
The Regional Artemisinin Resistance Initiative (RAI) will support purchase of long-lasting impregnated nets, malaria case detection and provision of directly observed antimalarial treatment in Cambodia, Laos, Myanmar, Thailand and Vietnam, as well as regional and national advocacy and awareness campaigns.
A disease burden and financial gap analysis led funds to be allocated as follows: 15% to the regional campaigns; 15% to Cambodia; 5% to Laos; 40% to Myanmar; 10% to Thailand; and 15% to Vietnam.
Central to the outreach component of RAI is work to reach migrant populations living and working in border areas who are normally overlooked and often marginalized. Each country has committed to complementary national campaigns targeting these populations.
Parasite resistance to artemisinin has been detected in all of the RAI countries, which has provoked concerns among malaria clinicians and researchers that a currently small problem could multiply exponentially and become a grave danger both within the region and beyond.
The risks presented by this growing resistance to artemisinin – the primary ingredient in combination therapies that have demonstrated the greatest success in treating malaria – drove the speed and deliberation with which the RAI proposal was achieved, according to RAI program manager Izaskun Gaviria.
“Artemisinin resistance is regarded as a global threat by the international community, which allowed the team to benefit from great support from key partners,” Gaviria said in an emailed response to Aidspan questions.
The split between regional behavior change and outreach activities and national-level service delivery was also a product of wide consultations with a variety of stakeholders including civil society groups, Gaviria said. It also reflects national and international priorities to coordinate with other regional initiatives on malaria funded by donors including The Bill and Melinda Gates Foundation, AusAID and DFiD.
While the ultimate goal is to contribute to the elimination of falciparum malaria in the Greater Mekong Sub region, and to prevent the emergence or spread of artemisinin resistance to new areas, incremental success for RAI will be assessed against the progress in: :
- Reduction of malaria falciparum cases per country and progress towards national malaria elimination targets (up to 50% in some countries)
- Ensuring high coverage with vector control and treatment interventions in designated areas and in particular among mobile/migrant populations
- Elimination of oral artemisinin-based monotherapies
RAI is one of three regional early applicants under the NFM. The other two are a malaria initiative in Mesoamerica and Hispaniola, EMMIE, that will strengthen malaria surveillance in Dominican Republic, Haiti, Panama, Costa Rica, Nicaragua, Guatemala, Belize and El Salvador; and a regional HIV harm reduction initiative stewarded by the Eurasian Harm Reduction Network in Eastern Europe and Central Asia.
A total of $116 million was initially envisioned under the transition phase for these three regional initiatives.
Global Fund News Release
KIGALI, Rwanda – The Government of Rwanda and the Global Fund are taking the lead on an innovative approach to health financing that is expected to significantly contribute to improving the efficiency of the fight against HIV in Rwanda and achieve greater impact.
A new grant agreement signed today will be used to implement Rwanda’s national strategic plan for HIV (2013-2018) with sharply reduced oversight. Rwanda and the Global Fund designed this new approach that is aligned with existing national systems and strategy, ties future disbursements directly to outcome and impact indicators, and lessens administrative burden and cost, in a framework of harmonization and mutual accountability.
It is the first time that the Global Fund is using this approach, and Rwanda has been chosen to pioneer this innovative model, because of its track record of success in health program and financial management.
Rwanda has emerged as a special success story for global health, having built a health care system, by coordinating development partners around one national plan, to give all citizens access to quality care. It has made tremendous gains against HIV and AIDS, and has already achieved a more than 50 percent reduction in HIV incidence rate among the adult population since 2000. If the current trends continue, Rwanda will go beyond the Millennium Development Goal target. As His Excellency President Paul Kagame said “MDGs are a ceiling not an end.”
Under the terms of the agreement signed here today, Rwanda and the Global Fund agreed that future disbursements will be directly tied to achievement of key outcome and impact indicators. This new flexible, Performance Based system emphasizes mutual accountability and greater country ownership of the national response.
“This is a great approach,” said Dr. Agnes Binagwaho, Minister of Health of Rwanda, adding that it is testimony to the achievements Rwanda has made in managing grant funding, and the partnership we enjoy with the Global Fund. We are confident that we will sustain the universal access to treatment and care, reduce new infections by two-thirds, and halve the number of AIDS deaths in the next five years.
The agreement, which includes funding of US$204 million, gives more flexibility on how funds are spent, and allows for savings to be re-invested in the national response. Grant funds will be part of a joint investment framework with financial assistance from the Government of Rwanda and other development partners.
Under the agreement, Rwanda will continue to monitor the achievement of universal access to HIV treatment and care for people living with HIV, and the reduction of new infections for key affected populations. The Global Fund will jointly verify the results with Rwanda.
“The main idea of this approach is to empower high-performing countries like Rwanda to further invest for higher impact,” said Dr. Nafsiah Mboi, Chair of the Board of the Global Fund. “They have proved this is possible, building on an outstanding HIV program, a robust HIV and AIDS national strategic plan, and strong financial and monitoring systems. We are proud to be their partners, and admire their accomplishments.”
