GFO Issue 462, Article Number: 2
ABSTRACT
This article discusses the Global Fund Executive Director's address to the Board, highlighting the severe global health challenges faced due to diminishing funding, escalating conflicts, and climate change. The Director emphasizes the financial uncertainty caused by recent US policy changes and the need for reprioritization of health programs. Despite these challenges, he underscores significant progress in areas like health systems strengthening, debt swaps, and market innovation. The article concludes with a call for unity, ambition, and realistic expectations in sustaining the Fund’s mission to save lives and advance global health equity.
In a pivotal and comprehensive update to the Board, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria painted a candid picture of a partnership at a critical juncture. Amid unprecedented global challenges, he outlined the Fund’s recent achievements, the urgent risks now threatening progress, and the difficult choices facing both the Board and the broader global health community.
A new era of complexity and risk
Speaking of the global context, the Executive Director described a "perfect storm" of escalating crises: diminishing development assistance, intensifying conflicts, worsening humanitarian emergencies, mounting debt burdens, the ongoing impacts of climate change, and a global backlash against human rights and gender equality. These forces, he emphasized, are not abstract; they are directly undermining the ability of countries to sustain and expand the fight against the three diseases.
He commended the professionalism and resilience of the Secretariat and its partners, praising their ability to maintain focus and adapt in the face of such turmoil. The Executive Director made it clear that the stakes are not merely institutional - they are human. "Hundreds of thousands, potentially millions, of lives" are at risk, he warned, with the very real possibility of reversing decades of hard-won progress in life expectancy and health system capacity.
The US funding crisis and its ripple effects
A central theme of the address was the acute financial uncertainty triggered by recent US policy changes. The United States, alongside the Global Fund, has long been a cornerstone of health financing in low- and middle-income countries. The Executive Director noted that the sector was already under strain prior to these disruptions, with governments worldwide facing growing scrutiny over aid spending and competing domestic priorities, including climate action and humanitarian relief.
Since the US "stop work" orders in January, the Secretariat’s primary focus has been to preserve program continuity. This has required operational flexibility, close collaboration with country partners, and difficult decisions to conserve resources. While most grant implementation has continued as planned, the need to delay non-essential disbursements and prepare for a systematic reprioritization has become unavoidable. The Executive Director was candid: "Any reprioritization exercise will have serious, real consequences," particularly as countries have already identified nearly $6 billion in unfunded program priorities.
Country ownership and the challenge of transition
The Executive Director emphasized that the approach to reprioritization must be country-led, inclusive, and context-specific. However, he acknowledged that the process would inevitably generate friction, as countries face difficult choices about which programs to delay or scale back. The viability of civil society and community implementers - often reliant on external funding - was highlighted as a particular concern, with abrupt funding cuts threatening not only services but the very survival of these organizations.
He noted that some governments have responded quickly to fill funding gaps, while others struggle to mobilize resources or maintain effective responses. The transition to nationally led and financed health systems is crucial, but the readiness of countries to make this transition varies widely. The Executive Director cautioned against unrealistic expectations, especially in countries facing extreme debt burdens or political instability and stressed the importance of supporting countries through co-financing requirements and public financial management reforms.
Progress amidst adversity: innovations and partnerships
Despite the challenging environment, the Executive Director highlighted several areas of progress:
- Health systems strengthening: Investments in resilient and sustainable health systems (RSSH) are larger and more effective than ever, positioning the Global Fund as the most effective mechanism for channeling external funding at scale.
- Debt swaps and financial innovation: Two debt swaps were executed since the last report, including a record €75 million transaction with Indonesia. Collaboration with the World Bank has deepened to ensure new financing is used effectively and complements existing efforts.
- Market shaping and local manufacturing: The Fund continues to reduce the cost of key commodities, achieving a 7% reduction in the price of antiretrovirals since late 2024. Efforts to support local manufacturing and procurement in Africa are progressing, with the first shipments of Africa-based HIV tests now underway.
- Private sector engagement: The recent $150 million pledge from the Children’s Investment Fund Foundation was cited as a milestone for both innovation and resource mobilization, supporting the introduction of long-acting HIV prevention and self-testing tools.
The Executive Director underscored the need to accelerate access to new technologies - such as malaria vaccines and digital diagnostics - and to ensure that market-shaping strategies continue to deliver affordable, reliable access to life-saving commodities.
Organizational adaptation: restructuring for resilience
Internally, the Secretariat is undergoing significant restructuring to adapt to the new environment. This includes the launch of offshore service centers, organizational changes, and rounds of voluntary separation and early retirement. The Executive Director acknowledged the strain on staff but emphasized the need for transparency and open communication. He noted that while the Secretariat’s challenges are real, they pale in comparison to those faced by frontline health workers and the communities the Fund serves.
