The Global Fund is seeking $18 billion to continue its fight against AIDS, tuberculosis (TB), malaria, and to strengthen health systems. The Global Fund Secretariat provided an update on the status of its replenishment campaign in a virtual meeting organized by the Global Fund Advocates Network (GFAN) 8 June 2022. At this meeting the Secretariat highlighted the rapidly evolving and challenging context in which the Seventh Replenishment is taking place and the strategies being used by the Global Fund to rally donors. The update also highlighted the steps towards the Replenishment Conference and the campaign tools used by the Global Fund to reach out to more stakeholders and attract financial commitments.

A difficult context for pushing the agenda for increasing health resource allocation

The Seventh Replenishment is occurring at a time when the world is facing the knock-on effects of the war in Ukraine and the economic and social legacy of the diminishing but still omnipresent COVID-19 crisis.

The global humanitarian and economic crises are likely to negatively impact the Global Fund’s replenishment campaign. The COVID-19 pandemic is not over, testing rates remain low, and disparities in vaccine coverage are increasing. The war in Ukraine has resulted in a costly humanitarian catastrophe and the economic damage from the conflict is expected to contribute to a significant slowdown in global growth in 2022. Globally, countries are already beginning to feel the effects of these crises, and this has a significant impact on the availability of financial resources to tackle other global threats, including HIV, TB and malaria.

Fuel and food prices have increased rapidly, hitting vulnerable populations in low-income countries the hardest. According to the International Monetary Fund (IMF) World Economic Outlook (April 2022), global economic growth is projected to slow from an estimated 6.1% in 2021 to 3.6% in 2022. Inflation has become a problem for many countries. Even prior to the war in Ukraine, inflation was rising due to soaring commodity prices and supply-demand imbalances due to the pandemic. Additionally, inequities in the global response to the pandemic have generated sharp reversals regarding other health priorities, leaving deep scars within societies, and forcing a significant reshaping of global health architecture.

The Global Fund’s Seventh Replenishment is anchored within the broader Sustainable Development Goal (SDG) 3 framework to “Ensure healthy lives and promote well-being for all at all ages”. This resonates well with most donors and stakeholders who say they understand the rationale for the target of $18 billion. The alignment of the Investment Case with the Global Fund Strategy’s themes and focus areas, including people-centered and integrated approaches, resilient and sustainable systems for health (RSSH) and community systems, human rights, and gender has generally been well-received. However, donors are also quick to point out the resource-constrained environment.

The United States has paved the way for a successful Replenishment

In December 2021 President Biden expressed renewed commitment to the global goal of ending the AIDS epidemic by 2030 and looked forward to hosting the Seventh Replenishment. On 28 March 2022 the President announced a $6 billion pledge for the Replenishment and offered to match $1 for every $2 contributed by other donors, thereby sending a strong signal regarding financial expectations.

Strategies used by the Global Fund to encourage donors to pledge ahead of the Seventh Replenishment conference

Amidst increasing pressures on official development assistance and overall health funding, internationally and domestically, the Global Fund must remain flexible and sensitive to the changing situation, and it is actively involved in inter-governmental processes and conversations about global health architecture reforms. Its resource mobilization efforts focus on six key areas:

Appealing directly to donor and decision-makers

At the 75th World Health Assembly when health leaders met to discuss future global health priorities, the Global Fund seized the opportunity to position the Replenishment and its role in the COVID-19 response. It held meetings with the health ministries of several donor and implementing countries and participated in key side events to mobilize support for the Replenishment. We reported on this side event, which urged African countries to place greater emphasis on domestic health financing while at the same time support the Replenishment, in our article in the last GFO, Who should pay for healthier and longer lives in Africa?.

At the World Economic Forum (WEF) 2022 the Global Fund launched a private sector call to action for the Seventh Replenishment. In addition, following the WEF, Comic Relief announced the first private sector pledge of $10 million, ahead of the Seventh Replenishment conference.

The Global Fund participated in the Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) which took place alongside the Commonwealth Heads of Government Meeting (CHOGM) on 23 June 2022 in Rwanda; the Summit was the first-ever global gathering to discuss malaria and NTDs. Commonwealth leaders debated the findings of the annual Commonwealth Malaria Report launched during the Commonwealth Health Ministers Meeting and reaffirmed commitments made at the 2018 CHOGM to halve malaria by 2023 and commit to bold new actions to get malaria programs back on track.

The Global Fund:

• Encouraged Commonwealth hospitals in Africa to mention the Global Fund and advocate for the Seventh Replenishment
• Engaged with Global Fund donors, implementers, civil society and advocacy partners, and the malaria community and advocate for the Seventh Replenishment
• Participated in several panel discussions to highlight themes of the Seventh Replenishment.
• Mobilized the media through ensuring a steady flow of publications regarding the Seventh Replenishment (e.g., the opinion piece by President Kenyatta who is also the Chairperson of the Africa Leaders Malaria Alliance (ALMA), published in the international Financial Times.

