03 November 2022: In two weeks, the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria will be meeting to decide how much total grant funding will be made available to countries in the next three years. But that funding looks unlikely to include additional pledges from big donors such as the United Kingdom.
The Global Fund’s target was $18 billion for its replenishment conference in September. But the U.K. surprised many when it didn’t pledge a penny during the event, only saying that it will announce its contribution “in coming weeks,” while Italy said it will provide “incremental updates in the coming weeks as appropriate.”
If both donors had come through, and pledged an amount that reflects a 30% increase from their previous pledges to the Global Fund, that would be an addition of more than $2 billion in funding. However, the U.K. and Italy have made no pledging announcements as of Oct. 31.
“We confirm no pledge has been announced yet by the UK and Italy,” a Global Fund spokesperson told Devex via email on Thursday.
Without the additional pledges from the U.K. and Italy however, countries will have to grapple with less funding for HIV and AIDS, tuberculosis, and malaria — which was already the concern when donors failed to meet the Global Fund’s funding target back in September, with the total pledges amounting to $14.25 billion.
Questions over U.S. funding
The Global Fund had asked donors to make their pledges by the end of October for it to be included in the total funding to be made available to countries. This is because preparations for the board meeting require two weeks in advance.
“For optimal planning purposes, we need donors to announce their pledges in advance of our November 16-17 Board Meeting. An important part of the Global Fund process is the Board approving the total funding that we have available for the 2023-2025 grant allocation period,” a Global Fund spokesperson told Devex via email.
Once the board approves the total funding this month, the Global Fund will start determining individual country grants for the 2023-2025 period.
The Global Fund spokesperson said donors can still pledge after the board meeting, but that funding will no longer be part of the main country allocations, and instead will be used as additional funding for other interventions. It can also be utilized in scaling up existing interventions, as part of its “portfolio optimization,” a Global Fund process that provides countries with additional funding utilizing all funding made available to the organization within its allocation cycle.
Without assurance of $18 billion, however, it’s unclear how much of the $6 billion U.S. pledge will be included in the main country allocations. U.S. law prohibits the government from providing more than one-third of the Global Fund’s budget. If the U.K. fails to pledge any amount, the U.S. contribution may go down to $4.12 billion, bringing down the replenishment total, according to Peter Baker, policy fellow and assistant director of global health policy at the Center for Global Development.
“The process of unlocking the U.S. funding ultimately depends on commitments made by other donors over the course of the Replenishment period. We will continue fundraising over the coming weeks, months and years to ensure we are able to unlock the full U.S. commitment,” said the spokesperson.
Chris Collins, president and CEO of the Friends of the Global Fight, however, said that replenishment pledges “make a big impact anytime,” but that the sooner they are made the better.
“[P]ledges received after the Global Fund board meeting in November will still be put to work and will unlock additional US funding. Because of the 2:1 match requirement on US contributions, every US dollar in new or topped up pledges yields an additional 50 cents from the US pledge,” he wrote via email.
Impact on TB and malaria
“It means very bad because basically TB will get — as it looks right now and without [U.K. and Italy] pledges — less than $700 million per year, which is the least TB got in [the] last 6 years,” she said, calling it “pathetic.”
Meanwhile, funding for malaria is expected to be $500 million less in the next replenishment cycle, taking into account conditionalities attached in the Global Fund’s funding pledges and exchange rates, Dr. Corine Karema, interim CEO of the RBM Partnership to End Malaria, said in a written response to Devex.
“[W]e anticipate a reduction to country allocations for 2024-2026 compared to the previous funding cycle, representing a decline of around US$500 million in malaria funding at a time when more resources are required than ever before,” she wrote..
The funding needed to achieve global malaria targets is higher than previous years amid increasing challenges, she said, such as low intervention coverage; drug, insecticide and diagnostic resistance; and increased costs of procurement and delivery. While she expects countries to fill the gaps in funding, it can be challenging given that malaria is concentrated in low-income and fragile settings that are heavily reliant on external aid.
“We call on those who haven’t yet pledged — including governments, malaria-endemic countries, philanthropists, and the private sector — to commit to the Global Fund’s Seventh Replenishment. It is not too late to take action, especially for those who have previously shown such leadership and commitment to global health,” she said.