Fiscal Year 2021 Written Testimony Submitted by Chris Collins, President, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Prepared for the United States Senate Appropriations Subcommittee on State and Foreign Operations and Related Programs in support of funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria

Thank you, Chairman, and all members of the subcommittee, for your steadfast support of America’s leadership in the fight against AIDS, tuberculosis (TB) and malaria. The U.S. investment you have championed has saved millions of lives and has brought the end of these most deadly epidemics within reach. Your bold support of an increase in fiscal year 2020—for the first time in six years—for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) helped spur the rest of the world to increase funding too. Today I am writing specifically to request sustained U.S. support of the Global Fund at $1.56 billion for fiscal year 2021 (FY21), as well a U.S. contribution of $4 billion over two years to the Global Fund’s COVID-19 Response Mechanism as part of future COVID-19-related supplemental funding. This allocation would provide emergency support to countries to address COVID-19 and protect fragile gains in the response to AIDS, TB and malaria. 

We hope funding for the Global Fund is part of robust overall international affairs annual appropriation and an urgent COVID supplemental global funding package.

Proven Lifesaving Impact

Since its creation in 2002, the Global Fund partnership has saved over 32 million lives. This achievement includes a remarkable 56 percent decline in AIDS- related deaths, a 22 percent decline in TB deaths and a 46 percent decline in malaria deaths since 2002 in countries where the Global Fund operates. In 2018 in countries and regions where the Global Fund invests, 18.9 million people were on antiretroviral therapy for HIV, 5.3 million people with TB received treatment and 131 million mosquito nets were distributed. However, these achievements are now at dire risk from the threats posed by COVID-19.

Since the Global Fund achieved its $14 billion Replenishment fundraising goal in 2019, before COVID-19 emerged, the Global Fund was on track to save an additional 16 million lives; cut the number of deaths from AIDS, TB and malaria by nearly half; and prevent 234 million infections.

The Global Fund also plays a consequential role in economic growth, yielding healthier workers and increasing the number of consumers for U.S. exports, and growing trade partners abroad—all directly benefiting the American people. The Global Fund projects that it will spur $19 in economic returns and health gains for every $1 invested. These results contribute to direct economic benefits for the U.S. Eleven of the top 15 U.S. trading partners are countries that are former U.S. aid recipients.

Leveraging Other Donors and Domestic Investments

By law, the U.S. can only contribute up to 33 percent of the Global Fund’s standard operating budget. For every dollar the U.S. contributes, the Global Fund must secure two dollars from other donors, or risk leaving U.S. money on the table. The 15.6 percent funding increase from the U.S. last year encouraged other major donors to increase their support, including a 20 percent increase from France, 17.6 percent from Germany, as well as 15 to 16 percent increase from the United Kingdom, the European Commission, Canada and Italy, just to name a few. The Global Fund won $1 billion in pledges from the private sector as well, a new high.

The U.S. contribution also catalyzes increased domestic investments in affected countries. In order to receive their full allocation from the Global Fund, countries must increase domestic spending on health, such as programs related to HIV, TB and malaria. If these commitments are not met, a portion of the money is withheld. This co-financing mechanism works. The Global Fund projects implementing countries will increase their domestic health investments by 48 percent from 2021 to 2023.

Benefits of Global Fund Investment

Sustaining $1.56 billion in annual funding to the Global Fund would enable:

  • 2.96 million people to receive antiretroviral therapy.
  • 312,000 women to receive treatment to prevent HIV transmissions to their babies.
  • 2.1 million people to receive TB care and treatment.
  • 107,640 people to receive treatment for multidrug-resistant TB.
  • 82.68 million mosquito nets to be distributed to protect children and families from malaria.
  • 8.81 million households to receive indoor residual spraying to prevent malaria.

Amplifying the Impact of Bilateral Programs. Among several benefits of investment in the Global Fund, foremost is extending the reach of U.S. bilateral global health programs. These include the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI) and the USAID TB program. Friends encourages increased appropriations for these programs.  U.S. bilateral programs and the Global Fund work to maximize the impact of U.S. investments in global health, collaborating and sharing country strategies.

Moreover, the Global Fund adds value to U.S. bilateral programs by making long-term country-ownership more viable. The Global Fund requires disease-affected populations, civil society, faith and private sector voices to be included in local implementation and on its own board.

Improving Governance. Along with giving voice to stakeholders, the Global Fund advances more democratic governance in countries in which it partners. Last year Georgetown University published a study finding that Global Fund support improves government accountability, control of corruption, political freedoms, regulatory quality and rule of law. Better governance advances regional stability and security, economic freedoms, growing prosperity and more vital trading partners. Moreover, the Global Fund helps fragile states, which face flaring epidemics of HIV and TB. The Global Fund’s catalytic funding supports innovative programs to detect cases of TB that would otherwise go untreated in fragile states.

