April 16, 2026
Written Testimony submitted by Chris Collins, president and CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, to the United States House Appropriations Subcommittee on National Security, Department of State and Related Programs in support of funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria
Chairman Diaz Balart, Ranking Member Frankel, distinguished members of the subcommittee:
Thank you for the opportunity to testify before this subcommittee about the lifesaving work of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Friends of the Global Fight asks you to consider an appropriation of $1.533 billion to the Global Fund in fiscal year 2027, one-third of the US pledge for the organization’s current three-year replenishment cycle. We also request the Global Fund be sent all funds appropriated by Congress in prior years in order to advance the goals of the America First Global Health Strategy (AFGHS).
I know you require no introduction to this innovative, multistakeholder partnership. Thank you Chairman Diaz-Balart and Rep. Frankel, for driving enactment of a strong appropriation for the Global Fund—carrying on a legacy of unflinching bipartisan support more than two decades in the making.
That legacy—equal parts compassion and shrewd investment—has empowered the Global Fund partnership to save the lives of more than 70 million people since 2002. Countless others are living healthy, prosperous, dignified lives because of your support. On their behalf, I say sincerely: thank you.
Now we are in a new era of global health. It is an era fraught with new challenges—evolving epidemics, shrinking aid budgets and rising competitors—but also exciting opportunities promised by revolutionary new biomedical technologies.
And in the United States, health assistance is transforming, too. With its AFGHS, the Trump administration is accelerating the transition from donor assistance to country ownership of health systems in low- and middle-income countries.
This is a moment the Global Fund was made for.
The United States has always been assured in its investment in the Global Fund because it gets results by being on the cutting edge of what foreign assistance should be. Long before “transition,” “sustainability” and “innovation” became the watchwords of our assistance agenda, they were at the core of the Global Fund model.
The goal of the Global Fund has always been to help countries move towards fully funding and implementing their own HIV, TB and malaria programs. For a decade, countries have been required to make co-financing commitments to receive support. 38 countries have transitioned away from all or part of their Global Fund assistance, with another eight countries in process and many more to come during the next grant cycle. The Administration has publicly said the U.S. will emulate that model.
Achieving successful, lasting transitions is no easy feat. It requires careful coordination between donors, partner governments, private sector and faith-based organizations, civil society and the communities that health programs are meant to serve. Transition also requires sustainable financing that can continue funding adequate health services even during shocks to the health system—epidemic outbreaks, natural disasters, financial crises and even conflict.
Transitions are fragile, and the costs of failure can be catastrophic. When health systems fail, epidemics surge, drug resistance grows and people lose trust in the leaders and institutions responsible for their care—and the progress made by our own investments could be squandered.
So why has the Global Fund had such success in saving lives and enabling transitions?
For one thing, the Global Fund model starts from the position that financial assistance is meant not only to fight diseases, but to build up durable, efficient, accountable and accessible systems that can keep up the fight as partner countries take the lead.
The programs that the Global Fund supports are designed, built and implemented by Country Coordinating Mechanisms–national committees comprising government, civil society, faith based groups, the private sector, multilateral agencies, technical experts, academic institutions, and members of affected communities. These diverse stakeholders work together to develop structures—health data systems, disease surveillance mechanisms, commodity management programs—that make it possible to end HIV, TB and malaria as epidemics and form the backbone of effective national health systems.
Those programs are backed by systems that ensure maximum efficiency and accountability. The Global Fund’s operating expenses are among the lowest of all international organizations, just 6.2%. Its financing model is performance-based and supported by rigorous oversight, including a technical review panel that evaluates funding proposals, independent auditors that monitor programs in all countries and an independent Office of Inspector General.
The Global Fund is also a procurement powerhouse. By crowding in funding from dozens of public and private donors, it secures the best possible prices for antiretrovirals, malaria bed nets, TB diagnostics, and hundreds of other products. For example, the cost of first-line HIV treatments now cost as little as $37 per patient per year—down from $10,000 per year when the Global Fund began its work.
But it doesn’t just buy in bulk: the Global Fund’s financing has a scale and reliability that allows it to invest in the full value chain for lifesaving health products, from development to delivery. It can place advance market commitments for products in development, which reduces risk and the costs of R&D. It brings these new products to market faster, with high quality standards and lower manufacturing costs.
Take lenacapavir for example, a revolutionary injection that protects the user from acquiring HIV for six months at a time. The Global Fund partnered with the State Department and the American manufacturer, Gilead Sciences, to procure two million doses at cost for high-burden countries in Africa. Products like lenacapavir have the potential to dramatically reduce transmission rates—a central factor in successful aid transition, giving countries a better shot at ending the epidemic on their own.
And countries can use their own resources to procure through the Global Fund, too, meaning health products remain both high-quality and affordable even after countries transition away from external assistance.
No other entity can match the Global Fund’s market position, or its experience bringing products to market quickly, affordably and at scale.
Beyond supporting the success of the health transition agenda, the Global Fund directly benefits public health, economic growth and national security in the United States.
The emergence of locally acquired malaria cases in Florida and elsewhere show the American people are vulnerable. The Global Fund programs strengthen countries’ capacity to prevent, detect and respond to infectious disease outbreaks—controlling them abroad before they have the chance to reach the United States. Laboratories supported by the Global Fund have helped identify and contain outbreaks of Ebola and mpox and are on the frontlines of the battle against antimicrobial resistance.
The Global Fund procures extensively from American companies. Since 2010, approximately $3.5 billion from the Global Fund has been invested in the U.S. private sector, mostly from procuring cutting-edge American-made health products.
The Global Fund also supports American security interests by providing services in fragile states and conflict zones, including places like Ukraine, Haiti and Sudan where U.S. agencies cannot operate safely. And because its model offers partnership, countries prefer to work with the Global Fund rather than exploitative arrangements of our strategic competitors.
For all these reasons, the Global Fund is an indispensable partner of the United States. That’s why the Trump Administration has recommitted the United States to the Global Fund’s eighth replenishment cycle, with a pledge of $4.6 billion for the three-year replenishment cycle.
To fulfill the second year of this pledge, we are requesting one-third of the total, $1.533 billion, be appropriated for the Global Fund in Fiscal Year 2027. That contribution would accelerate successful transition while saving an estimated 1.9 million lives and preventing 34 million new infections from AIDS, TB and malaria.
Even more lives would be saved if the Global Fund had all the resources that Congress intended, as the enacted FY26 bill rightly urges. Including last year’s appropriation, more than $3 billion appropriated for the Global Fund remains unspent today. The Global Fund has more than $5 billion in immediate needs it could fill with additional funding. With that money, the Global Fund could support more transitions from donor support, advance progress toward AFGHS targets, help prevent massive resurgences of malaria and TB and deploy lenacapavir and other biomedical innovations at greater scale.
I said before that the Global Fund was made for this new era of global health. And that’s because of nearly 25 years of American leadership and investment, which created a lean, adaptable, and highly effective mechanism for global good. Fully funded, the Global Fund is the tool that will make this the era when we finally win the fight against HIV, TB and malaria, and make it feasible for countries to be responsible for their own healthcare.
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