Engaging global alliances

The Global Fund continues to engage with the Global Seven (G7), an inter-governmental political forum providing global leadership, and the Group of 20 (G20) presidencies which is a leading forum for international economic cooperation. Members meet regularly to discuss ways to promote more inclusive economic growth and review progress on policy commitments. The Global Fund is a member of the G20 Health Working Group.

The Global Fund pushed the Replenishment agenda during the G7 Development Ministers Meeting, captured in the Ministers’ communication of 20 May reaffirming their commitment to the Seventh Replenishment:

“We commit to support toward the Seventh Replenishment of the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), to be hosted by US President Biden in the fall of 2022, which has the goal of raising total donor pledges by 30% to reach at least 18 billion USD for the 2023-2025 cycle. We welcome the new Global Fund strategy, which formulates an ambitious yet achievable path jointly with its main technical partners, such as WHO, Roll Back Malaria, Stop TB Partnership and UNAIDS, towards our goal of ending these three diseases while contributing to achieving UHC and the health-related SDGs by 2030.”

The Global Fund will advocate for the Replenishment at the upcoming G7 summit in Germany in late June to build momentum towards the Pledging Conference and encourage donors to pledge in advance.

The Global Fund works through diplomatic channels to publicize its work with ministries by highlighting:

• The Global Fund’s role in the global COVID-19 response and Access to COVID-19 Tool -Accelerator (ACT-A), a G20 initiative.
• COVID-19’s impact on the three diseases and the importance of a successful Replenishment.
• The Global Fund's contribution to RSSH, pandemic preparedness and response (PPR), and fighting antimicrobial resistance (AMR).
• The effectiveness of the multilateral system and partnerships.

Mobilizing champions and influencers

The Global Fund works in the following ways:

• Engaging champions from implementer countries, in addition to the five African co-hosts of the Seventh Replenishment Preparatory Meeting, to leverage their voices in favor of a successful Seventh Replenishment.
• Regular calls and briefings with advocacy partners and engagement in multiple events.
• High-level dialogues in each of the five host countries before the Preparatory Meeting and two global civil society dialogues.
• Engagement with the Communities, Developed Countries NGO, and Developing Countries NGO delegations.
• 20th Anniversary Torch Caravan in 20 countries across Africa.
• GFAN’s Global Week of Action

Using traditional and social media

To publicize the Replenishment, the Global Fund uses targeted media and social media outreach, speaking engagements and participation in major events. It encourages civil society to widen their advocacy work and create videos and stories; it recruits new champions and key influencers, and provides tools and resources for staff, supporters, donors and partners

Key initiatives include:

• Inviting audiences to share their personal experience, engagement and interpretation of the #Fight for What Counts campaign, for example, Carolyne’s Fight: Ending HIV and gender-based violence (Kenya) and Asad’s Fight: Surviving TB under the threat of COVID-19 (Bangladesh)
• Soliciting user-generated photo and video content using static slogan boards with key themes and phrases.
• Developing a 360 immersive video.
• Developing a series of stories from the frontline.

Coordinating efforts with civil society partners and networks

The International AIDS Conference 2022, the world’s largest conference on HIV, will be held in Montreal between 29 July and 2 August 2022. This will be a major milestone in the lead up to the Seventh Replenishment. The Global Fund will ensure visibility for its partnership and momentum for the Replenishment campaign by participating in the main program and satellite sessions/side events, as well as through sessions and activities led by communities and civil society partners. The Fund will highlight the themes of HIV, youth and Canada’s feminist foreign policy jointly with the Canadian Government, and potentially secure the early announcement of Canada’s pledge.

The Global Fund will convene a satellite symposium “Fight for what counts: Gender equality in the HIV response” on 29 July 2022 and will showcase the “Fight for What Counts” Replenishment campaign at the Global Fund booth in the AIDS 2022 exhibition space. The Fund will also help put community representatives in touch with the media.

Leveraging host country leadership

Given the short time remaining between now and the Pledging Conference, it is important to increase the campaign’s visibility in the next few months This is when Global Fund advocacy on subjects that resonate with donors can have a significant impact on pledge levels. The Global Fund will:

• Continue conversations with the host country through missions to Washington, D.C. and engagement with local advocacy networks.
• Plan for the Pledging Conference in the third quarter of 2022.
• Mobilize US diplomatic networks in support of the Replenishment campaign.
• Continue coordination with the Preparatory Meeting’s co-host countries as a key component of Replenishment advocacy.

A successful replenishment requires advocating for increased overall funding for health and development more broadly and increasing contributions from existing donors from the Organization for Economic Co-operation and Development's Development Assistance Committee (OECD-DAC) as well as securing a significant increase in the contribution of non-OECD-DAC donors/emerging economies. Efforts will be made to obtain commitments from new and current public sector donors and engage implementing countries through mobilizing national resources for health. Finally, the Global Fund would like to see a significant increase of contributions from the private sector, expanding partnerships with multilateral development banks to leverage co-investment and bring in additional resources.