GFO Issue 467, Article Number: 2
ABSTRACT
This article analyzes the Global Fund's eighth replenishment, which fell short of its financial target. This shortfall is seen as a symptom of the weakening of international solidarity. The article demonstrates that the mobilized funds remain crucial, especially for Africa, which is at the epicenter of the three diseases. While highlighting the concrete risks of underfunding for HIV, tuberculosis, and malaria programs, the article also identifies opportunities to leverage underfunding for strategic reorientation, such as protecting essential functions, strengthening national systems, and empowering African actors.
The day after the summit does not dispel concerns
One figure stands out at the conclusion of the Global Fund's 8th replenishment conference, held on November 21, 2025, in Johannesburg on the sidelines of the G20 summit and co-chaired by South Africa and the United Kingdom: The total amount pledged was US$11.34 billion, compared to a target of US$18 billion. The gap is considerable. In its Investment Case for 2027–2029, the Global Fund had already warned that $18 billion would no longer cover all needs, which are estimated to have increased by approximately 8% compared to the previous cycle. Failing to reach this threshold means entering the next cycle below the minimum that the Fund deems necessary to continue reducing the three diseases.
The 2025 results report confirms this fragility, noting that the Fund's investments have saved more than 70 million lives since 2002 and reduced the combined mortality rate of HIV, tuberculosis, and malaria by 63% in countries where the Fund invests (Figure 1). However, the report emphasizes that this progress is threatened by an "international financing crisis," including a contraction in official development assistance, a proliferation of competing crises, and budgetary constraints in almost all major economies. In other words, the 8th replenishment reflects more than a "temporary lack of generosity"; it reveals a structural shift in the environment in which the Global Fund must now operate.
Figure 1: Programmatic Results At a Glance
Source: Global Fund
The Fund's official statement emphasizes the "unity" and "resolve" of the partners and hails the result as one achieved in "one of the most turbulent geopolitical and economic years in recent memory." However, behind this diplomatic language, two realities coexist. On the one hand, a core group of countries and private partners are maintaining or increasing their contributions. On the other hand, a growing number of major donors are scaling back or postponing their commitments. This leaves lasting uncertainty about funding prospects beyond the $11.34 billion announced in Johannesburg.
What is the status of the mobilization the day after the 8th reenactment?
As of November 21, $11.34 billion has been consolidated for the 8th replenishment, which falls well short of the $18 billion target and is even lower than the $15.7 billion pledged for the 7th replenishment in 2022. However, this result is incomplete. The Fund emphasizes that several donors have not confirmed their pledges and that mobilization efforts will continue. Major players, such as France, Japan, and the European Commission, have not yet announced specific contributions. France has indicated that its support for the Fund "remains unchanged," but its pledge cannot be formally confirmed until December. This uncertainty poses a risk but also an opportunity: it leaves open the possibility of raising the total beyond $11.34 billion.
On a positive note, the Johannesburg conference reaffirmed the importance of historical foundations. The United States remains the largest donor by far, pledging $4.6 billion and continuing the well-known 1:2 matching mechanism (one US dollar for every two dollars from third-party donors). Although this contribution is lower than the $6 billion pledged in 2022, it is also interpreted as confirmation that the Fund remains one of the few multilateral instruments deemed compatible with the new "America First" doctrine in global health, given the United States' withdrawal from several multilateral organizations. The United Kingdom, co-host of the summit, announced £850 million, which is less than previous cycles but reaffirms the fund as a "strategic investment in health security and economic growth," according to Prime Minister Keir Starmer. Germany confirmed a pledge of €1 billion, and Canada, CAD 1.02 billion. Several medium-sized European donors have significantly increased their contributions. Norway was the first country to announce a pledge for the eighth replenishment: 2 billion Norwegian kroner (NOK) confirming strong continuity with previous cycles and its position as the most generous donor per capita. Spain has pledged €145 million, which is more than a 11% increase compared to its pledge for the seventh replenishment. Luxembourg has done the same, pledging €13.8 million, an increase of approximately 20%. Other countries that have announced early commitments include Denmark (DKK 375 million), Switzerland (CHF 64 million), and Portugal (€1.5 million).
