4.2.1

This new issue of GFO highlights the shockwave caused by the U.S. aid freeze on global health, particularly in Africa. As healthcare systems struggle under the weight of treatment disruptions and financial disengagement, the Global Fund itself faces an existential threat. The urgent need to diversify funding sources and strengthen domestic resource mobilization has never been greater. Meanwhile, the silent crisis of mental health among LGBTQ+ activists in Francophone Africa demands an immediate response. Finally, the joint fundraising initiative by South Africa and the United Kingdom offers a glimmer of hope in a fragile landscape. More than just a crisis, this moment presents an opportunity to rethink the balance of global health efforts.

Dear subscribers,

 

The world has woken up in 2025 with a geopolitical hangover, the first victims of which are the most precarious healthcare systems.<a href="https://aidspan.org/the-freeze-on-us-aid-an-assessment-of-the-situation/" target="_blank" rel="noopener"> The freeze on U.S. aid, imposed by the Trump administration, has triggered a shockwave whose repercussions manifest in treatment disruptions, weakened healthcare infrastructure, and silent abandonments</a>. More than just a budgetary restraint, this is a brutal rupture that jeopardizes decades of progress in the fight against infectious diseases.

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The facts are undeniable. The suspension of U.S. funding destabilizes not only the global response to major pandemics but also exposes the extreme dependence of many African states on these financial flows. The magnitude of the disaster is evident in the daily struggles of healthcare workers and patients: interrupted treatments, abandoned prevention campaigns, and depleted medical facilities. <a href="https://aidspan.org/usaid-freeze-from-shock-to-action/" target="_blank" rel="noopener">A situation that, when recounted, oscillates between nightmare and reality—a gaping void where decades of effort collapse</a>.

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This financial cataclysm does not spare the Global Fund. <a href="https://aidspan.org/the-future-of-global-health-financing-navigating-united-states-policy-shifts-and-the-global-funds-sustainability/" target="_blank" rel="noopener">The institution, with a third of its funding reliant on the United States, faces an existential threat</a>. The risk of a breakdown in the replenishment cycle becomes tangible and necessitates immediate reassessment. Diversifying funding sources, engaging emerging economies more actively, and strengthening domestic contributions have become categorical imperatives. But the equation is complex: how can donor confidence be maintained while ensuring the optimal efficiency of remaining resources?

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Yet, the moment is strategic. <a href="https://aidspan.org/the-global-funds-18-billion-appeal-for-2027-2029-cycle-an-investment-case-to-combat-hiv-tuberculosis-and-malaria/" target="_blank" rel="noopener">The Global Fund’s advocacy for an ambitious $18 billion funding target for the 2027-2029 grant cycle underscores an often-overlooked reality: investing in health is not an expense but a growth lever</a>. Every dollar injected saves lives, prevents new infections, and strengthens healthcare systems capable of withstanding future crises. A compelling argument at a time when the COVID-19 pandemic has starkly revealed the value of robust preparedness for health emergencies.

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<a href="https://aidspan.org/south-africa-and-the-united-kingdom-to-co-host-global-funds-eighth-replenishment-to-combat-aids-tuberculosis-and-malaria/" target="_blank" rel="noopener">Amidst this financial storm, the alliance between South Africa and the United Kingdom to organize a fundraising summit offers a glimmer of hope</a>. Far from being a mere diplomatic event, this initiative carries a vital mission: to convince the world that the fight against HIV, tuberculosis, and malaria cannot continue without strong financial commitment. It is a decisive test for international cooperation—can global solidarity endure the political upheavals of its historic contributors?

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But beyond figures and negotiations, another, quieter crisis is emerging. <a href="https://aidspan.org/behind-the-struggles-a-report-highlighting-mental-health-issues-among-activists-working-alongside-sexual-and-gender-minorities-in-french-speaking-africa/" target="_blank" rel="noopener">The latest report from the Global Alliance of Communities for Health and Rights (GATS PLUS) delivers a stark assessment of the mental health of activists defending sexual and gender minorities in French-speaking Africa</a>. Victims of dual oppression—both institutional and societal—these activists operate in a hostile environment, under constant pressure from donors and local authorities. While the 95-95-95 objectives should fully integrate these populations, their reality remains largely ignored, relegated to the fringes of public policies.

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The response must go beyond mere rhetoric. GATS PLUS proposes concrete solutions: increased funding for mental health, specialized training for healthcare professionals, and stronger advocacy for decriminalization. <a href="https://aidspan.org/new-safety-protocols-available-for-sexual-and-gender-minorities-in-francophone-africa/" target="_blank" rel="noopener">Furthermore, the adoption of digital security protocols and crisis management strategies for sexual and gender minorities demonstrates a proactive approach, tailored to a context where hostility is not only social but also technological and legal</a>.

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At a time when the United States threatens to turn away from global health, Europe, Africa, and emerging economies have a historic opportunity to redefine the financial and political balances of this struggle. This moment of rupture is also a moment of reinvention. It is up to global actors to prove that the commitment to health does not depend solely on the will of a single power but on a collective responsibility. If this realization does not emerge swiftly, the human toll will continue to rise inexorably.

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And any thoughts about which aspect in the global health initiative sector you’d like to see covered in our newsletter are always welcome and we’d really appreciate suggestions on who can pen an article on it! Anyone who wishes to voluntarily contribute as a guest columnist and provide an incisive analysis or first-person account of what is happening at micro – or macro – levels in the field of global health interventions is also welcome. Any feedback and suggestions in French, Spanish, English can be sent to Ida Hakizinka <a href="mailto:ida.hakizinka@aidspan.org">ida.hakizinka@aidspan.org</a> and/or <a href="mailto:christian.djoko@aidspan.org">christian.djoko@aidspan.org</a>

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If you like what you read, do spread the word around and ask others to subscribe!

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https://aidspan.org:9090/wp-content/uploads/2023/01/WhatsApp-Image-2023-01-16-at-10.07.45-AM-1024x576.jpeg

This article provides an update on the consequences of the US aid freeze, highlighting its impact on the healthcare sector in general, and more specifically on the fight against major infectious diseases.

<strong>Introduction</strong>

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For several decades, the United States has positioned itself as a major player in global public health, notably through the United States Agency for International Development (USAID). Thanks to massive funding, this agency has supported essential programs to combat major infectious diseases such as HIV, tuberculosis and malaria. Its commitment has saved millions of lives and improved access to healthcare in many low- and middle-income countries.

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However, the recent suspension of USAID funding is plunging activists, international organizations, community and civil society organizations and patients into growing uncertainty. Concern is growing about the repercussions of such a decision, the scale of which still seems to be underestimated by the governments of the recipient countries.

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Indeed, these governments have not fully grasped the consequences of the American freeze. They are struggling to grasp the extent of the problem and to devise an appropriate response. This is partly due to the fact that, until now, these governments have had limited visibility and control over these funds, which were often implemented in parallel with national schemes.

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While this shock could, in time, encourage these governments to strengthen their resilience and invest more in their own health systems, the major difficulty lies in the fact that these cuts are not limited to the health sector. In a context of multiple and often competing budget priorities, it will be extremely difficult to compensate for this loss.

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This article offers an up-to-date analysis of the consequences of this suspension. But before getting to the heart of the matter, it takes a closer look at the role and functioning of USAID, in order to better grasp the scale of the impending disaster.

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<strong>Setting the scene</strong>

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The United States has historically played a leading role in official development assistance, particularly in the field of health. USAID manages a budget of $42.8 billion, accounting for 42% of global humanitarian aid. This aid is divided into three main sectors: economic development, humanitarian assistance and health.

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<div align="center"><img class="aligncenter wp-image-32364 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art3-pic1.jpg" alt="" width="627" height="657" />Source: <a href="https://www.pewresearch.org/short-reads/2025/02/06/what-the-data-says-about-us-foreign-aid/">Pew Research Center </a>(Drew DeSilver)</div>
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In the field of healthcare, the United States is the world's leading contributor, investing massively in the fight against HIV, tuberculosis and malaria. Their commitment is particularly influential in the ecosystem of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The African continent is the main beneficiary of this funding, illustrating the scale of the United States' impact on global public health.

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<div align="center"><img class="aligncenter wp-image-32365 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art3-pic2.jpg" alt="" width="540" height="905" />Source: <a href="https://www.thinkglobalhealth.org/article/defining-moment-global-health-funding">Think Global Health (Allison Krugman)</a></div>
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However, the freezing of this aid jeopardizes the fragile balance of many public health programs. This suspension has dramatic consequences for patients, healthcare workers and healthcare systems in many countries, particularly on the African continent.

