Despite considerable progress in the fight against AIDS, malaria and tuberculosis, major challenges remain, these diseases still killing almost 2.5 million people every year. With its historic role in global health and its expertise, France contributes actively to multilateral financial structures with the aim of fulfilling Sustainable Development Goal (SDG) 3 and putting an end to these pandemics.
Progress in the fight against these diseases has been threatened by the COVID-19 crisis. COVID-19 has had damaging effects on prevention, screening and treatment of HIV, tuberculosis and malaria, compounded by inaccessible health services and increased human rights violations and gender-based violence. For example, it is considered likely in some of the most affected countries that the number of extra deaths from malaria will top that of those from COVID-19.
In the face of the pandemic, the Global Fund, UNITAID and Gavi have responded and continued their work, even developing new activities in response to the global public health emergency.
The international community’s commitment, especially since the creation of the Global Fund in 2002, has helped bring about immense progress against major pandemics, making it possible to move towards the goal of ending them by 2030 (SDG 3). Poverty, weak health systems, gender inequality, stigmatization and human rights violations are some of the main causes of difficulties accessing prevention, screening and treatment. At the same time, the spread of resistances to treatments and insecticides is a growing threat to the progress made in the last decade.
The COVID-19 crisis has reminded us of how fragile the progress made over the past two decades has been, with a major drop in access to diagnostics, to treatment and care, and to prevention for the three pandemics. There is a clear risk today that the major pandemics will regain ground. The financial resources of the vertical funds and domestic health funding need to be boosted in order to maintain and extend the progress made over the past two decades.
HIV/AIDS is the leading cause of death among women aged 15 to 44 worldwide, and of teenagers in sub-Saharan Africa. Mortality linked to AIDS has been halved since 2005, but the virus continues to kill more than 690,000 people annually. Currently, 37.7 million people are living with HIV, including 1.5 million who were infected in 2020.
The COVID-19 pandemic also seriously disrupted the HIV/AIDS response. In 2020, the number of people reached by HIV/AIDS prevention programmes dropped by 11% and the number of people tested fell by 22%.
Despite a 37% fall in deaths attributable to tuberculosis since 2000, the epidemic remains one of the 10 top causes of death worldwide, and the leading one among infectious diseases. In 2020, there were 5.8 million new cases of tuberculosis, which killed 1.5 million people, mostly from the most vulnerable populations. According to WHO, multidrug-resistant tuberculosis (MDR-TB) is one of the biggest threats to global health security. Largely as a result of the COVID-19 pandemic, the number of people treated for MDR-TB decreased by 37% in 2020.
Almost half of the global population lives in regions where there is a risk of malaria transmission, yet mortality rates have plunged by 60% since 2000. However, after falling steadily for years, the number of malaria cases is rising and pregnant women and children remain those most affected.
In 2020, 241 million new infections were diagnosed, compared to 229 million the previous year. Malaria caused 627,000 deaths, 95% of which were in Africa.
France has demonstrated continuous determination in the fight against HIV/AIDS, tuberculosis and malaria, making it a pillar of its global health strategy. In order to make its action as impactful as possible, France has chosen to consolidate its political and financial commitment through strong support to multilateral funds.
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Since its creation in 2002 at the initiative of France, the European Union and the G7, the Global Fund has saved more than 38 million lives and reduced the number of deaths annually from AIDS, tuberculosis and malaria by almost 40%.
Pooling the financial contributions of more than 60 countries and private and non-governmental actors, it has invested over $49 billion since 2002 to support national programmes to fight the pandemics, in 142 countries. The Global Fund is currently the main resource mobilization mechanism to fight pandemics in developing countries, providing 20% of total funding for AIDS, 69% for tuberculosis and 65% for malaria.