The Global Fund will be looking into extending the approach to other countries, and also consider it for tuberculosis and malaria grants.
SEATTLE – The Bill & Melinda Gates Foundation has selected Susan Desmond-Hellmann, M.D., M.P.H., as its next chief executive officer. Currently the chancellor of the University of California, San Francisco (UCSF), Desmond-Hellmann will assume her role on May 1, 2014.
“We chose Sue because of her scientific knowledge and deep technical expertise on the foundation’s issues, as well as the organizational and leadership skills required to lead a large, growing and dynamic global organization. Sue shares our commitment and passion to create a more equitable world,” said Melinda Gates, co-chair of the foundation.
“I am honored by the opportunity that Bill and Melinda have extended to me. I’m excited to join such a dynamic and ambitious organization, with such a clear and focused mission—improving the lives of the world’s most vulnerable,” said Desmond-Hellmann.
“Sue’s background in public health policy, research and development, and higher education, make her an exceptional fit for this role. She impressed us as an innovator and an outstanding leader and manager,” said Bill Gates, co-chair of the foundation.
An oncologist by training, Desmond-Hellmann is a recognized leader on issues of higher education, public health, drug development, regulatory innovation and health policy. She has led UCSF since August 2009, when she became the first woman to serve as the university’s chancellor, overseeing all aspects of the university and medical center’s strategy, academic programs and operations. She has extensive experience in product development, and a deep understanding of how to bridge applied research to delivery of product. Prior to her tenure at UCSF, she was President of Product Development at Genentech, where she led the development and introduction of two of the first gene-targeted therapies for cancer, Avastin and Herceptin.
Desmond-Hellmann also served as a member of Genentech’s executive committee, beginning in 1996. She sits on the boards of directors of Procter and Gamble and Facebook, and was previously a member of the Federal Reserve Bank of San Francisco’s Economic Advisory Council.
Desmond-Hellmann will take over from Jeff Raikes, who announced his retirement from the foundation in September 2013 after five years at the helm. He was the foundation’s second CEO, and served after a long and successful career as a senior executive at Microsoft.
Global Fund News Release
CAPE TOWN, South Africa –Mark Dybul, Executive Director of the Global Fund, said the paternalism overshadowing relations between rich countries and poor in global health is giving way to an era of partnership that owes much to the vision of Nelson Mandela.
In a closing speech at the 17th International Conference on AIDS and sexually transmitted diseases in Africa (ICASA), Dr. Dybul paid a rousing tribute to the late South African leader, saying Mandela “broke the silence on HIV in Africa and he broke the silence on HIV in the world.”
“This week, let us finally end the paternalism in the world,” said Dr. Dybul.
Instead, he urged everyone to embrace Mandela’s vision for a world where every human being was a master of his or her destiny. A meeting of the International AIDS Society in Durban in 2000, which Mandela addressed, was widely seen as a turning point in the fight for wide access to treatment for HIV and opened the way to the creation of the Global Fund two years later.
The theme of the ICASA conference in Cape Town was entitled “Now More Than Ever: Targeting Zero,” underscoring a mood of growing optimism that the HIV pandemic can be turned into a low-level endemic that no longer poses a public health risk.
Dr. Dybul also called for the next ICASA meeting to add tuberculosis — the leading cause of death among those with HIV — to its name so that the disease “receives the emphasis it deserves.”
“HIV and TB are like two evil twins and we have the power and the responsibility to release them and we have the power and the responsibility to defeat them,” he said.
The time was long gone for “people from somewhere else” to tell countries in Africa how to tackle the AIDS, tuberculosis and malaria. “Your results have shattered the paternalistic myths of what should and can be done,” Dr. Dybul said.
Earlier in the day, Edwin Cameron, who serves as a justice on South Africa’s constitutional court, said stigma was one of the biggest obstacles to defeating the HIV pandemic.
“Stigma remains the most intractably resistant force in the epidemic,” Justice Cameron said. “It spreads blame, fear, inhibition, inaction and silence.”
Justice Cameron, who became the first senior official in South Africa to state in public that he was living with HIV, said men who have sex with men were shamefully treated in Africa: “Thirty-eight countries in Africa still persecute those who, like me, are oriented towards our same sex.”
The chair of the ICASA conference, Robert Soudré, said African countries could not continue to rely indefinitely on external support for HIV treatment.
“More than 80 percent of medicines are financed from external sources and that cannot continue,” said Soudré. “Our countries will have to make available their own resources and governments will have to rely above all on themselves.”
He added: “Zero stigma is what we should aim to achieve everywhere in the world, but also on our African continent.”
Dr. Dybul said although there was no single “silver bullet” that could end the HIV pandemic it was essential to deal with strongholds of infection among young women and girls; men who have sex with men; sex workers; people who inject drugs and prisoners.
“If we are going to address this epidemic we must deal with the strongholds. We must have our tools available for the most vulnerable and that means creating an inclusive human family,” he said.
“Let’s end silver bullet approaches to this epidemic and let’s just end the epidemic.”
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.