Resource mobilization and the eighth replenishment
The Eighth Replenishment campaign was launched in February, co-hosted by South Africa and the United Kingdom. However, the Executive Director was realistic about the challenges: the investment case was overtaken by events almost as soon as it was published, with downward revisions in expected bilateral and domestic funding. The replenishment process will be more protracted than usual, likely concluding late in the year, and will require a rolling approach rather than a single set-piece event.
Despite these challenges, the campaign has begun well, with early pledges - including from the private sector - helping to sustain momentum. The Executive Director stressed that while donor realism is necessary, so too is a clear-eyed understanding of what it will take to achieve the Board’s ambitious goals.
Board and stakeholder interventions: Key themes
Following the Executive Director’s address, Board members and partners echoed many of his concerns and priorities:
- Community engagement: There was strong consensus on the need to protect and empower community systems and civil society implementers, recognizing their central role in delivering services and safeguarding progress.
- Country ownership and sustainability: Delegates called for greater country ownership, integration of disease programs into national health systems, and increased domestic resource mobilization, while cautioning that transitions must be context-sensitive and not rushed.
- Innovation and market shaping: The importance of accelerating access to new technologies, supporting local manufacturing, and leveraging private sector expertise was repeatedly emphasized.
- Transparency and guidance: Several speakers urged clearer guidance to countries on reprioritization and efficiency measures to minimize harm and ensure alignment with local realities.
- Global solidarity: There was a recurring call for donors to honor and, where possible, increase their commitments, and for all partners to maintain the spirit of collective problem-solving that has defined the Global Fund.
Board members also highlighted the need for the Fund to remain adaptable and innovative, sustain its comparative advantages, and continue embedding support for human rights and gender equality in all its work.
Looking forward: a defining moment for the partnership
The Executive Director closed with a call for unity, ambition, and realism. He acknowledged the tensions inherent in balancing core values with the need for adaptation, and between prevention and treatment priorities in a constrained environment. The stakes are high: failure would mean millions more infections and deaths, and the destruction of the community and health system capacities painstakingly built over the years.
He urged the Board and the wider partnership to continue practicing transparency and openness, to support the Secretariat in managing workload and change, and above all, to remain steadfast in the mission to save lives and advance global health equity. "We need to be united, we need to be determined, we need to be ambitious, and we owe it to the people who depend on us… Being realistic does not equate to being defeatist. We owe it to the people who depend on us to keep going."
Conclusion: sustaining impact in a changing world
The months ahead will test the resolve and adaptability of the Global Fund partnership. Yet, as the Executive Director and Board members made clear, this is also a moment of opportunity - to innovate, strengthen solidarity, and reimagine the future of global health financing and delivery. The Global Fund’s legacy of saving over 65 million lives is a testament to what is possible through bold, collective action. The challenge now is to sustain and build on that legacy, even as the world grows more complex and uncertain.
In a pivotal and comprehensive update to the Board, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria painted a candid picture of a partnership at a critical juncture. Amid unprecedented global challenges, he outlined the Fund’s recent achievements, the urgent risks now threatening progress, and the difficult choices facing both the Board and the broader global health community.
A new era of complexity and risk
Speaking of the global context, the Executive Director described a "perfect storm" of escalating crises: diminishing development assistance, intensifying conflicts, worsening humanitarian emergencies, mounting debt burdens, the ongoing impacts of climate change, and a global backlash against human rights and gender equality. These forces, he emphasized, are not abstract; they are directly undermining the ability of countries to sustain and expand the fight against the three diseases.
He commended the professionalism and resilience of the Secretariat and its partners, praising their ability to maintain focus and adapt in the face of such turmoil. The Executive Director made it clear that the stakes are not merely institutional - they are human. "Hundreds of thousands, potentially millions, of lives" are at risk, he warned, with the very real possibility of reversing decades of hard-won progress in life expectancy and health system capacity.
The US funding crisis and its ripple effects
A central theme of the address was the acute financial uncertainty triggered by recent US policy changes. The United States, alongside the Global Fund, has long been a cornerstone of health financing in low- and middle-income countries. The Executive Director noted that the sector was already under strain prior to these disruptions, with governments worldwide facing growing scrutiny over aid spending and competing domestic priorities, including climate action and humanitarian relief.
Since the US "stop work" orders in January, the Secretariat’s primary focus has been to preserve program continuity. This has required operational flexibility, close collaboration with country partners, and difficult decisions to conserve resources. While most grant implementation has continued as planned, the need to delay non-essential disbursements and prepare for a systematic reprioritization has become unavoidable. The Executive Director was candid: "Any reprioritization exercise will have serious, real consequences," particularly as countries have already identified nearly $6 billion in unfunded program priorities.
Country ownership and the challenge of transition
The Executive Director emphasized that the approach to reprioritization must be country-led, inclusive, and context-specific. However, he acknowledged that the process would inevitably generate friction, as countries face difficult choices about which programs to delay or scale back. The viability of civil society and community implementers - often reliant on external funding - was highlighted as a particular concern, with abrupt funding cuts threatening not only services but the very survival of these organizations.
