On 6 October Friends of the Global Fight, in partnership with Malaria No More and Nothing But Nets, hosted a 90-minute panel discussion on future directions for global health financing at the Henry J. Kaiser Family Foundation in Washington, DC.  Speakers included US Ambassador-at-Large and Global AIDS Coordinator Dr. Deborah Birx, who heads up the President’s Emergency Plan for AIDS Relief, or PEPFAR, U.S. Global Malaria Coordinator Rear Admiral Timothy Ziemer, who heads the US President’s Malaria Initiative, Dr. Nomonde Nolutshungu of the South African Embassy in Washington, and Kate Roberts of the Maverick Collective and Population Services International.  Dr. Jennifer Kates of the Kaiser Family Foundation moderated the panel and Chris Collins, as its new president, represented Friends of the Global Fight. The event, which was billed as “A conversation on emerging trends in public, private and domestic financing on the heels of the Global Fund’s Fifth Replenishment and the UN General Assembly,” was open to the public and was webcast live online.  It was a unique opportunity to hear the informal reflections of high-level officials in a somewhat intimate space. The clearest message to emerge from the discussion was the need to build upon and promote recent successes in the responses to HIV, TB, and malaria so greater resources can be mobilized and the targets of ending the epidemics can be reached.  Speakers highlighted key areas for greater investment and for how to stretch limited resources further.  Like the Global Fund Replenishment meeting in Montreal last month, the mood was fairly upbeat and optimistic. Mr. Collins opened the event by recounting the recent report by the Kaiser Family Foundation which described a decline in donor government funding for HIV in 2015, the first time funding has decreased in five years.  However, he sought to set the tone for the day’s discussion by recalling the successful Global Fund replenishment, and the opportunities which may be presented by imminent changes in the US Government as a result of elections of a new president and congress this November. Mr. Collins also referred to a study reported on the same day in 
The Guardian
 showing that in the last 35 years, the world has added a decade in average life expectancy, thanks in part to global efforts to tackle infectious diseases.  He concluded his opening remarks by asking, “How do we remake the case to the general public about the need for increased investment in global health?  How are we going to transform funding and ensure marginalized populations are not left behind?  Ultimately, how will we bring together donor commitment, domestic funding, and innovative finance to meet that goal to end these epidemics?” Before introducing the panelist, moderator Jennifer Kates made some brief comments on the current landscape of global health financing.  In particular, she pointed to a 2016 Kaiser Family Foundation poll which found that 68% of Americans supported the US government being part of global efforts to improve health. The first question, directed to Ambassador Birx, was “What is the case for investment?”  “I want to be clear on where we have been successful,” replied the Ambassador.  She described success in reaching women with HIV testing, and said that we should focus on “How we will bring that same level of success” to areas which have proved more challenging.  Dr. Birx offered as an example the DREAMS initiative.  DREAMS is a new partnership between PEPFAR, the Bill and Melinda Gates Foundation, Girl Effect, and pharmaceutical companies Johnson & Johnson, Gilead Sciences, and ViiV Healthcare, which is focused on reducing HIV infections among young women and girls in 10 African countries. Referencing the unprecedented level of African countries’ contributions to the Global Fund replenishment this year, Dr. Kates then asked Dr. Nomonde Nolutshungu of South Africa how these pledges, and increasing levels of domestic investment in Africa, could be further built upon.  After acknowledging that, as the country with the largest HIV and third largest TB epidemics on Earth, “We have no choice but to be friends of the Global Fund,” Dr. Nolutshungu further emphasized the importance of using data to build an investment case for health.  She noted that we now have much more and much better data at our disposal which allows us to develop long-term plans, ones that all stakeholders are engaged in developing; a more democratic processes than in the past. Rear Admiral Timothy Ziemer commented on the need for, and benefits of, greater coordination among donors and implementers, and heralded the US relationship with the Global Fund as, “a great example of effective partnership.”  He stated that when the President’s Malaria Initiative (PMI) began, only three of the fifteen recipient countries were  receiving support from the Global Fund. However, based on the work of a Harmonization Working Group, which PMI, the Global Fund and Roll Back Malaria are part of, he said, “today all nineteen of our focus countries are beneficiaries [of the Global Fund].” Kate Roberts, of PSI’s “Maverick Collective,” discussed the need for greater involvement of philanthropists in the ongoing dialogue about responding to the three diseases.  In particular, Ms. Roberts highlighted a “massive gap” at the innovation stage of these responses.  “We felt that we were missing a ton of resources by not engaging philanthropists…right from the beginning, to really help us pilot new innovation so we could measure it, and go to our existing partners and leverage it.” Dr. Kates asked the US government panelists, if they had more money next year, where would they spend it?  Ambassador Birx said her first priority would be to target the prevention of new infections in young people under 25, with a comprehensive package such as DREAMS.  Mr. Ziemer declared that if more money were to become available, we must not “play a shell game” in which the same money is moved around, rather than increasing the total money available.  He also pointed to a number of areas where more investment in needed, such as scaling up existing programs that work and buying more malaria nets.  He also noted that with more funding, the US could help countries who are currently in malaria pre-elimination stages, to move towards full elimination. As the final and convening panelist, Chris Collins was asked what he would do with all the insights shared.  “I would take these folks on the road!  What you’ve heard up here is people who are innovating, who are asking questions about effectiveness, and who are expecting results.  So you don’t have people here who are saying, ‘Well, this is the way we’ve always done it, so that’s the way we need to do it. We just need to make it bigger.  That’s the opposite of what you’re hearing.”  Mr. Collins then further discussed the need to match the (American) public’s support for investing in global health with campaigns to increase those investments. After the panel members had each spoken, the floor was opened to the audience for the final thirty minutes.  About ten questions were asked, of varying depth and specificity, by the audience, which was primarily comprised of global health and development professionals. One of the most notable audience questions was posed by Denys Nazarov, of AIDS Healthcare Foundation.  Mr. Nazarov said that, with regard to the Global Fund, China is “conspicuously missing in action,” and he asked Mr. Collins how we might motivate China to contribute at higher levels, to be more in alignment with the size of its economy.  While Mr. Collins said he didn’t have the answer to that question, he reflected on being in the room during the September replenishment meeting and how, for the ministers of health and prime ministers who were also in the room, “it felt like it was a club that people wanted to be a part of. The Global Fund is a global meeting point that you want to be a part of.” Mr. Collins said that perhaps this would lead to China coming around to seeing the Global Fund as an important entity for significant investment.  Ambassador Birx added, “We have to recognize that over the last decade China went from not treating people with HIV until they were very sick, to having a very comprehensive response to their HIV problem.”  She urged patience in interpreting China’s miniscule contribution of US$18 million to the Global Fund for 2017-2019. The event was streamed live online by Friends of the Global Fight.  A complete recording is now viewable on YouTube.