March 4, 2026
The Global Fund: A fulcrum of successful aid transition
By Chris Collins
Global health is at an inflection point. The systems built over two decades to fight AIDS, tuberculosis and malaria — systems that have saved over 100 million lives — are being fundamentally rethought. The Trump administration’s America First Global Health Strategy is accelerating a transition toward country leadership that African leaders themselves have called for, most visibly through the Accra Reset. The question is not whether this transition happens. It is whether it succeeds.
The answer depends on the continued strength of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
This is not an argument for the status quo. The old model — in which wealthy donor nations designed, funded and managed global health programs with limited input from host countries — was never sustainable. Country ownership is the right long-term goal alongside continued progress against diseases. African governments, civil society organizations and communities should be leading the response to health challenges that devastate their own people. The Accra Reset and the administration’s bilateral agreements with partner countries reflect a genuine shift in that direction.
But transitions are fragile. The history of global health is littered with examples of hard-won progress unraveling when funding gaps opened or coordination collapsed. AIDS, TB and malaria are unforgiving. Interrupt treatment, and drug resistance emerges. Pull back on prevention, and transmission accelerates. The epidemics do not pause while new systems are built.
That is precisely why the Global Fund is so important right now — far from being a vestige of the old model, the Global Fund has been out front driving both concrete outcomes and transitions to country leadership simultaneously. Crucially, the Global Fund invests in the systems necessary to make country leadership successful.
Consider what the Global Fund actually does. It is a procurement powerhouse. By pooling purchasing across more than 100 countries, it drives down the cost of antiretrovirals, bed nets and diagnostics to a fraction of what any single country could negotiate. It shapes markets in ways that no bilateral agreement can replicate. When a transformative new HIV prevention tool like lenacapavir — a twice-yearly injectable that could revolutionize HIV prevention — needs to be deployed at scale, it is the Global Fund’s infrastructure that makes broad access possible.
The Global Fund also maintains a reach and efficiency that is genuinely difficult to replicate. Its administrative overhead is among the lowest of any major multilateral institution. It operates in the lowest-income, highest-burden countries — precisely the places where bilateral agreements may offer less coverage and where disease resurgence poses the greatest risk. At its February 2026 board meeting, the Global Fund reaffirmed three strategic shifts aligned with the new environment: a sharper focus on the poorest, highest-burden countries; defined and predictable transition timelines; and optimized use of resources. This is an institution adapting, not resisting.
Critically, the Global Fund adds dimensions that bilateral global health agreements may not to prioritize. Its Country Coordinating Mechanism structure brings together governments, NGOs, faith communities and affected populations in shared decision-making. It has deep ties to community health workers and community-led organizations — the front lines of any successful epidemic response. Reaching the most vulnerable people, including those marginalized by poverty, stigma or geography, requires exactly this kind of community engagement. We cannot end AIDS, TB and malaria without it.
From a purely strategic American perspective, investing in the Global Fund is not charity. It is efficiency. Every dollar the US contributes is matched by contributions from other donors and from the countries themselves. The Global Fund does foundational work — supply chain systems, community infrastructure, disease surveillance — that enables US bilateral programming to function. Without that foundation, bilateral investments become more expensive and less effective.
Congress now faces a clear choice. The administration has made a welcome pledge of $4.6 billion to the Global Fund’s Eighth Replenishment. In fiscal year 2027, Congress should appropriate $1.533 billion as one of three payments to reach that commitment. Equally important, Congress should continue to press its own directive, included in the FY2026 consolidated appropriations bill, to release approximately $1.7 billion in previously appropriated but withheld funds from the Global Fund’s Seventh Replenishment. Releasing those funds would save lives immediately while advancing progress towards the goals outlined in the administration’s America First Global Health Strategy.
The world is in the middle of a necessary and historic shift in how global health is financed and governed. That shift can succeed — or it can become a story of preventable deaths and resurgent epidemics. The Global Fund is one of the most important tools we have for making the new approach work. Now is the time to double down our investment, accelerate progress and set up partner countries to succeed.