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<div align="center"><img class="aligncenter wp-image-32366 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art3-pic3.jpg" alt="" width="592" height="867" />Source: <a href="https://www.pewresearch.org/short-reads/2025/02/06/what-the-data-says-about-us-foreign-aid/">Pew Research Center </a>(Drew DeSilver)</div>
<div align="center"></div>
<strong>The impact</strong>

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<em>HIV: a care system in peril</em>

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) funds a major part of the fight against HIV in many countries. The freezing of this aid has immediate and severe repercussions, as evidenced by the <a href="https://www.unaids.org/sites/default/files/media/documents/20250218-US-Shift-Sitrep_ext_en.pdf">UNAIDS Public Brief</a>

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<div align="center"><img class="aligncenter wp-image-32367 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art3-pic4.jpg" alt="" width="627" height="404" />Source : <a href="https://www.unaids.org/sites/default/files/media/documents/20250218-US-Shift-Sitrep_ext_en.pdf">UNAIDS</a></div>
More specifically, this note, with data updated to February 17, 2025, highlights three key points:
<ul>
 	<li>Critical dependence on US funding: In countries such as Côte d'Ivoire, Haiti and Tanzania, over 90% of the HIV budget comes from PEPFAR. Other nations such as Ethiopia, Nigeria and Uganda also rely heavily on this program.</li>
 	<li>Frontline healthcare workers affected: In South Africa, 15,374 PEPFAR-funded healthcare workers are directly affected. In Cameroon, 2,332 professionals, including 258 doctors and nurses, have been laid off.</li>
 	<li>Compromised access to treatment: At least 14 countries are reporting serious disruptions in access to antiretroviral treatment. Haiti and Ukraine report dangerously low stocks, putting thousands of patients at risk.</li>
 	<li>Discontinuation of prevention programs: the DREAMS program, designed to prevent HIV infection among young women, has been suspended in Kenya, Malawi and South Africa.</li>
</ul>
An article published on February 18, 2025 <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.26423">in the Journal of the International AIDS Society entitled "Early impacts of the PEPFAR stop-work order: : a rapid assessment" </a>is also very alarming about the consequences of this freeze.

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<div align="center"><img class="aligncenter wp-image-32368 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art3-pic5.jpg" alt="" width="500" height="380" /></div>
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<em>Tuberculosis: screening and treatment under threat</em>

According to a <a href="https://www.stoptb.org/sites/default/files/documents/Impact%20of%20funding%20freeze%20report_0.pdf">STOP TB Watch Note of February 14, 2025</a>, the USAID freeze has caused serious interruptions in the global response to tuberculosis (TB), particularly in 12 high-burden countries.
<ul>
 	<li>A drop in screening: in Bangladesh, paediatric screening projects have been suspended, while in Cambodia, 100,000 people have not been tested, increasing the risk of undetected transmission.</li>
 	<li>Infrastructures in crisis: Ukraine has lost USAID support for its laboratories, seriously disrupting case detection.</li>
 	<li>Impending drug shortages: Kenya faces an imminent shortage of tuberculosis drugs, while in Ukraine, a crisis is expected as early as September 2025.</li>
 	<li>An interruption in prevention: In Pakistan, all prevention activities have been suspended in 27 districts, increasing the risk of future infections.</li>
 	<li>Closure of specialized care units and mass layoffs of health workers. In Ethiopia, 5,000 USAID-funded health workers are no longer working. In Nigeria, 1,800 health workers in 18 states with high TB prevalence have been laid off.</li>
</ul>
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<em>Malaria: a regression in health progress</em>

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USAID funding plays a crucial role in the fight against malaria, notably through the distribution of impregnated mosquito nets, spraying campaigns and access to treatment. The malaria activists and community health workers we interact with in countless webinars claim that the freeze has already led to :
<ul>
 	<li>Major interruptions: The suspension of funding has led to shortages of essential tests and treatments, particularly in rural areas.</li>
 	<li>A step backwards in prevention: awareness campaigns and mosquito net distribution are cancelled, increasing the risk of epidemics in vulnerable regions.</li>
 	<li>Economic repercussions: The regression in the fight against malaria affects the productivity of exposed populations, aggravating poverty and limiting economic development.</li>
</ul>
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In addition to these aspects, the freeze on US aid funding has led to the suspension of a flagship malaria vaccine development program, disrupting global health research. USAID's Malaria Vaccine Development Program (MVDP), which funds collaborative research between institutions such as Johns Hopkins University in the USA and Oxford University in the UK, has been forced to halt its work. This interruption affects important research aimed at improving the efficacy and duration of recently introduced malaria vaccines.

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The MVDP's aim is "to reduce the impact of malaria on children living in malaria-endemic areas of the world". In sub-Saharan Africa, approximately 450,000 under-5s are killed by malaria each year". <a href="https://www.theguardian.com/global-development/2025/feb/02/trump-aid-spending-freeze-halts-leading-mvdp-malaria-vaccine-programme">Researchers warn that this pause could lead to the further spread of drug-resistant HIV and a significant setback to medical progress. </a>Although the funding freeze was initially scheduled to last 90 days in order to re-evaluate spending, the absence of expert staff in US health agencies to lead this review is causing uncertainty about the future. Other projects, such as the production of active pharmaceutical ingredients for antiretrovirals in Africa, are also threatened by the loss of funds and personnel. The scientific community is calling for a reconsideration of this decision to avoid decades of setbacks in the fight against infectious diseases.

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<em>Polio</em>

Finally, the United States plays an essential role in the Global Polio Eradication Initiative (GPEI), which enables hundreds of millions of children to be vaccinated against polio in over 40 countries every year. They contribute more than a quarter of the initiative's annual budget. <a href="https://betterworldcampaign.org/funding/what-we-know-about-the-pause-on-u-s-foreign-aid">During the 90-day freeze period, up to 110 million children who were due to receive polio vaccines could now find themselves unprotected</a>.

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<strong>Conclusion</strong>

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The USAID funding freeze is a major threat to global public health. By jeopardizing essential programs in the fight against HIV, tuberculosis and malaria, this suspension of aid puts millions of lives at risk. It accentuates health inequalities, weakens already vulnerable healthcare systems and hampers global efforts to control infectious diseases.

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In the face of this crisis, it is imperative that alternatives are found to guarantee the continuity of care and the sustainability of public health initiatives. Increased domestic funding, greater mobilization of other international donors, strategic reallocation of resources and vigorous political advocacy are essential to avoid, at least in the short term, a large-scale humanitarian catastrophe. Global health cannot afford to take a step backwards: action is urgently needed.

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This article takes a dual approach to exploring the issue. First, a dream narrative illustrates the tangible effects of aid suspension on healthcare professionals and vulnerable populations, highlighting the urgency and scale of the challenges. Then, an in-depth analysis draws key lessons from the crisis while emphasizing the opportunities to rethink the financing and organization of the African healthcare sector.

 

The sudden suspension of American aid, notably via the United States Agency for International Development (USAID), has sent shockwaves through many African countries. This decision, whose consequences are particularly serious in the fight against HIV, malaria, tuberculosis, reproductive health and child health, highlights the structural fragility of African healthcare systems. For decades, these systems have been largely supported by external funding, creating a situation of dependency that is now proving to be a tangible danger. Faced with this crisis, Africa finds itself at a decisive turning point: either it continues on the path of dependence, hoping for further international aid, or it seizes the opportunity to thoroughly restructure its health sector and build sustainable health sovereignty.

 

This article takes a two-pronged approach to exploring this issue. First, a narrative dive into a dream I had will highlight the concrete effects of this suspension of aid, illustrating the realities experienced by healthcare professionals and vulnerable populations. This scenario will help us to grasp the urgency and scale of the challenges posed by this new situation. Secondly, an in-depth analysis will draw out the main lessons of this crisis, highlighting the opportunities it offers for rethinking the financing and organization of the African health sector.

 

<strong>The harmattan season and the awakening of the lions</strong>

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I had a dream. A troubling dream, burning with realism, where Africa stood at an uncertain crossroads. The warm harmattan wind blew with unusual harshness across the savannah. This was no mere seasonal breeze, but an allegory of change, challenge and renewal. And in this dream, destinies intertwined: that of a destitute doctor, a desperate mother, a child battling fever and a continent seeking to emancipate itself from a deadly dependency.

