May 23, 2023
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, Chairman Coons 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 critical to reaching the goal of a healthier, safer world for all. I want to thank the Committee for the extraordinary support of the Global Fund’s work through an appropriation of $2 billion for fiscal year 2023, in line with the U.S. pledge of $6 billion over three years in its seventh replenishment cycle. But the fight is not over.
Today, I write to request sustained U.S. support for the Global Fund at $2 billion for fiscal year 2024 (FY24) and report language supportive of the $6 billion three-year pledge from the U.S. for the Global Fund’s seventh replenishment cycle.
As the world faces crisis after crisis featuring health emergencies, conflict, displaced people, food insecurity and more, we must not take for granted the progress that has been made and ensure that we finally bring the deadly epidemics of AIDS, TB and malaria to an end. The United States has a major stake in the Global Fund as an investment that bolsters low- and middle-income countries’ resilience and capacity to combat pandemics as well as our own national security.
Proven Lifesaving Impact and Economic Returns
Since its inception in 2002, the Global Fund partnership has saved more than 50 million lives. Over that time, AIDS-related death rates have fallen by 74%, TB death rates have fallen by 42% and malaria death rates have fallen by 48%. In 2021, in countries and regions where the Global Fund invests, 23.3 million people received antiretroviral therapy for HIV, 5.3 million people were treated for TB, and 133 million mosquito nets were distributed to protect from malaria. These results came in spite of marked inhibitors to progress from the COVID-19 pandemic.
In addition to vital health gains, the Global Fund is consequential for economic growth, supporting healthier workforces in the over 120 countries with which it partners, 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 people and workforce.
Saving lives and advancing global health equity
Friends of the Global Fight is requesting sustained funding for the Global Fund of $2 billion in FY24, as the second installment of the U.S. three-year pledge of $6 billion for the seventh replenishment. This level for FY24 is consistent with the president’s FY24 budget request and is supported by sufficient two-to-one matching from other donors, as required by U.S. law.
This funding would have tremendous lifesaving impact. For example, a $2 billion FY24 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
- Enable screening of 37 million people for TB
- Enable distribution of mosquito nets to 153 million people to protect them from malaria
- Produce $58 billion in additional economic gains.
The Global Fund’s investment case estimates that with full funding from donors 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.
The Global Fund promotes equitable access to health services to all, without discrimination, including women and girls and other key populations. For instance, in its annual Results Report, the Global Fund confirms that:
“Adolescent girls and young women remain a key focus for the Global Fund’s response to HIV. We have significantly increased our investments, focusing on the 13 priority countries where HIV burden is highest. In these countries, the HIV incidence rate among adolescent girls and young women has dropped by 56% since 2010.”
Due to the Global Fund, women, girls and other groups subject to poverty, prejudice and persecution who are acutely vulnerable to AIDS, TB and malaria can live freer from fear of pandemics and freer to thrive in dignity.
Amplifying the Impact of Bilateral Programs
An important benefit of investment in the Global Fund is that the organization reinforces the impact of crucial 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. In a year marking PEPFAR’s 20th anniversary, Friends notes that increased appropriations for these highly effective programs, each of which have also saved millions from deadly infectious disease, is more important than ever. The U.S. bilateral programs and the Global Fund closely coordinate and collaborate—using each program’s respective comparative advantages—to maximize the reach and impact of U.S. investments in global health.
Friends also emphatically supports reauthorizing PEPFAR through congressional legislation that maintains the match requirement for all U.S. funding to the Global Fund and continues the longstanding bipartisan nature of support for global HIV programming.
Inspiring Other Donors
All of these steps are important for getting back on track toward ending these epidemics after the height of COVID-19, and they would not be possible without bold U.S. investment and leadership. In fact, due to the distinctive matching requirement for the Global Fund, a sustained U.S. contribution would continue to encourage, inspire and press other donors to share the burden and indeed increase their own pledges during the three-year replenishment cycle.
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 those donors risk leaving U.S. money on the table. At last fall’s Global Fund replenishment conference—the most successful replenishment ever—the bold U.S. pledge encouraged several major donors—including Canada, Japan, Germany, France and the European Commission—to increase their own pledges by percentages as much as the United States did. Moreover, implementing countries themselves, such as South Africa, Kenya, and Rwanda, exceeded the percentage increase of the U.S., reflecting solidarity beyond their borders and regions.
Agility in Crisis: Navigating Complex 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 Ukraine. 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 such settings. Global Fund investments in these places amplify U.S. bilateral aid and complementary policies through the Global Fragility Act. Investment in the Global Fund promotes stability in such fragile, crisis zones where health challenges exacerbate insecurity, saving American taxpayers down the road from far higher costs due to those hotspots.
Challenges the Global Fund Must and Can Surmount
Despite its great achievements, the Global Fund and its partners still face significant challenges toward ending HIV/AIDS, TB and malaria as epidemics by 2030, in line with the Sustainable Development Goals. Challenges include increased drug resistance in the fights against malaria and TB and wide disparities in access to HIV treatment among vulnerable populations, among others. COVID-19 disrupted prevention, detection and treatment of the three diseases. The Global Fund assisted implementing countries to protect health care programming through generous U.S. and other support for its COVID-19 Response Mechanism. Food insecurity, forced migration and diseases spurred by climate change—like malaria—complicate ending the three epidemics. To protect and safeguard our progress against these diseases, it remains critical for the U.S. to invest in the Global Fund, with a track record of agility meeting evolving challenges.
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 international community works to strengthen 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 and equity of access. It has a proven record of results combatting pandemics, health system strengthening, and deep multisectoral partnerships in over 120 countries—most uniquely with local civil society and faith-based communities and implementers.
By leveraging the Global Fund in multilateral 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. While focusing on HIV, TB and malaria, the Global Fund will continue to contribute significantly to building resilient health systems in communities, facilitating better detection and treatment of infectious disease and stronger pandemic preparedness at the country level.
When capitalizing on the Global Fund’s clear strengths of speed, accountability and transparency, the United States 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.
Friends of the Global Fight thanks the Appropriations Committee for its leadership in the battle against the world’s most deadly epidemics, and we ask the Committee to sustain funding for the Global Fund at $2 billion in FY24 for the second installment of the Global Fund’s seventh replenishment, and to include report language noting support for the three-year, $6 billion U.S. pledge. We also support increased allocations to PEPFAR, PMI, USAID’s TB program, and, of course, the overall foreign assistance budget.
As the largest donor to the Global Fund, the United States has made possible immense impact and rallied other donors and partners demonstrably. There are few investments with such clear and justified returns to the American public, to marginalized people around the globe, and to a safer, more prosperous world. Congress should maintain its bold support for this lifesaving investment. Thank you.