Will the U.S. Congress Rise to the Moment and Save Lives? Or Will They Let COVID-19 Roll Back Years of Fragile Gains Against HIV, Tuberculosis, and Malaria?

A new report from The Global Fund to Fight AIDS, Tuberculosis, and Malaria warns that without sufficient scale-up in the global health response, the coronavirus pandemic could roll back 20 years of progress against the pre-existing pandemics of AIDS, TB, and malaria by disrupting treatment and prevention services – causing millions more deaths on top of those from COVID-19. The report, combined with recent analyses which found that COVID-19 could result in more than double the number of people dying of AIDS and a drastic increase in the number of HIV infections among children, should serve as a call to action for congressional appropriators creating a budget in the context of converging pandemics. It is increasingly impossible for the U.S. Congress to ignore the mounting evidence for rapid funding scale up is immediately needed to deliver high-impact treatment and prevention services and protect front-line healthcare workers with the life-saving personal protective equipment they need to care for patients. We have already seen these harms in countries where we work — from adults and infants with HIV having no way to get refills for life-saving treatment, to attacks on LGBT people and sex workers under the pretense of the COVID-19 response, to people dying needlessly in childbirth because they have no way of reaching a hospital.

Delays, underfunding, pandering to price gouging pharmaceutical companies, and wilful neglect will result in a tsunami of death and suffering that will have devastating knock-on  effects for decades to come. For a number of years, Congress has dithered when it comes to investing in the global HIV response – seemingly satisfied to coast on prior years of success rather than approving increased funding to enable bold scale up of treatment and prevention to save as many lives as possible. But there’s no excuse for underfunding the U.S. global HIV response in 2020. And inaction now will be deadlier than ever.

Congress has held PEPFAR funding essentially flat since 2010. During the Obama administration, Congress cut funding for PEPFAR, and the funding has never returned to 2010 levels despite increased need. PEPFAR enjoys bipartisan support and Members of Congress often point to the program as a resounding success, but the cuts, flat funding, and failure to keep up with inflation or true needs are setting the HIV response back. COVID-19 is catalyzing those setbacks and exposing the urgent need for massive funding scale up.

The Global Fund’s survey in 106 countries found that approximately 75% of current HIV, TB, and malaria programs had been disrupted by COVID-19. The report estimates that $28.2 billion in new funding is needed to respond to the multiple concurrent pandemics, and that 62% of that – $17.7 billion – is needed in the next year alone to mitigate harm to the HIV, TB, and malaria responses caused by COVID-19. This is on top of existing funding gaps, such as the $7 billion HIV funding shortfall for the HIV response – before COVID-19 emerged.

Congress must commit to appropriating $500 million in immediate additional funding for PEPFAR as well as a $4 billion increase for the Global Fund over the next two years in any COVID-19 emergency supplemental, alongside a $500 million annual increase to PEPFAR’s budget in the State and Foreign Operations 2021 fiscal year.

HIV, TB, and malaria are global emergencies that kill 2.8 million people per year – a staggering loss of life that nevertheless represents progress from the worst days of the pandemics. While fragile gains in the fight against HIV has saved millions of lives over the past two decades, the world has left many, many others behind to die because of a lack of political will to generate the financial resources needed to fully rise to the occasion, prioritize health as a human right, and invest in health systems the way we know is necessary to end the pandemic.

COVID-19 is threatening to roll the clock back to the peak of the epidemics, before PEPFAR and the Global Fund existed, before the current life-saving antiretroviral treatment regimens existed, to the days when an HIV diagnosis was a death sentence. For 20 years, AIDS activists around the world have worked tirelessly to expand treatment and prevention, striving to reach all people around the world. They’ve put their bodies on the line countless times, risking arrest, spending time in jail, some have been tortured as they fought for access to the scientific gains that profit-driven drug companies fight to keep for only those who can pay top dollar. The gains have been hard fought, and they’re fragile. COVID-19 threatens to explode that progress.

At the same time, Congress appears unwilling to do more than pay lip service to the need to ensure COVID-19 technologies such as therapeutics, tests and an eventual vaccine are made available to all people as public goods, no matter where they live. U.S. taxpayer-funded research agreements between the U.S. government and pharmaceutical companies to spur vaccine development, such as with Johnson and Johnson, Moderna, and AstraZeneca, are essentially massive corporate giveaways when they should come with hard and fast conditionalities requiring the outcomes from publicly funded research to be made available on a non-exclusive basis worldwide – no patents, no profiteering, and no sending poor people in poor countries to the back of the line to wait and die.

In this pivotal moment, sitting Members of Congress have a choice to make about how the history books will be written. Will they see this evidence and rise to the occasion by fighting for significant new investment in the global HIV, TB, malaria, and COVID-19 responses? Or will they choose the status quo that sentences millions of people around the world to sickness and death, and allows health systems to crack under the pressure of mounting disease?