Global Fund investments have reduced deaths in HIV, tuberculosis and malaria by 61% and saved 65 million lives since 2002 – while simultaneously improving health service delivery, according to its annual Results Report released on Thursday. 

The past year (2023) has brought significant wins: a 55% reduction in the price of bedaquiline, the main treatment for drug-resistant TB and a 25% cut in the cost of TLD, the preferred first-line HIV treatment.

It has also introduced new dual-active ingredient insecticide-treated mosquito nets that are 45% more effective against malaria.

These wins are the result of what The Global Fund terms “marketing-shaping”: using its substantial buying power to encourage manufacturers to lower prices. 

While The Global Fund focusses on the three priority diseases, its impact has been far wider. 

‘’In 2023, we invested $1.8 billion, the highest amount ever in a single year, to strengthen health and community systems,” Executive Director Peter Sands told a media briefing on Wednesday.

“In this grant cycle period, [2024- 2026] we’re looking at investing around $6 billion in supporting countries to deliver better health outcomes, through pandemic preparedness, through stronger systems and through accelerating their journey towards universal health coverage.”

One significant area of investment, health facilities’ oxygen supplies, has assisted around 22 million patients with respiratory illnesses.

Reducing health system pressure

The report also quantifies for the first time how its focus on the three diseases has alleviated stress on countries’ health services.

Currently, it supports 25 million people on antiretroviral medication – and this has saved around 1.66 billion hospitalisation days and 1.36 billion outpatient visits, which translates into   a saving of around $85 billion. 

“Where the three diseases absorb over 50% of health system resources, the impact of reducing their burden on overall health system performance can be dramatic,” said Sands. “It means lower infant and maternal mortality and fewer deaths from acute trauma and other conditions.

“In addition, our continued investments in community health workers, labs, supply chains, disease surveillance systems and other health system components better prepare countries to prevent, detect and respond to other diseases like mpox or future pandemics.” 

Climate change challenges

The Global Fund invests 70% of its funding in the 50 most climate-vulnerable countries, and its operations have been affected by changing climate – from floods disrupting services to rising temperatures “cooking” valuable medicines. 

However, the most significant impact is on malaria.

“There are two different things going on, said Sands. “One is the gradual rise in temperatures, which means that communities and places that were previously not subject to malaria, often because of higher altitudes which were too cold at night for the mosquitoes, are now becoming susceptible to malaria.”

The second, which is more difficult to predict, is “the impact of climate change on the frequency of extreme weather events, leading to cyclones and flooding” such as seen in Malawi and Pakistan – and resulted in surges in malaria.

But addressing malaria is “particularly challenging”, added Sands, because it is surging in conflict zones there is  “increased resistance both of mosquitoes to insecticides and to the most commonly used treatments”.

To support countries to adapt to the impact of extreme weather and climate events, it restructured grants and offered access to emergency funds in countries such as Zambia, Kenya and Somalia. 

The Fund has also established partnerships with the World Bank and the Green Climate Fund that have “significant expertise and resources around both climate mitigation and adaptation”, said Sands. 

He stressed that very little funding has gone to climate adaptation in health and “we need to work together to respond more effectively to what’s happening, because, if anything, it appears to be happening faster and more significantly than projected”.

Human rights barriers

In HIV, human rights barriers like punitive laws, stigma, discrimination and violence, including gender-based violence, prevent people from getting HIV prevention, testing, treatment and care. 

“The fight against diseases is as much a fight for justice and equity as it is a biomedical fight,” said Sands. “Even the most innovative biomedical tools will fail if those who most need them can’t get them.” 

To tackle human rights and gender-related barriers to accessing health services, the partnership expanded the Breaking Down Barriers initiative, which aims for inclusivity and equity in healthcare delivery. 

“Our model is anchored by a partnership that thrives on inclusive governance, making us a global movement of civil society, governments, private sector partners, technical partners and communities affected by the three diseases in more than 100 countries,” said Sands. “That partnership came to count enormously as we responded to the many challenges we faced in the year.”

Image Credits: Vincent Becker/ Global Fund, Brian Otieno /Global Fund, Brian Otieno/ Global Fund.