In Africa, the gesture is as political as it is financial. South Africa announced a contribution of $36.6 million from a joint public-private commitment. The government's share was more than double that of the previous replenishment, and the private sector contributed around $10 million. Several African contributing and beneficiary countries have accumulated $51.6 million in pledges in total, illustrating the continent's progressive assertion as a co-investor rather than a mere beneficiary.
Finally, the private sector is consolidating its rise to power. The Gates Foundation has pledged $912 million; the Children's Investment Fund Foundation (CIFF) has pledged an additional $135 million; (RED) has pledged $75 million; and other private partners have pledged $91.85 million, bringing the total to $201.85 million. These commitments bring pledges from the private sector and foundations to a total of $1.34 billion for the eighth replenishment. This demonstrates confidence in the Fund's ability to deploy innovations such as long-acting injectable PrEP, low-cost molecular diagnostics for tuberculosis, and dual-insecticide bed nets for malaria at scale.
However, this good news shouldn't obscure the reality that, even if actors like France, Japan, or the European Commission join the effort in the coming months, it will be difficult to cover the remaining €6.7 billion needed to reach the €18 billion target. Thus, the eighth replenishment confirms that the days of hoping to "catch up" with last-minute promises are long gone.
What the comparison with previous cycles reveals
To understand the importance of this result, it must be considered in the context of replenishment history. In 2019, the sixth replenishment in Lyon nearly missed its $14.02 billion target, but ultimately reached it - a feat hailed as "the largest fundraising ever achieved for a multilateral health organization." Despite growing geopolitical tensions, this victory demonstrated that the fight against HIV, tuberculosis, and malaria remained a sufficiently consensual global public good to mobilize funding.
Three years later, the 7th replenishment introduced a subtle yet consequential shift. The Global Fund requested $18 billion for the 2024–2026 period, arguing that this funding would save an additional 20 million lives and reduce deaths from the three diseases by 64%. Paradoxically, the result was an all-time high of pledges ($15.7 billion), yet the target was not reached, as acknowledged by the Executive Board's decision in November 2022. The Board hailed a "historic result" while noting the gap with the needs.
The 8th replenishment exacerbates this paradox. The Investment Case (Figure 2), published in February 2025, states that $18 billion would save 23 million lives between 2027 and 2029, reduce combined mortality by 64% compared to 2023, and prevent 400 million additional infections (Figure 3).
Figure 2: Overall resource needs and projected available resources for HIV, TB and malaria
Figure 3: Investment Case results for HIV, TB and malaria
On the other hand, the financial result - $11.34 billion so far confronts the Fund with a harsh arithmetic reality: even considering continued fundraising efforts and subsequent contributions, it will be impossible for it to finance all the priorities it deems essential. The 6th, 7th, and 8th replenishment phases thus tell a simple story: ambition remains high on paper, but the political capacity to finance it is eroding.
This erosion is part of a broader restructuring of official development assistance. Projections for 2025 cited in several analyses indicate declines of 30 to 40 percent in certain aid flows dedicated to the three diseases compared to 2023, due to the combined effect of wars, climate crises, migration pressures, and internal budgetary trade-offs. In this context, the Fund's decision in July 2025 to reduce funding already allocated for the 2024–2026 cycle by $1.43 billion - approximately 11 percent of the amounts initially committed - appeared as a warning sign: even before the 8th replenishment, the system had already begun to "manage the scarcity" by cutting existing programs.
Added to this is a gradual shift in political priorities. Health security, pandemic preparedness, the fight against climate change, and, more recently, energy and military security are absorbing an increasing share of attention and budgets. The Global Fund is not excluded from these new frameworks ,in fact, it is increasingly positioning itself explicitly as an actor in global health security and the strengthening of health systems - but it must now demonstrate its relevance in an environment saturated with competing demands. The 8th reconstruction shows that this argument still works to some extent, but with more difficulty than before.