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The harmattan was blowing with unusual harshness across the savannah. The dry, dust-laden wind rushed through the winding alleys of the Koroma hamlet, raising ochre clouds that settled in an impalpable veil over the terracotta huts. In the small clinic, Doctor Amadou wiped his sweaty forehead and gazed helplessly at the half-empty shelves of his pharmacy. The pungent smell of disinfectants and fading remedies wafted through the air, but their efficacy would soon no longer suffice. Since the abrupt announcement of the suspension of American aid, stocks of medicines had been melting like raindrops on a dry land.

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In this region, where life was often based on a fragile balance, the sudden disappearance of treatments for malaria, antiretrovirals and vaccines posed a mortal threat. Amadou knew this better than anyone: he had already had to send patients away, explaining that there was nothing left to administer. And that morning, when a young mother, Mariama, crossed the threshold of the clinic, carrying her fever-burning son against her chest, he felt his heart clench. Ibrahim, barely three years old, was suffering from a severe attack of malaria. In the past, a single pill would have been enough to turn the tide. Today, all that remained was hope and prayer.

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A few hundred kilometers away, in the big city of Bamako, the corridors of the Ministry of Health echoed with the worried discussions of experts and politicians. Reports flashed across the desks, each figure testifying to the scale of the impending crisis. One question was on everyone's lips: how to deal with this health catastrophe, the result of a dependency that has been nurtured for too long?

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But in the midst of this storm, a glimmer of audacity was beginning to emerge. In the most visionary circles, the idea of a historic turnaround was germinating. What if, instead of panicking, Africa were to seize this ordeal as an opportunity for transformation? Since 2001, the Abuja Declaration has committed African countries to devoting at least 15% of their national budgets to health. Yet very few countries had met this commitment. Perhaps it was time to reverse the trend, break with the habit of external aid and build a truly autonomous healthcare system.

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In the field, Amadou was already seeing the first signs of this change. Deprived of international resources, some communities were reorganizing. Local collections were set up, community health insurance initiatives were born, and partnerships between local businesses and health institutions began to emerge. Africa, resilient and ingenious, refused to give in.

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Thus ended my dream, a dream imbued with profound meanings and valuable lessons. Allow me to explore some of these illuminating lessons.

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<strong>Deciphering the storm and building for the future</strong>

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The suspension of USAID aid is not just a crisis: it's an eye-opener. It exposes the weaknesses of a development model that has relied too long on international aid.

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<ol>
 	<li><strong><em> Dependence on external aid: a sword of Damocles</em></strong></li>
</ol>
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African healthcare systems have been built with international funding, leaving many countries vulnerable to donor decisions. "<a href="https://www.bbc.com/pidgin/articles/c626y4rq3qwo">Last year, USAID allocated $8 billion in aid to Africa, of which seventy-three percent was dedicated to healthcare</a>," said Jean Kaseya, Africa CDC's director general, on the BBC's Newsday program on January 29, 2025. By way of example, in 2023, Nigeria received almost <a href="https://theconversation.com/us-health-funding-cuts-what-nigeria-stands-to-lose-248921">$600 </a>million in health aid from the United States, representing more than 21% of its national health budget for that year. For its part, <a href="https://www.nature.com/articles/d41591-025-00009-9">South Africa is one of the main beneficiaries of the PEPFAR program, with an envelope of $332.6 million in 2024</a>. However, in recent days, many HIV treatment centers have announced to their distraught patients that their services have been abruptly interrupted. The disruption in the supply of antiretroviral drugs is bound to have dramatic consequences, putting countless lives at risk.

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<div align="center"><img class="aligncenter wp-image-32377 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art2-pic1-1.jpg" alt="" width="627" height="571" /></div>
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Although the USA has made a significant contribution to global health efforts, its disproportionate influence is a structural obstacle to equity and justice, both in the field and on a global scale. While it is easy to measure the consequences of their withdrawal, it is more difficult to assess the cost of their "generosity".

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When it comes to the production of academic knowledge, global health is a highly centralized field, where a handful of players, mainly based in the USA (and Western Europe), hold considerable power, to which others must submit or which they seek to imitate. This domination is not limited to funding: it shapes research orientations, methods, training, scientific publications, programmatic priorities and governance structures. This intellectual monopoly engenders and perpetuates inequitable practices that serve above all the interests of the United States, often to the detriment of the countries and populations for whom, with whom and in whose name this knowledge is supposed to be produced.

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Faced with such an imbalance, how should the world react when the power and influence of a single country are so deeply rooted in global structures that its decisions alone can destabilize entire systems?

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Like a tree whose roots sink into unstable soil, these systems falter as soon as the source of funding dries up. This crisis is a cruel reminder that dependence on external aid is not a viable solution. Above all, it highlights the urgent need for governments to step up their commitment to ensuring sufficient and sustainable domestic funding. The direction is uncertain and, to a large extent, beyond our control. However, it is an opportunity to express our aspirations and create new models. We are faced with a miniature space on which other horizons can be imagined.

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<ol start="2">
 	<li><strong><em> Investing in health: an underestimated economic lever</em></strong></li>
</ol>
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In a document entitled <a href="https://www.afro.who.int/sites/default/files/2019-03/Productivity%20cost%20of%20illness%202019-03-21.pdf"><em>A Heavy Burden: The Productivity Cost of Illness in Africa</em></a>, published in 2019, the World Health Organization (WHO) estimates the loss of productivity caused by diseases and epidemics affecting the population of the 47 countries in the Africa region at 2,400 billion international dollars a year, equivalent to 630 million lost years of working life. The report also highlights the fact that 14 million Africans fall into poverty every year as a result of ever-increasing healthcare costs. "<a href="https://www.lemonde.fr/afrique/article/2019/10/02/en-afrique-les-maladies-plombent-le-budget-des-menages-et-l-economie-des-pays_6013972_3212.html?fbclid=IwAR1SSM9lDtJ1UBvREFis3YxD4bmk8Kb3n_9St7TJzUevu2GYkGLDRfGiof8">With around 100 health emergencies a year, costs are exploding for Africans, whose per capita out-of-pocket payments have risen from $15 in 1995 to $38 in 2014.</a>"

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The 2024 Global Spending <a href="https://iris.who.int/handle/10665/379750">on Health: Emerging from the Pandemic </a>report, published by the World Health Organization (WHO), reveals a decline in per capita public spending on health in 2022 compared to 2021, irrespective of countries' income levels. This trend follows a significant increase during the early years of the pandemic. The WHO also points out that, in 30 low- and lower-middle-income countries, out-of-pocket expenses remain the main source of financing for the healthcare system. Indeed, in 20 of these countries, more than half of total healthcare expenditure comes directly from patients' pockets, exacerbating the cycle of poverty and vulnerability.

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Too often perceived as a cost or an expense, health is in fact a strategic investment. A healthy population is more productive, generates fewer unforeseen expenses and enables more stable economic growth. To ignore this aspect is to sacrifice the economic and human potential of a young and dynamic continent. The report <a href="https://www.who.int/publications/i/item/9789240041059"><em>Saving Lives, Spending Less: The Case for Investing in Noncommunicable Diseases </em></a>(2021) analyzes the situation in 76 low- and lower-middle-income countries. The authors identify the "best options" for combating non-communicable diseases (NCDs) and demonstrate that every dollar invested in scaling up these interventions in the countries concerned could generate a return of US$7, which could represent a total of US$230 billion by 2030.

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<ol start="3">
 	<li><strong><em>Building health sovereignty</em></strong></li>
</ol>
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One of the most encouraging aspects of this crisis is that it could potentially lead to an increase in domestic health funding. Indeed, if the suspension of US aid has had such a significant impact and such serious consequences, it is precisely because health funding in Africa has never been up to the level of the health challenges facing the continent. The cases of Nigeria and South Africa mentioned above illustrate our point once again. Despite the Abuja Declaration of 2001 and numerous recent commitments by governments to devote up to 15% of their budgets to health, the situation has not really changed (see Figures 1 and 2).

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<div align="center"><img class="aligncenter wp-image-32378 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art2-pic2-1.jpg" alt="" width="627" height="261" />. Source : AFIDEP 2023</div>
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<div align="center"><img class="aligncenter wp-image-32379 size-full" src="https://aidspan.org/wp-content/uploads/2025/02/Art2-pic3.jpg" alt="" width="627" height="268" />Source: AFIDEP 2023</div>
<div align="center"></div>
Long before the suspension of US aid, the COVID-19 pandemic highlighted the need for African countries to build sustainable sovereignty. This implies, as <a href="https://aidspan.org/augmenter-le-financement-interieur-de-la-sante-en-afrique-enjeux-et-necessite/">Aidspan </a>has regularly stressed, a substantial, systemic and sustainable increase in domestic funding for the health sector.

