Some light is shed on future of Global Fund disbursements; critical time on the Hill for future global health funding

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“It’s not that the income of the Global Fund is going down – we are predicting fairly stable income over the next few years,” said Dr. Christoph Benn, Director of External Relations at the Global Fund to Fight AIDS, Tuberculosis and Malaria. He spoke by conference call with members of the advocacy community in early December to clarify the outcome of the board meeting in Ghana in November and the Transitional Funding Mechanism agreed to at the meeting.

Benn said that they are deeply concerned about the decision that Round 11 will not be funded because of the uncertainties around the Global Fund budget for the next two years, but he stressed that the situation is not as dire as it has seemed in the media. 

The Global Fund is anticipating to disburse between 2011 and 2013 approximately $9.5 to $10 billion, Benn said, significantly more than the previous replenishment period, when the Fund disbursed about $8 billion.

“I want to correct one misperception: We will see in 2012 and 2013 a scale up in many parts of program. We are predicting that through increased disbursements from earlier rounds and Round 10 that the number of people on antiretroviral treatment supported by the Global Fund will go up to about 5 million people by the end of 2013, up from about 3.3 million right now,” Benn said.

However, Round 11 would have been absolutely critical to reach the millions of people who are still lacking access to prevention, care and treatment. This is particularly tragic in a situation where we have all the scientific evidence to demonstrate that the programs work and when we have a historic opportunity to end the AIDS epidemic.

Benn clarified that the Transitional Funding Mechanism introduced at the board meeting would ensure that all currently funded programs would receive ongoing support even if they are set to expire in the 2011-2014 time frame – meaning there would be no interruption of treatment or other essential services for these programs. One exception will be the upper middle-income G20 countries – Brazil, Russia, China and Mexico – whose programs receiving Phase Two funding will be limited going forward, the board has decided. Benn stressed that this does not mean future Global Fund rounds will exclude lower middle-income countries.

“We will continue to focus on vulnerable populations, including in G20 and middle-income countries. It is my hope that we will not be diminishing our commitment to these populations,” Benn said. He added that middle-income countries with “extreme disease burden,” such as South Africa, are protected from the exclusion.

One of the outcomes of the decision around G20 countries was that China would no longer be eligible for its Phase Two grants, which totaled around $800 million. “We still have a number of grants in China that are in Phase One that will continue to be supported,” Benn said. UNIADS issued a press statement on December 1 that reported China’s Premier H.E. Wen Jiabao had agreed to cover the funding gap for HIV services with domestic funding.

Meanwhile, advocacy groups worked to rally representatives on the Hill in support of lifesaving global health programs, as word came down that fiscal year 2012 numbers for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund would likely be decided in the next few days. Advocates are pressing for the Senate’s higher funding levels, which essentially preserve current funding for PEPFAR and the Global Fund.

The House of Representatives subsumed all global programs in one funding number – which represents a more than nine percent reduction over current funding, leaving the Obama Administration to parcel out the much smaller funding pie among all global health programs. Moreover, new budget rules that place a cap on “security” spending are imperiling the $300 million in funding for the Global Fund that has been historically committed through the National Institutes of Health budget. This could slash approximately one-third of the Global Fund’s U.S. contribution.

This potential cut in the U.S. contribution to the Global Fund would have a disastrous impact on a program that provides a lifeline to millions with HIV, TB and malaria across the developing world.

There are now indications that a compromise between the House and the Senate funding levels has been reached although the details have yet to be disclosed.  According to reports, final funding levels for fiscal year 2012 came in somewhere between the House and Senate proposed funding levels. Negotiations are still under way on a variety of policy riders—including riders that would prohibit federal funding for syringe exchange programs domestically and internationally.

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