The single most important public health measure of this year is the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
These three diseases, which kill about 2.5 million people per year, could be fully contained by 2030, with deaths reduced to nearly zero.
The Global Fund is the primary instrument for success and it needs to raise US$10 billion per year to accomplish its mission.
The Global Fund, established in 2001 by Kofi Annan, has been credited with saving 27 million lives and controlling the three epidemics to the point that they could realistically be ended by 2030.
Although none of the three diseases can be completely eradicated by then, almost all deaths and new infections could be stopped, because diagnostics, prevention and treatment have improved markedly and have become far less costly over the past 25 years.
In the case of AIDS, treatment of the HIV virus not only keeps infected people healthy, but also reduces the virus load so much that they are unlikely to infect others.
In this sense, treatment is prevention: Treating a sufficiently high proportion of HIV-positive people would largely end the transmission of the virus.
Similarly, advances in diagnostics (a simple pin-prick blood test), prevention (long-lasting insecticide-treated bed nets, among other tools) and treatment (low-cost artemisinin-based combination drugs) make it possible to eliminate almost all malaria deaths, which are already down by about 60 percent from their peak in the early 2000s.
An uptick in infections and deaths is a worrying sign that the world is again underinvesting in the fight.
For tuberculosis, the challenge continues to be early diagnosis and effective treatment, with special attention to multidrug-resistant tuberculosis. The mortality rate has declined by about 42 percent since 2000. With sufficient coverage of effective monitoring and treatment, the remaining deaths could also be largely ended.
The relatively low costs and enormous benefits of these interventions mean that high-income and upper-middle-income countries should prioritize their health programs and national budgets accordingly.
Shockingly, in the US, only about half of HIV-positive people are receiving treatment, owing to the federal government’s neglect.
However, for low-income and many lower-middle-income developing countries, national budgets are not sufficient. Calculations by the IMF show that these countries lack the means to ensure universal health coverage and other basic services called for by the Sustainable Development Goals.
This was one of two reasons for creating the Global Fund: to bolster poorer countries’ ability to control the epidemics. The other reason was to bring top global science and rigorous management to bear on the three epidemics.
Thanks to its unique business model, the Global Fund does both: It generates and disseminates the knowledge needed to fight the three diseases, and it rigorously monitors the implementation of the projects that it funds.
The Global Fund got off to a great start in the early 2000s, with strong bipartisan support in the US and similar cross-party support in other countries. Former US president George W. Bush was the fund’s strongest backer among world leaders, and Bill Gates was its leading philanthropist.
However, the budget leveled off following the 2008 financial crisis and a gap opened between what is needed and what is funded.
That gap needs to be closed in October, when the fund is to be replenished for next year to 2022 at a conference in Lyon hosted by the French government.
In the previous replenishment round, the Global Fund identified a total three-year financing need of around US$98 billion, of which all but around US$30 billion could be met by domestic budgets and other sources. Yet, instead of filling the US$30 billion gap (about US$10 billion per year), the donors gave the Global Fund just US$13 billion. The lack of adequate funding meant that all three diseases continued to kill and to spread unnecessarily.
This time, the entire shortfall must be covered. The Global Fund is to soon issue its own assessment of financing needs, but the numbers are unlikely to change much: about US$30 billion over three years, or US$10 billion per year.
This is a remarkably small price to pay to save millions of lives. Consider what US$10 billion per year really means. For the 1.2 billion people in high-income countries, it means US$8 per person per year. For the Pentagon, it means about five days of spending, and for the world’s 2,208 billionaires, it means just 0.1 percent of their combined net worth — about US$9.1 trillion.
Here, then, is a basic proposal: The Global Fund should pledge its efforts to raise US$30 billion for the next three years. Half of the US$30 billion could come from donor governments. The US should continue its tradition of bipartisan support. China, a past beneficiary, should now become a donor.
The other half of the funding should come from the world’s richest people, whose wealth has soared in recent years. Gates has set the standard and, under the Giving Pledge that he and Warren Buffett have launched, hundreds of the super-rich could easily pledge US$5 billion per year from next year to 2022.
In a world divided by conflict and greed, the Global Fund’s fight against the three epidemic diseases is a matter of enlightened self-interest. It is also a reminder of how much humanity can accomplish when we cooperate to save lives.
Jeffrey Sachs, a professor of sustainable development and professor of health policy and management at Columbia University, is director of Columbia’s Center for Sustainable Development and of the UN Sustainable Development Solutions Network. Guido Schmidt-Traub is executive director of the network and Vanessa Fajans-Turner is director of SDG costing and financing.
Copyright: Project Syndicate
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