Global Fund Response to Threats from COVID-19

Developing countries face significant threats to their health systems from COVID-19. Imperial College London estimates “in high burden settings, HIV, TB and malaria related deaths over five years may be increased by up to 10%, 20% and 36%, respectively, compared to if there were no COVID-19 epidemic.” UNAIDS has estimated that absent action against COVID-19, projected annual HIV/AIDS-related deaths in sub-Saharan Africa might double from 500,000 to 1 million (back up to a mortality rate last seen in 2008). The Stop TB Partnership estimates that COVID-19 could lead to an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million deaths. Disruptions to bed net campaigns and to the distribution of antimalarial medicines could lead to double the number of malaria deaths in Africa this year (as compared to 2018).

To respond effectively, countries facing COVID-19 must:

  • Ramp up laboratory testing for COVID-19 while maintaining laboratory services related to AIDS, TB, malaria and other infectious disease killers.
  • Implement effective surveillance, contact tracing, public information campaigns on social distancing and other prevention measures.
  • Adapt their regular health services – taking into account additional expenses related to social distancing and personal protective equipment for healthcare workers – to avoid substantial increases in illness and death from chronic and infectious diseases during the COVID-19 outbreak.
  • Take exceptional measures to procure sufficient personal protective equipment and diagnostics for COVID-19 and deliver these through their in-country supply chains – while also maintaining effective procurement and supply chains for all other health commodities.

In response, the Global Fund has created the COVID-19 Response Mechanism to help countries fight COVID-19 and mitigate its impact on health systems, particularly AIDS, TB and malaria programs. The Global Fund’s primary advantage is that it can rapidly deliver funding to existing local partners in over 100 countries – with all of the same accountability and transparency present in normal Global Fund operations.

We are requesting a U.S. contribution to the COVID-19 Response Mechanism of $4 billion over two years, based on estimates from the Global Fund and its partners. Those estimates state that it will cost $46-58 billion globally to protect HIV, TB and malaria program responses to COVID-19 and to provide personal protective equipment, diagnostics and therapeutics to low and middle-income countries. The Global Fund would utilize a quarter of that funding ($12 billion over two years). The $4 billion request over two years is based on the U.S. providing 33 percent of total funding, consistent with our usual share of Global Fund financing. Progress on HIV, TB and malaria depends on this emergency funding.

The Global Fund is also working urgently to raise emergency funds from other donors. The Global Fund will receive assistance from the Coronavirus Global Response, which is spearheaded by the EU and includes the UK, Canada, Japan, France, Germany, Spain, Italy, Norway and Saudi Arabia.

In this exceptional situation, Friends urges that U.S. funds for the Global Fund COVID-19 Response Mechanism not be subject to the 33 percent limit on U.S. contributions to the core work of the Global Fund. Waiving the match requirement exclusively for the COVID-19 Response Mechanism will enable the Global Fund to move funding to countries without delay.

It is important to note that by establishing the COVID-19 Response Mechanism the Global Fund is not straying from its core mandate. Indeed, if it does not address the grave challenges presented by COVID-19, the Global Fund, its donors and their partners risk losing the progress on AIDS, TB and malaria that they have fought so hard to achieve.

Conclusion

Along with robust funding for the overall U.S. international assistance budget (the 150 Account), for global health assistance generally and the three U.S. bilateral programs, Friends asks for the following:

  • Maintaining funding for the Global Fund at $1.56 billion in FY21, as a second installment in the sixth Replenishment.
  • Maintaining the U.S. share of annual funding to the Global Fund at 33 percent, continuing to reject the Administration’s proposal to amend the longstanding matching rates for U.S. contributions to the Global Fund.
  • Ensuring the full amount of the previously appropriated $1.56 billion FY20 funding and the FY21 funding is used toward the Global Fund’s 2020-2022 grant cycle.
  • Contributing $4 billion over two years to the Global Fund’s COVID-19 Response Mechanism, exempted from the 33 percent cap on U.S. contributions to the Global Fund. We request this appropriation to move quickly and if at all possible, to be included as part of robust global funding in supplemental appropriations legislation by July.

The U.S. should be proud that it played such an instrumental role in building the capacity of the Global Fund to be ready to rise to an unprecedented global challenge like COVID-19. With its nearly two decades of experience fighting major infectious disease killers and building procurement and supply chain capabilities, the Global Fund is ready to scale up a substantial response to fight COVID-19 and protect our long-term investments in AIDS, TB and malaria programs.

Friends asks Congress to once again set an example for the world and invest in defeating AIDS, TB and malaria and helping vulnerable countries respond forcefully to the new pandemic of COVID-19.