What this changes in concrete terms for Africa
It is in Africa, and particularly in sub-Saharan Africa, that the consequences of insufficient replenishment will be most tangible. It is there that the epidemiological burden of the three diseases is heaviest, and there also that dependence on the Global Fund is most pronounced. This is because many of the countries operating in these countries fall into what the Global Fund refers to as "challenging intervention contexts."
The situation regarding malaria is stark: Africa accounts for approximately 94% of global cases and 95% of deaths in 2023, according to the WHO's 2024 Global Malaria Report . In the African Union member states alone , there are an estimated 251 million cases and over 579,000 deaths, 76% of which occur in children under five. The Global Fund, which provides 59% of all international funding for malaria programs , is essentially the backbone of the fight in most African countries.
According to UNAIDS figures, the epicenter of HIV remains in Africa. In 2024, 4,000 adolescent girls and young women (aged 15-24) were infected with HIV each week, 3,300 of them in sub-Saharan Africa . Women and girls account for 63% of new infections in the region. In many African countries with a high burden of disease, the Global Fund finances a substantial portion of prevention, testing, and treatment programs, alongside PEPFAR and other mechanisms .
Finally, tuberculosis remains one of the world's deadliest infectious diseases. According to the WHO, there were approximately 1.25 million tuberculosis-related deaths in 2023. The Global Fund is the primary donor for tuberculosis (TB) programs in low- and middle-income countries, supporting 76% of the global TB response, as noted by Médecins Sans Frontières (MSF).
Beyond the products and figures, however, it is the systems themselves that are faltering. Cuts to subsidies already granted, effective in 2025, have shown that community systems and "support" costs - training, supervision, information systems, and public management strengthening - are often the first areas affected because they are perceived as fungible. However, these investments are crucial for African countries, especially Francophone ones, to achieve genuine health sovereignty, including robust public financial management systems, integrated monitoring and evaluation mechanisms, harmonized information systems, and community networks capable of acting as safeguards.
Between disillusionment and opportunity: what to do now?
The main lesson from the eighth replenishment is twofold. First, the $11.34 billion result confirms that the era of continuous expansion of multilateral funding for HIV, tuberculosis, and malaria has ended. International solidarity, as it was known during the era of major HIV initiatives, is under strain. Second, this amount, which exceeds $10 billion over three years when additional contributions and expected supplementary funding from major absentees are included, shows that a solid base of partners refuses to abandon these three diseases.
Three main trends emerge for Africa:
1) Protecting the essentials: In an environment of scarcity, the primary responsibility of African stakeholders - including governments, CCM, and civil society - will be to ensure that the trade-offs imposed by underfunding do not compromise vital functions, such as essential health products, frontline human resources, community systems, and health information and monitoring mechanisms. This requires resisting the temptation to make cuts at the "community" or "systemic" levels first, simply because these areas are less politically visible.
2) Anchoring Financing in National Systems: The Fund's efforts to collaborate more closely with national public financial management systems are given new significance in this context. As every dollar becomes scarcer, its impact will depend on states' ability to absorb, track, and use resources effectively rather than creating parallel mechanisms. The Accra Reset, experiments with integrating national audit and control systems, and joint initiatives with the African Union should not be viewed as technocratic luxuries but as essential conditions for the survival of multilateral solidarity.
3) Building Broader Political Coalitions Around the Fund: Africa can no longer simply advocate as a "beneficiary"; it must emerge as a co-architect of the mobilization. The 8th replenishment being held on the continent, the active participation of several African heads of state, and the contributions from low- and middle-income countries, though modest, are all positive developments. However, Africa still needs to translate this political presence into the real capacity to influence budgetary debates in the capitals of the Global North. This can be achieved by more closely linking arguments in favor of the Fund to issues of health security, economic stability, and climate justice.
