I am writing this blog a week after the XVIII International AIDS Conference in Vienna and only a few days after coming back from the African Union Summit in Kampala. I am writing this blog nearly 30 years after the first cases of AIDS were reported; 10 years after the International AIDS Conference in Durban brought the world’s attention to the moral outrage of the failure to provide antiretroviral treatment in much of the developing world; 10 years after member states of the United Nations agreed to achieve the Millennium Development Goals (MDGs) by 2015; and 8 years after the Global Fund was established to vastly scale up the response to AIDS, tuberculosis (TB) and malaria.
Today, we are at a defining moment in the response to AIDS, TB and malaria, and more broadly in the effort to meet the health-related MDGs.
Health is the one area of development where we have made considerable progress in the last 10 years. There has been unprecedented societal mobilization around health both in the North and in the South, political commitment, and increased financial resources.
The results achieved have truly been remarkable. In no other area has there been such direct and rapid correlation between resources and impact as in recent years’ investments in fighting AIDS, TB and malaria:
- In 2002, when the Global Fund was established, virtually no-one with AIDS was receiving antiretroviral therapy (ART) in developing countries. Today, over 5 million people have gained access to ART. AIDS mortality has decreased in most high-burden countries and the number of new HIV infections is also decreasing in most parts of the world, particularly amongst young people.
- In 2002, malaria was a neglected disease. Today, at least 10 of the most endemic countries in Africa have reported declines in new malaria cases and an impressive decline in malaria mortality of 50 to 80 per cent.
- Since 2002, TB has been diagnosed much more effectively. Six million additional people have gained access to DOTS treatment with Global Fund support. Prevalence of TB was 220 per 100,000 in 2000. We are on track to meet the international target of 124 per 100,000 by 2015. TB mortality is also declining in many countries.
The Global Fund has played a key role in this progress. Programs financed by the Global Fund are providing ART to 2.8 million people. We support ART for over 50% of people on ART in Africa and for 75% of people on ART in Asia. The Global Fund is also the major multilateral funder of prevention.
Overall, we estimate that the programs we support have saved more than 5.7 million lives. Every day, an additional estimated 4000 lives are being saved.
The Global Fund’s contribution to the MDGs extends far beyond its contribution to MDG 6. Global Fund investments to combat HIV, TB, and malaria also contribute directly to MDGs 4 and 5, and benefit the health of mothers and children. The three diseases are often rooted in poverty and, as such, affect development in general and impact on all eight MDGs.
In the next months, donors will decide if further progress will be made, allowing the world to meet the health-related MDGs. If adequate resources are provided and scale up of programs is allowed to continue at the current rate, major successes are within reach. By 2015, we can:
- prevent millions of new HIV infections;
- dramatically reduce deaths from AIDS;
- virtually eliminate transmission of HIV from mother to child;
- substantially reduce child mortality and improve maternal health;
- eliminate malaria as a public health problem in most malaria endemic countries;
- achieve significant declines in TB prevalence and mortality; and,
- further strengthen health and community systems.
These goals are realistic and we can achieve them.
In contrast, if our commitment wavers, we risk reversing the gains achieved. Without a successful Global Fund replenishment, AIDS, TB and malaria will gain force again and the world will not meet the health-related MDGs.
As an organization that provides over 50% of AIDS treatment in resource-poor countries, and two thirds of international funding for TB and malaria, the Global Fund is crucial to that effort.
Currently, it is still too early to say what the outcome of the replenishment efforts will be. The consensus, as expressed at the International AIDS Conference and African Union Summit, is that the Global Fund has proven itself and deserves support. But we are worried that this will not translate into significantly increased contributions from donors. This would have devastating consequences:
- The world would continue denying treatment to over half of the people living with HIV in urgent need of it.
- HIV, TB and malaria prevention would also be denied to millions.
- The yearly number of new HIV infections would rise again. Hundreds of thousands of children would be born with HIV every year.
- Malaria morbidity and mortality would increase again and antimalarial drug resistance would become a major problem. The goal of eliminating malaria as a public health problem would become unattainable.
- Drug- and multidrug-resistant TB would become a major global public health problem, threatening the success of TB control efforts achieved to date and leading to substantial increases in TB prevalence and mortality.
- In addition, we risk losing progress made in reducing child mortality and improving maternal health – despite the stated commitment to taking greater action.
The unique chance we have to come close to, reach, or even exceed the health-related MDGs would be lost. Ultimately, the promise by world leaders to pursue “all necessary efforts … towards the goal of universal access to comprehensive prevention programmes, treatment, care and support” would be irrevocably broken. Health inequities between rich and poor countries would grow, and the hope of millions of people for a different future would be lost.
Now is not the time to flat line funding for AIDS, TB and malaria.
Now is the time to redouble our efforts!