The Global Fund’s 2021 Results Report was issued a few weeks agon and we reported on its highlights in the last issue (Global Fund Results Report Reveals COVID-19 Devastating Impact on HIV, TB and Malaria Programs (aidspan.org)). In this article, we look into the results in more detail.

In spite of program constraints, nonetheless we can celebrate some significant achievements

Since 2002 in countries where the Global Fund invests, programs supported by the Global Fund partnership had saved 44 million lives as of the end of 2020. The number of deaths caused by AIDS, tuberculosis (TB) and malaria has been reduced by 46%, according to data as of end-2020 for HIV and end-2019 for malaria and TB (2020 data were not available at time of publishing). These achievements are due to unstinting efforts by the many different stakeholders who make up the Global Fund partnership – including governments, multilateral agencies, bilateral partners, civil society groups, people affected by the diseases, and the private sector.

However, over the past year the brunt of the COVID-19 pandemic has been devastating. For the first time in the Global Fund’s history, key HIV, TB and malaria (HTM) programme results declined. To regain momentum and end the three diseases, practitioners must also fight COVID-19 – and this means urgently reinforcing the systems for health needed to defeat today’s pandemics and prepare for tomorrow’s (see our article in this issue of the Global Fund Observer on What C19RM reveals about our impact on health systems).

The status of the battle against the three diseases

The Global Fund provides 25% of all international financing for HIV programs. AIDS-related deaths have dropped by 68% since the peak of the epidemic in 2004 in countries where it invests. Eight countries have surpassed the UNAIDS ‘90-90-90’ 2020 testing and treatment targets; however, most countries have missed these goals. While more people than ever before are on treatment, the number of infections is not dropping fast enough – and COVID-19 interrupted critical testing and prevention activities, particularly for key and vulnerable populations (KVPs) who are most at risk of contracting HIV.

Key HIV results in 2020 

21.9 million people were on HIV antiretroviral therapy – an 8.8% increase compared to 2019 despite COVID-19. However, testing and HIV prevention were badly affected by the pandemic. For HIV testing, 104 million people were tested – a 22% decrease compared to 2019. Regarding HIV prevention services, 8.7 million people were reached – an 11% decrease from 2019.

The Global Fund provides 77% of all international financing for TB programs. TB deaths (excluding HIV-positive people) have dropped by 28% since 2002 in countries where it invests. Together with technical partners and implementing countries, the Global Fund is finding more ‘missing’ people with TB – people who go undiagnosed, untreated and unreported. However, this progress was severely hit by COVID-19 in 2020. All TB testing and treatment results declined significantly in comparison to the previous year.

Key TB results in 2020

4.7 million people were treated for TB – an 18% decrease compared to 2019 due to COVID-19. 101,000 people received treatment for drug-resistant TB – a 19% decrease compared to 2019 due to COVID-19. However, there is better news for pediatric treatment: 194,000 children in contact with TB patients received preventative therapy – a 13% increase compared to 2019 despite COVID-19.

The Global Fund provides 56% of all international financing for malaria programs. Malaria deaths have dropped by 45% since 2002 in countries where it invests. New innovations are emerging, including improved insecticide-treated nets and pilot projects of a new malaria vaccine for children. In the face of COVID-19, the Global Fund successfully adapted malaria activities like mosquito net distributions and preventative therapy for children under five. Progress against malaria largely continued to be steady, but did not advance.

Key malaria results for 2020

188 million mosquito nets were distributed to protect families from malaria – a 17% increase compared to 2019 despite COVID-19. 11.5 million pregnant women received preventive therapy – nearly the same as in 2019. And 259 million people were tested for malaria – a 4.3% decrease compared to 2019 due to COVID-19.

Strengthening systems for health

Resilient and sustainable systems for health are the foundation for defeating today’s infectious diseases and the basis for preventing, preparing for and responding to future pandemics. The Global Fund is the largest multilateral investor in grants for systems for health, investing more than $1 billion a year. Most low- and middle-income countries were able to immediately respond to the COVID-19 pandemic using the same laboratories, disease surveillance, community networks, trained health workers and supply chains that were created to fight HTM. The Global Fund partnership is also building on crucial lessons learned and community expertise from fighting existing epidemics, including breaking down human rights and gender-related barriers to ensure everyone can access the health services they need.

Fighting COVID-19

The Global Fund responded swiftly to COVID-19, providing significant funding and leveraging its expertise and strong global networks. As of August 2021, the Fund had approved $3.3 billion to 107 countries and 16 multi-country programs through COVID-19 Response Mechanism (C19RM) funding. The Global Fund also allowed countries flexibilities in existing grants to support country responses to COVID-19 with critical tests, treatments and medical supplies, protect front-line health workers, adapt lifesaving HTM programs, and reinforce fragile systems for health.

The Global Fund is a founding partner of the Access to COVID-19 Tools (ACT) Accelerator, a unique global collaboration working to accelerate the development and equitable distribution of COVID-19 tests, treatments and vaccines and strengthen health systems. The Fund co-leads the ACT-Accelerator’s Diagnostics Pillar and Health Systems Connector, and supports procurement and distribution for the Therapeutics Pillar. Through the ACT-Accelerator, the Global Fund is now the primary channel for providing grant support to low- and middle-income countries for COVID-19 tests, treatments (including medical oxygen), personal protective equipment (PPE) and critical elements of health systems strengthening.