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Long before U.S. aid was suspended, the COVID-19 pandemic brought into sharp focus the need for African countries to build sustainable health sovereignty. <a href="https://www.nature.com/articles/d41591-025-00009-9">As Ntobeko Ntusi in <em>Nature magazine</em></a>rightly reminds us: "If African countries, for example, had taken control of HIV treatment in the region, PEPFAR's retreat would have had only a limited impact. If Africa had a regional vaccine manufacturing system, the continent would not have been left behind during the COVID-19 or Mpox crises".

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Taken in isolation, African states remain vulnerable, hampered by limited resources that impede the development of a robust local pharmaceutical industry. It is against this backdrop that the creation, in 2021, of the African Medicines Agency (AMA) marks a strategic step forward. With a mandate to pool resources and expertise on a continental scale, the AMA could play a decisive role in reducing Africa's pharmaceutical dependence. Provided, however, that it receives substantial political, financial and material support from its member states. By reinforcing access to safe, affordable medical products, it would not only contribute to the continent's health autonomy, but also to its resilience in the face of the gradual disengagement of international donors, particularly American.

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Making Africa the master of its health destiny requires a profound rethinking of priorities: intensifying local drug production, investing in the training of health professionals and modernizing medical infrastructures. Like a lion that must learn to hunt rather than rely on opportunistic carcasses, the continent can no longer afford chronic dependence on external funding for public health.

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<strong>Conclusion</strong>

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The harmattan, though merciless, often heralds the rainy season and the rebirth of parched lands. In the same way, this sudden suspension of foreign aid could be the catalyst for change, a test that forces African states to reconsider their approach to public health.  <a href="https://speakingofmedicine.plos.org/2025/02/14/stop-looking-north-look-to-the-world-can-we-imagine-global-health-without-the-usa-at-its-centre/">Cristian Montenegro's words speak for themselves</a>:

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<em>"The withdrawal of the United States from WHO and the potential collapse of USAID have revealed the extent to which the field has become dependent on a single actor. More precisely, they reveal how the global health system has been designed around this dependence. This is a difficult moment, but also an inflection point. The temptation to restore the status quo and breathe a sigh of relief is strong - to see the US return to the center, injecting resources to keep existing structures afloat. Others might wish to replace American leadership with an equally centralized arrangement, but this would only perpetuate the status quo, plugging systemic gaps rather than addressing the deeper inequalities that have long defined global health. Such relief would be understandable, but ultimately short-sighted. Instead, we must use this moment to confront the deeper structural inequalities that have shaped global health, and work towards meaningful transformation.</em>"

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While the shadow of precariousness hangs over the immediate future in many African countries, it can also be dispelled by a strong political will and the strategic mobilization of local resources. Health is not a cost, but a vital investment in the continent's development. Africa must not only weather this storm; it must emerge stronger, more resilient and, above all, in control of its own health destiny. Let's hope that the <a href="https://x.com/AfricaCDC/status/1890400125102485706">high-level meeting of African leaders, held on the sidelines of the African Union summit on February 14, 2025</a>, marks a decisive turning point in favor of national health financing and the effective alignment of investments with the continent's priorities. Sustainable solutions exist: the African Epidemic Fund offers an autonomous response to crises, independent of donors, while health taxes, strategic partnerships and the <a href="https://www.nepad.org/publication/african-leadership-meeting-investing-health-declaration-briefing-paper">ALM Declaration </a>are essential levers for sustainable financing.

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South Africa and the United Kingdom to co-host Global Fund’s Eighth Replenishment to combat AIDS, Tuberculosis, and Malaria

The article talks about the cooperation between South Africa and the United Kingdom to co-host a major fundraising event for the Global Fund. This event aims to gather funds to fight AIDS, tuberculosis, and malaria for the 2027-2029 cycle. The announcement was made in Johannesburg when they launched a plan to raise these funds. 

 

<a href="https://www.theglobalfund.org/en/news/2025/2025-02-18-south-africa-united-kingdom-unite-co-host-eighth-replenishment/">On 18 February 2025, South Africa and the United Kingdom (UK) announced they would work together to co-host the Global Fund’s Eighth Replenishment to raise money to fight AIDS, tuberculosis, and malaria.</a> They made this announcement in Johannesburg while launching the Global Fund’s Investment Case, a plan to raise $18 billion, for 2027-2029 cycle. <a href="https://www.theglobalfund.org/en/news/2025/2025-02-18-global-fund-partnership-launches-investment-case-eighth-replenishment/">The Investment Case contains ambitious goals to save 23 million lives, reduce deaths from these diseases by 64%, and strengthen global health security</a>. This announcement happened alongside the first meeting of the Group of Twenty (G20) Foreign Ministers in Johannesburg, held for the first time in Africa, emphasizing the group's emphasis on global cooperation, fairness, and sustainable development. The two-day G20 Foreign Ministers Meeting provides a platform where leaders discuss global political issues, review key achievements of South Africa’s G20 Presidency, and reflect on the G20’s impact over the past 20 years.

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<strong>The Global Fund’s impact on strengthening health systems</strong>

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The Global Fund assists countries in strengthening their healthcare systems, enhancing services, and employing cutting-edge technologies while also minimizing disease impacts. <a href="https://www.theglobalfund.org/en/results/">Since its establishment in 2002, the Global Fund has played a crucial role in saving 65 million lives by funding health initiatives that deliver vital tools and services to prevent, diagnose, and treat HIV, TB, and malaria</a>. For instance, in Zambia, life expectancy increased from 43 years in 2002 to 58 years in 2021, largely due to a decline in deaths caused by AIDS, TB, and malaria. Additionally, other nations that have benefited from Global Fund support have experienced significant advancements by collaborating to combat these diseases and enhance overall health. To prepare for potential future pandemics, the organization plans to allocate approximately one-third of the requested funding towards essential health infrastructure, including laboratory networks, disease surveillance, and healthcare worker training.

&nbsp;

<strong>South Africa and the UK unite for global health solidarity</strong>

&nbsp;

South African President Cyril Ramaphosa emphasized the significance of international cooperation in health initiatives. “Our pursuit of global health is a collective endeavor,” he remarked. “Our partnership with the Global Fund has been crucial for preserving lives and fortifying health systems across our country and continent. Co-hosting the Global Fund’s Replenishment aligns seamlessly with South Africa’s leadership in the G20 this year, as substantial investment in health represents one of the best avenues for fostering solidarity, equality, and sustainable development.”

&nbsp;

In agreement, the UK reaffirmed its commitment to eliminating these life-threatening diseases. Over the last twenty years, the UK has been a leading donor to the Global Fund, contributing billions to fund life-saving treatments, prevention efforts, and community-led health programs. UK Foreign Secretary David Lammy stressed the necessity of continuous action, declaring, “The UK is honored to partner with South Africa as co-hosts for the Global Fund’s Replenishment. Over the past two decades, the Global Fund has played a role in saving 65 million lives. Nonetheless, challenges posed by AIDS, tuberculosis, and malaria continue, as stigma, antimicrobial resistance, and the climate crisis impede our progress toward eradication. The UK is steadfast in its commitment to tackling global health challenges, not only because it is the right moral choice but also as it furthers our Plan for Change in the UK by promoting global stability and development.”

&nbsp;

<strong>Enhancing global health leadership</strong>

&nbsp;

Peter Sands, the Executive Director of the Global Fund, praised South Africa and the UK for their strong commitment to improving global health. He emphasized that continuous funding is necessary to fight diseases like HIV, TB, and malaria. According to Sands, both nations play key roles in ensuring health is accessible to everyone and in strengthening the world’s ability to respond to urgent health threats. Sands also pointed out that leaders like South African President Cyril Ramaphosa and UK Prime Minister Keir Starmer are pushing for global cooperation to make healthcare a top priority and to create a fairer, healthier world.

&nbsp;

South Africa’s Health Minister, Aaron Motsoaledi, reiterated the importance of ongoing efforts to prevent and treat diseases. He emphasized how collaborations, especially with the Global Fund, have been instrumental in significantly lowering HIV and TB rates in South Africa. In recent decades, the country has seen a 75% decrease in new HIV infections, while tuberculosis cases have fallen by over 66%. Nevertheless, Motsoaledi highlighted that ongoing support is essential, particularly for the most at-risk groups. He referred to the forthcoming Global Fund’s Eighth Replenishment as a crucial opportunity for countries to unite, reinforce their commitments, and advance the progress that has already been achieved.

