The future of global efforts to combat HIV, tuberculosis and malaria has been thrown into doubt after a major funding shortfall at the Global Fund to Fight Aids, TB and Malaria. Advocates have warned that decades of progress in reducing deaths from these deadly infectious diseases “hangs in the balance” following disappointing pledges at a summit held on the fringes of the G20 in South Africa.
The Global Fund had set a target of $18bn (£14bn) for the period 2026 to 2028. However, only $11.3bn has been confirmed so far. Several leading donors, including France, Japan and the European Commission, failed to announce specific contributions at the meeting, though they have indicated they may pledge at a later date.
The United States promised up to $4.6bn, which would still make it the largest single donor. Yet this represents a significant reduction from the $6bn it pledged in the previous funding round. The UK, co‑host of the replenishment drive alongside South Africa, announced £850m, down from £1bn last time. Campaigners had feared that Britain’s 15% cut might encourage other countries to follow suit.
Researchers argue that the timing of the shortfall is particularly damaging. Advances in HIV prevention drugs, improved malaria control measures and new tuberculosis treatments and vaccines mean that ending the three diseases as public health threats could soon be achievable but only with sufficient resources.
Adrian Lovett, executive director for the UK, Middle East and Asia Pacific at the One Campaign, said: “Just as the world stands on the brink of an incredible breakthrough in reducing deaths from these devastating diseases, some partners have stepped back from the fight. At the last replenishment, nearly 90% of the funds pledged came from seven leading donors. This time, four of those reduced their pledge and three, France, Japan and the European Commission, did not pledge today.”
Mike Podmore, chief executive of StopAids, warned that unless those three donors maintain pledges close to their previous levels, the Global Fund will fall short of the $18bn required. “Decades of progress that have seen Aids‑related deaths decline by 82% in Global Fund partner countries hang in the balance,” he said.
Beatriz Grinsztejn, president of the International Aids Society, stressed the human cost of the funding gap. “Every dollar short of the Global Fund replenishment goals represents lives that could have been saved, but now may not be. Countries that bear the heaviest HIV burden are being forced to make difficult choices. Those choices have just got harder: who receives life‑saving services, who goes without?”
Concerns were echoed by Gareth Jenkins, executive director of Malaria No More UK, who said the pledges fell well short of what was needed to prevent a resurgence of malaria. “Millions of children’s lives are at risk and economic shock waves could be felt around the world,” he said, urging France, Japan and the European Commission “to be as ambitious as possible”.
French NGOs expressed disappointment at President Emmanuel Macron’s failure to commit funds. Yann Illiaquer of Global Health Advocates said: “Macron missing this opportunity to pursue his – so far remarkable – leadership on global health is beyond understanding. We’re shocked by the consequences this desertion will have on global solidarity but moreover on the lives of millions.”
Some countries did increase their pledges. Ireland and India announced higher contributions, while the private sector and philanthropic foundations appear to be playing a greater role than in previous rounds. South Africa’s president, Cyril Ramaphosa, described the amount pledged so far as an “extraordinary achievement”.
Nevertheless, experts warn that the Global Fund faces an era of austerity. Janeen Madan Keller, deputy director of global health policy at the Center for Global Development, said: “The reality is that the Global Fund must make tough cost‑cutting decisions if it is to stand any chance of ending the epidemics of Aids, tuberculosis and malaria.” She suggested a radical rethink of the funding model, with grants protected for the poorest nations most affected by the diseases, and loans issued to wealthier countries.
The pledging summit has highlighted both the progress made in tackling these diseases and the fragility of that progress. Without renewed commitment from major donors, campaigners warn that the world risks reversing hard‑won gains and allowing preventable deaths to rise once again.
