After the blistering pace of its heady start in the early 2000s, the Global Fund to Fight AIDS, TB and Malaria (GFATM) of late has been losing some steam. First, there was the issue with corruption in Africa, where millions of dollars worth of GFATM funded malaria drugs were embezzled in over half a dozen African countries. And then there has been a crippling short fall in finances. Funding requirements to just meet existing obligations for the year 2011- 2013 run a total of 13 billion dollars. The Fund has a little over 11 billion dollars in its coffers.
The first issue sabotages credibility. Transparency has been a keystone of the Global Fund’s operation, without which none of the donors will put their money on the table. For an organisation whose sole purpose is to pool together financial resources for the sake of global health, that lack of credibility will be akin to a death blow in the keel.
A discredited Global Fund could likely undo the organisation, but way more importantly, it will undo the revolution that has been unleashed globally in AIDS, TB and malaria control through the use of such funds. And the revolution has been nothing short of spectacular. Before the Global Fund arrived AIDS treatment was beyond the fancy of much of the patients in the developing world. Today support from the Fund alone provides AIDS treatment to over 3 million people and TB treatment to more than 8 million people. Hundreds of millions of insecticide treated bed-nets have been disbursed.
These three killer infectious diseases together claim around four million deaths all over the world each year.
Earlier on, due to the lack of a centrally coordinated funding mechanism, donors had their individual funds to disburse, oftentimes overstepping each other’s priority areas, and in the meantime creating a colossal waste through the creation of a panoply of redundant monitoring mechanisms. Herein was the Global Fund’s genius; it not only did away with such multi-vessel trickle down fund disbursement, it also allowed individual countries to come up with their own priority areas to use the funds on.
The global fund is said to have saved almost as many as 7 million lives since its inception in 2002. As many as 150 countries the world over depend on global fund resources in order to battle these three leading killer infectious diseases.
A few months ago Gabriel Jaramillo, a banker, replaced a public health expert at the helm of the Global Fund after the African scandal rocked the fund. To his credit, Mr Jaramillo is trying to shore up the fund’s financial discipline while maintaining its global-health do-good ethos.
The discipline may well take care of the credibility part, however there is no denying the squeeze of the difficult economic times. While the continuing generosity of a lot of the donors has been vital to the Fund, some have been forced to withhold their pledges, or have not been able to scale up their commitments. The two billion dollar funding deficit will force thousands of patients in some far off corner in the world off their treatment regimens. As much as the global fund has been able to renew hope in millions of lives all over the world, such situation will prove to be equally catastrophic not only in the lives of the patients involved, but also to our moral authority to say that we have a collective will to fight off such scourges facing humanity. When the tide of global burden of infectious diseases has been showing signs of inflecting, letting go of our willpower to fight them will only make these diseases much bigger a global public health threat than what we started with.
The seven odd billion dollar price that we need to run the global fund on a year or year basis is indeed a lot of money. However if you consider the fact that 12 million people are benefiting with life saving AIDS and TB drugs from the use of that money globally, and that we could possibly achieve zero malaria deaths by 2015, it swings the balance a lot in the funds favor. When we have been annually spending billions of dollars in meaningless sabre rattling at borders-crosses all over the world, and billions more in amassing ammunition that can annihilate the world a dozen times over, saving lives at a few hundred dollars per person per year is a great deal of a return on investment by any standards. For that reason alone, the Fund can’t afford to lose its momentum halfway down the highway.