The Global Fund: A Foundation for Health Equity

The Biden-Harris administration can rally the global community and transform the world’s pandemic preparedness, prevention, and response

As civil society, we believe the Biden-Harris administration can help reset the world’s approach to health, moving us toward the end of the existing pandemics and helping stop the next ones. 

An effective U.S. approach to pandemic preparedness should:

• generate radical shifts in health equity everywhere and for everyone;
• reject dangerously narrow views of “health security” that prioritize only people in the United States and other wealthy countries; 
• provide additional funding for pandemic preparedness and prevention, while also expanding funding for treatment and prevention for ongoing pandemics; 
• strengthen, rather than detract from, the fight to end AIDS, tuberculosis, and malaria;
• dramatically expand resources for civil-society and country-level planning; 
• embrace inclusive governance, with directly affected communities and civil society in the global South as equal partners in decision making at a local, national, and global level; 
• mobilize pandemic preparedness resources from other donors; and 
• deliver impact against ambitious, measurable targets. 

We believe that where new, additional funds for pandemic preparedness are channeled, their scale and their governance will determine our collective success on these goals. 

The Global Fund to Fight AIDS, Tuberculosis, and Malaria is the best-situated funding mechanism to scale up the health systems investments required for pandemic preparedness, rooted in a vision of global health solidarity. It is a false choice between tackling existing pandemics and stopping future ones. Building on the Global Fund’s investments in resilient and sustainable health systems will help stop emerging and future pandemics while reinvigorating the fight against the pandemics of HIV/AIDS, tuberculosis, and malaria. 

We are concerned about channeling new funds through the World Bank or other institutions that lack inclusive governance or proven impact on health equity. Creating a new financing mechanism from scratch could lead to further siloing, unrepresentative governance, and disconnection from core health services. We do not have time, and the burden on communities and governments in the South is unnecessary. Instead, by leading a global effort to significantly increase resources through the Global Fund, the Biden-Harris administration has the chance to reset the world’s approach to health. We believe the replenishment of the Global Fund in 2022 is a chance to bring together significant new resources, raise global ambition, and put health equity at the center of pandemic preparedness. 

Strengths of the Global Fund for pandemic preparedness

There are pieces of pandemic preparedness beyond the scope of the Global Fund – but any element of real health security requires a health system that is reaching the most marginalized groups, isolated communities, and people facing poverty. This is where the Global Fund partnership is essential.

• The way to keep pandemic preparedness tools and personnel ready to respond is not to leave them “on the shelf,” but rather to integrate them in ongoing health services. As former CDC Director Tom Frieden wrote, “A crucial lesson from preparedness work over the past 20 years has been that the most effective emergency response systems build on robust, scalable systems that respond to everyday events.”
  
• The Global Fund’s core strength is deploying disease-fighting interventions at scale. The organization is uniquely positioned to reach well over 100 countries without delay. It has proven itself agile and able to provide support quickly during the COVID-19 pandemic. It channeled $1 billion in support to countries to fight COVID-19 in 2020 and is on track to deliver a far higher level in 2021.
  
• Inclusive governance at a local, national, and global level, an explicit commitment to human rights and reaching marginalized groups, and local ownership have to be embedded in the financing of pandemic preparedness. Among international funding mechanisms, the Global Fund is far and away the best model of inclusive governance and mutual accountability. Its Board has equal representation from both donors and implementers, and community and civil society are involved at every level – from national country coordinating mechanisms to board authority. As the vast inequity in the Covid-19 response illustrates, mere consultations with communities and countries in the global South are insufficient; they must be at the decision-making table.
• U.S. contributions to the Global Fund leverage other donor contributions and domestic co-financing. Since its founding, other donors have matched U.S. contributions to the Global Fund 2:1, including in the last replenishment. Global Fund grants also include co-financing obligations for implementing countries (typically 15-30% of grant value) and generally achieve over 95% adherence. The Global Fund also arranges blended finance transactions with the World Bank (for example, in India, the Global Fund helped buy down the interest on a $400 million World Bank loan, to incentivize its use for TB).
• The Global Fund has valuable technical expertise and experience in fighting infectious diseases and supports coordination at a country level. Global Fund Country Coordination Mechanisms bring together relevant local and international partners in each country to design and prioritize programs – including the major U.S. bilateral programs like PEPFAR, and affected civil society populations.

The U.S. has long had bipartisan support for the Global Fund, and now the Biden-Harris administration should expand the vision, reach, and impact of that commitment as a global leader in the wake of COVID-19.