April 30, 2025
Should AIDS, TB and malaria remain a focus in global health?
By Chris Collins
Over 20 years ago, the world responded to an explosive HIV crisis and ongoing major pandemics of malaria and TB by creating new institutions to tackle these infectious disease killers. This included the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and, in the U.S., the President’s Emergency Program for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). These programs have had incredible impact, working together to save millions of lives.
Yet, with so many current challenges in the global health and foreign aid space, is it time to move on from disease-focused programs in favor of broader global health investments?
No, and here are some reasons why:
Results focus. The track record of results for people is irrefutable. The Global Fund partnership has saved 65 million lives since 2002, reducing the combined death rate from the three diseases by 63%. In 2001 – the year before the Global Fund was founded – AIDS, TB and malaria killed a staggering 4.6 million people globally: 1.9 million from AIDS; 1.8 million from TB and 870,000 from malaria. Based on the most recent data, those deaths have now dropped by about half to 2.4 million.
The life expectancy gap is narrowing between rich and poor countries. In Zambia for example, life expectancy has increased dramatically, from just 43 years in 2002 to 58 years in 2021. More than two-thirds of that gain is due to fewer people dying from AIDS, TB and malaria. When you focus on a specific, measurable challenge, it’s easier to make big accomplishments and see the concrete return on investment.
AIDS, TB and malaria are still major killers. In fact, TB currently reigns as the world’s biggest infectious disease killer, claiming 1.25 million lives in 2023. In 2024, TB cases in the U.S. rose to their highest levels in more than 12 years.
Nearly every minute, a child under the age of 5 dies of malaria, and the threat is not just overseas. Malaria is surging back in states like Florida and Texas for the first time in over 20 years.
Every week, 4,000 young women and girls are infected with HIV globally – 3,100 of them in sub-Saharan Africa. AIDS still takes 630,000 lives each year. These deaths are unacceptable because they are preventable. We cannot afford to backslide now.
Wider impacts. The Global Fund is a major force in health systems strengthening and pandemic preparedness. An analysis in the Lancet from 2022 found that over one third of Global Fund investments support health security.
In addition, the Global Fund plays a unique role in building core aspects of health systems. Effective use of health data, well-trained community health workers and widely available medical oxygen are considered critical elements of functioning health systems. The Global Fund invests in all three areas. For example, through mid-2022, the Global Fund invested $617 million in medical oxygen services.
Agility. Disease focused programs have proven their ability to adapt to new situations. In 2020, the Global Fund created the COVID-19 Response Mechanism (C19RM) to fight COVID-19, adapt lifesaving HIV, TB and malaria programs and reinforce fragile systems for health. As the pandemic evolved, C19RM investments adapted to respond to countries’ urgent needs, shifting from the acute emergency response to COVID-19 to strengthening systems for health and preparing for future pandemics. Areas of investments in this shift included surveillance system strengthening; improvements to laboratory systems and diagnostics; human resources for health and community strengthening; medical oxygen; respiratory care and therapeutics; and health product and waste management systems.
Civil society engagement and reaching the most vulnerable. Donor supported disease focused programs have been at the leading edge of supporting community engagement in decision-making, community systems and in reaching the most vulnerable.
Promoting country leadership and investment. The Global Fund requires countries that receive grants to increase domestic financing for health. The Global Fund works closely with countries to help them achieve long-term sustainability of health programs, so they can maintain progress and transition to self-financing their responses.
In many ways, disease focused programs embody values we all want for global health programming: a focus on delivering results, promoting country leadership, engaging communities and reaching the most vulnerable. As global health increasingly focuses on country leadership, pandemic preparedness and stronger systems, AIDS, TB and malaria programming remains a crucial pathway to success.