GFO Issue 462, Article Number: 1
ABSTRACT
This new issue of the GFO is devoted entirely to the 53rd meeting of the Global Fund Board, which took place from May 7 to 9, 2025, in Geneva, revealing a pivotal moment for the institution as it confronts major funding gaps, governance challenges, and the urgent need for reform. From the Executive Director’s call for unity and realism to debates over grant reprogramming, risk management, and ethical oversight, the meeting underscored the fragile balance between ambition and constraint.
Dear subscribers,
From May 7 to 9, 2025, Geneva became the setting for an important meeting in global health governance. The 53rd Board Meeting of the Global Fund to Fight AIDS, Tuberculosis, and Malaria did more than address its agenda items: it laid bare the deep fault lines of an institution caught between ambition and systemic fragility.
The Board leadership and partners set the tone through their various presentations on the current state of the three diseases. The Executive Director of the Global Fund further emphasized the urgency of the moment by underlining the severity of the situation. In a context marked by the weakening of multilateralism, escalating conflicts, and climate disruptions, he warned of growing financial uncertainty - particularly in light of the recent shifts in U.S. policy. This was not a declaration of defeat, but a call for clarity: preserving the Global Fund's mission - to save lives and advance health equity - requires a reprioritization of goals and unprecedented unity of action. Notable progress was acknowledged in areas such as health system strengthening, market innovation, and debt restructuring. But the core message was elsewhere: the current model has reached its limits.
The 2023-2028 Strategic Performance Report, presented during the meeting, illustrated this precarious balance between resilience and ongoing tension. Far from misguided triumphalism, it outlined a forecast of uncertainty: tangible but fragile progress, threatened by chronic funding deficits and growing structural instability. This diagnosis was reinforced by the Risk Management Report and the Chief Risk Officer's annual opinion, which highlighted the growing vulnerability of operations to exogenous shocks and unilateral political decisions.
In this context, the approved reform of the Technical Review Panel (TRP) model stands out as a significant effort to reconcile technical rigor with streamlined processes. Differentiated review approaches by portfolio type, lighter procedures for high-performing programs, and greater flexibility - these changes respond to an urgent need: to ease the review burden without compromising scientific integrity. Whether this streamlining will be sufficient to restore partner trust and ensure field impact remains to be seen.
The May 7 retreat, organized in response to the scale of the budget shortfall (largely due to the U.S. withdrawal), exposed the scope of future trade-offs. Over 200 grants from Grant Cycle 7 are being reprogrammed, with targeted cuts to unspent funds aimed at protecting high-need countries. Yet criticism has grown: decision-making opacity, lack of community involvement, and a sense of technocratic detachment from the field. As Cycle 8 approaches, the demand for equity, transparency, and inclusion is becoming imperative.
Technically, Grant Cycle 7 statistics reflect both the mechanism's effectiveness - 96% of proposals reviewed, 241 grants approved - and its limitations: $5.7 billion in unmet needs, delays in catalytic investments, and persistent gaps in ethical oversight and co-financing. The same challenges resurface: simplify, clarify, engage.
Against this complex backdrop, the Eighth Replenishment campaign, launched on February 18, 2025, sets an ambitious tone. Co-hosted by South Africa and the United Kingdom, it aims to raise at least $18 billion, including $2 billion from the private sector. But figures alone will not suffice: the mobilization dynamic depends on restoring eroded trust, redefining priorities, and demonstrating that every dollar invested has measurable and equitable impact.
The 2024 OIG Annual Report, presented to the Board, provided a clear-eyed diagnosis: real progress despite a deteriorating global context, but also major governance risks requiring bold operational reforms. Finally, ethics was not sidelined: the integrity of the mechanism and the Global Fund's core values were critically examined - a sign of the determination not to sacrifice principles on the altar of crisis.
In sum, this 53rd Board Meeting was less a technical validation body than a stage for political truth. The Global Fund has shown it still stands. But the pressing question remains: for how long? It is clear that the times ahead will be challenging for everyone, and that tough decisions will need to be made. In this context - where every life matters - there is a genuine concern that prevention may be sidelined due to financial constraints.