It uses its own specific governance model:
• The Fund not only has donor countries and recipient countries as voting members of its Board, but also NGOs, the communities affected by pandemics, and the private sector;
• In each implementing country, a Country Coordinating Mechanism submits requests for funding and oversees implementation of grants. These bodies bring together representatives of national authorities as well as technical and financial partners, populations affected by the diseases, and NGOs;
• The Global Fund is not directly represented in implementing countries but instead funds local recipients which implement the grants. The Secretariat, which is based in Geneva, has around 750 staff who are responsible for day-to-day management and implementing the organization’s strategies and policies.
The Global Fund and COVID-19
The Global Fund is also a founding member of the Access to COVID-19 Tools Accelerator (ACT-A), launched in 2020 at the initiative of France, the European Commission, Germany and WHO.
In order to support the fight against COVID-19 and mitigate its impact on Global Fund programmes, the organization has made two major choices:
1. to ensure the continuity of its work to fight HIV/AIDS, tuberculosis and malaria;
2. to provide additional resources for beneficiary countries to help address the COVID-19 crisis.
In March 2020, the Global Fund set up the temporary COVID-19 Response Mechanism (C19RM) with the aim of:
• Preserving as far as possible programmes to combat AIDS, tuberculosis and malaria;
• Developing a suitable response to COVID-19 by funding access to tests, contact tracing, distribution of personal protective equipment for healthcare personnel and health system strengthening.
The C19RM was renewed in early 2021 to continue providing this support to countries fighting the pandemic. It benefitted from the March 2021 decision of the US Congress to allocate an additional $3.5 billion to the Global Fund to fight COVID-19.
In 2022, the Global Fund allocated $3.429 million to 124 recipients, to finance:
• Emergency response (purchases of masks, diagnostics and therapeutics, healthcare personnel salaries), at a cost of $723 million;
• More structural and long-term efforts (health system strengthening, lifting of barriers linked to human rights and gender) at a cost of $2.707 billion.
In total, 75% of the funds are used to strengthen the national COVID-19 response in countries, 14% to urgently improve health systems and 12% to mitigate the impact of COVID-19 on programmes to combat HIV/AIDS, tuberculosis and malaria ($399 million for this last component).
France’s preeminent support for the Global Fund
France provides key political and financial support for the Global Fund, of which it is a founding country and the second-largest historic contributor, having contributed over €4.61 billion in grants since 2002.
Due to the scale of its financial support, France has its own seat on the Board of the Global Fund and sits on two of the three permanent committees responsible for preparing and monitoring the board’s work (the Strategy Committee and the Audit and Finance Committee), where it defends the Global Fund’s fundamental values:
• The role of communities affected by the diseases and civil society in designing and implementing programmes;
• Taking into account the needs of fragile countries and key populations, a human rights-based approach etc.
Since 2011, France has made part of its contribution to the Global Fund in the form of technical expertise. It supports Francophonie countries eligible for Global Fund support in designing and implementing the programmes. The agency responsible for this mechanism, called “Initiative (formerly Initiative 5%)”, is Expertise France.
In 2019, France contributed directly to the success of the Global Fund’s Sixth Replenishment Conference, which it hosted in Lyon. The Conference raised $14 billion for the period 2020-2022, the most ever raised by an international health organization.
With that amount, 16 million extra lives should be saved and 234 million new infections prevented. It should put the international community back on track to eradicate the pandemics by 2030, in accordance with the Sustainable Development Goals (SDGs). At the Conference, the French President announced that France’s contribution for this new period would be €1.296 billion, up 20% on the previous three years.
France is actively working with the Global Fund’s Board and Strategy Committee to create the new 2023-2028 strategy, in order to oversee the ambitious targets set in the areas of health system strengthening, community involvement, defence of human rights and gender equality.
More information on the conference.
Unitaid, innovating for global health
Unitaid’s mission is to develop innovative solutions to prevent, diagnose and treat HIV/AIDS, tuberculosis and malaria, as well as their co-infections, more quickly, cheaply and effectively. That makes it a unique global health player providing considerable added value, engaged in seeking innovative solutions to speed up fair access to new treatments and diagnostic tests. Between 2017 and 2021, these products and approaches have prevented 560,000 deaths and 17 million cases of infections.
