June 29, 2022
Written Testimony submitted by Friends of the Global Fight Against AIDS, Tuberculosis and Malaria President & CEO Chris Collins to 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, Senator Coons, Senator Graham and members of the Subcommittee, for your unwavering support of U.S. leadership in the fight against AIDS, tuberculosis (TB) and malaria. For two decades, U.S. leadership, rallying others, has saved millions of lives and has brought us closer to ending AIDS, TB and malaria as deadly epidemics. Your vision and support for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is key to reaching the goal of a healthier, safer world for all. As we continue to manage the COVID-19 crisis, I want to thank the Subcommittee for the significant funding appropriated for the global COVID-19 response over the past two years. This includes a $3.5 billion contribution to the Global Fund’s COVID-19 Response Mechanism in 2021 and the sustaining $1.56 billion for the Global Fund in annual fiscal year 2022 appropriations. But the fight is not over. Today, I write to request increased U.S. support for the Global Fund at $2 billion for fiscal year 2023 (FY23) and continued support for a $6 billion three-year pledge from the U.S. for the Global Fund’s seventh replenishment, consistent with President Biden’s request. As the U.S. prepares to host the Global Fund’s replenishment donor conference in September, now is a critical juncture to ensure high-value global health programming for the future.
Proven Lifesaving Impact and Economic Returns
Since its inception in 2002, the Global Fund partnership has saved more than 44 million lives. From 2002 to 2020, AIDS-related death rates have fallen by 74%, TB death rates have fallen by 42% and malaria death rates have fallen by 47% in countries where the Global Fund is active. In 2020, in countries and regions where the Global Fund invests, 21.9 million people were on antiretroviral therapy for HIV, 4.7 million people were treated for TB and 188 million mosquito nets were distributed to protect from malaria. These results came in spite of marked challenges to progress from COVID-19.
In addition to vital health gains, the Global Fund is consequential for economic growth, supporting healthier workforces, increasing U.S. exports, and fortifying trade around the world. The Global Fund estimates that every dollar invested during 2024-2026 will lead to a $31 return of health and economic gains—an outcome that would directly benefit the American workforce.
Saving Lives and Advancing Global Health Equity
Friends of the Global Fight is requesting an increase of funding for the Global Fund to $2 billion in FY23 as the first installment of the U.S. three-year contribution of $6 billion for the seventh replenishment. This level is consistent with the president’s FY23 budget request and is in line with the U.S. continuing to support one-third of the Global Fund’s funding, given the seventh replenishment target of $18 billion over three years.
This funding would have tremendous lifesaving impact, furthering the Global Fund’s impressive record over the last twenty years. For example, a $2 billion FY23 appropriation would:
- Save an additional 2.3 million lives;
- Prevent 51 million new infections or cases;
- Provide 3.1 million people with antiretroviral therapy for HIV;
- Test 37 million people for TB;
- Distribute mosquito nets to 153 million people to protect them from malaria; and,
- Produce $58 billion in additional economic gains.
A fully funded Global Fund, with an investment of $2 billion annually from the U.S., would facilitate substantial progress toward the global goal of ending the AIDS, TB and malaria epidemics by 2030. The Global Fund’s investment case estimates that over the seventh replenishment period of 2024-2026, the Global Fund would:
- Save 20 million additional lives;
- Reduce the combined annual AIDS, TB and malaria death toll from 2.4 million in 2020 to 950,000 in 2026; and,
- Reduce HIV, TB and malaria infections by nearly 60%, relative to 2020 levels.
The Global Fund also plays a key role advancing human rights, equity and democratic governance. In particular, the Global Fund is taking new and concerted steps to address the needs of women and girls and other key populations who are disproportionately burdened with infectious disease. The Global Fund also supports non-health interventions in this effort to finance the tools marginalized people need to access health services. Its COVID-19 response and new 2023-2028 strategy have redoubled this human rights focus.
Amplifying the Impact of Bilateral Programs
An 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 also encourages increased appropriations for these highly effective programs, each of which have also saved millions from infectious disease. The U.S. bilateral programs and the Global Fund collaborate—using each program’s comparative advantages—to maximize the reach and impact of 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 in organization-wide decision-making. Even as it has taken on burgeoning challenges from COVID-19 and humanitarian crises, the Global Fund also stresses accountability and its inspector general notes that as of June 2021, the Global Fund had recovered 99% of funds mismanaged by implementers.