It is now up to the global community to act with clarity, courage, and coherence. Saving the Global Fund, particularly during its upcoming 8th replenishment, is more than just preserving an institution: it is about protecting the very idea of a global health framework built on justice and solidarity.
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 became the setting for an important meeting in global health governance. The 53rd Board Meeting of the Global Fund to Fight AIDS, Tuberculosis, and Malaria did more than address its agenda items: it laid bare the deep fault lines of an institution caught between ambition and systemic fragility.
The Board leadership and partners set the tone through their various presentations on the current state of the three diseases. The Executive Director of the Global Fund further emphasized the urgency of the moment by underlining the severity of the situation. In a context marked by the weakening of multilateralism, escalating conflicts, and climate disruptions, he warned of growing financial uncertainty - particularly in light of the recent shifts in U.S. policy. This was not a declaration of defeat, but a call for clarity: preserving the Global Fund's mission - to save lives and advance health equity - requires a reprioritization of goals and unprecedented unity of action. Notable progress was acknowledged in areas such as health system strengthening, market innovation, and debt restructuring. But the core message was elsewhere: the current model has reached its limits.
The 2023-2028 Strategic Performance Report, presented during the meeting, illustrated this precarious balance between resilience and ongoing tension. Far from misguided triumphalism, it outlined a forecast of uncertainty: tangible but fragile progress, threatened by chronic funding deficits and growing structural instability. This diagnosis was reinforced by the Risk Management Report and the Chief Risk Officer's annual opinion, which highlighted the growing vulnerability of operations to exogenous shocks and unilateral political decisions.
In this context, the approved reform of the Technical Review Panel (TRP) model stands out as a significant effort to reconcile technical rigor with streamlined processes. Differentiated review approaches by portfolio type, lighter procedures for high-performing programs, and greater flexibility - these changes respond to an urgent need: to ease the review burden without compromising scientific integrity. Whether this streamlining will be sufficient to restore partner trust and ensure field impact remains to be seen.
The May 7 retreat, organized in response to the scale of the budget shortfall (largely due to the U.S. withdrawal), exposed the scope of future trade-offs. Over 200 grants from Grant Cycle 7 are being reprogrammed, with targeted cuts to unspent funds aimed at protecting high-need countries. Yet criticism has grown: decision-making opacity, lack of community involvement, and a sense of technocratic detachment from the field. As Cycle 8 approaches, the demand for equity, transparency, and inclusion is becoming imperative.
Technically, Grant Cycle 7 statistics reflect both the mechanism's effectiveness - 96% of proposals reviewed, 241 grants approved - and its limitations: $5.7 billion in unmet needs, delays in catalytic investments, and persistent gaps in ethical oversight and co-financing. The same challenges resurface: simplify, clarify, engage.
Against this complex backdrop, the Eighth Replenishment campaign, launched on February 18, 2025, sets an ambitious tone. Co-hosted by South Africa and the United Kingdom, it aims to raise at least $18 billion, including $2 billion from the private sector. But figures alone will not suffice: the mobilization dynamic depends on restoring eroded trust, redefining priorities, and demonstrating that every dollar invested has measurable and equitable impact.
The 2024 OIG Annual Report, presented to the Board, provided a clear-eyed diagnosis: real progress despite a deteriorating global context, but also major governance risks requiring bold operational reforms. Finally, ethics was not sidelined: the integrity of the mechanism and the Global Fund's core values were critically examined - a sign of the determination not to sacrifice principles on the altar of crisis.
In sum, this 53rd Board Meeting was less a technical validation body than a stage for political truth. The Global Fund has shown it still stands. But the pressing question remains: for how long? It is clear that the times ahead will be challenging for everyone, and that tough decisions will need to be made. In this context - where every life matters - there is a genuine concern that prevention may be sidelined due to financial constraints.
It is now up to the global community to act with clarity, courage, and coherence. Saving the Global Fund, particularly during its upcoming 8th replenishment, is more than just preserving an institution: it is about protecting the very idea of a global health framework built on justice and solidarity.
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!