Unitaid has developed unrivalled expertise in several areas:
• Shaping markets (negotiations with the pharmaceutical industry);
• Exhaustive monitoring of innovations across healthcare;
• Multidisciplinary project engineering, combining expertise in bio-medical and social innovations, which are essential to ensuring the final impact of solutions;
Above and beyond that central mission, the organization contributes to the goal of universal health coverage through its major work in management of childhood fever, access to oxygen, the fight against cervical cancer and, more recently, management of Chagas disease. It also contributes to health system strengthening, a key and cross-cutting goal of France’s global health strategy, addressing the needs of the populations most vulnerable and most exposed to pandemics.
Unitaid and COVID-19
Unitaid has worked to contribute to the multilateral response to the COVID-19 pandemic crisis, adapting its ongoing projects.
It takes part in the ACT-A initiative as a co-convenor of the Therapeutics Partnership.
Within the partnership, it keeps track of research and development and production of treatments accessible to all, including both novel drugs and existing, re-purposed medications. The Therapeutics Partnership has enabled 1,700 clinical trials. Unitaid also enables some 20 low- and middle-income countries to access medical oxygen and corticosteroids intended for other purposes. On 31 December 2021, Unitaid allocated $83 million to the Oxygen Emergency Taskforce due to the COVID-19 emergency.
France, Unitaid’s leading donor
Unitaid is a partnership hosted by WHO. It was launched in September 2006 at the initiative of five founding countries: France, Brazil, the United Kingdom, Norway and Chile. France is the organization’s leading donor, having provided more than €1.8 billion in contributions since Unitaid’s creation, or 60% of its total resources. France has committed to a multi-year contribution of €255 million for the period 2020-2022, and disbursed an extra €40 million under its action within the ACT-A to further equitable access to COVID-19 treatment.
Gavi, the Vaccine Alliance
Gavi, the Vaccine Alliance, is an international organization that was created in 2000 to deliver better access to new or under-used vaccines for children in the world’s poorest countries.
Since its creation, it has vaccinated over 888 million children in 77 countries and saved 15 million lives. Gavi currently vaccinates almost half the world’s children against fatal and debilitating infectious diseases, giving it unrivalled negotiating power to obtain vaccines at affordable prices for the poorest countries.
However, 1.5 million children continue to die each year from avoidable diseases. Reaching vulnerable communities therefore remains a major challenge.
Gavi and COVID-19
The pandemic has made Gavi central to international efforts to achieve universal access to COVID-19 vaccines, which are considered global public goods.
The partnership has also taken a key role through the creation of the COVAX facility, the ACT-A vaccines pillar.
Some 191 countries have joined COVAX, which has two components:
• One for higher-income, “self-financing” countries, which buy vaccines for themselves (69 countries) at the price negotiated by Gavi;
• One for 92 lower-income, “funded” countries – the Gavi COVAX Advance Market Commitment (AMC) – which is funded through contributions from donor countries and the private sector.
For the period 2021-2025, Gavi has made equity central to its strategy so that nobody is left behind in terms of access to vaccinations. It aims to vaccinate at least 300 million children, which would save 8 million lives in the poorest countries. This strategy contributes to sustainable development and will strengthen the health systems of countries which will gradually cease to require the Alliance. The new strategy also includes gender-related issues and increased investments for international health security in order to better respond to epidemics.
France’s contribution to Gavi
France has supported Gavi since 2004. It renewed its support at the Global Vaccine Summit in June 2020, announcing a historic contribution to address current challenges, involving an additional direct contribution of €250 million. When added to previous pledges, that brings France’s total contribution over the period 2021-2025 to €500 million. Since 2020, France has also provided €300 million to Gavi under the COVAX facility’s ACT-A.
With these contributions, France is the sixth-largest contributor to Gavi.
Updated June 2022