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10 Years On, Funding Crisis Threatens the Global Fund's Effort to End AIDS

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This week marks the 10th anniversary of The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The last 10 years, the Global Fund has proved to be one of the most successful efforts in the history of public health. Millions of lives have been saved in some 150 countries. But projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is a devastating and unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap.

We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.

At the World Economic Forum in Davos, two key donors cast votes of confidence with their checkbooks. Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami, and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the Global Fund's impact and effectiveness and a challenge to other donors to step up.

This week marks 10 years since the Global Fund opened its doors. Its achievements over the last decade have been extraordinary. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that's up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing 82 percent of donor financing for TB.

As someone who's worked on this issue for well over a decade, I can tell you that before the Global Fund, donor financing for TB was miniscule, and TB patients and programs were dying from neglect, and that has changed.

Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25 percent globally in the last 10 years, and malaria deaths have been halved in some African countries.

But these gains have not been earned by doing business as usual. In fact, the Global Fund is business unusual. For 10 years, the Global Fund has been on the cutting edge of innovation and effective aid delivery. The Global Fund empowers the countries and communities that benefit to determine how the aid is best used. In the country, ownership is complemented by rigorous accountability and unmatched transparency. The U.K.'s Multilateral Aid Review found the Global Fund among the highest-rated institutions offering strong value for money.

And the next decade holds remarkable promise. In particular, new evidence demonstrates that early initiation of AIDS treatment can massively reduce the spread of the virus to uninfected partners. This finding was named the 2011 breakthrough of the year by Science magazine and has actually allowed public health experts to credibly plot the end of the epidemic.

But just as science is telling us we can end AIDS within the next generation, making funding for scale-up for treatment and other proven prevention more critical and impactful than ever, this opportunity is jeopardized by the decision to halt new Global Fund scale-up opportunities until 2014. As many as seventy countries are beginning to feel the impact of funding cancellation. In Zambia, over 130,000 people won't have access to life-saving treatment. Without scale-up of prevention of mother-to-child treatment services, 25,000 mothers in Zimbabwe risk transmitting HIV to their unborn children.

The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries' capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we're not just in danger of slowing progress, but actually reversing it.

The U.S. and other donors can fix this situation. If the U.S., the U.K., and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases, topping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.

So we're calling on the U.S. to host this meeting. We strongly believe that if the U.S. hosts this emergency donor's conference, other donors will join in. If we convene it, they will come.

The Obama administration, from Secretary Clinton to the president to Ambassador Goosby, our global AIDS coordinator, has reiterated their commitments to the Global Fund and to fulfilling the U.S.'s pledge. By doing this and by exerting U.S. leadership globally through convening an emergency meeting, the U.S. can lead the way in reversing this devastating setback.

The Global Fund has a decade-long track record of impact and innovation in the fight against AIDS, TB, and malaria, but these diseases won't wait around for the world to sort out its financial challenges. Now, if we don't advance against these epidemics, we're now moving backwards, and we don't want that to happen.

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