In keeping with tradition, Peter Sands opened discussions at this 43rd meeting of the Global Fund Board. Held virtually with a lighter agenda, this meeting was above all an opportunity to look back at the unprecedented global health crisis the world is currently facing and how the Global Fund has responded to prevent the very serious effects anticipated.
The Executive Director discussed three important points: update since the last Board meeting of November 2019, the effect of the COVID-19 crisis and finally, some preliminary reflections on what this means for the Global Fund – for our overall mission and for our role within the global health community.
Updates since the last Board meeting of November 2019
Peter Sands highlighted some of the important activities that the Secretariat successfully conducted. One of them is the creation of the Youth Council, which had selected 16 young people and one observer member, representing youth and the diversity of our world. The Council has begun its work and is due to meet again by the end of May. Also, the Secretariat reviewed the monitoring and evaluation framework, and discussed the issue of learning and knowledge management. But those discussions did not give rise to an in-depth review of the overall architecture of monitoring and evaluation or the measurement of impact.
Peter Sands described progress with regard to mapping and analysis of procedures. The Secretariat addressed the issue of digital security, in a world where cyber-attacks are increasingly frequent. The Global Fund has been awarded an ISO certificate that confirms that it meets required standards. Despite the move to the Global Health Campus site, the Secretariat's operating expenses are fully controlled, and internal risk management is being carried out more often, according to the latest Office of the Inspector General (OIG) report.
Sands acknowledged some weaknesses. The current working conditions have delayed progress on some important projects, particularly the recruitment of staff, and in the area of supply chain or health system strengthening. Despite these difficulties, internal reorganization continues: a department dedicated to health financing has been created, the external relations directorate has merged with the communications directorate, and reviews of the Multisectoral Accountability Framework (MAF) or Technical Advice and Partnership (TAP) department are underway. Peter Sands warmly thanked Seth Faison, a colleague and friend who has worked as Director of Communications for seven years, and is leaving the organization in June 2020.
The COVID-19 crisis and challenges
Peter Sands spoke about the consequences of the COVID-19 pandemic on the Secretariat staff that has to work from home in addition to managing new activities linked to COVID-19. The Secretariat commissioned a qualitative survey that discussed staff well-being. According to the survey, 94% of employees said they are well accommodated during this period and 70% said that they are sufficiently informed. Peter Sands said this unprecedented period, has generated an additional workload of at least 50%, and the staff performance is 20% lower than average. Therefore, his priority is to protect the Secretariat staff against burnout.
Peter Sands described the perspectives at the end of 2019: “In November [during the last Board meeting] we were looking towards 2020 with a sense of excitement about how, reinforced by the success of the Sixth Replenishment, we could truly step up the fight against HIV, tuberculosis (TB) and malaria, save many more lives and materially accelerate the end of the epidemics. With country allocations up by an average of 23.4%, we could visualize how we could turn the tide on HIV prevention, attack transmission in the highest-burden malaria districts, and finally close the gap of missing people with TB”.
But the emergence of COVID-19 has reordered priorities and brought about threats previously unknown in their scale and speed; the Global Fund, as an important player in the field of global health, is a witness to this. “Just a little over four months after it first hit the news, COVID-19 has disrupted every aspect of what we do: from the way we run the Secretariat or the Board itself, to the way we distribute insecticidal bed-nets or deliver prevention programs for key populations. And it’s far from over. The full force of the pandemic has yet to strike many of the communities with which we work the most. The full extent of the potentially devastating knock-on impact on the fight against HIV, TB and malaria is still far from clear”.
For Peter Sands, the COVID-19 epidemic is a game changer and requires the Global Fund stakeholders to keep what is essential in mind. He asked Board members to keep the whole Secretariat focused on ensuring the survival of patients on treatment, and the partnership that defines the Global Fund with goverments, technical partners, international donors such as GAVI or the World Bank, bilateral cooperation (GIZ, AFD, USAID), the private sector, and the communities.
The Executive Director described the Global Fund’s proactive approach to the pandemic by allowing countries flexibility to use savings from grants for their COVID-19 response and the additional COVID-19 Response Mechanism (C19RM). He explained that 79 countries and 5 regional projects received additional funds to respond to the COVID-19 crisis. He regretted that the response was nevertheless very vertical, from the decision-makers downwards, which sometimes left the civil society organization and the Country Coordinating Mechanisms (CCM) out of the loop for the reprogramming of funding. For the C19RM , CCMs will have to approve COVID-19 funding requests. He also expressed his concern that the Board had not received any C19RM funding requests up until that point. This raised questions on how to balance consultation with emergency responses, and how to make funding available to those in need within a short period of time.
For the Global Fund, this crisis is a reminder that crucial factors such as economics and politics play a fundamental role. After the financial crisis of 2008, all conversations were focused solely on the global economy, making it impossible to achieve the necessary balance between finance, global health, geopolitics and resilience to shocks. The seventh replenishment of the Global Fund will take place in this context, while all efforts will be directed towards research on and the development of a COVID-19 vaccine.
Pandemics and public health
The COVID-19 pandemic forces us to question our priorities and the global agenda, and to help protect the Global Fund mandate to fight AIDS, TB and malaria. Peter Sands said that this reminds us that a crucial debate on international health security, the place of science and the role of communities in the fight against epidemics was looming; all this while needing to respect the rights that are often put to the test in times of emergency. The Global Fund must be part of this debate as a global health actor, and this debate must inform the Global Fund's next strategy. Amid the COVID-19 crisis, the strategy development process had to be revised to include virtual meetings, which are not ideal.
Before considering this new strategy, it is necessary to take stock of the damage that the COVID-19 crisis has had on supply chains, laboratories and other services within countries. However, it is important to continue to focus on the end of HIV, TB and malaria epidemics: “we must finish the fight against pandemics,” said Peter Sands.