Abd Al Gader could barely walk when he arrived at a refugee camp in Jordan fleeing the war in Syria. After receiving treatment for TB, the 12-year-old is strong enough to play football and attend one of the camp’s schools.
Abd Al Gader, a 12-year-old with big, dark eyes, could barely walk when he arrived at the Zaatari refugee camp in the Jordanian desert after escaping the war in Syria. Suffering from tuberculosis and having run out of medicine, Abd Al Gader fled with his family from their farm east of Damascus with the few belongings they could carry and embarked on a dangerous journey towards safety.
Abd Al Gader’s cough worsened as the family trekked for days, sleeping in the open during cold, February nights and enduring shelling and thieves, before finally reaching the border. “We lost our crops and our house was destroyed,” said the boy’s father, Awash. “I feared for his life. That is when I decided we had to leave.”
In Zaatari, the family settled into a tentAbd Al Gader resumed his TB treatment at the camp’s clinic. Today, cured of the disease, he is strong enough to play football with his friends in a dusty pitch and to attend one of the camp’s schools.
In cooperation with local and international partners, the Global Fund is supporting the provision of essential TB prevention, diagnosis and treatment services to Syrian refugees in Lebanon and Jordan. The assistance comes from the Global Fund’s Emergency Fund, a special initiative to provide quick, flexible access to funds to respond to HIV, TB and malaria in acute emergency situations.
Tuberculosis, a highly infectious disease spread from person to person through the air, can move quickly in close quarters like a crowded refugee camp. Stopping TB is necessary, not only to protect refugees immediately at risk, and also to free up critical resources within refugee settings to treat basic illnesses, which are chronic in emergency situations like the Syria crisis. Since the outbreak of the conflict, more than 4 million Syrians have sought shelter in neighboring countries, mostly in overcrowded camps like Zaatari and in informal settlements with no or limited access to health services. Infectious diseases such as TB are increasing the burden on already overstretched public health systems.
“To defeat these diseases we must follow the people wherever they are, regardless of their status, circumstance, or ethnic and religious background,” said Mark Dybul, Executive Director of the Global Fund. “Partnerships like this give us the flexibility to respond quickly and better serve the people in need.”
Global Fund grants in the region are funding interventions that include TB diagnostics and treatment, screening of refugees upon arrival, strengthening referral services, training of health workers and raising awareness of the disease. The International Organization for Migration is implementing the programs in collaboration with WHO and the National Tuberculosis Programs of Jordan and Lebanon.
Since the program started, there have been more than 400 confirmed cases of TB in Jordan and Lebanon and four cases of multidrug-resistant TB in Jordan (according to 2014 data, the latest available), and the success rate of TB treatment among Syrian refugees is 90 percent. The Global Fund is extending emergency interventions in Lebanon and Jordan, and providing funding for TB services for Syrian refugees in Iraq.
The Zaatari camp now houses 79,000 refugees. Like most refugees, Abd Al Gader’s family first moved into tents, later replaced by prefabricated shelters. The father has built a kitchen and bathrooms, but dreams of returning to Syria one day. Abd Al Gader’s cough is now gone, but needs to pause to catch his breath when he plays football. When asked what he wants to do when he grows up, his eyes light up: “I want to be a football player for Barcelona FC.” He pauses, then adds: “Or maybe an architect and rebuild Syria.”
The Global Fund is evolving towards more differentiation and tailored partnerships. In the Middle East, a new initiative aims to increase coverage of HIV, TB and malaria care for people affected by conflict.
Differentiated approaches are required to increase the impact of health investments, particularly in settings that face special challenges, such as armed conflict or an influx of refugees. To improve efficiency and offer more flexible and simplified responses, the Global Fund is launching an initiative in the Middle East that will use one integrated grant management platform. The Global Fund currently has separate grants through country allocations in Syria, Iraq, Palestine and Yemen, and provides emergency funding to support TB care among Syrian refugees in Jordan and Lebanon. By managing all grants through one system to be managed by a qualified international organization with experience on the ground, the Middle East HIV, TB and Malaria Response aims to increase coverage of HIV, TB and malaria services and reach key and vulnerable populations.
Preventable diseases like HIV, TB and malaria strain health systems that are already overburdened, leaving fewer resources to provide basic health services or prepare for emerging health threats. In refugee situations, stopping diseases from spreading not only protects already weakened refugees from falling ill, it frees up critical resources to treat other illnesses or provide other health services – care that is desperately needed for families who have lost everything, and for communities that may be struggling to host them.
Mark Dybul, Executive Director of the Global Fund, said the Middle East initiative marks a fundamental shift from the way the Global Fund has managed grants in the past.
“To reach the people we need to reach and have more impact, the Global Fund needs to change the way we engage in challenging operating environments,” Dybul told a recent meeting of donors, technical partners, government representatives and civil society organizations in Amman, Jordan. “Tailored approaches are the future of the Global Fund.”
