We stand on the brink of a watershed decision for global health. For many years, health has been under-resourced by governments around the world; and political commitments to overcoming these resource constraints have remained largely unfulfilled. This passive but devastating apathy is directly responsible for millions of unnecessary deaths every year, from preventable and treatable diseases.

As a result, although it is widely accepted that the health-related MDGs are “within our reach” – as stated by UN Secretary-General Ban Ki Moon at the 2010 MDG summit – they remain out of reach for millions of people around the world, particularly in developing countries, because of the reluctance of world leaders to prioritize the attainment of these goals over competing political priorities such as military, which drain countries’ resources without contributing to human development.

The establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in 2001 brought the promise of a turning point in the global prioritization of human development, in that it represented an unprecedented expression of unified political will to respond to pressing global health challenges. Less than 10 years later, the Global Fund has saved more than 5 million lives; and every day, a further 3600 deaths are prevented through investment in programmes that have provided 2.5 million people with treatment for HIV and AIDS, treated 6 million people through live-saving drugs for TB, and distributed 104 million bed nets for malaria. Prevention efforts have been similarly promising – data that was recently issued by UNAIDS demonstrated that sub-Saharan Africa, once the spiraling hotbed of the epidemic, is now leading the global drop in the rate of new HIV infections.

However, these gains – while encouraging, are fragile. This is a pivotal moment in time for the Global Fund and for the global community. The Third Voluntary Replenishment Meeting of the Global Fund will be held in New York (USA) on the 4th and 5th October 2010. Governments and donors will come together at this meeting to not only signal their commitment towards the Global Fund, but also to the millions of people affected and infected by HIV, TB and Malaria around the world. The replenishment must raise at least USD 20 billion if the extraordinary gains made by the Global Fund over the past decade are to be sustained and accelerated.

If adequately resourced, the Global Fund can eliminate malaria in endemic areas, prevent millions of new HIV infections, virtually eliminate the transmission of HIV from a mother to her child, and achieve significant declines in TB prevalence and mortality by 2015.

These interventions, although they have been dismissed by critics as too ‘disease-specific’, have far-reaching benefits across the health system, including massive contributions to decreasing child and maternal mortality, especially in sub-Saharan Africa; and a substantial reduction of co-morbidities associated with HIV which previously placed a severe drain on the countries’ health and hence socio-economic systems.

Additionally, there is an increasing body of scientific evidence demonstrating that ARVs are in fact the most valuable biomedical HIV prevention tool that we have – a recent study of sero-discordant couples showed a 90% reduction in HIV transmission associated with the use of ARVs. It is thus not surprising that the World Bank warned in a 2009 report, “responding to immediate fiscal pressure by reducing spending on HIV treatment and prevention will reverse recent gains and require costly offsetting measures over the longer term.”

We re-iterate this concern with this letter; and further emphasize that health – including investment in universal access to HIV treatment – is a human right as well as an imperative for social and economic development. We therefore demand that governments commit to the health of communities across the world by: increasing their financial contribution to the Global Fund, thus raising the USD 20 billion needed at the Third Voluntary Replenishment on October 5.

We also recognize that other major contributors to the global HIV response, particularly the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) face an uncertain future due to dwindling funding streams. Since 2003, PEPFAR has been instrumental in building up country responses to HIV; however, this has come under threat in the past two years. We call on the United States government to demonstrate its commitment to universal access in keeping with the funding promises made during President Obama’s campaign; and to refrain from imposing restrictions on the use of funding for treatment initiation at CD4 levels higher than 200, which are financially driven rather than evidence-based.

Finally, we call on African governments to demonstrate genuine commitment to the pledge made in the 2001 Abuja declaration – namely, to dedicate 15% of domestic expenditure to health. Until this target is met, efforts to fight HIV, TB, malaria and other diseases will be limited in their immediate impact, and ultimately unsustainable.


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