GFO Issue 461, Article Number: 1
ABSTRACT
This special issue dedicated to the 53rd Board Meeting, to be held from May 7 to 9, 2025, explores the growing tension between strategic ambitions and budgetary constraints within the Global Fund. Balancing hope, warnings, and ethical dilemmas, it highlights the critical issues that will shape the decisions ahead.
Dear subscribers,
From May 7 to 9, 2025, Geneva will host the 53rd Board Meeting of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Judging by the draft agenda, the event promises to be pivotal. And the heart of the matter is hard to miss: the future of the Global Fund now hangs in the balance -caught between bold ambitions and tightening financial constraints.
The Eighth Replenishment campaign, launched in February 2025, aims to raise a formidable $18 billion for the 2026–2028 cycle. Yet behind this bold target, a more sobering narrative is unfolding: that of an institution increasingly expected to perform miracles with diminishing resources. Structural expenditures are being deferred. Investments in research and infrastructure are on hold. What might seem like prudent fiscal stewardship under normal conditions reveals itself, under scrutiny, as a form of silent erosion. Programs implemented by frontline NGOs are already feeling the tremors of this austerity. Financial pragmatism has become the order of the day, but one must ask: at what point does efficiency begin to cannibalize purpose? And when austerity masquerades as responsibility, who bears the hidden cost?
In response to this looming crisis, civil society has begun to stir. On March 11, 2025, the Global Fund Advocates Network Africa launched the "One World, One Fight" campaign, a clarion call for the full replenishment of the Global Fund. More than a fundraising effort, the campaign repositions African leadership at the center of the global health narrative. It champions domestic health investment not as a contingency plan, but as a foundational pillar. This is not charity. This is shared survival. The campaign insists on global solidarity, not in abstraction, but as a contractual obligation between nations—rich and poor, North and South.
The questions of equity and responsibility are nowhere more glaring than in the ongoing struggle to deploy malaria vaccines in Africa. While wealthy nations swiftly adopt and fund cutting-edge vaccines, African countries are still asked to weigh their cost-effectiveness—an insidious euphemism that belies the deeper inequity of the global health economy. Proven, effective tools are withheld by fiscal hesitations dressed as rational governance. This is not a debate about efficacy. It is a debate about moral clarity. The refusal to fund malaria vaccines in Africa is not a budgetary oversight—it is a failure of ethical imagination.
This failure is compounded by the geopolitical tremors sent by the United States’ freeze on foreign aid and its withdrawal from the World Health Organization. In interviews with Lucica Ditiu, Executive Director of the STOP TB Partnership, and Olivia Ngou, Executive Director of Impact Santé Afrique, the consequences of this disengagement are laid bare. TB and malaria programs in Africa, already fragile, now face a dangerous void. Funding gaps are not just numbers on a balance sheet; they are disruptions in drug supply chains, layoffs of frontline workers, and delayed diagnoses that cost lives. Ditiu and Ngou both issue a clear warning: without resilient, diversified funding strategies and renewed international commitment, the current crisis could reverse decades of public health gains.
As the 53rd Board Meeting approaches, one sentiment prevails: the Global Fund is caught in a vise. On one side, its mission—to fight three of the deadliest diseases in human history—is as urgent as ever. On the other, the mechanisms meant to support that mission are fraying under political, economic, and institutional pressures. The pursuit of efficiency cannot become an alibi for moral abdication. If the cost of staying afloat is measured in neglected communities and stalled progress, then we must question not only the means, but the ends.
The Global Fund still stands. But standing is not surviving. And surviving is not winning. In this moment, what is needed is not another call for resilience, but a demand for reckoning. The health of millions depends not on the rhetoric of commitment, but on the uncomfortable decisions that must now be made. The question is not whether we can afford to act—it is whether we can afford not to.
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
ida.hakizinka@aidspan.org
and/or
christian.djoko@aidspan.org
If you like what you read, do spread the word around and ask others to subscribe!
Dear subscribers,
From May 7 to 9, 2025, Geneva will host the 53rd Board Meeting of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Judging by the draft agenda, the event promises to be pivotal. And the heart of the matter is hard to miss: the future of the Global Fund now hangs in the balance -caught between bold ambitions and tightening financial constraints.
The Eighth Replenishment campaign, launched in February 2025, aims to raise a formidable $18 billion for the 2026–2028 cycle. Yet behind this bold target, a more sobering narrative is unfolding: that of an institution increasingly expected to perform miracles with diminishing resources. Structural expenditures are being deferred. Investments in research and infrastructure are on hold. What might seem like prudent fiscal stewardship under normal conditions reveals itself, under scrutiny, as a form of silent erosion. Programs implemented by frontline NGOs are already feeling the tremors of this austerity. Financial pragmatism has become the order of the day, but one must ask: at what point does efficiency begin to cannibalize purpose? And when austerity masquerades as responsibility, who bears the hidden cost?
In response to this looming crisis, civil society has begun to stir. On March 11, 2025, the Global Fund Advocates Network Africa launched the "One World, One Fight" campaign, a clarion call for the full replenishment of the Global Fund. More than a fundraising effort, the campaign repositions African leadership at the center of the global health narrative. It champions domestic health investment not as a contingency plan, but as a foundational pillar. This is not charity. This is shared survival. The campaign insists on global solidarity, not in abstraction, but as a contractual obligation between nations—rich and poor, North and South.
The questions of equity and responsibility are nowhere more glaring than in the ongoing struggle to deploy malaria vaccines in Africa. While wealthy nations swiftly adopt and fund cutting-edge vaccines, African countries are still asked to weigh their cost-effectiveness—an insidious euphemism that belies the deeper inequity of the global health economy. Proven, effective tools are withheld by fiscal hesitations dressed as rational governance. This is not a debate about efficacy. It is a debate about moral clarity. The refusal to fund malaria vaccines in Africa is not a budgetary oversight—it is a failure of ethical imagination.
This failure is compounded by the geopolitical tremors sent by the United States’ freeze on foreign aid and its withdrawal from the World Health Organization. In interviews with Lucica Ditiu, Executive Director of the STOP TB Partnership, and Olivia Ngou, Executive Director of Impact Santé Afrique, the consequences of this disengagement are laid bare. TB and malaria programs in Africa, already fragile, now face a dangerous void. Funding gaps are not just numbers on a balance sheet; they are disruptions in drug supply chains, layoffs of frontline workers, and delayed diagnoses that cost lives. Ditiu and Ngou both issue a clear warning: without resilient, diversified funding strategies and renewed international commitment, the current crisis could reverse decades of public health gains.
As the 53rd Board Meeting approaches, one sentiment prevails: the Global Fund is caught in a vise. On one side, its mission—to fight three of the deadliest diseases in human history—is as urgent as ever. On the other, the mechanisms meant to support that mission are fraying under political, economic, and institutional pressures. The pursuit of efficiency cannot become an alibi for moral abdication. If the cost of staying afloat is measured in neglected communities and stalled progress, then we must question not only the means, but the ends.
The Global Fund still stands. But standing is not surviving. And surviving is not winning. In this moment, what is needed is not another call for resilience, but a demand for reckoning. The health of millions depends not on the rhetoric of commitment, but on the uncomfortable decisions that must now be made. The question is not whether we can afford to act—it is whether we can afford not to.
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
ida.hakizinka@aidspan.org
and/or
christian.djoko@aidspan.org
If you like what you read, do spread the word around and ask others to subscribe!