More broadly, a structural risk to the sustainability of programs in Africa is emerging: the fragmentation of co-financing policies. While all partners - from the Global Fund to Gavi, and from the United States to European donors - rightfully encourage increased domestic financing, the lack of genuine alignment among them creates unsustainable pressure for countries.
Donors often set their own requirements without prior consultation, without sufficiently involving Ministries of Finance, and without adhering to medium-term expenditure frameworks (MTEFs) or national budgeting processes. However, these co-financing policies are intended to reflect a comprehensive macroeconomic vision. In practice, their lack of coherence results in a layering of sometimes conflicting directives.
In a context of limited budgetary resources, this situation can lead to unrealistic sustainability trajectories or outright "planned failure." Therefore, it is imperative that donors and governments engage in structured dialogue to align expectations, consider countries' actual financial capacities, and develop multi-year plans that consolidate - rather than undermine - the progress made in responding to HIV, tuberculosis, and malaria and strengthening health systems.
Solidarity needs to be rebuilt
Following the eighth replenishment, it's clear that the international community has not adequately responded to the needs outlined in the Global Fund's Investment Case. The $11.34 billion pledged in Johannesburg represents enduring international solidarity, albeit shrinking. The fact that major players such as France, Japan, and the European Commission have yet to announce their final contributions highlights the magnitude of the risk and the remaining room for maneuver. The final result is not set in stone but will likely fall short of the $18 billion target.
However, calling it a failure would be misleading. As long as the mobilized resources - even if they fall short of the targets - are used to protect essential services, strengthen public systems, and support frontline communities, they can continue saving millions of lives and preventing a massive resurgence of the three diseases. Conversely, if budget cuts are distributed through technocratic mechanisms without clear political vision or genuine dialogue with countries and communities, Africa risks paying a double price in terms of lives lost and compromised sovereignty.
The eighth replenishment is therefore neither a resounding success nor an absolute disaster. It is a test of our collective capacity to do more with less and redefine international solidarity in terms of not only sums but also governance, trust, and power sharing. For African countries, the question now is how to transform the 11.34 billion dollars and the additional funds that will follow into a lever for the sustainable strengthening of health systems and health sovereignty rather than a mere lifeline. The true future of the fight against HIV, tuberculosis, and malaria on the continent will be determined here, in the coming years.
The day after the summit does not dispel concerns
One figure stands out at the conclusion of the Global Fund's 8th replenishment conference, held on November 21, 2025, in Johannesburg on the sidelines of the G20 summit and co-chaired by South Africa and the United Kingdom: The total amount pledged was US$11.34 billion, compared to a target of US$18 billion. The gap is considerable. In its Investment Case for 2027–2029, the Global Fund had already warned that $18 billion would no longer cover all needs, which are estimated to have increased by approximately 8% compared to the previous cycle. Failing to reach this threshold means entering the next cycle below the minimum that the Fund deems necessary to continue reducing the three diseases.
The 2025 results report confirms this fragility, noting that the Fund's investments have saved more than 70 million lives since 2002 and reduced the combined mortality rate of HIV, tuberculosis, and malaria by 63% in countries where the Fund invests (Figure 1). However, the report emphasizes that this progress is threatened by an "international financing crisis," including a contraction in official development assistance, a proliferation of competing crises, and budgetary constraints in almost all major economies. In other words, the 8th replenishment reflects more than a "temporary lack of generosity"; it reveals a structural shift in the environment in which the Global Fund must now operate.
Figure 1: Programmatic Results At a Glance
Source: Global Fund
The Fund's official statement emphasizes the "unity" and "resolve" of the partners and hails the result as one achieved in "one of the most turbulent geopolitical and economic years in recent memory." However, behind this diplomatic language, two realities coexist. On the one hand, a core group of countries and private partners are maintaining or increasing their contributions. On the other hand, a growing number of major donors are scaling back or postponing their commitments. This leaves lasting uncertainty about funding prospects beyond the $11.34 billion announced in Johannesburg.
