The moans are what I remember the most.
Several times an hour, anguished cries echoed through the open-air corridors of the referral hospital in Lilongwe, Malawi, causing us to cut short our clinical rounds as we mourned the loss of another young life to HIV. Providing clinical care without access to HIV drugs in 1999 was heartbreaking and deeply moved me and my Malawian colleagues. Since then, I have experienced many ups and downs in medical care and public health, but I have never witnessed a set of inequities so troubling or in need of change.
Although it seemed like an eternity, the world has taken a big step three years later. In the middle of my medical residency at Harvard in 2002, I was invited to attend a meeting about a fund set up to support access to treatment and prevention of HIV, tuberculosis (TB) and malaria in hard-hit countries. Shortly after, I returned to Malawi to support a locally led effort by the Office of the Vice President of Malawi to develop an application to the new Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
Malawian leaders understood the enormous power of listening to those on the front lines and convened district health workers from across the country to feed their ideas into the app. The writing team worked tirelessly to develop a plan that could be quickly implemented and built upon the existing healthcare system. And with leadership from government, civil society, religious leaders and many others, Malawi’s proposal was one of the first to be endorsed by the Global Fund.
This funding began saving lives from day one by providing lifesaving antiretroviral therapy, establishing longitudinal care programs and supporting prevention programs to break the stigma and fear of increased testing. Now, 20 years later, that funding is up for its largest-ever renewal — an $18 billion goal to get back on track after COVID-related setbacks and to meet the approaching 2030 goals. rapidly.
President Biden’s leadership in organizing the upcoming Seventh Replenishment Conference in New York tomorrow – as well as his $2 billion budget request for 2023 – should be hailed for setting a standard that donor countries, foundations and the private sector should urgently match.
Initial grants from the Global Fund, combined with the US President’s Emergency Plan for AIDS Relief (PEPFAR), have saved a generation of people. For example, sustained progress in Malawi has resulted in 93% of people living with HIV knowing their HIV status and 91% of people eligible for HIV treatment, leading to a rapid decline in the death rate. . And while much more needs to be done, treating mothers has enabled 100,000 babies to be born HIV-free, and new HIV infections in Malawi have fallen by more than 80% since their peak.
Today, the fund has provided this kind of remarkable support to 155 countries, disbursed more than $50 billion, and is estimated to have saved 44 million lives. And, as he did in Malawi, he encouraged governments and civil society to take not only a leadership role, but the leadership in defining the national response to HIV. And when problems do arise, the Global Fund takes transparent action to hold governments and other actors to account, while ensuring that health gains are sustained.
It also invests hand in hand with other donors. When I was PEPFAR’s Chief Medical Officer and Deputy Global AIDS Coordinator during the Obama-Biden administration, we worked closely with the Global Fund to strategically align our funding. Meeting governments and civil society from over 30 countries during this time convinced me that dual multilateral and bilateral approaches were the yin and yang of public health, enabling country agility, responsiveness and leadership.
Today’s historic moment rivals that of the days before the Global Fund was established. We have been through a massive new pandemic that has claimed millions of lives. Yet this time, the fund has played a fundamental role in helping their partner countries detect, prevent and respond to COVID, and reduce the setback against HIV, TB and malaria. Likewise, PEPFAR, the US President’s Malaria Initiative (PMI), and others have achieved admirable results in protecting gains and serving as a vehicle for global health security. Their success and momentum should be built on, not wasted.
It is inconceivable today to imagine a world without the Global Fund. He gave hope and fulfilled the promise of partnerships between nations and solidarity of humanity. Yet we cannot achieve our 2030 goals or a strengthened pandemic preparedness posture unless we match our ambition to the current threats we face. If we have learned one thing since those tragic days before the Global Fund was created, it is that we must never look back.
Charles B. Holmes, MD, MPH is Director of the Center for Global Health Innovation at Georgetown University, Professor of Medicine at Georgetown Medical School, and Distinguished Scholar at the O’Neill Institute for National and Global Health Law. He previously served as chief medical officer and deputy coordinator of the US President’s Emergency Plan for AIDS Relief (PEPFAR) during the Obama-Biden administration.
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