Dear subscribers,

The 54th Global Fund Board meeting, held in Geneva on 12–13 February 2026, did more than adjust priorities: it exposed a political shift. The Global Fund is entering a phase where the question is no longer simply “what to fund?”, but “how far should funding go- and for how long?”. Shrinking aid budgets, rising pressure from donors’ domestic politics, and the language of “efficiency” are converging toward the same outcome: a narrower space for action and tougher trade-offs.

The most structuring development is the explicit return of the principal donor’s doctrine. The United States’ weight is not new; what has changed is the nature of its influence: a clearer demand for alignment with its domestic priorities and with its definition of what is “legitimate.” In that framing, anything not immediately “visible” is less tolerated: advocacy, rights work, and the political and social labour that makes access possible are easily pushed to the margins. The mandate then risks narrowing to a “life-saving” vision reduced to commodities, procurement, and measurable interventions. But epidemics are not controlled by inputs alone; they are controlled through systems, trust, behaviour, and civic space where people can seek care without fear.

A second, even sharper signal is the normalization- indeed acceleration -of transition. The message that “the Global Fund is twenty years old; it cannot last another twenty years” turns planning into a countdown. The notion that, for a large share of countries, GC9 could be the final cycle changes the meaning of GC8: every decision becomes a decision about trajectory. What should be consolidated if external funding withdraws? What can realistically be moved to domestic budgets- and at what political cost? What must be protected when the state cannot fund, or refuses to fund, especially for criminalized populations? The “predictability” promised through transition pathways can help countries prepare; it can also become a cold disengagement mechanism if timelines are unrealistic and safeguards absent.

This is the lens through which the GC8 “strategic shifts” must be read: integration, prioritization, differentiated co-financing, “tailored” transition pathways. On paper, the argument is rational: scarcer resources, a need for efficiency, and stronger country ownership. But the central risk is political: risk is being shifted onto countries—and, more acutely, onto communities and the most vulnerable populations. For two decades, the Global Fund has partly functioned as a collective insurance mechanism against states’ budgetary, administrative, and sometimes moral failures. Under GC8, those failures risk being handed back to countries, even where systems lack both fiscal space and civic space to absorb the shock. In Africa, this will rarely appear as an immediate spectacular collapse; more often it will take the form of silent breakages: loss to follow-up, delayed diagnosis, treatment interruptions, and gradual erosion of indicators long before crisis becomes politically audible.

The real test is community systems financing. Communities are repeatedly described as being “at the centre,” yet their sustainability is increasingly conditioned on integration and domestic financing- approaches that, in many contexts, do not work for key populations. Where the state represses, stigmatizes, or criminalizes, asking it to finance these responses is tantamount to asking it to fund what it opposes. The blind spot is persistent: sustainability is treated as a budget-line issue when it is first and foremost about rights, security, and power. The Rapid Community Protection Fund illustrates this contradiction: it is promising, but under-resourced- as if protection could remain marginal at precisely the moment pressure on community actors is intensifying.

In this context, the idea of stopping funding for “advocacy” in order to focus solely on “life saving” is less an optimization than a misdiagnosis. In HIV, TB, and malaria, there is no stable boundary between saving lives and making services accessible. Reducing fear of police around a testing site, securing suitable service hours, protecting confidentiality, and countering stigma are not add-ons; they are conditions for effectiveness. Cutting these functions weakens the performance of biomedical investments- and therefore, paradoxically, weakens “life saving.”

Should domestic financing be rejected? No. The shock could also force states to break out of comfortable dependency and take their budgetary responsibility seriously. But that opportunity will not materialize through slogans. It requires moving the debate to ministries of finance and the highest political levels; creating explicit, fundable protections for services for key populations; and radical transparency on GC8 trade-offs so countries can plan, contest, and adjust with full information. Without this, “transition” risks becoming an imposed exit dressed up as ownership.

The Board also highlighted a more assertive market-shaping and procurement strategy: negotiating prices, accelerating access to innovations, ensuring supply continuity, and enabling countries to use pooled procurement mechanisms with their own funds. This is a real lever- one of the few areas where “efficiency” can mean “more health” without sacrificing the most vulnerable. But it will not, on its own, compensate for accelerated allocation reductions. And it presupposes national capacity in planning, regulation, and supply chain management -precisely the capacities that must be strengthened before any disengagement.

Ultimately, Geneva confirmed a shift in era: the Global Fund will no longer be able to be all things at once- massive financier, protector of communities, rights catalyst, guarantor of access for criminalized populations, and shock absorber. The question becomes: who decides the trade-offs, by what criteria, and with what political accountability?

For implementer regions with many upper-middle-income countries or lower-middle-income countries, the operational agenda is immediate: demand country-by-country quantified transition scenarios; embed non-negotiable community safeguards in funding requests and national plans; and secure full transparency from the Global Fund on its compromises, exceptions, and protection mechanisms. Because a “strategic shift” without a dashboard is not a strategy- it is a transfer of responsibility, and too often a transfer of risk to those least able to carry it.

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 Djesika Amendah djesika.amendah@aidspan.org and/or christian.djoko@aidspan.org

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