JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts.

The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge.

South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”.

“Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. 

“Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.”

United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South.

“Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer.

“Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added.

Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully.

Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy.

The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted.

However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added.

“The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. 

“The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin.

“Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded.

The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors.

Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands committing €195.2 million; Norway, which committed $200million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation which pledged $912 million.