What is the status of the mobilization the day after the 8th reenactment?
As of November 21, $11.34 billion has been consolidated for the 8th replenishment, which falls well short of the $18 billion target and is even lower than the $15.7 billion pledged for the 7th replenishment in 2022. However, this result is incomplete. The Fund emphasizes that several donors have not confirmed their pledges and that mobilization efforts will continue. Major players, such as France, Japan, and the European Commission, have not yet announced specific contributions. France has indicated that its support for the Fund "remains unchanged," but its pledge cannot be formally confirmed until December. This uncertainty poses a risk but also an opportunity: it leaves open the possibility of raising the total beyond $11.34 billion.
On a positive note, the Johannesburg conference reaffirmed the importance of historical foundations. The United States remains the largest donor by far, pledging $4.6 billion and continuing the well-known 1:2 matching mechanism (one US dollar for every two dollars from third-party donors). Although this contribution is lower than the $6 billion pledged in 2022, it is also interpreted as confirmation that the Fund remains one of the few multilateral instruments deemed compatible with the new "America First" doctrine in global health, given the United States' withdrawal from several multilateral organizations. The United Kingdom, co-host of the summit, announced £850 million, which is less than previous cycles but reaffirms the fund as a "strategic investment in health security and economic growth," according to Prime Minister Keir Starmer. Germany confirmed a pledge of €1 billion, and Canada, CAD 1.02 billion. Several medium-sized European donors have significantly increased their contributions. Norway was the first country to announce a pledge for the eighth replenishment: 2 billion Norwegian kroner (NOK) confirming strong continuity with previous cycles and its position as the most generous donor per capita. Spain has pledged €145 million, which is more than a 11% increase compared to its pledge for the seventh replenishment. Luxembourg has done the same, pledging €13.8 million, an increase of approximately 20%. Other countries that have announced early commitments include Denmark (DKK 375 million), Switzerland (CHF 64 million), and Portugal (€1.5 million).
In Africa, the gesture is as political as it is financial. South Africa announced a contribution of $36.6 million from a joint public-private commitment. The government's share was more than double that of the previous replenishment, and the private sector contributed around $10 million. Several African contributing and beneficiary countries have accumulated $51.6 million in pledges in total, illustrating the continent's progressive assertion as a co-investor rather than a mere beneficiary.
Finally, the private sector is consolidating its rise to power. The Gates Foundation has pledged $912 million; the Children's Investment Fund Foundation (CIFF) has pledged an additional $135 million; (RED) has pledged $75 million; and other private partners have pledged $91.85 million, bringing the total to $201.85 million. These commitments bring pledges from the private sector and foundations to a total of $1.34 billion for the eighth replenishment. This demonstrates confidence in the Fund's ability to deploy innovations such as long-acting injectable PrEP, low-cost molecular diagnostics for tuberculosis, and dual-insecticide bed nets for malaria at scale.
However, this good news shouldn't obscure the reality that, even if actors like France, Japan, or the European Commission join the effort in the coming months, it will be difficult to cover the remaining €6.7 billion needed to reach the €18 billion target. Thus, the eighth replenishment confirms that the days of hoping to "catch up" with last-minute promises are long gone.
What the comparison with previous cycles reveals
To understand the importance of this result, it must be considered in the context of replenishment history. In 2019, the sixth replenishment in Lyon nearly missed its $14.02 billion target, but ultimately reached it - a feat hailed as "the largest fundraising ever achieved for a multilateral health organization." Despite growing geopolitical tensions, this victory demonstrated that the fight against HIV, tuberculosis, and malaria remained a sufficiently consensual global public good to mobilize funding.
Three years later, the 7th replenishment introduced a subtle yet consequential shift. The Global Fund requested $18 billion for the 2024–2026 period, arguing that this funding would save an additional 20 million lives and reduce deaths from the three diseases by 64%. Paradoxically, the result was an all-time high of pledges ($15.7 billion), yet the target was not reached, as acknowledged by the Executive Board's decision in November 2022. The Board hailed a "historic result" while noting the gap with the needs.
