In June 2001, at the United Nations General Assembly Special Session on HIV/AIDS, world leaders unanimously endorsed the creation of an international fund as an efficient way to channel money from wealthy countries and donors to developing nations hardest hit by three diseases that kill 6 million people annually. The Global Fund has been in operation since January 2002, and is primarily funded by donations from wealthy governments, including the United States.

In April 2003, the U.S. General Accounting Office (GAO) released a report that said that despite “noteworthy progress,” the fund faced severe budget shortfalls that

Let’s blame all of us for the moment ... We are 20 years into this pandemic, and the response has been pathetic and trivial. We have been engaged in serial denial in country after country. We have denied that it is going to be large or it is going to be serious. — Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Guardian, 2/18/03)

could prevent it from financing new programs, a crisis that fund officials had themselves been warning about for months.

In April, the fund held only $300 million in its accounts, and was estimated to need five times as much as much by the end of this year to fund a new round of proposals. The Global Fund has already committed to spending $1.5 billion on 153 projects in 92 countries. Fund officials said that they will be able to fully fund those projects, which generally last two years (Reuters Health, 5/8/03).

As the fund’s largest contributor, the United States has pledged $1.65 billion, more than half of total commitments to its coffers (Boston Globe, 5/7/03). Yet this is small compared to the amount that United Nations Secretary General Kofi Annan has estimated is ultimately needed to combat HIV/AIDS alone: $7 to $10 billion annually.

The U.S. Role

While the U.S. legislation authorizes up to $1 billion for the Global Fund for fiscal year 2004, the size of that contribution ultimately depends on commitments from other wealthy nations; the bill states that the U.S. contribution should account for no more than one third of total contributions to the fund. The possibility that a U.S. donation will be much smaller has increased fears about the initiative’s future.

“A bill is not the same as a check,” said Paul Davis of Health GAP, a U.S.-based advocacy group that has partnered with other health organizations to launch “Fund the Fund,” a campaign demanding that the world’s richest countries meet the Global Fund’s long-term needs. “If other donor countries contribute, then the United States will make a serious long-overdue contribution,” Davis said (Associated Press, 5/19/03).

The amount the legislation earmarks for the Global Fund is a small portion of the $15 billion it authorizes for global AIDS programs. The rest is slated to go to bilateral programs that the State Department can more closely control.

The Administration has voiced reservations about the Global Fund on the grounds that it “does not have a proven track record." Republicans have been hesitant to support increasing the U.S. donation without proof of the fund’s transparency and accountability. To assuage their fears, the legislation establishes a new federal task force that will monitor its progress.

Democrats have argued that a larger American commitment is imperative to the health of the fund; as the world’s wealthiest nation, it can set the precedent for international giving.

U.S. Health and Human Services Secretary Tommy Thompson—also the Global Fund’s board chairman and chief fund raiser—has proclaimed U.S. dedication to the initiative.

In June, Thompson urged other nations to match the U.S. commitment to fighting HIV/AIDS. “We are active players, we are going to continue to be active players, and we want other members of the world community also to shoulder the burden,” he said (USA Today, 6/4/03). Thompson has said the fund will hold a donor conference in July to assess the shortfall.

Who’s At Fault?

Americans are not the only ones who have been slow to contribute; European and Japanese financial support has been lagging as well. At the Group of Eight (G-8) summit in June, the fund’s second largest donor, the United Kingdom, increased its

Our feedback from groups in Africa is that this is working; it is creating new momentum. It is not business as usual on the ground in Africa. This is exciting. — Paul Zeitz, director of the Global AIDS Alliance (The Boston Globe, 5/7/03)

pledge from $218 million to $280 million and France tripled its pledge to $150 million after next year. However, the $1.2 billion total pledged at the G-8 meeting represents only 17 per cent of what fund officials estimate it needs, based on current and future project approvals, to 2005. (Financial Times,6/7/03).

Global Fund Executive Director Richard Feachem has been reluctant to assign blame for the current financial situation. In a seven-page reaction to the GAO’s report, Feacham wrote: “To date, the United States has led the way in giving, acting as a beacon for others.” He called the report “constructive” and said the findings reflect “growing pains.”

In a February interview Feacham told The Guardian “Let’s blame all of us for the moment ... We are 20 years into this pandemic, and the response has been pathetic and trivial. We have been engaged in serial denial in country after country. We have denied that it is going to be large or it is going to be serious.” He was optimistic that the U.S. offer would be increased and that proof of the Global Fund’s success would encourage additional donations.

Positive Feedback

Despite the Global Fund’s troubles, many international advocates for people with HIV/AIDS have continued to voice support for the initiative and are optimistic about its success.

“Our feedback from groups in Africa is that this is working; it is creating new momentum. It is not business as usual on the ground in Africa. This is exciting,” said Paul Zeitz, director of the Global AIDS Alliance (The Boston Globe, 5/7/03).

The fund aims to encourage countries to develop comprehensive, strategic responses to epidemics by requiring that they submit grants through partnerships representing government agencies, nongovernmental agencies, and many segments of society including individuals living with HIV, tuberculosis, or malaria.

As of early June, the fund had signed formal grant agreements for programs in 49 countries. Initial disbursements of $32 million had been made to or requested for 27 countries.

According to Global Fund figures, local programs approved in the first two rounds of grants will support antiretroviral treatment for 500,000 people over five years. This will triple treatment coverage in poor countries—increasing it six-fold in Africa. An expected 500,000 children orphaned by AIDS will receive support and an estimated two million people with infectious tuberculosis will be treated. The Global Fund also intends to finance 20 million courses of combination drug treatment for resistant malaria worldwide.

Continuing Concern

Some developing countries have expressed concern about the Global Fund’s financial situation.
Malawi Vice President Justin Malewezi told The Guardian in February: “If we get into a program like this, which is a long-term program, we cannot abandon it half way.”