June 25, 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
Chairman Graham, Ranking Member Schatz, distinguished members of the subcommittee:
Thank you for the opportunity to testify about one of the United States’ most efficient and effective investments in foreign assistance: the Global Fund to Fight AIDS, Tuberculosis and Malaria. Friends of the Global Fight is requesting $2 billion in funding for the program in fiscal year 2026, the first appropriations year of the Global Fund’s 8th Replenishment.
I want to start by thanking the Chairman and the Ranking Member for your leadership on the Global Fund. Senator Graham, your robust allocations to the program have sent a clear message to other donors about sustained American commitment, spurred them to step up and match us, and had the direct impact of saving many lives. Senator Schatz, your tireless support has been invaluable for keeping America in the fight against these epidemics.
With the considerable changes taking place in international assistance today, the subcommittee’s bill will play a critical role in shaping the future of US global health and health security leadership. I would argue that the Global Fund should play a foundational role in this future as a driver of burden sharing, transition to country leadership, pandemic preparedness and lifesaving results.
Established in 2002, the Global Fund is an international partnership that leverages contributions from governments and the private sector to provide lifesaving treatment and prevention for HIV, TB and malaria with the goal of bringing these epidemics to an end. Since 2002, the Global Fund partnership has reduced the combined death rate of these three diseases by 63% and saved more than 65 million lives. In 2023 alone, the Global Fund supported 25 million people on life-saving antiretroviral therapy for HIV, treated 7.1 million people for TB and distributed 227 million mosquito nets to protect families from malaria.
The Global Fund is America’s way of making sure other countries contribute their fair share to the fight against AIDS, TB and malaria. Every $1 contributed by the U.S. has been matched by $2 from other donors. For more than twenty years, that highly successful financing structure had been defined by a provision in U.S. law. This is a proven, concrete mechanism that has driven tremendous burden sharing, leveraging $49.5 billion from other countries and private sector corporations who have joined us in fighting these deadly pandemics that threaten Americans at home and abroad. We urge that the 2:1 match rate be maintained as it provides maximum leverage to U.S. investments, leads to greater investment by other donors, and positions the U.S. at the leading supporter of the Global Fund with the influence that brings.
The Global Fund also accelerates the path to country independence from aid: partner countries are required to demonstrate increasing commitment to financing health as a condition of Global Fund assistance.
The Global Fund is highly efficient, keeping operating expenses at just 6.2%, with multilayered oversight and accountability mechanisms to make sure every dollar goes as far as possible. In fact, the Global Fund has no staff on the ground, implementing through qualified partners like health ministries and local caregivers, including faith based humanitarian organizations. This local implementation model also lays the groundwork for transitioning financial responsibility to recipient countries.
The U.S. has a central role in determining Global Fund policy with a permanent seat on its board—with influence far beyond that because of its ability to leverage other donor contributions as well as PEPFAR’s global leadership and expertise. The U.S. also provides crucial technical assistance, contributes to program design at the country level and coordinates implementation on the ground.
Perhaps the best way the Global Fund ensures good stewardship of taxpayer dollars is by adopting the ethos of the private sector, emphasizing value-for-money, return-on-investment and the power of innovation. The private sector plays a vital role in the Global Fund. In fact, private sector partners have a dedicated voting seat on the Global Fund Board. The Global Fund works with manufacturers to secure better prices on the health commodities it procures. For example, the Global Fund recently negotiated a 25% price reduction for the preferred first-line HIV treatment by pooling orders, negotiating price ceilings and enabling generic manufacturing. American companies are major suppliers of the Global Fund, which has invested $3.5 billion in the U.S. economy since 2010, serving Americans’ prosperity. This is an organization that embraces the market and recognizes its potential to solve global problems.
Investment in the Global Fund protects Americans – a Lancet study found that more than a third of the Global Fund’s investments contribute to pandemic prevention, preparedness and response. Disease outbreaks continue to pose an enormous and urgent threat to the United States. TB cases have recently surged in places like Kansas and local malaria transmissions have been detected in Florida, Texas, Maryland and New York this year alone. In addition, biological threats continue to proliferate globally, including recent outbreaks of Mpox, Marburg virus disease, Ebola and H5N1 avian influenza. The Global Fund is one of the world’s biggest investors in building the health surveillance and laboratory systems abroad that form the first line of defense against biological threats to America.
Health assistance is a potent expression of American power and leadership, allowing us to cultivate goodwill and influence in countries where we face acute competition from our strategic rivals. While China offers opaque infrastructure loans and Russia provides security assistance to despots, the U.S. leverages its distinct medical and innovation advantages as tools of global influence. With clear and measurable results, health assistance—including through the Global Fund—is the U.S.’s most visible, enduring and effective form of diplomacy in many low-income countries.
The Global Fund is also uniquely positioned to save lives in the world’s most challenging environments. Because of its model of local implementation, the Global Fund supports lifesaving programs in conflict zones where even American personnel cannot operate safely. It runs mobile clinics on the front lines of Ukraine, which has some of the highest burdens of HIV and TB outside of Africa. It is fighting malaria outbreaks in camps for Sudan’s internally displaced peoples, screening for TB on the Afghanistan-Pakistan border, and treating survivors of sexual violence for HIV in Haiti. Where health systems are on the brink of collapse, it is the Global Fund which holds them together.
The Global Fund represents the best of foreign assistance: results driven, cost efficient, market oriented, locally implemented and with independent oversight. It makes America safer, more secure and more prosperous—and it saves lives.
This year, the donor countries will make pledges towards the Global Fund’s three-year replenishment cycle—and as always, they will look to the United States as an example.
A $2 billion support level in FY26 would be consistent with the U.S. historically providing one-third of Global Fund resources. That investment would save an estimated 2.5 million lives and avert 44 million cases of HIV, TB and malaria.
These are not forever investments. We are on track to win this fight and transition partner countries to eventually finance their own responses. For Americans and the world, this is an investment that with a lifechanging rate of return.
Mr. Chairman and Ranking Member Schatz, thank you for your lifesaving support for the Global Fund.