The 8th replenishment exacerbates this paradox. The Investment Case (Figure 2), published in February 2025, states that $18 billion would save 23 million lives between 2027 and 2029, reduce combined mortality by 64% compared to 2023, and prevent 400 million additional infections (Figure 3).
Figure 2: Overall resource needs and projected available resources for HIV, TB and malaria
Figure 3: Investment Case results for HIV, TB and malaria
On the other hand, the financial result - $11.34 billion so far confronts the Fund with a harsh arithmetic reality: even considering continued fundraising efforts and subsequent contributions, it will be impossible for it to finance all the priorities it deems essential. The 6th, 7th, and 8th replenishment phases thus tell a simple story: ambition remains high on paper, but the political capacity to finance it is eroding.
This erosion is part of a broader restructuring of official development assistance. Projections for 2025 cited in several analyses indicate declines of 30 to 40 percent in certain aid flows dedicated to the three diseases compared to 2023, due to the combined effect of wars, climate crises, migration pressures, and internal budgetary trade-offs. In this context, the Fund's decision in July 2025 to reduce funding already allocated for the 2024–2026 cycle by $1.43 billion - approximately 11 percent of the amounts initially committed - appeared as a warning sign: even before the 8th replenishment, the system had already begun to "manage the scarcity" by cutting existing programs.
Added to this is a gradual shift in political priorities. Health security, pandemic preparedness, the fight against climate change, and, more recently, energy and military security are absorbing an increasing share of attention and budgets. The Global Fund is not excluded from these new frameworks ,in fact, it is increasingly positioning itself explicitly as an actor in global health security and the strengthening of health systems - but it must now demonstrate its relevance in an environment saturated with competing demands. The 8th reconstruction shows that this argument still works to some extent, but with more difficulty than before.
What this changes in concrete terms for Africa
It is in Africa, and particularly in sub-Saharan Africa, that the consequences of insufficient replenishment will be most tangible. It is there that the epidemiological burden of the three diseases is heaviest, and there also that dependence on the Global Fund is most pronounced. This is because many of the countries operating in these countries fall into what the Global Fund refers to as "challenging intervention contexts."
The situation regarding malaria is stark: Africa accounts for approximately 94% of global cases and 95% of deaths in 2023, according to the WHO's 2024 Global Malaria Report . In the African Union member states alone , there are an estimated 251 million cases and over 579,000 deaths, 76% of which occur in children under five. The Global Fund, which provides 59% of all international funding for malaria programs , is essentially the backbone of the fight in most African countries.
According to UNAIDS figures, the epicenter of HIV remains in Africa. In 2024, 4,000 adolescent girls and young women (aged 15-24) were infected with HIV each week, 3,300 of them in sub-Saharan Africa . Women and girls account for 63% of new infections in the region. In many African countries with a high burden of disease, the Global Fund finances a substantial portion of prevention, testing, and treatment programs, alongside PEPFAR and other mechanisms .
Finally, tuberculosis remains one of the world's deadliest infectious diseases. According to the WHO, there were approximately 1.25 million tuberculosis-related deaths in 2023. The Global Fund is the primary donor for tuberculosis (TB) programs in low- and middle-income countries, supporting 76% of the global TB response, as noted by Médecins Sans Frontières (MSF).
Beyond the products and figures, however, it is the systems themselves that are faltering. Cuts to subsidies already granted, effective in 2025, have shown that community systems and "support" costs - training, supervision, information systems, and public management strengthening - are often the first areas affected because they are perceived as fungible. However, these investments are crucial for African countries, especially Francophone ones, to achieve genuine health sovereignty, including robust public financial management systems, integrated monitoring and evaluation mechanisms, harmonized information systems, and community networks capable of acting as safeguards.
Between disillusionment and opportunity: what to do now?
