The United States is pledging $4 billion over three years to the Global Fund for AIDS, Tuberculosis and Malaria.  United States Global AIDS Coordinator Eric Goosby announced the pledge on a call with reporters moments ago.  It represents a 38% increase over prior American commitments to the Fund.

The America pledge comes on the first day of a triennial “replenishment conference” for the Global Fund, which was created in 2002 to pool donor resources to fight AIDS, TB, and malaria and to strengthen the heath care systems in the developing world.  To date, the fund has raised about $19 billion and paid for approximately one quarter of all AIDS treatments in the developing world and two thirds of treatment for Malaria and TB. In all, 2.5 million people are on ARV treatments because of the Global Fund. 35% of Fund dollars are earmarked for health systems strengthening.

So what will the U.S. commitment mean for those that depend on the kinds of health care interventions that the Global Fund makes possible?

Prior to the replenishment conference, the Global Fund released three estimates based on different funding scenarios. The top scenario, based on a $20 billion commitment, would let the Fund introduce new programs and significantly scale up pilot programs that have proven to be successful.  The middle scenario foresaw a commitment of $17 billion, which would let the Fund continue its current operations and fund new programs at the same level as recent years.  The bottom scenario is a $13 billion commitment. This would let the Fund sustain its current operations, but far fewer new programs would be introduced or brought to scale.

Despite the American pledge, it looks increasingly like the bottom scenario of $13 billion will not even be met at the conference.  The global financial crisis seems to be taking its toll.

Here is what that means in human terms:

About 3 million fewer people on anti-retro viral treatment.

A bout 80 million anti-Malaria bed nets not distributed.

And a difference of about 1 million babies unable to receive protection from contracting AIDS at birth.

Advocates have a somewhat mixed reaction to the US contribution. The One Campaign, for example, called it a “solid increase, given difficult economic times.” But One, which had called for a $6 billion US pledge, added, “We are disappointed that the U.S. is not making better use of the Global Fund to achieve its goals on AIDS, TB, and malaria.”

On the press call, Ambassador Goosby said, “There is no stronger supporter of the Global Fund than the United States.”  He is right. But as you can see, it would appear that the global financial crisis is taking a toll on overall funding.

Here is a list of the major public sector contributions to the Global Fund, as of this afternoon.  (The “fair share” calculations are estimated by Global Fund based on donor countries’ Gross National Income.  By statute, the United States does not pay more than 33% of the total annual contributions to the global fund. You will also note that Italy, which typically pays about 6% of the Global Fund, is not on this list. Italy is not making a contribution this round.)

US: $4 billion over three years.  38 percent increase over their 2007 to 2009 commitments.  91% of fair share of $13b scenario based on GNI

France: $1.4 billion over three years.  20 percent increase over their 2007 to 2009 commitments.  194% of fair share of $13b scenario based on GNI

UK: $1.012 billion over four years (as remaining amount of their one billion GBP pledge for 2008-2015)

Germany: $827 million over three years.  flatline over their 2007 to 2009 commitments.  87% of fair share of $13b scenario based on GNI

Japan: $800 million over three years.  28 percent increase over their 2007 to 2009 commitments.  67% of fair share of $13b scenario based on GNI

Canada: $540 million over three years.  20 percent increase over their 2007 to 2009 commitments.  142% of fair share of $13b scenario based on GNI

European Commission: $455 million over three years.  10 percent increase over their 2007 to 2009 commitments.  75% of fair share of $13b scenario based on GNI

Norway: $225 million over three years. 20 percent increase over their 2007 to 2009 commitments.  97% of fair share of $13b scenario based on GNI

China: $14 million over three years.  133 percent increase over their 2007 to 2009 commitments.  19% of fare share of $13 bn based on GNI

The bottom line is that the Global Fund has been a remarkably successful mechanism for adding coherence to global health strategies.  By short changing the fund, the international community is risking to undermine the great progress that has been made in the fight against the developing world’s three deadliest scourges.   It is a perilous gamble that will undoubtedly cost lives.

UPDATE:  MSF/Doctors without Borders explains one consequence of short changing the Global Fund.

This year, the United States participated in the Global Fund replenishment for the first time. It has pledged $4 billion over three years – a disappointing amount given that the US generally contributes one-third of the Fund’s finances.  The US has already flatlined funding for the bilateral President’s Emergency Plan for AIDS Relief (PEPFAR). Countries including France, have increased their contributions to The Fund, albeit modestly. Germany’s funding levels remained the same.

Malawi is one example of what is at stake.  The Malawian government recently submitted a Global Fund application for a program that would dramatically reduce the transmission of HIV from pregnant women to their children. The program, which could reduce the rate of mother-to-child infections down from 35 percent to as low as two percent, may no longer be possible. Similarly, efforts in Kenya and South Africa to provide treatment to all who require it will be made nearly impossible without a well-financed Global Fund.

UPDATE II: The Global Fund released its final tally of contributions.  The verdict: $11.7 billion over three years. This of course,  is below the minimalist scenario. But it does include some huge contributions from new players, namely the Bill and Melinda Gates foundation, which is pledging $300 million.

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