The fight against AIDS, tuberculosis and malaria: France’s commitment

State of play in the fight against AIDS, tuberculosis and malaria

The international community’s efforts, especially since the creation of the Global Fund in 2002, have 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 highlighted the fragility of the progress made over the past two decades, with a major drop in access to diagnostics, therapeutics and care, and undermining of prevention work relating to the three pandemics. There is a clear risk today that the major pandemics will regain ground. International and domestic health funding need to be boosted in order to preserve, deepen and ensure the sustainability of the last two decades’ progress.

HIV/AIDS

While AIDS mortality has been cut three-fold since 2004, the virus continues to kill one person per minute and more than 630,000 per year. In 2022, 39 million people were living with HIV, and girls and young women accounted for 44% of new infections. In sub-Saharan Africa in 2023, that figure stood at 62%.

The COVID-19 pandemic also seriously disrupted the HIV/AIDS response: in 2020, the number of people reached by prevention programmes dropped by 11%, and the number of people tested fell 22%.

Tuberculosis

Despite a 54% drop in mortality since 2002, tuberculosis is now once again, after the three-year COVID-19 pandemic, the most deadly infectious disease worldwide. In 2023, there were 10.8 million new cases and 1.25 million people died, mostly from the most vulnerable populations. According to WHO, multidrug-resistant tuberculosis (MDR-TB) is one of the leading threats to global health security, yet only two in five people living with the disease received treatment in 2023.

Malaria

Despite the great progress made, with mortality down 47% between 2002 and 2022, results have since stagnated. COVID-19 contributed to this trend, while climate change and insecticide and drug resistance are having an increasing impact. In 2022, 249 million new cases were diagnosed, as against 247 million the year before, and the disease killed at least 608,000 people, 96% of whom in Africa. In sub-Saharan Africa, Malaria remains the leading cause of death among children aged under 5 years.

What is France doing internationally?

France has demonstrated continuous determination in the fight against HIV/AIDS, tuberculosis and malaria, making it a pillar of its global health strategy for 2023-2027. In order to make its action as effective 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 65 million lives and reduced the number of deaths annually from the three pandemics by 61%.

By pooling the financial contributions of more than 60 countries and private and non-governmental actors, it has invested over $65 billion since 2002 to support national programmes to fight the pandemics in more than 100 countries. The Global Fund is currently the main fundraising mechanism to fight pandemics in developing countries, providing 28% of total funding for AIDS, 76% for tuberculosis and 62% 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 draws up requests for funding and oversees its use. These bodies bring together representatives of national authorities as well as technical and financial partners, communities affected by the diseases, and NGOs;
• The Global Fund is not directly represented in implementing countries but instead funds local recipients which deliver projects. Its Secretariat in Geneva handles day-to-day management and applies the organization’s strategies and policies.

The Global Fund and lessons learned from COVID-19

As early as April 2020, the Global Fund took action by creating the ad hoc COVID-19 Response Mechanism (C19RM). It allocated $4.7 billion to 125 beneficiaries, including $723 million for emergency COVID-19 action, the rest being aimed at strengthening health systems, particularly community systems, and pandemic preparedness, in five areas: surveillance system strengthening, improvements to laboratory systems and diagnostics; human resources for health and community systems strengthening; medical oxygen, respiratory care and therapeutics; and health product and waste management systems. The C19RM has been extended to the end of 2025 to support the strengthening and resilience of Global Fund implementing countries’ health systems.

France’s leading support for the Global Fund

France provides key political and financial support for the Global Fund, as a founding country and the second-largest contributor over time, having contributed over €7.2 billion in grants since 2002.

This financial contribution means France has its own seat on the Board of the Global Fund and sits on two of the three permanent committees that prepare and monitor 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 affected communities and civil society in drawing up and implementing programmes and supporting health and community systems;
• Taking into account fragile countries and key populations to ensure enhanced equitable access to health, understood as a fundamental human right.

Since 2011, France has dedicated part of its Global Fund contribution to L’Initiative, a facility implemented by Expertise France to provide technical expertise and support for Global Fund projects in 40 of the most vulnerable implementing countries, particularly in West and Central Africa, so as to maximize the Fund’s impact. In an illustration of its real impact in boosting the Global Fund’s work and strengthening countries’ health systems, L’Initiative’s share in the French contribution to the Global Fund rose from 5% to 9% in 2022 and will reach 20% for the 2023-2025 cycle, or €106 million per year.