&nbsp;

In addition to government efforts, the success of the Eighth Replenishment will rely on the active participation of the private sector and civil society organizations. Contributions from the private sector have increasingly become important in financing innovative health solutions, improving treatment availability, and creating new technologies to combat infectious diseases. Meanwhile, civil society organizations have played a key role in advocating policy reforms, mobilizing communities, and ensuring that essential resources reach the most marginalized populations. A vital aspect of this replenishment will be making sure that investments yield concrete results, especially in addressing health disparities. Experts emphasize the necessity of channeling funds toward strengthening health systems, improving local capabilities, and guaranteeing that vulnerable communities gain access to essential interventions.

&nbsp;

<strong>Looking forward</strong>

&nbsp;

As the world readies for the Global Fund’s Eighth Replenishment, the joint hosting of the initiative by South Africa and the UK represents a critical step in maintaining global health financing and intervention strategies. With billions of dollars at stake, the outcome of this funding initiative will significantly influence the global capacity to halt new infections, deliver life-saving treatments, and enhance healthcare systems, particularly in at-risk regions. In the coming months, stakeholders, including governments, donors, and advocates, will collaborate to rally support, secure funding pledges, and strive towards ambitious financial targets.

&nbsp;

The Global Fund’s Eighth Replenishment is an important turning point for all stakeholders to pull together efforts to combat AIDS, TB, and malaria. Global leaders, civil society organizations, and private sector partners all have important roles in making it a success. By continuing to team up and invest in health programs, the goal of a world without these deadly diseases moves closer to reality.

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The future of global health financing: Navigating United States policy shifts and the Global Fund’s sustainability

This article explores the Global Fund’s financial future as shifting United States policies threaten its stability. President Trump’s 2025 executive order freezing foreign aid endangers United States contributions, which provide 34% of the Fund’s funding. Cuts could disrupt global health efforts and destabilize replenishment cycles. To mitigate risks, the Global Fund must diversify funding sources by engaging high-income and emerging economies, strengthening domestic resource mobilization, and adopting innovative financing strategies. Ensuring efficiency and maintaining donor confidence will be crucial for sustaining progress in global health.

 

Since its inception in 2002, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has actively led efforts to combat these three diseases in developing countries. By February 2025, the organization had secured $78 billion from various donors to finance health programs in low- and middle-income countries. The United States remains the largest contributor, providing 34% of the Global Fund’s total funding. However, uncertainties arising from shifts in United States policies could impact financial sustainability and the broader global health landscape.

 

<strong>The evolution of United States support for the Global Fund</strong>

&nbsp;

The United States government played a key role in creating the Global Fund, with the Bush administration making the <a href="https://2001-2009.state.gov/s/gac/rl/fs/29706.htm">initial contribution</a> and integrating its support into the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003. <a href="https://www.ncbi.nlm.nih.gov/books/NBK207014/">Aligning the Global Fund with PEPFAR</a> enabled a unified strategy to combat HIV/AIDS, particularly in low-income countries. <a href="https://data-service.theglobalfund.org/downloads">Data obtained from the Global Fund</a> website indicate that during the Bush administration, the United States contributed $1.5 billion for 2001-2005, $1.2 billion for 2006-2007, and $2.8 billion for 2008-2010, to the Global Fund. During the Obama administration, the United States maintained strong financial support to the Global Fund. It contributed $3.7 billion, $3.8 billion, and $3.7 billion for the 2011-2013, 2014-2016, and 2017-2019 cycles, respectively. Bipartisan backing during this period strengthened the Global Fund’s ability to expand life-saving interventions worldwide.

The <a href="https://www.cgdev.org/blog/looking-back-looking-ahead-trends-us-multilateral-funding-and-what-trumps-second-term-could">Trump first-term administration shifted the United States approach to Global Fund financing</a> by repeatedly proposing funding cuts in its annual budget requests to Congress and reducing its pledge for the next replenishment period. It proposed a $3.3 billion pledge, matching $1 for every $3 contributed by other donors—over $1 billion less than the previous United States pledge under the Obama administration, which had committed up to $4.3 billion with a $1-for-$2 matching ratio. However, Congress ultimately rejected these funding reductions. <a href="https://data-service.theglobalfund.org/downloads">Data obtained from the Global Fund</a> website show that from 2020 to 2022, the United States contributed $7.8 billion to the Global Fund, including $3.5 billion in COVID-19 emergency relief. The <a href="https://www.theglobalfund.org/en/news/2022/2022-03-28-president-biden-signals-a-6-billion-pledge-for-the-seventh-replenishment/">Biden administration reinvigorated United States support by pledging $6 billion for the 2023-2025 cycle</a>, reaffirming the country’s zeal in combating the three diseases. As of 5 February 2025, the United States had provided a total of $26.3 billion to the Global Fund, representing 34% of overall contributions (Table 1). This solidified its position as the leading donor to the Global Fund by a wide margin, with France in second place at $8.4 billion (10.8%), followed by the United Kingdom, Germany, Japan, and Canada.

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<div align="center">
<p style="text-align: center;">Table 1: Donor contributions to the Global Fund as of 5 February 2025</p>

<table style="width: 451.6pt; border-collapse: collapse;" width="602">
<tbody>
<tr style="height: 31.0pt;">
<td style="width: 225.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 31.0pt;" width="300">Donor</td>
<td style="width: 161.5pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 31.0pt;" width="215">Contribution to the Global Fund as of 5 Feb 2025</td>
<td style="width: 65.1pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 31.0pt;" width="87">Proportion</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">United States</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $ 26,312,167,650</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">33.53%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">France</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   8,441,539,523</td>
<td style="width: 65.1pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">10.76%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">United Kingdom</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   7,675,506,897</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">9.78%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Germany</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   6,207,155,300</td>
<td style="width: 65.1pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">7.91%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Japan</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   4,875,227,525</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">6.21%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Canada</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   4,077,706,037</td>
<td style="width: 65.1pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">5.20%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">European Commission</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   4,026,540,590</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">5.13%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Bill &amp; Melinda Gates Foundation</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   3,615,261,989</td>
<td style="width: 65.1pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">4.61%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Sweden</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   1,939,030,096</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">2.47%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">All other countries</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   9,487,405,678</td>
<td style="width: 65.1pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">12.09%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">All other private sector &amp; NGOs</td>
<td style="width: 161.5pt; border: solid lightgrey 1.0pt; border-top: none; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $   1,820,337,439</td>
<td style="width: 65.1pt; background: #D9E1F2; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">2.32%</td>
</tr>
<tr style="height: 15.75pt;">
<td style="width: 225.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="300">Total contribution</td>
<td style="width: 161.5pt; border-top: none; border-left: solid lightgrey 1.0pt; border-bottom: solid windowtext 1.0pt; border-right: solid lightgrey 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="215"> $ 78,477,878,724</td>
<td style="width: 65.1pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; height: 15.75pt;" width="87">100.00%</td>
</tr>
</tbody>
</table>
<p style="text-align: center;">Source: Data obtained from the Global Fund’s <a href="https://data-service.theglobalfund.org/downloads">Pledges and Contributions</a></p>

</div>
&nbsp;

<strong>Uncertainty and risks following potential United States policy changes</strong>

&nbsp;

The United States contributions to the Global Fund remain uncertain as political and economic pressures grow, despite the country’s long-standing commitment to global health. After beginning his second term, President Trump significantly altered United States funding rules for overseas health projects. On January 20, 2025, he issued an <a href="https://www.whitehouse.gov/presidential-actions/2025/01/reevaluating-and-realigning-united-states-foreign-aid/">executive order</a> freezing new foreign aid obligations and disbursements for ninety days to allow for a comprehensive evaluation. This decision immediately disrupted PEPFAR-funded programs. Although the <a href="https://www.state.gov/emergency-humanitarian-waiver-to-foreign-assistance-pause/">Secretary of State granted a temporary waiver for PEPFAR</a> a week later, allowing some activities to continue, many other health initiatives remain in limbo.