The main lesson from the eighth replenishment is twofold. First, the $11.34 billion result confirms that the era of continuous expansion of multilateral funding for HIV, tuberculosis, and malaria has ended. International solidarity, as it was known during the era of major HIV initiatives, is under strain. Second, this amount, which exceeds $10 billion over three years when additional contributions and expected supplementary funding from major absentees are included, shows that a solid base of partners refuses to abandon these three diseases.
Three main trends emerge for Africa:
1) Protecting the essentials: In an environment of scarcity, the primary responsibility of African stakeholders - including governments, CCM, and civil society - will be to ensure that the trade-offs imposed by underfunding do not compromise vital functions, such as essential health products, frontline human resources, community systems, and health information and monitoring mechanisms. This requires resisting the temptation to make cuts at the "community" or "systemic" levels first, simply because these areas are less politically visible.
2) Anchoring Financing in National Systems: The Fund's efforts to collaborate more closely with national public financial management systems are given new significance in this context. As every dollar becomes scarcer, its impact will depend on states' ability to absorb, track, and use resources effectively rather than creating parallel mechanisms. The Accra Reset, experiments with integrating national audit and control systems, and joint initiatives with the African Union should not be viewed as technocratic luxuries but as essential conditions for the survival of multilateral solidarity.
3) Building Broader Political Coalitions Around the Fund: Africa can no longer simply advocate as a "beneficiary"; it must emerge as a co-architect of the mobilization. The 8th replenishment being held on the continent, the active participation of several African heads of state, and the contributions from low- and middle-income countries, though modest, are all positive developments. However, Africa still needs to translate this political presence into the real capacity to influence budgetary debates in the capitals of the Global North. This can be achieved by more closely linking arguments in favor of the Fund to issues of health security, economic stability, and climate justice.
More broadly, a structural risk to the sustainability of programs in Africa is emerging: the fragmentation of co-financing policies. While all partners - from the Global Fund to Gavi, and from the United States to European donors - rightfully encourage increased domestic financing, the lack of genuine alignment among them creates unsustainable pressure for countries.
Donors often set their own requirements without prior consultation, without sufficiently involving Ministries of Finance, and without adhering to medium-term expenditure frameworks (MTEFs) or national budgeting processes. However, these co-financing policies are intended to reflect a comprehensive macroeconomic vision. In practice, their lack of coherence results in a layering of sometimes conflicting directives.
In a context of limited budgetary resources, this situation can lead to unrealistic sustainability trajectories or outright "planned failure." Therefore, it is imperative that donors and governments engage in structured dialogue to align expectations, consider countries' actual financial capacities, and develop multi-year plans that consolidate - rather than undermine - the progress made in responding to HIV, tuberculosis, and malaria and strengthening health systems.
Solidarity needs to be rebuilt
Following the eighth replenishment, it's clear that the international community has not adequately responded to the needs outlined in the Global Fund's Investment Case. The $11.34 billion pledged in Johannesburg represents enduring international solidarity, albeit shrinking. The fact that major players such as France, Japan, and the European Commission have yet to announce their final contributions highlights the magnitude of the risk and the remaining room for maneuver. The final result is not set in stone but will likely fall short of the $18 billion target.
However, calling it a failure would be misleading. As long as the mobilized resources - even if they fall short of the targets - are used to protect essential services, strengthen public systems, and support frontline communities, they can continue saving millions of lives and preventing a massive resurgence of the three diseases. Conversely, if budget cuts are distributed through technocratic mechanisms without clear political vision or genuine dialogue with countries and communities, Africa risks paying a double price in terms of lives lost and compromised sovereignty.
The eighth replenishment is therefore neither a resounding success nor an absolute disaster. It is a test of our collective capacity to do more with less and redefine international solidarity in terms of not only sums but also governance, trust, and power sharing. For African countries, the question now is how to transform the 11.34 billion dollars and the additional funds that will follow into a lever for the sustainable strengthening of health systems and health sovereignty rather than a mere lifeline. The true future of the fight against HIV, tuberculosis, and malaria on the continent will be determined here, in the coming years.
