12.06.13

Recap: “The Global Fund 2014-2016: Sustaining the Fight Against AIDS, Tuberculosis, and Malaria”

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Mark Dybul at Georgetown Conference

This week Washington, DC hosted the Fourth Global Fund Replenishment, which was followed by a half-day conference: “The Global Fund 2014-2016: Sustaining the Fight Against AIDS, Tuberculosis, and Malaria,” held at Georgetown University. While the Global Fund fell short of its $15 billion goal, the $12 billion pledged represents a 30% increase over its last funding round —and the Georgetown conference struck an optimistic tone. This post offers a summary of what was discussed during the keynote address and during each of the three panels.

Keynote Address

The conference began with a keynote address by Ambassador Mark Dybul, Executive Director of the Global Fund. He offered an optimistic and inspiring vision of an “historic moment”—one in which the world could realistically imagine the end to two plagues that have haunted humanity for millennia (tuberculosis and malaria) and a modern plague that has caused tremendous devastation (AIDS). His optimism was tempered with a warning, however. Progress made toward eradication is fragile and could easily be undone if the global community fails to devote the necessary resources and attention to controlling, and ultimately eliminating, these diseases.

He concluded by outlining how international financial assistance must be reconceptualized in order to ensure that progress in fighting these three diseases continues. For instance, those most affected by the three Global Fund diseases are the most vulnerable members of a population (e.g. sex workers, injection drug users or those living in extreme poverty). Simply adding more clinics or sending more drugs cannot solve the issue of stigma. Moreover, an intervention that works for Rwanda may not be effective in the Central African Republic. Global health must therefore eschew its paternalistic roots and adopt a development strategy that is person-to-person, country-owned, and based on the concept of an “inclusive human family.”

Panel 1: Perspectives from the Global Fund Board

The first panel consisted of three Global Fund board members: Lucy Chesire, David Stevenson and Todd Summers, and was moderated by Georgetown professor Steven Radelet. Discussion focused heavily on a new funding model the Global Fund has developed, which focuses on health impact and country ownership. Moreover, the new model is meant to be more cooperative, with the Global Fund and its partner countries working together in “getting to yes.” Relatedly, the panel discussed the Global Fund’s rollout of “strategic investments,” designed to ensure the greatest possible impact per dollar.

The panel also contemplated the dwindling number of “low-income” countries (as defined by the World Bank)—many of which have graduated to middle-income status. The panel emphasized that these World Bank indicators could not be used as a reliable proxy for poverty and health needs (in fact, the majority of the world’s poor live in middle-income countries). However, in places where a country’s wealth is sufficiently high, there could be an opportunity for the Global Fund to transfer some responsibilities to the state, with the Global Fund and states sharing “mutual accountability” for controlling its disease burden—although states would remain in control of their response.

Panel 2: U.S. Programmatic and Scientific Perspectives

The second panel included four U.S.-based global health leaders: Anthony Fauci, Director of the NIH’s National Institute of Allergy and Infectious Diseases; Thomas Frieden, Director of the CDC; Ambassador Eric Goosby, Former U.S. Global AIDS Coordinator; and, Rear Admiral Timothy Ziemer, U.S. Global Malaria Coordinator. The panel was moderated by Larry Gostin, the Faculty Director of the O’Neill Institute and Georgetown professor.

The panel began with a discussion of how U.S. national interests dovetail with the interests of recipients of U.S. foreign assistance. The conversation later turned to what were likely to be the greatest achievements of the 21st century, with panelists discussing such developments as: a safe and effective vaccine for HIV/AIDS, the elimination of violence against women and girls, vaginal microbicides, better and more widespread use of information systems to inform programming, and closing the gap between scientific evidence and implementation.

The issue of fake drugs spurred a discussion of the overarching importance of good consumer education, combined with more aggressive attempts to identify and remove such products from the market. Finally, the conversation turned to the question of promoting global health programs in the current U.S. political climate, and particularly to how advocates could convince voters and politicians of the need for global health interventions. Panelists pointed out that it was imperative that Americans understand that foreign aid for global health was not discretionary, and in particular that such aid prevents international instability (and thus threats to U.S. national security); and, echoing Mark Dybul’s discussion of promoting an “inclusive human family,” that improving global health is the morally right thing to do.

Panel 3: Partnerships and the Future of the Global Fund

The panelists for the final discussion included: Jesse Bump, a Georgetown professor; Lisa Carty, Director of the U.S. Liaison Office, UNAIDS; Cheryl Healton, Director of the Global Institute of Public Health at New York University; and, John Monahan, Advisor for Global Health to the U.S. State Department and Senior Fellow and Special Advisor at Georgetown University. The moderator was Berhard Liese, Chair of the Department International Health at Georgetown.

The panel’s wide-ranging conversation began with a discussion of the future of global health, and whether a treaty on counterfeit drugs would be effective. Panelists expressed concern over the time, cost, and need for careful planning for such a treaty—along with a more general concern that the efforts could potentially distract from efforts to use the formidable tools already available to fight disease and prevent counterfeiting.

In a discussion of new mechanisms needed for the Global Fund, Prof. Bump argued for a WTO-like dispute settlement mechanism to deal with global health issues. Others argued for the need for mechanisms to facilitate greater engagement with regulators—particularly regional bodies—and for the vital importance of including civil society at all levels of decision-making.

Finally, panelists argued that the private sector was an important partner in the fight against the three diseases of the Global Fund. For instance, they suggested thatthe private sector injects much-needed funding and other resources into institutions and brings innovative ways of thinking about health problems. The panelists also raised concerns that not enough is being done to reach out to the private sector in developing countries.

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