&nbsp;

If conservative groups succeed in pushing for PEPFAR funding cuts, they could jeopardize the Global Fund’s financial stability. A reduction in United States contributions would disrupt global health efforts, cutting off life-saving HIV, tuberculosis, and malaria interventions for millions who rely on Global Fund support. Fluctuating United States commitments may further destabilize the Global Fund’s replenishment cycles, forcing it to adopt emergency funding measures or scale back planned programs. Reduced United States contributions could also weaken donor confidence, discouraging other countries from increasing their commitments due to fears of instability in multilateral health financing. This would be a huge setback for the upcoming <a href="https://aidspan.org/a-view-from-different-angles-the-global-funds-upcoming-8th-replenishment-part-1/">Global Fund’s eight replenishment</a>.

&nbsp;

<strong>Alternative strategies available to the Global Fund</strong>

&nbsp;

To address the uncertainty arising from the United States' recent intention to freeze aid, the Global Fund should reconsider its resource mobilization strategies to diversify funding sources. The organization could explore engaging high-income donors such as France, the United Kingdom, and Germany to secure additional contributions. The organization also needs to seek increased financial commitments from emerging economies such as China, India, and Gulf countries to diversify sources of funds and reduce dependence on traditional donors.

&nbsp;

At the same time, it is necessary to accelerate domestic resource mobilization efforts, calling on recipient countries to contribute more to health sectors and end their reliance on foreign aid. Some countries, including <a href="https://africa.businessinsider.com/local/markets/ghana-scrambles-to-cover-dollar156-million-shortfall-after-us-aid-freeze/40nqzvz">Ghana</a>, have already signaled that they would fill gaps in funding caused by recent United States freezes in assistance. Strengthening such a move will go a long way towards long-term health financing sustainability.

&nbsp;

Innovative financing options such as health bonds, blended finance models, and debt-for-health swaps could attract private capital and sustain funding. Efficiency improvements, including optimized procurement, cost-effective interventions, and stronger financial oversight, would maximize impact and maintain donor confidence.

&nbsp;

Advocacy efforts involving civil society, patient networks, and global forums like the Group of Seven (G7), the Group of Twenty (G20), and World Economic Forum can help sustain political commitment. Aligning with global health priorities, such as pandemic preparedness, Universal Health Coverage, and the Sustainable Development Goals, would further strengthen the Global Fund’s appeal to diverse funders.

&nbsp;

<strong>Conclusion</strong>

&nbsp;

The Global Fund faces a pivotal moment as shifting United States policies threaten its financial stability and global health efforts. While the United States has been its largest donor, political and economic uncertainties could disrupt future contributions, potentially weakening multilateral health financing. To safeguard its mission, the Global Fund must diversify its funding sources by engaging high-income and emerging economies, strengthening domestic resource mobilization, and exploring innovative financing mechanisms. Enhancing efficiency, maintaining donor confidence, and aligning with global health priorities will be essential for resilience. By adapting to evolving challenges, the Global Fund can continue driving progress in the fight against AIDS, tuberculosis, and malaria.

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The Global Fund’s $18 billion appeal for 2027-2029 cycle: An Investment Case to combat HIV, Tuberculosis, and Malaria

The article highlights the Global Fund's investment case that seeks funding of $18 billion for the 2027-2029 grant period aimed at fighting HIV, tuberculosis, and malaria. It highlights the positive effects of complete funding, such as saving countless lives, preventing new infections, and enhancing health systems to be better equipped for future health emergencies. In addition to health benefits, this investment is expected to yield considerable economic returns by decreasing healthcare expenses and increasing productivity.

 

<a href="https://www.theglobalfund.org/en/news/2025/2025-02-18-global-fund-partnership-launches-investment-case-eighth-replenishment/">The Global Fund is seeking $18 billion to enhance and broaden its initiatives in combating HIV, tuberculosis (TB), and malaria—three of the deadliest diseases globally</a>. This funding will support the continuation of life-saving programs, accelerate efforts to decrease infections and fatalities, and strengthen healthcare systems to better tackle future health challenges. During the 2027-2029 grant cycle, the funding will be allocated to supply medication, preventive tools, and healthcare services to millions in need. If this funding goal is achieved, it has the potential to save millions of lives, avert hundreds of millions of new infections, and enhance global preparedness for future health emergencies.

&nbsp;

<strong>South Africa and the United Kingdom to co-host the Global Fund’s Eighth Replenishment</strong>

&nbsp;

<a href="https://www.theglobalfund.org/en/news/2025/2025-02-18-south-africa-united-kingdom-unite-co-host-eighth-replenishment/">The Global Fund launched its Investment Case on 18 February 2025 during a meeting in Johannesburg, South Africa. At the meeting, South Africa and the United Kingdom (UK) jointly announced that they would co-host the Global Fund's Eighth Replenishment of funds to combat AIDS, TB, and malaria</a>. This announcement coincided with the first-ever Group of Twenty (G20) Foreign Ministers' meeting in Africa, underscoring the G20’s dedication to global cooperation, equity, and sustainable development. The Investment Case sets forth ambitious goals, targeting the saving of 23 million lives, a 64% reduction in deaths from these diseases, and the enhancement of global health security.

&nbsp;

<strong>Lives at stakes</strong>

&nbsp;

The $18 billion investment holds great promise. If fully funded, it will prevent 400 million new infections, save 23 million lives, and reduce deaths from HIV, TB, and malaria from 2.3 million in 2023 to 920,000 in 2029. Beyond saving lives, this funding will improve health systems to address current and future health emergencies, helping lower-income countries better prepare for the next pandemic.

&nbsp;

The time to act is now. The COVID-19 pandemic exposed the perils of inadequate health systems, as care disruptions contributed to an increase in instances of malaria and tuberculosis. Health disparities are still growing because of economic hardships and climate change. Two decades of progress in the fight against these diseases will be lost if immediate action is not taken.

&nbsp;

<strong>A smart investment in health and economy</strong>

&nbsp;

Allocating $18 billion towards combating HIV, TB, and malaria goes beyond just protecting lives—it’s also a sound financial choice. The Global Fund indicates that for every dollar spent, there could be a return of $19 in health and economic benefits, culminating in a total effect of $323 billion by 2029.<a href="https://aidspan.org/the-freeze-on-us-aid-an-assessment-of-the-situation/"> This occurs because individuals in better health are more capable of working and contributing to their communities, governments and families incur lower costs for expensive medical care, and local economies benefit from having fewer sick individuals</a>. Thus, investing in global health not only saves lives but also bolsters economies and enhances overall well-being.

&nbsp;

These illnesses not only worsen the health of individuals but also weaken economies in most countries. Sick people in most cases are unable to work, leading to decreased economic growth. High medical costs burden family budgets, and it becomes harder to maintain the basics and drive them further into poverty. Prevention and care expenditures allow governments to avoid such costs, protect public health, and promote economic stability.

&nbsp;

<strong>Where the Funds will be used</strong>

&nbsp;

The $18 billion that the Global Fund aims to raise will be utilized for maximum effectiveness. This funding will enable more individuals to receive life-saving treatments for HIV, TB, and malaria, while also enhancing health and community systems to provide care more effectively. Despite progress in the battle against HIV, a considerable number of those infected still lack access to treatment, and high infection rates persist due to insufficient preventive measures. To tackle this issue, the Global Fund aims to enhance access to HIV treatments, particularly for vulnerable groups, while also bridging the gaps in testing and treatment services.

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In its efforts against TB, the Global Fund plans to improve the availability of diagnostics and treatment, especially for drug-resistant TB, which remains a considerable public health concern. The use of advanced screening technologies, such as digital X-rays and AI-assisted detection tools, will be vital in identifying and treating TB cases sooner, thereby decreasing transmission rates.

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For malaria, the emphasis will be on distributing insecticide-treated mosquito nets, introducing new malaria vaccines, and enhancing seasonal malaria chemoprevention to support at-risk groups, specifically children under five and expectant mothers. The impact of climate change on the spread of malaria to new areas necessitates an urgent escalation of interventions to prevent outbreaks from becoming overwhelming. Additionally, a segment of the funding will be dedicated to strengthening health systems, which includes training healthcare professionals, enhancing disease surveillance, and ensuring effective supply chains for medical supplies. Strengthening health systems will enable nations to more effectively address these three diseases and any emerging health issues.

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<strong>Promoting domestic funding commitment</strong>

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The appeal for $18 billion seeks to attract donor support, while the rationale for investment also underscores the significance of domestic financial contributions. The Global Fund anticipates that countries receiving aid will co-finance the health programs, which will support the long-term sustainability of health initiatives. Enhancing national health budgets and encouraging local ownership of disease response plans will be essential for achieving a lasting impact.

