Flash Quote: MSF Response to Global Fund pledges
Quote by Tess Hewett, Global Fund focal point and health advisor for MSF
“The recent reductions in pledges to the Global Fund, from countries that have historically been strong contributors, are deeply concerning – with implied deadly consequences. Should other countries follow this trend, it would set a dangerous precedent with potentially devastating consequences for millions.
Missing the US$18 billion funding goal puts millions of lives at risk from HIV, TB, and malaria, diseases that are preventable. It would stall decades of progress, weaken health systems, and delay the rollout of existing and new tools like malaria and TB vaccines and HIV prevention options. Vital work such as strengthening data systems that track disease incidence, will be undermined. Fundamentally the lives and work of people at the forefront, facing the realities of HIV, TB and malaria, are at risk and they will suffer the most from the funding cuts. For MSF this is especially concerning in low-income countries and combined with increasing conflicts and emergencies. The people impacted by HIV, TB and malaria are the key to ensuring relevant and realistic actions. Without this vital funding their work, voices and lives will be lost. Decades of progress towards the sustainable development goals are at risk.”
Background
What is the Global Fund?
- The Global Fund is an international financing organisation founded in 2002 at the suggestion of Kofi Annan, to combat HIV/AIDS, tuberculosis (TB), and malaria.
- It brings together governments, civil society, the private sector, and affected communities to tackle these deadly diseases collaboratively.
- It is the world’s largest multilateral funder of global health grants in low- and middle-income countries.
- Over the last two decades, the Global Fund has saved 70 million lives and reduced the combined death rate from HIV/AIDS, TB, and malaria by 63% since its inception. This progress is now at risk. If donors fall short of the target, hard-won achievements could be reversed.
- Its model emphasizes country ownership, meaning nations lead their own responses tailored to local needs.
What is the 8th replenishment?
- The Global Fund is seeking US$18 billion for its 8th Replenishment, a three-year cycle used to secure investments from donors to fund future programs in the following cycle, in this case from 2027 to 2029.
- This investment aims to save 23 million lives, reduce the death toll from 2.3 million to under 1 million, and prevent 400 million new infections across HIV, TB, and malaria.
To date, the Global Fund has secured just over US$11 billion, far below what is needed to sustain momentum. Major traditional donors – UK, Germany, USA and Canada pledged so far have both decreased their commitments compared to the last cycle (Germany: €1 billion instead of €1.3 billion; UK: £850 million instead of £1 billion, USA: $4.6 billion instead of $6 billion, Japan 518.873.202USD). While private donors such as the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation (CIFF) have pledged early and private contributions have increased relative to previous years, these commitments alone cannot close the potential gap left by reduced government funding.
If France and Japan do not weigh in properly the US pledge will not be fulfilled. In 7th replenishment, France pledged € 1.28 bln, EC € 715K.
Pledges announced at the GF Summit (first round):
• *Canada*, CAD$1.02 billion ≈ US$720 million (decrease from CAD$1.21 billion)
• *Italy*, €150 million
• *Japan*, 81 billion JPY (518.873.202USD, decrease from 1.08 billion USD)
• *France*, to be announced later
• *Malta*, same amount as last time (€150,000)
• *Monaco*, €600,000
• *New Zealand*, NZD$3 million ≈ US$1.68 million
• *Singapore*, US$1 million
• *India*, US$30 million
• *Côte d'Ivoire*, US$2.5 million
• *Morocco*, €1.29 million
• *Namibia*, US$1 million
• *Nigeria*, US$15 million
• *Zimbabwe*, US$1 million
• *Rockefeller Foundation*, up to US$10 million
• *Senegal*, political support
• *European Commission*, later in early 2026
• *Korea*, US$100 million
• *Siemens*, €5 million (for GF's Diagnosis Integration Fund)
• *Sweden*, no pledge, reaffirmed support
• *United States*, US$4.6 billion (conditioned on historical matching rule)
Delays in pledges beyond 21 November will place countries at risk of receiving minimal allocations and being unable to optimise all potential available resources for national planning processes.
