Reviews | Covid has eroded the fight against tuberculosis and other diseases. The world must act.

One of the noblest things the United States and other developed nations have done in recent decades has been to save the lives of tens of millions of people in the poorest countries from preventable infectious diseases. And one of the banking cruelties of the coronavirus pandemic has been to seriously undermine those gains.

Take the case of the Global Fund to Fight AIDS, Malaria and Tuberculosis. The United States has its own highly effective programs to combat infectious diseases, including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (GPA). But the Global Fund was created in 2002 share the burden of these efforts. The US share of the fund’s budget is capped at 33%, meaning other donors must provide 67% to trigger America’s total contribution.

Over the two decades of its existence, the Global Fund has distributed $55 billion and, together with its local partners, saved approximately 44 million lives. The combined mortality rate of the three diseases has been reduced by more than half in the countries where the fund is active.

In the process, the Global Fund has carved out a vital role in improving health systems in developing countries – building new labs, improving supply chains, training community health workers. Over the years, improvements in global health have become so widespread and rapid that in 2015 the United Nations set as Sustainable Development Goal 3 the elimination of AIDS, malaria and tuberculosis as threats to public health. by 2030.

Then came 2020 and the arrival, rapid spread and genetic mutations of a new respiratory infection. This has (understandably) redirected global attention and complicated local efforts to prevent and treat existing diseases. The turnovers came quickly. For the first time since the creation of the Global Fund, progress against the three diseases has deteriorated.

Another of the world’s deadliest respiratory diseases, tuberculosis, has been the most affected by the shock of the global health system. The number of people treated for TB in countries where the Global Fund invests has fallen by more than 1 million. Malaria cases and deaths increase. HIV testing decreased by more than 20 percent.

To undo this derailment, the Global Fund believes it will take $18 billion over the next three years – an increase of almost 30% compared to the funds raised during its last reconstitution, three years ago. This means that donor countries must increase their pledges by 30% at a time when war and rising energy prices complicate the politics of generosity.

These are challenging but enlightening times for global health. Twenty years ago, the United States and other developed countries made a human decision to prevent preventable disease. And over the years, surprising success has made possible the eradication of some of humanity’s worst microbial enemies. It was what the Greeks called a “kairos” moment – ​​a moment of great opportunity and awesome consequences.

Now the wealthiest countries face another such moment. Do they recap one of the great moral ambitions of history, or do they signal that preventable diseases should be avoided except for the most vulnerable people on the planet?

A source familiar with the negotiations says the results so far have been “mixed”. The Biden administration has acted admirably. He proposed an increase of around 30% in his funding pledge, in order to $6 billion (if other nations are involved), and will host the Global Fund replenishment summit in New York this month. The German government, under enormous economic pressure due to energy disruptions, reported an increase in 30 percent. Japan has significantly increased its commitment as well.

Wildcards are Britain and France. Britain’s decision will indicate the attitude of a new Prime Minister and a new government towards foreign aid. People close to the negotiations fear that lump sum funding may be the best outcome. They are also hearing worrying rumors that the French government of President Emmanuel Macron – which hosted the last replenishment summit and is the second largest contributor to the Global Fund – could increase its pledge by just 5-15%, which would be a serious disappointment.

Leaders of donor countries all face the same question: is there a zero-sum game between serving my people and helping the world’s poorest? Basically, the last few years have answered this question. To fight any future pandemic, the world depends on the ability of health systems in developing countries to detect, contain, monitor, treat and vaccinate against new threats. There is a close relationship between the ability to fight current infectious diseases and the ability to fight newly emerging infectious diseases. Building these capacities is one of the strengths of the Global Fund.

What remains is a political question: is a leader trying to gain national advantage by inflicting unnecessary suffering on the poor and vulnerable? However, the question is not only political. It is ultimately a moral test.

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