France was fully committed to the success of the Global Fund’s sixth Replenishment Conference, which it hosted in Lyon in September 2019, and pledged €1.3 billion, a significant increase. This very high-level conference marked a culmination of France’s global health commitment and came during its G7 Presidency, raising $14 billion for the 2020-2020 period – a record for an international health organization.

At the Fund’s seventh Replenishment Conference in New York in 2022, France’s President renewed France’s strong commitment to fighting the three pandemics with an unprecedented contribution of €1.6 billion for the period 2023-2025 (up 23% on 2020-2022), 20% of which is allocated to L’Initiative;

While the global effort to fight the three pandemics has slowed since 2020 due to the COVID-19 pandemic, France remains active and committed to implementing the Global Fund’s new 2023-2028 strategy and works to ensure the ambitious goals on health system strengthening, community involvement, human rights and gender equality are met.

Unitaid: innovating for global health

Unitaid’s mission is to support the development and introduction of innovative health products to prevent, diagnose and treat HIV/AIDS and their co-infections, tuberculosis, and malaria, more quickly, cheaply and effectively. That makes it a unique global health player engaged in seeking innovative solutions to speed up equitable access to new health products and technologies. Unitaid’s work is believed to enable 300 million people to access lifesaving products every year.

Since its creation in 2006, Unitaid has contributed to the deployment of over 100 innovative health products, including new HIV treatments, the first HIV and tuberculosis drugs for children, and latest-generation mosquito nets which are more effective in combating malaria.

Unitaid has developed unrivalled expertise in several areas:

• Exhaustive monitoring of health sector innovations (diagnostics and tests, therapeutics and tools);
• Multidisciplinary project engineering, combining expertise in bio-medical and socio-economic innovations, which are essential to ensuring the final impact of solutions for the communities concerned;
• Market shaping through negotiation with pharmaceutical companies to reduce market access barriers for low- and middle-income countries.

Above and beyond that key mission, the organization contributes to the goal of universal health coverage through its major work concerning, for example, access to medical oxygen, fighting cervical cancer, treating pregnancy- and maternity-related pathologies (pre-eclampsia, post-partum haemorrhages, anaemia) and early childhood conditions, and management of Chagas disease in endemic regions. It also contributes to health system strengthening, a cross-cutting priority of France’s global health strategy, addressing the needs of those most vulnerable and most exposed to pandemics.

Unitaid’s increased role in light of COVID-19

During and following the COVID-19 pandemic crisis, Unitaid has worked to contribute to the multilateral response to the pandemic, developing innovative tools to boost health emergency prevention, preparation and response. As such, it has taken a partnership approach to support the development of simplified tests and therapeutics and new or repurposed therapeutics. Unitaid has also enabled around 20 low- and middle-income countries to access medical oxygen and repurposed corticosteroids and, building on that experience, spearheaded the launch of the Global Oxygen Alliance (GO2AL) during the World Health Assembly in May 2023.

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 almost €2 billion in contributions since Unitaid’s creation, or 56% of its cumulative resources. France is also Unitaid’s leading annual donor, having committed to a multi-year contribution of €255 million for the period 2023-2025, and disbursed an extra €40 million under its action within ACT-A to further equitable access to COVID-19 therapeutics.

• More information is available on the Unitaid website and on the page dedicated to more specific collaboration between France and Unitaid.

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. In 2023, Gavi, the Vaccine Alliance, celebrated the symbolical threshold of 1 billion vaccinated children and 17 million lives saved since its creation. 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 preventable 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 played a key role through the creation of the COVAX facility, under the ACT-A vaccines pillar.

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. 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. The Alliance is currently on track to achieve all its goals. Its 2026-2030 strategy aims to vaccinate at least 500 million more children, which should save more than 8 million lives in the poorest countries.

France’s contribution to Gavi

France has supported Gavi since 2004. It renewed its support in June 2024 by hosting the Global Forum for Vaccine Sovereignty and Innovation, where it reaffirmed the strength of its commitment to vaccination and regional production in line with the Sustainable Development Goals for 2030.

France has been a partner and major supporter of Gavi since its creation and is one of its leading donors, pledging €500 million during the previous financing cycle (2021-2025). Since 2020, France has also contributed €300 million to the creation and financing of the COVID-19 Vaccines Global Access Facility (COVAX).

These contributions, make France the sixth-largest contributor to Gavi.

• More information on the Gavi website

Updated: November 2024