Inspiring Other Donors
All of these steps above are important for getting back on track toward ending these epidemics, and they would not be possible without bold U.S. investment and leadership. In fact, due to the Global Fund’s unique matching requirement, an increased U.S. contribution will encourage and inspire other donors to share the burden and increase their own pledges toward this lifesaving effort.
By law, the U.S. can only contribute up to 33% 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. During the last replenishment cycle, the 15.6% funding increase from the U.S. encouraged other major donors to increase their support, including a 20% increase from France, 17.6% from Germany, as well as a 16% increase from 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.
At the seventh replenishment this fall, we expect an increased U.S. contribution – if it is included in Senate appropriations legislation – to have similar effects on other contributions. We are encouraged by the Biden Administration’s concerted diplomatic efforts to stress to other donors the importance of increasing Global Fund pledges and to emphasize that every two dollars of international funding will unlock one U.S. dollar for the Global Fund (up to the $2 billion annualized pledge).
Agility in Crisis: Navigating COVID-19 and Global Conflicts
The Global Fund continues to quickly reach those most in need in challenging operating environments, from the Democratic Republic of the Congo to post-withdrawal Afghanistan to Ukraine today. Despite hosting less than 14% of the world’s population, challenging operating environments account for approximately one-third of the global disease burden for HIV, TB and malaria. Since 2002, the Global Fund has disbursed more than $15 billion in challenging operating environments.
COVID-19 presented the gravest threat in decades to the fight against AIDS, TB and malaria, leading to devastating impacts in ongoing infectious disease response and to broader health systems around the world. For the first time since 2002, the fight against AIDS, TB and malaria has gone backwards.
However, the declines in treatment and testing, and increase in deaths, could have been much worse without the swift response from the Global Fund and other global health actors. Through its COVID-19 Response Mechanism, the Global Fund quickly, efficiently and accountably deployed more than $4 billion in 2020 and 2021 to address disruptions in service delivery and supply chains, provide vital diagnostic tools and personal protective equipment, and protect community health workers. The Global Fund provided grants to more than 120 countries and regions and laid a powerful foundation for protecting health infrastructure in the absence of adequate vaccine supply.
Much of this response would not have been possible without the major U.S. contribution to the Global Fund’s COVID-19 response mechanism as part of the 2021 American Rescue Plan. Congress deserves immense recognition for enabling these lifesaving interventions to protect millions of lives and decades of progress. As we continue to navigate the COVID-19 pandemic, it is crucial that the U.S. continue to lead by example through its annual support for the Global Fund and other global health organizations.
The Global Fund and Pandemic Preparedness
Unfortunately, COVID-19 will not be the last pandemic, and for that reason, we must bolster our preparedness efforts and resources to more effectively address future global health challenges. As the world community considers a new financial mechanism for pandemic preparedness, the Global Fund stands ready to play a central role in these efforts as part of a global, comprehensive effort that prioritizes stronger health systems, civil society and equity of access.
By including the Global Fund in pandemic preparedness efforts, we can maximize efficiency and, in turn, achieve the greatest return on U.S. investments in global health. In fact, in its newest six-year strategy (2023-2028), the Global Fund intends to increase its already consequential investments in local health systems and security. A fully funded Global Fund will contribute $2 billion per year to building resilient health systems, facilitating better detection and treatment of infectious disease and better pandemic preparedness at the country level.
By capitalizing on the Global Fund’s clear strengths of speed, accountability and transparency, we can ensure that new investments in preparedness are used in the most efficient manner and toward critical, achievable projects such as bolstering community health workers, supply chains, and laboratory capacities.
In addition, as members of Congress consider the role of a new financial intermediary fund designed to address pandemic preparedness, we urge members to ensure it is structured for the highest possible benefit. Civil society must play a significant role in the governance of a new mechanism. Any new instrument should mobilize new funds, rather than limiting or decreasing funding for existing global health programs. The Global Fund should be a model for a new mechanism’s governance and a major implementer through which funding can be channeled.
Friends thanks the Appropriations Committee for your leadership in the battle against the world’s most deadly epidemics, and we ask the Committee to increase funding for the Global Fund to $2 billion in FY23 to form the first installment of the Global Fund’s seventh replenishment.
With the seventh replenishment hosted by the U.S., we hope to see many of you at the pledging conference, representing two decades of bipartisan support for the Global Fund.
As the largest donor to the Global Fund, the United States has had a proven track record of immense impact and rallying other donors and partners. There are few investments with such clear and justified returns to the American public, and to a thriving, safe international community. Congress can and should expand its support for this powerful instrument for overcoming longstanding and emerging pandemics. Thank you.