Pledges finalised after the Replenishment Summit may have to be passed to countries through less predictable means such as portfolio optimisation or mid-cycle grant and catalytic investment top ups, which are less efficient mechanisms than having full allocation amounts known at the time of funding request and grant development, ultimately limiting impact.
The timelines for certainty of pledges also cannot be pushed back further without compromising effective programming, as the funding request and grant making processes for 70% of the value of the portfolio whose current grants run out at the end of 2026 has already been compressed from 12 to 9 months due to the extended Eighth Replenishment timeframe.
Why don’t low and middle-income countries pay for their own health programs?
- They do. Up to 80% of TB services and almost 60% of HIV services are paid for through domestic sources. But this is not enough to meet the large needs for TB, HIV or malaria health services in these countries. Where countries cannot meet these needs, and if donors do not fill the funding gaps, the costs fall on the patients themselves, often the people least able to afford them.
- By contributing to the Global Fund, donor countries are making a strategic investment in the health and economies of recipient countries where 1$ of investment will result in 19$ of return in health and economic gains.
- Addressing infectious diseases like TB, HIV and malaria in low- and middle-income countries keeps people in these countries, and in donor countries, safer from infection.
Why is it important for donor countries to continue to support the Global Fund?
- The replenishment is designed to accelerate progress toward Sustainable Development Goal 3, which targets ending TB, HIV and malaria as public health threats.
- With the right resources, the Global Fund believes it can halve the death toll in just six years, building on two decades of impact (it took 18 years to halve the combined death toll of HIV, TB and malaria previously).
- With the right support, the Global Fund can:
- Continue strengthening health and community systems and pandemic preparedness
- Close the equity gaps and accelerate service coverage
- Reduce global inequality in life expectancy (where people in low-income countries live much shorter lives than people in high-income countries) by 7% between 2023 and 2029.
- Catalyse improved and more targeted domestic investments
- Improve resilience to climate change
- Save 42 billion in primary health care costs
How does the Global Fund replenishment affect MSF?
- MSF does not receive funding from the Global Fund. MSF works in partnership with many organisations who are supported by the Global Fund and has witnessed the impact of funding gaps first-hand.
Doctors Without Borders (MSF) Medical Doctor Ramya, conducting testing of reflexes. Photographer: Siddhesh Gunandekar | Date: 29/10/2023 | Location: India
MSF counsellor Ajit More handing over the leaflet on endTB clinical trial to a female DRTB patient enrolled in the endTB clinical trial. Photographer: Siddhesh Gunandekar | Date: 29/10/2023 | Location: India
A medical staff getting a blood sample of a patient in Mayen Abun hospital. Photographer: Paula Casado Aguirregabiria | Date: 15/10/2024 | Location: Sudan
A picture of different medications a person living with HIV may take on a daily basis. Photographer: Michel Lunanga | Date: 31/08/2022 | Location: kinshasaFlash Quote GF Replenishment Summit Reaction.docx
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Jane Rabothata
About Doctors Without Borders (MSF)
Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.
In South Africa, we currently run a non-communicable diseases (NCDs) project in Butterworth, Eastern Cape province, where we support the Department of Health (DoH) in improving care for patients with diabetes and hypertension. The project focuses on improving screening, diagnosis, management, and prevention of NCDs through advocacy, research, health promotion, training, and mentorship of Community Healthcare Workers.
MSF is also recognised as one of the pioneers in providing antiretroviral treatment (ART) in the public sector. It started the first HIV programme in South Africa in 1999. The organisation's earlier interventions in the country have primarily been on developing new testing and treatment strategies for HIV/AIDS and Tuberculosis (TB) in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape). The Eshowe project was handed over to DoH in 2023 after 12 years of operations. The Khayelitsha project was closed in 2020 after 22 years of activities and campaigning for improved HIV and TB treatment.
Other projects we have been involved in include our Migrant Project in the country's capital, Tshwane, which was handed over to authorities and a local Community-Based Organisation after building the capacity to work with undocumented populations. We also previously offered free, high-quality, and confidential medical care to survivors of sexual and gender-based violence in Rustenburg, North West province.
To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work:
- SMS “JOIN” to 42110 to donate R30 Once-off
- Visit https://www.msf.org.za/donate