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The Global Fund is also working with businesses, charities, and international organizations to help governments improve healthcare funding. Partnerships with technology companies and drug manufacturers are especially important because they help make life-saving medicines more affordable and improve how healthcare services are delivered. Collaborating on resources, knowledge, and innovative concepts enhances the battle against HIV, TB, and malaria. When nonprofits, corporations, and governmental bodies unite, they can achieve greater results and accelerate progress toward eradicating these harmful diseases.

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<strong>The repercussions of inaction</strong>

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If funding falls short, the consequences will be dire. A funding shortfall could trigger a resurgence of HIV, TB, and malaria, undoing decades of advancements. This would lead to millions of avoidable fatalities and exacerbate global health inequalities, putting the most at-risk communities in even greater jeopardy.

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Insufficient investment would further undermine health systems, rendering them unprepared to tackle future pandemics. The COVID-19 crisis highlighted the significance of robust healthcare infrastructure, and inaction at this time would result in the world being ill-equipped for the next health emergency.

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<strong>A call to action</strong>

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The Global Fund's request for $18 billion is not just a call for financial assistance; it is a persuasive invitation for governments, donors, and health advocates to renew their commitment to the fight against HIV, TB, and malaria. This funding is essential not just for delivering medicine and prevention tools at this moment but also for bolstering healthcare systems so they can keep saving lives in the future. When global leaders and donors consider their contributions, they must understand that their support will influence whether we maintain our momentum in combating these diseases or jeopardize the significant progress and achievements made in recent years.

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The choice is clear: act immediately to intensify the battle against these deadly diseases or let them continue to thrive and reverse the advances made in global health. Through decisive action and steadfast dedication, the world can confront this challenge and move toward a future free of HIV, TB, and malaria.

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Behind the struggles: A report highlighting mental health issues among activists working alongside sexual and gender minorities in French-speaking Africa

This article presents the report Behind the Struggles by The Global Alliance of Communities for Health and Rights (GATS PLUS), which examines the mental health of activists defending sexual and gender minorities in French-speaking Africa. In a context of criminalization, this issue, often relegated to the background in HIV control programs despite the 95-95-95 objectives, is nonetheless becoming essential. Faced with constant stress and multiple pressures, these activists have to deal with major challenges, including the demands of donors and a hostile working environment. The report highlights these realities and makes a number of recommendations: increased funding for mental health, appropriate training for health professionals and stronger advocacy for decriminalization.

 

<strong><em>Introduction</em></strong>

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On October 10, 2024, the <a href="https://wmhdofficial.com/about-2024/">World Federation for Mental Health </a>celebrated its 75<sup>th </sup>anniversary under the theme "<em>It's time to prioritize mental health in the workplace</em>".  This theme is yet another reminder of the importance of mental health in the workplace, especially when working with marginalized communities with limited civic space

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Before getting to the heart of the matter, let's recall one of the most widely recognized definitions of mental health. According to the World Health Organization (WHO), it is defined as <em>"a state of mental well-being that enables us to cope with life's stressors, realize our potential, learn and work well, and contribute to community life. It is an integral part of health and well-being, which underpins our individual and collective ability to make decisions, build relationships and shape the world in which we live. Mental health is a fundamental human right. It is also an essential aspect of personal, community and socio-economic development."</em>

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Yet the mental health of activists defending sexual and gender minorities (MSG) remains largely ignored in programs to combat HIV, tuberculosis and malaria. In hostile legal contexts where the criminalization of sexual minorities persists, these human rights defenders find themselves on the front line, exposed to constant pressure and recurrent violations of their own fundamental rights.

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The <a href="https://www.coalitionplus.org/2024/10/10/rapport-derriere-les-luttes-par-agcs-plus-2024/">"Behind the Struggles" report, </a>published by the Global Alliance of Communities for Health and Rights (GATS PLUS) on the occasion of World Mental Health Day 2024, highlights the psychological challenges faced by activists in Côte d'Ivoire, Guinea and Burkina Faso. By documenting their realities, it calls on donors, notably the Global Fund, to fully integrate mental health into their intervention and funding strategies.

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<strong><em>Mental health, a blind spot in HIV programs</em></strong>

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Efforts to combat HIV in sub-Saharan Africa, particularly in French-speaking Africa, are still largely focused on medical care, with psychosocial care taking a back seat. Although UNAIDS targets 95-95-95 and 10-10-10 aim for a global approach, they do not sufficiently integrate mental health, which is crucial for key populations and the activists who support them. The latter, on the front line in defending human rights, operate in highly discriminatory and anxiety-provoking environments, seriously damaging their psychological well-being.

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While the Global Fund (GF) has taken steps to include mental health in its country programs, these efforts remain insufficient. In the last funding cycle (GC7), the mental health module was little used by countries, as revealed by <a href="https://www.theglobalfund.org/media/13448/trp_2023-observations_report_en.pdf">the report of the Technical Review Panel </a>for Windows 1 and 2. This low prioritization reflects a lack of systemic recognition of the inseparable link between mental health and the fight against HIV.

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The <em>Behind the Struggles </em>report highlights the harrowing reality of activists working in contexts where laws criminalizing LGBTQI+ people remain in force. In Côte d'Ivoire, Guinea and Burkina Faso, these human rights defenders operate in a hostile social and legal environment that undermines their commitment and well-being.

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While medical care is relatively accessible, psychosocial support remains largely neglected, exposing these activists to chronic stress, anxiety and post-traumatic stress disorder. The repercussions are manifold: burnout, severe depression, and a high turnover rate within organizations, exacerbated by the forced exile of many activists to countries in the North. This situation illustrates a major flaw in the response to the challenges of public health and the defense of fundamental rights.

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<strong><em>Some of the mental health challenges facing activists</em></strong>

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The report <em>behind the struggles </em>highlighted many challenges including:

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<strong>Anxiety-provoking environment: </strong>The context of criminalization of identities in which community leaders evolve is a constant source of stress and anxiety. Many of them internalize this marginalization and see themselves as outlaws, living in perpetual anxiety. This oppressive climate drives many activists into exile as soon as an opportunity arises, weakening the rights movement and hampering the continuity of struggles.

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<strong>Donor pressure</strong>: the demands of donors, often focused on rigid results-based management, rarely take into account the well-being of activists. The quest for efficiency takes precedence over the human factor: no matter how exhausted activists are, objectives must be met and reports submitted on time. This approach, insensitive to the realities on the ground, accentuates the psychological precariousness of human rights defenders.

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<strong>The toxicity of the movement itself</strong>: the working environment for activists is itself a major source of stress. The scarcity of funding fuels fierce and sometimes unfair competition between organizations, forcing some to use questionable strategies to capture the attention of development partners. This unbridled competition, far from strengthening solidarity, contributes to the isolation and fragility of activists, already facing countless external pressures

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<strong><em>Recommendations and prospects for an inclusive response</em></strong>

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The Global Alliance of Communities for Health and Rights (GATS PLUS), through its "Behind the Struggles" report, calls on donors, including the Global Fund, to adopt a more holistic approach to the fight against HIV, tuberculosis and malaria in French-speaking Africa. The report's key recommendations include:

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<u>Increased funding for mental health services</u>: It is essential to develop psychosocial support programs specifically for activists and key populations, to provide them with appropriate support in the face of the pressures of activism in hostile contexts.

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<u>Strengthen the training of healthcare professionals</u>: The report calls for increased training of healthcare professionals in the areas of mental health and the needs of MSG. This includes the ability to manage trauma and respond sensitively to the realities of criminalized populations.

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<u>Create support spaces for activists</u>: In the face of constant pressure, spaces for discussion and sharing must be created to enable activists to recharge their batteries and manage their stress. These spaces could be integrated into community initiatives supported by the Global Fund.

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<u>Advocacy for decriminalization</u>: For activists to be able to carry out their work without fear of persecution, decriminalization of LGBTQI+ people is an imperative. The Global Fund and its partners must take clear positions to encourage legal reform in countries with repressive laws.

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<strong><em>An invitation to technical and financial partners</em></strong>

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The "Behind the Struggles" report calls for a renewed commitment from technical and financial partners to build the capacity of activists and address mental health needs in French-speaking Africa. The Global Fund, with its focus on community resilience, is ideally placed to integrate these recommendations into its next funding rounds, particularly as part of the 8th replenishment. The inclusion of a mental health component in funded programs could have positive spin-offs not only for activists but also for marginalized communities as a whole.

