House Testimony by President & CEO Chris Collins in support of the Global Fund (FY 2025)

Written Testimony submitted by Chris Collins, President and CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, to United States House Appropriations Subcommittee on State, Foreign Operations and Related Programs in support of funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria

Thank you to Chairman Díaz-Balart, Ranking Member Lee, and members of the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs for your longstanding, bipartisan support for the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). As you know, the Global Fund is a multistakeholder partnership that raises and invests more than $5 billion per year to fight HIV/AIDS, tuberculosis (TB), and malaria. U.S. leadership and support—driven for two decades by Congress—has provided the Global Fund with the resources, partnership, and oversight to save 59 million lives since 2002.

Since the establishment of the Global Fund at the height of the AIDS epidemic, the U.S. has played a crucial role in its success. Congress mandated that U.S. contributions make up no more than one-third of the Global Fund’s resources, ensuring that dozens of other donor countries around the world match your generous and far-sighted appropriations two-to-one. Today, I ask you to continue this proven approach by fulfilling the United States three-year pledge to the Global Fund and leveraging twofold investments from our international partners. On behalf of Friends of the Global Fight, I respectfully request that Congress appropriate a minimum of $1.2 billion for the Global Fund in Fiscal Year 2025.

Results

The Global Fund has made astonishing progress in the fight against these three epidemics. Since the U.S. helped establish the Global Fund in 2002, the combined death rate from AIDS, TB and malaria declined by 55% in countries where it operates. In that same period, life expectancy in fifteen high-burden countries in Africa increased by 26%. Behind those figures are now multiple generations of people given the opportunities to live healthy, productive, and dignified lives.

The Global Fund is achieving more and more every year. In 2022, the Global Fund investments provided 24.5 million people with antiretroviral therapy for HIV, treated 6.7 million people living with TB, and distributed 220 million bed nets to prevent malaria. Compared with the year before, the Global Fund increased HIV prevention services by 22%, increased TB diagnosis and treatment by 26%, and treated 11% more people for malaria.

Despite this progress, the fight against HIV/AIDS, TB and malaria is far from over. Fortunately, the Global Fund is equipped to anticipate and adapt to new challenges. The Global Fund invests in bringing new technologies to market, promotes access to care for marginalized populations by partnering with those communities, and is highly attuned to shifting dynamics in-country, thanks to its model of local implementation and country ownership. Some of the progress to control TB has been reversed by increasing drug resistance and by the spread of COVID-19, which is a respiratory disease like TB. Using innovative models and technologies, the Global Fund fought back, registering dramatic increases in TB coverage after two years of COVID-related declines. Drug and insecticide resistance, and the emergence of new mosquito dynamics in Africa, threatens to worsen the malaria epidemic. In response, the Global Fund helped bring new types of insecticide-treated bed nets to market and is improving surveillance of malaria vectors. It also invests in promoting health equity—a major obstacle to providing HIV services, especially in countries like Uganda, where shrinking civic space is putting pressure on vulnerable communities most at risk of suffering from HIV.   

What U.S. Investment Buys

In 2022, the U.S. made a bold a bold pledge to contribute up to $6 billion during the three-year Seventh Replenishment of the Global Fund, the final year of which is FY25. Thank you for Congress supporting that pledge in FY23 and FY24. Based on current and expected contributions by other donors, $1.2 billion in FY25 would complete the three year pledge, accounting for 33% cap on U.S. contributions. Fulfilling this pledge would send a powerful statement of the U.S.’s enduring commitment to strengthening global health and leading the fight against HIV/AIDS, TB and malaria.

That investment would enable the Global Fund to continue its lifesaving work in an increasingly challenging global health environment. $1.2 billion from the U.S. would save an estimated 1.4 million lives and avert 30 million new cases of the three diseases.  Any additional contribution above that level could catalyze new short-term investments from other donors and strengthen the investment case for others to increase pledges for the Global Fund’s 8th Replenishment in FY26. Most importantly, additional funding will save more lives.

Leveraging and Strengthening U.S. Investments

U.S. contributions don’t just help pay for the Global Fund’s lifesaving work. They also leverage and reinforce a wide range of health programs to respond now surging needs among the world’s most vulnerable people—maximizing value for money and return on investment. As mentioned previously, every dollar the U.S. invests in the Global Fund mobilizes two dollars of investment from our international partners. The Global Fund also works with partner countries to incentivize their own increased domestic investments in health systems. The Global Fund works closely with implementing countries to realize a transition to sustainability and self-sufficiency. The Global Fund is also exploring supplementing its resources with innovative financing mechanisms, such as facilitating debt relief in exchange for countries’ own health investments.

The Global Fund works strategically with U.S. bilateral health assistance programs like PEPFAR and the President’s Malaria Initiative. Through this collaboration, the Global Fund accelerates the effectiveness of U.S. bilateral programs and fills gaps in service delivery.

The Global Fund has demonstrated keen agility to fight the three epidemics and deliver care in challenging operating environments such as Ukraine and Nigeria. That is because the Global Fund has built trusted relationships and resilient supply chains in partnership with local faith, civic and private sector partners, and invested in community health workers. Since 2002, the Global Fund has disbursed more than $15 billion in challenging operating environments, complementing U.S. efforts to increase stability and security in conflict zones and fragile states around the world.

The Global Fund’s work to fight the three epidemics also contributes to global health security, reinforcing the U.S.’s own emphasis on pandemic prevention, preparedness, and response. An independent study published in the Lancet concluded that one-third of Global Fund investments also support health security. By building health systems that can fight against epidemics today, the Global Fund is contributing to preventing the pandemics of tomorrow.  

Efficiency and Oversight

Thanks to the Global Fund’s operational effectiveness, efficiency and unique partnership model, it is an outstanding steward of U.S. taxpayer dollars. The Global Fund has no paid staff in any implementing country. Instead, local Country Coordinating Mechanisms—including non-government partners—design and implement programs with rigorous oversight by the Global Fund. This ensures that countries are empowered to take ownership of health programs, while keeping Global Fund operating costs to a minimum. In fact, the Global Fund’s operating expenditure as a percentage of donor contributions has steadily decreased, and is 5.1%, significantly below most comparable organizations. The U.S. exercises oversight of its investments through a permanent seat on the Global Fund Board and detailed reporting to Congress.

The Global Fund also ensures value for money by working with the private sector to shape markets so that it can procure and deliver high quality interventions affordably and efficiently. The private sector, which is represented in a permanent seat on the Global Fund’s board, works closely with the Global Fund on procuring commodities, incentivizing and deploying innovations, and strengthening supply chains. It is no surprise, then, that 20 leading American and global corporations recently wrote a letter to you supporting a $1.2 billion contribution to the Global Fund for FY25. As they note, Global Fund programs greatly improve operating environments for U.S. companies—including by making workers and consumers healthier and more prosperous—and produce $31 in economic gains for every dollar invested.

Conclusion

For more than two decades, the U.S. has invested in the Global Fund with historic impact. It is no exaggeration to say that millions of women, children, and other vulnerable people owe their lives to the generosity of the American people and their representatives in Congress. Today, I ask you to keep up the fight. A $1.2 billion contribution to the Global Fund, along with robust appropriations for the bilateral health assistance programs with which it coordinates so closely, will save lives and reinforce U.S. global leadership. With your continued support, the world can rid itself of these terrible epidemics. This is not only the right thing to do— this investment keeps all Americans safer and demonstrates our values in other countries. It is also a preeminent sign of American leadership based on unique comparative advantages. Truly, we cannot afford to step back. Thank you for your lifesaving leadership in support of the Global Fund and global health investments.