June 24, 2021
Written Testimony submitted by Friends CEO & President, Chris Collins, to United States House 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, Chairwoman, 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 funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) helped spur the rest of the world to increase investment with us. I want to offer my deep appreciation for congressional support for efforts to respond to the COVID-19 crisis globally, including the contribution of $3.5 billion to the Global Fund’s COVID-19 Response Mechanism. Future progress against the AIDS, TB and malaria epidemics depends on ending the new pandemic of COVID-19. Today I am writing to request sustained U.S. support of the Global Fund at $1.56 billion for fiscal year 2022 (FY22).
Proven Lifesaving Impact
Since its creation in 2002, the Global Fund partnership has saved over 38 million lives. This achievement includes a remarkable 61 percent decline in AIDS-related deaths, a 25 percent decline in TB deaths and a nearly 50 percent decline in malaria deaths since 2002 in countries where the Global Fund operates. In 2019 in countries and regions where the Global Fund invests, 20.1 million people were on antiretroviral therapy for HIV, 5.7 million people with TB received treatment and 160 million mosquito nets were distributed. However, these achievements remain at risk from the threats posed by COVID-19.
FY22 funding will serve as the third and final year of the U.S. commitment to the Global Fund’s sixth Replenishment. Friends of the Global Fight is requesting flat funding for the Global Fund at $1.56 billion, which is consistent with the contributions from the U.S. for the two previous years of the Replenishment cycle, as well as the president’s FY22 budget request. This level of support in FY20 and FY21 would not have been possible without the strong bipartisan support in Congress for the work of the Global Fund.
The U.S. contribution continues the unique matching requirement for the Global Fund, which allows the U.S. to encourage burden sharing by other donors. 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. in FY20 encouraged other major donors to increase their support, including a 20 percent increase from France, 17.6 percent from Germany, as well as a 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.
Since the Global Fund achieved its $14 billion Replenishment fundraising goal in 2019, the organization 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. However, COVID-19 could set back progress on those epidemics by a decade if not addressed (detailed below).
The Global Fund also plays a consequential role in economic growth, supporting 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 generate $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 fifteen U.S. trading partners are countries that are former U.S. aid recipients.
The Global Fund supports non-health interventions to achieve its mission, consistent with calls from Members of Congress in both parties. Global health aid through the work of the Global Fund has been key in advancing human rights and economic opportunity, particularly for women and girls and other key populations at risk of contracting HIV, TB or malaria. For example, it is supporting adolescent girls to stay in school to reduce their probability of HIV infection and financing legal services to marginalized people irrespective of gender to reduce the barriers they face to accessing health services. We were very pleased to see the Global Fund ranked as one of the “12 very high-scoring” organizations on gender equality in the Global Health 50/50 Report.
Amplifying the Impact of Bilateral Programs
One important benefit of investment in the Global Fund is that the organization reinforces the impact 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 U.S. Agency for International Development’s TB program. Friends encourages increased appropriations for these highly effective programs. U.S. bilateral programs and the Global Fund work closely together to maximize the results from U.S. investments in global health.
Moreover, the Global Fund adds value to U.S. bilateral programs by making long-term country- ownership more viable. The Global Fund requires that affected populations, civil society, faith and private sector voices be included in local implementation and on its own board. A particular added value of the Global Fund is its strong governance model; a 2019 study determined Global Fund support advances key areas of good governance.
Global Fund Response to Threats from COVID-19
COVID-19 has led to serious impacts on fragile health systems in many low- and middle-income countries. Congressional leadership has been crucial in helping these countries respond. I especially want to thank the Chairwoman for leading an effort with then-Congresswoman Martha Roby calling for support for the Global Fund to respond to COVID-19 in the early months of the pandemic last year. The inclusion of $3.5 billion in the America Rescue Plan for the Global Fund’s COVID-19 Response Mechanism, as well as other contributions to the other Access to COVID-19 Tools (ACT) Accelerator pillars, will be instrumental in paving the way for vaccine delivery, protecting health workers, scaling diagnostic tests and treatment, and bringing this new pandemic to an end.
The Global Fund 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 more than 120 countries – with all of the same accountability and transparency present in normal Global Fund operations. In 2020, the Global Fund’s COVID-19 Response Mechanism distributed nearly $1 billion in desperately needed aid to assist low- and middle-income countries respond to the pandemic. A regular order audit by the Global Fund’s independent Inspector General in April 2021 found this first phase of the COVID-19 Response Mechanism well- managed, effective and accountable.