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<strong><em>Conclusion</em></strong>

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On the eve of the 8th re-enactment, it is essential to emphasize that struggles for health and human rights are not just about medical care, but also about protecting and supporting those working for equality and inclusion. For The Global Alliance of Communities for Health and Rights (GATS PLUS), and for all those who campaign alongside MSG, mental health is not a luxury, but a fundamental necessity. It is essential to ensure that rights defenders can continue their fight, resist repression and play an active part in building an inclusive French-speaking Africa, free of HIV and respectful of the rights of all.

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New safety protocols available for sexual and gender minorities in Francophone Africa

Sexual and gender minorities in French-speaking Africa are the target of numerous crises that accentuate their vulnerability. The Global Alliance of Communities for Health and Rights (GATS PLUS) has developed a set of protocols aimed at strengthening digital security and responding to health crises faced by sexual and gender minorities (SGMs). These protocols, whose usefulness is no longer in doubt, form a basis to be adapted to each context.

 

<strong>Introduction</strong>

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The issue of security for sexual and gender minorities in Francophone Africa is currently at the heart of discussions on HIV response programs. Many countries in West and Central Africa, such as Cameroon, have reported numerous cases of violations of people's rights based on their assumed or real sexual orientation or gender identity. Yet <a href="https://www.theglobalfund.org/en/strategy/">the Global Fund's current strategy (2023-2028) </a>places the communities most affected and vulnerable by HIV/AIDS, tuberculosis and malaria at the heart of its concerns. This commitment is reflected in the field by the Global Fund's CRG (Community, rights and gender) department, which implements the program to remove barriers to achieving the goals of ending AIDS by 2030.

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In addition to implementing advocacy actions aimed at creating a calming social environment for these minorities, it is becoming crucial to put in place a set of measures aimed at protecting their safety. With this in mind, the Global Alliance of Communities for Health and Rights (GATS PLUS) has facilitated the implementation of a set of protocols covering digital crises, intra-community crises, political crises, reputational crises and health crises. These protocols were recently presented in a webinar moderated by the GATS PLUS Coordinator.

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The GATS PLUS is a network of organizations implementing actions to improve the overall health and rights of sexual and gender minorities (SGMs) in 13 French-speaking African countries, mainly in North, West and Central Africa. Most the GATS PLUS member organizations are also recipients of Global Fund HIV grants within civil society. The design of these security protocols is one of the recommendations to emerge from the workshop held in July 2022 in Abidjan (Côte d'Ivoire), where activists from these regions came together.

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<strong>A protocol for sexual and gender minorities to address new health crises: COVID-19 and MPOX</strong>

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The COVID-19 pandemic revealed the fragility of our healthcare systems, unable to respond effectively to new epidemics. These crises exacerbate pre-existing inequalities in access to healthcare for many populations. For example, the COVID-19 crisis amplified the stigma attached to MSG, often wrongly perceived in the popular imagination as "responsible" for the disease. In the U.S., studies have also shown that MSG have a significantly higher risk of being affected by MPOX (MPOX is a rare viral infectious disease caused by the Monkeypox "orthopoxvirus", a virus related to the smallpox virus).

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The health crisis management protocol (access the protocol  <a href="https://www.linkedin.com/posts/agcsplus_protocole-agcs-pluscrise-sanitaire-activity-7232699288152113153-esP0?utm_source=share&amp;utm_medium=member_desktop">here </a><u>) set </u>up by the Global Alliance of Communities for Health and Rights (GATS PLUS) was inspired by the experiences of organizations faced with such crises, and provides a set of measures to be observed for the management and prevention of such crises by identity-based organizations.  This protocol may also inspire the Global Fund, which recently updated its <a href="https://www.theglobalfund.org/media/12435/core_mpox_technicalbrief_en.pdf">technical document </a>on detecting, preventing and responding to MPOX. These recommendations do not take into account the community dimension of this new epidemic, declared by the World Health Organization in July 2022 and by the <a href="https://africacdc.org/">African Centre for Disease Control and Prevention </a>in August 2024.

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What's more, the protocol stresses the urgent need to keep abreast of new health crises, strengthen the community health system with a skilled workforce, offer available services and document good practice. Some examples of good practice are included in this protocol, for example the cases of <a href="https://globalfund.exposure.co/kikis-story-defending-transgender-rights-during-covid19-in-cameroon">Cameroon </a>and <a href="https://equal-eyes.org/database/2021/1/19/uganda-safety-and-security-of-the-lgbtiq-community-in-uganda">Uganda</a>, where MSG activists and organizations have shown perfect community resilience to reduce the impact of COVID19 within their communities.

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<strong>Digital security: A major concern for activists and organizations working alongside sexual and gender minorities</strong>

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The digital space brings many advantages to people's lives, considerably reducing the boundaries between individuals and offering them a wide range of opportunities. But like all inventions, it also has its drawbacks, which are not always brought to light. Indeed, the digital space is a breeding ground for incitement to hatred against MSG. Anti-gender movements use this space to distill hatred against these populations. In Côte d'Ivoire, for example, we have recently witnessed the "stop aux woubi" movement, which is in fact a call through social networks for violence against MSG. The AGCS PLUS digital security protocol (available <a href="https://www.linkedin.com/posts/agcsplus_crisesdigitales-vosaviscomptent-activity-7216030791716204544-aqdG?utm_source=share&amp;utm_medium=member_desktop">here</a>) outlines the most important aspects to know about the types of risks involved, how to report the perpetrators of online hate and how to prevent them. The protocol places particular emphasis on the Facebook social network, which is clearly very popular with MSG, although it is acknowledged that the TikTok social network has also been gaining ground of late. The protocol also details how to identify threats in the digital space, the importance of training partners, and crisis prevention and management methods. Finally, it includes case studies of digital crises in various countries.

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<p style="margin-bottom: 0cm; text-align: center; line-height: 150%;"><span style="font-size: 12.0pt; line-height: 150%; color: black;">Country concerned</span></p>
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<p style="margin-bottom: 0cm; text-align: center; line-height: 150%;"><span style="font-size: 12.0pt; line-height: 150%; color: black;">Summary of the digital crisis</span></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>Nigeria</strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">Photos of a dozen young men presumed to be "homosexuals" were published by the police on August 29, 2023.</p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>Cameroon</strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">Visibility given to Shakiro and Patricia's trial on February 8, 2021</p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>Cameroon</strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">French LGBTI rights ambassador Jean-Marc Berthon's interrupted visit in 2023</p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>North Africa and Middle East </strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">Members of the LGBTI community trapped by police through dating sites</p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>Egypt</strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">Condemnation of members of the LGBTI community through evidence collected on the internet</p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;"><strong>Chile</strong></p>
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<p style="margin-bottom: 0cm; text-align: justify; line-height: 150%;">In 2020, the Movement for the Integration and Liberation of Homosexuals (Movilh) launched an alert against the government for arresting homosexuals on dating sites.</p>
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<strong>Other protocols just as important for managing intra-community, political and reputational crises</strong>

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The GATS PLUS has also put in place a number of other protocols to ensure the holistic safety of MSG in French-speaking Africa, the quintessence and, above all, importance of which should be recalled here.

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Given the scarcity of funding allocated to the fight against HIV and discrimination, civil society organizations supporting MSG often find themselves in competition, sometimes in unhealthy and counterproductive ways. Moreover, incidents, misunderstandings and differences of opinion can sometimes divide community members. It is therefore essential to put in place mechanisms to effectively manage these crises and prevent them from being exposed in the public arena.

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It is with this in mind that this protocol (access it <a href="https://www.linkedin.com/posts/agcsplus_protocolecrise-intra-communautaire-activity-7226135992317968385-9IuM?utm_source=share&amp;utm_medium=member_desktop">here </a>) has been developed. It emphasizes the importance of building strong partnerships, identifying threats, and building community capacity for crisis prevention and management. It also addresses the provision of services and the documentation of situations.

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We have also set up a protocol for managing political crises. Political crises can take the form of riots in the streets, or in extreme cases, revolts, violence or war. These crises can have a particular impact on MSG: for example, in pre-election periods in some countries, sexual and gender minorities become scapegoats for certain politicians. These crises can occur on a city or national scale. Our political crisis management protocol, available <a href="https://www.linkedin.com/posts/agcsplus_protocolecrise-politique-activity-7220084348639735808-qC__?utm_source=share&amp;utm_medium=member_desktop">here, </a><u>is designed to provide solutions.</u>

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All in all, the various protocols presented in this article add to the panoply of tools that already exist to deal with MSG safety issues. They are far from exhaustive and complete, but they do provide a basis that should be adapted to each context and crisis situation involving MSG.

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