He noted that some governments have responded quickly to fill funding gaps, while others struggle to mobilize resources or maintain effective responses. The transition to nationally led and financed health systems is crucial, but the readiness of countries to make this transition varies widely. The Executive Director cautioned against unrealistic expectations, especially in countries facing extreme debt burdens or political instability and stressed the importance of supporting countries through co-financing requirements and public financial management reforms.
Progress amidst adversity: innovations and partnerships
Despite the challenging environment, the Executive Director highlighted several areas of progress:
- Health systems strengthening: Investments in resilient and sustainable health systems (RSSH) are larger and more effective than ever, positioning the Global Fund as the most effective mechanism for channeling external funding at scale.
- Debt swaps and financial innovation: Two debt swaps were executed since the last report, including a record €75 million transaction with Indonesia. Collaboration with the World Bank has deepened to ensure new financing is used effectively and complements existing efforts.
- Market shaping and local manufacturing: The Fund continues to reduce the cost of key commodities, achieving a 7% reduction in the price of antiretrovirals since late 2024. Efforts to support local manufacturing and procurement in Africa are progressing, with the first shipments of Africa-based HIV tests now underway.
- Private sector engagement: The recent $150 million pledge from the Children’s Investment Fund Foundation was cited as a milestone for both innovation and resource mobilization, supporting the introduction of long-acting HIV prevention and self-testing tools.
The Executive Director underscored the need to accelerate access to new technologies - such as malaria vaccines and digital diagnostics - and to ensure that market-shaping strategies continue to deliver affordable, reliable access to life-saving commodities.
Organizational adaptation: restructuring for resilience
Internally, the Secretariat is undergoing significant restructuring to adapt to the new environment. This includes the launch of offshore service centers, organizational changes, and rounds of voluntary separation and early retirement. The Executive Director acknowledged the strain on staff but emphasized the need for transparency and open communication. He noted that while the Secretariat’s challenges are real, they pale in comparison to those faced by frontline health workers and the communities the Fund serves.
Resource mobilization and the eighth replenishment
The Eighth Replenishment campaign was launched in February, co-hosted by South Africa and the United Kingdom. However, the Executive Director was realistic about the challenges: the investment case was overtaken by events almost as soon as it was published, with downward revisions in expected bilateral and domestic funding. The replenishment process will be more protracted than usual, likely concluding late in the year, and will require a rolling approach rather than a single set-piece event.
Despite these challenges, the campaign has begun well, with early pledges - including from the private sector - helping to sustain momentum. The Executive Director stressed that while donor realism is necessary, so too is a clear-eyed understanding of what it will take to achieve the Board’s ambitious goals.
Board and stakeholder interventions: Key themes
Following the Executive Director’s address, Board members and partners echoed many of his concerns and priorities:
- Community engagement: There was strong consensus on the need to protect and empower community systems and civil society implementers, recognizing their central role in delivering services and safeguarding progress.
- Country ownership and sustainability: Delegates called for greater country ownership, integration of disease programs into national health systems, and increased domestic resource mobilization, while cautioning that transitions must be context-sensitive and not rushed.
- Innovation and market shaping: The importance of accelerating access to new technologies, supporting local manufacturing, and leveraging private sector expertise was repeatedly emphasized.
- Transparency and guidance: Several speakers urged clearer guidance to countries on reprioritization and efficiency measures to minimize harm and ensure alignment with local realities.
- Global solidarity: There was a recurring call for donors to honor and, where possible, increase their commitments, and for all partners to maintain the spirit of collective problem-solving that has defined the Global Fund.
Board members also highlighted the need for the Fund to remain adaptable and innovative, sustain its comparative advantages, and continue embedding support for human rights and gender equality in all its work.
Looking forward: a defining moment for the partnership
The Executive Director closed with a call for unity, ambition, and realism. He acknowledged the tensions inherent in balancing core values with the need for adaptation, and between prevention and treatment priorities in a constrained environment. The stakes are high: failure would mean millions more infections and deaths, and the destruction of the community and health system capacities painstakingly built over the years.
He urged the Board and the wider partnership to continue practicing transparency and openness, to support the Secretariat in managing workload and change, and above all, to remain steadfast in the mission to save lives and advance global health equity. "We need to be united, we need to be determined, we need to be ambitious, and we owe it to the people who depend on us… Being realistic does not equate to being defeatist. We owe it to the people who depend on us to keep going."
Conclusion: sustaining impact in a changing world
The months ahead will test the resolve and adaptability of the Global Fund partnership. Yet, as the Executive Director and Board members made clear, this is also a moment of opportunity - to innovate, strengthen solidarity, and reimagine the future of global health financing and delivery. The Global Fund’s legacy of saving over 65 million lives is a testament to what is possible through bold, collective action. The challenge now is to sustain and build on that legacy, even as the world grows more complex and uncertain.
