The Global Fund’s Fifth Replenishment Conference in Montreal involved much more than just donors making their formal pledges for the next three years. Civil society advocates came to ensure the voices of key populations and women and girls, and those living in countries transitioning out of Global Fund eligibility, were heard; and the private sector, rock stars, philanthropists, and diplomatic leaders showed up to demonstrate their support for the Fund and its mission – giving dimension to the meeting through a series of side-meetings and events.
In nearly achieving its stated goal of US$13 billion, the Global Fund partnership appears to have again demonstrated that it matters, and that governments and corporations are willing to put billions towards the achievement of its mission. “Given the many challenges governments face today, I’m inspired by the generosity of partners at this replenishment. It is a great outcome,” said Bill Gates, whose namesake foundation pledged US$600 million to the Fund. “The Global Fund has consistently proven that it is one of the most impactful investments a donor can make in global health.”
See separate article in this issue for more details on the pledging component of the Replenishment Conference.
Civil society gathers to discuss transitions
A two-day day pre-meeting – Celebrating the Gains, Meeting the Challenges: A Civil Society Workshop – was held on 15-16 September to discuss and refine civil society priorities ahead of the conference. The planning meeting, organized by the Interagency Coalition for AIDS and Development (ICAD), ICASO, the Global Fund Advocates Network, RESULTS Canada, and the Canadian Network for Maternal, Newborn and Child Health, brought together Canadian and international advocates to develop and activate strategies for mitigating the impact on key populations of donors transitioning out of middle-income countries; ensuring the preeminence of human rights in the HIV, TB, and malaria responses; and identifying new directions for resource mobilization for communities.
“Transition” is the term used to describe the process of the Global Fund (and other donors) downsizing investments in (mostly) middle-income countries and turning over responsibility for funding the responses to the diseases to national governments and other local stakeholders. Civil society has expressed concern that national governments may not demonstrate the same commitment to supporting key populations as the Fund has, thereby threatening some of the gains made to-date and affecting the well-being of vulnerable populations. Mike Podmore, Director of the UK-based network STOPAIDS and Global Fund Alternate Board Member for the Developed Country NGO Delegation, said at the pre-meeting: “This is not transition, it is abandonment.”
Photo: Left to right, Matt Cavanaugh (Health GAP), Joanne Carter (RESULTS), Mike Podmore (STOPAIDS), RD Marte (APCASO), and Jaevion Nelson (Caribbean Vulnerable Communities Coalition)
The Global Fund uses the World Bank’s income level classification system to help determine a country’s eligibility for funding. These classifications are also used as part of the formula which determines how much money each eligible component and country receives. But this method does not necessarily lead to funds reaching the poorest people, civil society activists argue. “Donors say they are pulling out of countries because they want to reach the poorest. But 70% of the world’s poorest people live in middle-income countries,” noted Joanne Carter of RESULTS.
On the evening of 15 September, a separate event was organized by and for civil society – Sharpening our Focus: Human Rights and Key Populations in the Global Response to HIV, TB, and Malaria. The event was opened by indigenous Mohawk Elder, Sedalia Fazio, as is the custom in Canada. She directed attendees to think about the health of the planet, and our role in preserving it. “Everything on Earth is doing exactly what it was instructed to do, except human beings,” she said.
After welcoming remarks from the Honorable Marie-Claude Bibeau, Canada’s Minister of International Development, and Global Fund executive director Mark Dybul, AIDS Free World co-founder and Canadian development icon Stephen Lewis gave the keynote address. Mr Lewis commended the progress made by the Global Fund, but centered his remarks on the need for even greater, and smarter, investment in combating the diseases. “The 13 billon dollar target is ridiculous,” he said. “It’s just not that hard to reach. The Global Fund should be asking for much more money.” Mr Lewis called on donors to re-double their aid as an essential component of the global response. “You can talk till doomsday about innovative financing. But you will never solve the epidemics until the donors pull their weight.”
Private sector self-congratulates and expands commitments
On 16 September, private sector donors also held a pre-meeting in Montreal. The two-hour event was chaired by Paul Shaper of Merck/MSD and the Global Fund Board Member for the Private Sector Constituency. Attendees were mostly from industry and foundations, but also included some high-level public figures such as U.S. Ambassador and Global AIDS Coordinator Dr Deborah L. Birx.
Some private sector entities have contributed to the Global Fund in ways other than just giving money. Several have launched innovative initiatives to impart expertise and training to strengthen health systems and improve program implementation. Beatriz Perez, who presented on behalf of Coca-Cola, addressed the famous question posed by Melinda Gates: “If the Coca-Cola company can deliver a bottle of soda to a village deep in the African countryside on a daily basis, why can’t governments and nonprofits figure out how to do the same with life-saving pharmaceuticals?” She discussed Coca-Cola’s efforts at leveraging its supply chain superiority to help keep drug stocks refrigerated and get them to people in remote areas. The program is up and running, or about to be, in Tanzania, Ghana, Nigeria, Swaziland, and Mozambique. Ms. Perez closed her remarks with this maxim: “Businesses are for profit, but there won’t be any profit left if the people aren’t profiting first.”
Ecobank’s philanthropic efforts were described by Ecobank Foundation CEO Julie Essiam. Ecobank is a large, Africa-based bank with operations in more than thirty African countries, and offices around the world. Ecobank contributed US$3 million to the Global Fund for 2014-2016, and pledged to do so again for 2017-2019.
David Sin, Executive Chairman of the Asian medical-services giant Fullerton Healthcare Corporation, spoke about the partnership agreement Fullerton Health Foundation International has reached with the Global Fund. The agreement includes a donation of S$25 million (Singapore dollars) in money and in kind.
Sherwin Charles, CEO of Goodbye Malaria, a Johannesburg-based private sector initiative, also spoke at the event.
Rock stars also show up
Another sector of the AIDS response was also on hand in Montreal to support the Fund: rock stars. Bono, the U2 front man, noted anti-poverty advocate, and ONE co-founder, and a familiar face in health and development circles, spoke on a panel with U.N. Secretary-General Ban Ki-moon, Bill Gates, and others. In a moment of levity, Bono mused that, “Replenishment sounds less like number-crunching and more like something you might receive at an exclusive spa,” before recalling the progress made through the Global Fund. “It might be important to remember what the global emergency looked like 10-15 years ago,” he said.
In conjunction with the Replenishment Conference, the entertainment-for-good organization, Global Citizen, organized a large concert on the evening of 17 September at the Bell Center in downtown Montreal. The concert, which included performances from perennial hit-maker Usher, The Roots, Half Moon Run, and Montreal’s own Grimes, among others, was billed as “A concert to end AIDS, Tuberculosis, and Malaria,” and was attended by some 12,000 fans.
Rather than purchasing tickets, admission to the concert was earned through the completion of an “Action Journey,” in which prospective concert-goers were required to watch an informational video, take a quiz, sign several petitions targeting world leaders with messages about polio and girls’ education, and put a call in to Canadian Prime Minister Justin Trudeau in support of “strong investments in health and development.” During the high-energy event, a t-shirt and jeans-clad Trudeau joined Bill Gates on stage to thank the crowd for their efforts. He was warmly received by the largely millennial crowd. The concert was also broadcast live on Canadian television.