Joseph Serutoke, the Global Fund’s Regional Manager for Middle East and North Africa, said the new approach fits the needs and challenges of the region. Advantages of bringing the grants together include increasing efficiency through consolidated reporting, a more integrated approach, and supporting stronger regional partnerships that can deliver in hard to reach areas. Because of conflict these countries face constantly shifting needs, limited capacity and severe constraints to provide essential services. In Yemen, Iraq and Syria, most of the health facilities have been destroyed. Health infrastructure in countries hosting displaced populations is overstretched. As part of the new approach, typical Global Fund procedures and in-country coordinating measures will be adapted to meet the individual situation of each country. “The whole idea of this grant is to be agile and to adjust to the changing situation in the countries we serve,” Serutoke said.
The Global Fund is calling for proposals from qualified international organizations to assume the role of Principal Recipient. The grant is expected to start in July and will have a duration of two years, with the possibility of an extension.
The Global Fund is putting a stronger focus on challenging operating environments with the aim of increasing coverage and reaching key and vulnerable populations affected by HIV, TB and malaria.
Challenging operating environments, which may experience disease outbreaks, natural disasters, armed conflicts and weak governance, has been identified as an important priority for the Global Fund. Challenging operating environments account for a third of the global disease burden for HIV, TB and malaria, and for a third of Global Fund investments.
By Jane Andrews
I arrived at the Johns Hopkins University campus with a sense of déjà vu; it was my first visit to my alma mater in years. I had travelled to Baltimore for a meeting about the licensing of sutezolid, a much-awaited drug candidate for treatment of Mycobacterium tuberculosis. The research faculty, technology transfer officers, university administration, and advocates at the meeting felt the weight of the responsibility. We knew that licensing a tuberculosis drug candidate could be a historic event. Frustratingly, in the past 40 years the world has added only two new drugs to the arsenal against tuberculosis, the second most deadly infectious disease on the planet. The statistics are infuriating: more than 9 million people developed tuberculosis in 2013, and an estimated 44% of those in countries such as the Philippines, Thailand, and South Korea have resistance to at least one of the second-line agents for tuberculosis treatment.
Horrifically, only one of two people treated for multidrug resistant (MDR) tuberculosis are cured, and the toxic 2-year treatment regimen involves thousands of pills and hundreds of injections. For extensively drug resistant tuberculosis (XDR-TB) the cure rate drops to 20%. With new agents like sutezolid being used in combination with other drugs, we might be on the brink of being able to save more lives with less toxicity. Sutezolid, originally U-100480, began development alongside linezolid in 1996. Even then it showed favourable pharmacokinetic properties, efficacy against drug-resistant strains of tuberculosis, and low toxicity in rat models. After lying undeveloped for several years in the hands of Pfizer and others, there is a new window of opportunity for the drug. Sequella, a pharmaceutical corporation, acquired the licence for the development and commercialisation of sutezolid from Pfizer in 2011. However, Johns Hopkins University still owns some key pieces of the intellectual property.
GENEVA – As part of a new framework for procuring health products in the most cost-effective and sustainable way, the Global Fund has reached an agreement to purchase insecticide-treated mosquito nets that prevent malaria with projected savings of US$93 million over two years.
By achieving sharply lower prices for nets – a 38 percent reduction from 2013 – the agreement serves the Global Fund’s goal of accelerating progress against malaria, a preventable disease that most seriously affects young children and pregnant women. Building on the Global Fund’s large-scale purchasing power, the framework improves the supply of an important tool to fight the epidemic.
The Global Fund projects US$350 million in mosquito net purchases over the next two years through its Pooled Procurement Mechanism. A tender process has selected 10 suppliers and includes volume commitments from the Global Fund and performance contracts from the suppliers.
The agreement creates a level of certainty for suppliers, allowing them greater visibility and planning time to manufacture and deliver nets. That facilitates lower prices, and yields significant savings for the Global Fund partnership. The US$93 million in projected savings is equivalent to about 40 million additional nets.
“The money saved here can buy more nets,” said Christopher Game, Chief Procurement Officer at the Global Fund. “We worked closely with partners to strike the balance between achieving cost savings, promoting sustainable supply, and recognizing manufacturer investment in the development of new products to fight malaria.”
A previous Global Fund procurement tender for insecticide-treated mosquito nets was concluded in late 2013 and implemented over 2014-2015. That agreement saw the successful purchase of 170 million nets at a stable price, with a major improvement in delivery times.
The agreement is geared to purchase nets from multiple suppliers, reducing risk and encouraging local production, which reduces transport costs. About one-fifth of the nets to be procured will be manufactured in Africa. For the first time, the nets will be color-coded, allowing their durability to be tested at six-month intervals. The data collected from this research creates the possibility for future product innovation.
International News – Pakistan
By Shahina Maqbool
The Global Fund to fight AIDS, Tuberculosis and Malaria has cautioned Pakistan that if it does not sign, by mid-February 2016, the framework agreement for allocation of a US$255 million grant in support of the country’s national programmes for AIDS, TB, and Malaria, the GFATM will not be able to allocate funds to the country due to its own obligations, ‘The News’ learnt on good authority here Wednesday.
The Global Fund felt constrained to convey its stance to the Ministry of Health in the wake of unwarranted delay on part of Pakistan to sign the framework agreement, which is a generic document signed by all recipient countries. The delay was caused by misinterpretation of and technical objections to some clauses of the agreement by some line ministries that were part of the consultations. And even though the Global Fund made amendments to the agreement in the light of these observations, Pakistan still delayed furnishing an official response on the agreement to the Global Fund.