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 worked so hard to achieve.
On March 30, 2021, the Global Fund Board – on which the U.S. is an active participant through PEPFAR leadership – unanimously approved phase two of the COVID-19 Response Mechanism. Lack of funding had put the COVID-19 support on hold for several months, with no other international institution filling the void. Now, strong support from the United States and other major donors makes this lifesaving work possible. It allows the regular appropriations for the Global Fund to help put the organization and its partners back on track against AIDS, TB and malaria. Thank you again.
To complement the efforts of COVAX, the World Bank and additional U.S. bilateral and multilateral investments in combatting COVID-19, the Global Fund’s COVID-19 aid will focus on:
- Essential non-vaccine elements of the COVID-19 response which help to distribute vaccines, including scaling up diagnostics, treatment and PPE
- Adaptations to HIV, TB, and malaria programs to mitigate the indirect impacts of the pandemic on the three epidemics
- Urgent health system enhancements to support the two points above, such as lab strengthening, community-led interventions to support transmission reduction, reinforcement of clinical care and enhanced disease surveillance Funding proposals to the COVID-19 Response Mechanism will be developed by Global Fund Country Coordinating Mechanisms. The Global Fund will continue to leverage technical expertise when reviewing COVID-19 Response Mechanism requests by using current Global Fund structures, including Grant Approvals Committee partners and the Global Fund Board. The Global Fund has also established a new technical advisory group to review the COVID-19 related aspects of countries’ funding requests.
We will keep you abreast of how the contribution from the U.S. to the COVID-19 Response Mechanism is deployed in the coming months, as well as contributions from other donors as they come in. A second contribution from Germany of 140 million euros was recently announced, which follows 150 million euros from Germany last June. We are encouraged that the Biden Administration has offered to help with diplomatic outreach to other donors and the Global Fund is eagerly taking them up on the offer.
Global Fund Contributions to Pandemic Preparedness and Response
As COVID-19 has shown, future pandemics are inevitable – and the world must address the drivers of new pandemics as well as be prepared to respond quickly and effectively. We were pleased to see the passage out of the House Foreign Affairs Committee of the Global Health Security Act, which would require a formal strategy to address and prepare for pandemics. That bill, along with other pieces of legislation being developed in the Senate, calls for new proposals to improve the global health architecture in support of pandemic prevention, preparedness and response to ensure less disruption and loss of life. As Congress – and this subcommittee – considers such proposals and the funding they may require, the United States and other countries should turn to the Global Fund to play a central role in pandemic preparedness and response as part of a comprehensive effort.
The Global Fund is capable of immediately playing an expanded role in several areas of pandemic preparedness, building on the investments it already makes in most of these key areas as part of the response to AIDS, TB, malaria and COVID-19. A January 2021 study published in the Lancet determined that Global Fund-supported programming is actively engaged in multiple aspects of health security and over one third of its investments promote health security.
The Global Fund is already one of the largest sources of international funding for global health security and is in the process of considering a range of options for work in this area as it develops its next six-year strategy. The Global Fund must continue its focus on AIDS, TB and malaria, but it could embed expanded global health security programming in its ongoing work to strengthen health systems, particularly in aspects of health security where it is already active.
Channeling pandemic preparedness resources through the Global Fund would offer several advantages. The Global Fund would be ready to deliver funds with its proven speed, accountability and transparency, and would ensure that pandemic preparedness resources build on platforms used to fight existing diseases and strengthen local health systems. Using the Global Fund would bring more coherence – rather than fragmentation or silos – to the global health architecture.
Friends thanks the Appropriations Committee for your leadership in the battle against the world’s most deadly epidemics, and we ask the Committee to maintain funding for the Global Fund at $1.56 billion in FY22, the third and final installment in the sixth Replenishment. We also support increased allocations to PEPFAR, PMI, TB at USAID, and, of course, the overall foreign assistance budget. We again express our profound thanks for the contribution from the U.S. to the Global Fund’s COVID-19 Response Mechanism and look forward to ongoing conversation on how best to make that contribution deliver access for the poor, marginalized and stigmatized. And we welcome dialogue on fully leveraging the Global Fund as an asset on pandemic preparedness and response.
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 has scaled 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 COVID-19 and future pandemics.