MSF Warns: Global Fund Crisis Risks Undoing Decades of Progress on HIV, TB & Malaria
Investments Must Be Sustained to Prevent Catastrophic Cuts and Soaring Patient Costs
Ahead of the Global Fund’s Eighth Replenishment Summit in Johannesburg, Doctors Without Borders (MSF) calls for world leaders to fully fund the Global Fund’s US$18 billion target. Failure to meet this goal risks catastrophic cuts to essential services, threatens the resurgence of HIV, tuberculosis (TB), and malaria, and forces the financial burden of healthcare onto the world’s most vulnerable patients.
The high-level fundraising meeting, co-hosted by the UK and South Africa, will take place on Friday, November 21, 2025, on the margins of the G20 Leaders’ Summit. For this three-year funding cycle (2027–2029), there is a high risk that the Global Fund may receive pledges several billion below the target required to respond impactfully to HIV, TB and malaria, possibly even billions below the last replenishment of 15 billion, which still fell drastically short of the funding needed to tackle these diseases.
"The international community cannot afford to falter now. We are seeing major traditional donors signalling deep cuts, even as the need for sustained investment grows," said Tess Hewett, Health Policy Advisor, MSF. "When funding falls short, it is the patients—those least able to afford care—who pay the price."
The consequences of failing to meet the US$18 billion target will be severe and immediate. If pledges are insufficient, vital work such as support for data collection systems which monitor disease incidence and service delivery, will suffer, leading to the loss of momentum gained during the previous two replenishments. Cuts could severely impact the global TB response, as the Global Fund currently supports 76% of the worldwide donor response for TB. In addition, the adoption of promising new tools, such as new TB vaccines, existing malaria vaccines and new HIV prevention tools like lenacapavir, will be limited.
Delays in finalising pledges beyond November 21 will compromise effective programme planning and force funding into less efficient mechanisms, such as portfolio optimisation or mid-cycle top-ups.
When funding is insufficient, the financial burden is often shifted onto vulnerable populations through an emphasis on increasing ‘domestic resource mobilisation’. While this is envisaged as an increase in health spending by national governments, in reality, this shift frequently results in a hike in out-of-pocket payments by people themselves. This is particularly true in low-income countries where patients’ spending is already the most important source of health financing.
Initial pledges for the 8th replenishment have been deeply concerning. Germany and the United Kingdom, the only major traditional donors to pledge so far, have both decreased their commitment compared to the last cycle (Germany - 1 billion EU instead of 1.3 billion EU, UK – 850 million GBP instead of 1 billion GBP). No donor has increased their pledge when considering inflation.
If major donors follow Germany and the UK’s example, the results will be catastrophic for people worldwide impacted by TB, HIV and malaria – the world’s top three deadliest, but completely preventable, infectious diseases.
"We urge the remaining big donors to heed the evidence contained in MSF’s Deadly Gaps Report and commit fully on November 21," Tess Hewett concluded. "To accelerate progress toward Sustainable Development Goal 3 and end TB, HIV, and malaria as public health threats, the Global Fund needs the full US$18 billion. With the right resources, the Global Fund believes it can save 23 million lives and halve the death toll in just six years".
INTERVIEWS WITH OUR SPOKESPEOPLE AVAILABLE
- Claire Waterhouse: South African perspective, G20 and global overview
- Tess Hewett: Global Fund (global perspective), impact of cuts on TB and HIV globally
- Antonio Flores: Technical info on TB and HIV, impact of reductions on TB and HIV globally
Hameeda, 65, photographed in her home, is Iraq’s first patient to be cured with the new oral treatment for multidrug-resistant tuberculosis. Before starting this treatment, she was having daily painful injections that had the potential of causing serious side effects; like hearing loss and kidney damage. Since her first diagnosis, Hameeda has relapsed several times. Photographer: Chloe Sharrock | Date: 07/09/2021 | Location: Iraq
A patient walking outside the tuberculosis (TB) center in the Makeni Regional Hospital. Photographer: Mohamed Saidu Bah | Date: 19/07/2023 | Location: Sierra Leone
MSF Laboratory staff, inside the laboratory of the Makeni Regional Hosptial in Bombali District, Sierra Leone, conducting a microscopic tuberculosis (TB) test to monitor the response of tuberculosis treatment on a test sample from a TB patient. Photographer: Ammar Obeidat | Date: 08/12/2023 | Location: Sierra Leone
Ministry of Health Laboratory staff inside the laboratory of the Makeni Regional Hospital in Bombali District, Sierra Leone, preparing sputum and stools samples for GeneXpert tuberculosis testing. Stool test samples are routinely used to diagnose tuberculosis (TB) in children. Photographer: Ammar Obeidat | Date: 08/12/2023 | Location: Sierra Leone.jpg)
A doctor from the advanced HIV unit of the Centre Hospitalier Universitaire Communautaire (CHUC) in Bangui explains the effects of HIV and the next treatment procedure to a patient who was just informed of his HIV status. Photographer: Marco Scardovi | Date: 15/10/2020 | Location: Central African Republic
MSF nurse Josiane Wonzou holds the hand of a patient in the sorting room of the Centre Hospitalier Universitaire Communautaire (CHUC) of Bangui, where MSF runs the advanced HIV unit. Photographer: Adrienne Surprenant | Date: 25/11/2020 | Location: Central African Republic
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
Seipati Moloi