7 Asks for the 7th Replenishment – A GFAN Sign On Letter

The Preparatory Meeting, where the investment case will be released, is around the corner. This year, it is hosted virtually by 5 countries: the DRC, Kenya, Rwanda, Senegal and South Africa, and will take place on Feb 23-24.

During the Preparatory Meeting, the Global Fund Secretariat will release its Investment Case for the 7^th Replenishment. It is an important document. It sets the tone and frames the conversation until the Pledging Conference in September. Just as importantly, it contains the Ask of the Global Fund. That number embodies the Global Fund’s contribution to the world’s ambition in the fight against the three diseases for the three years to come. The theme during the last replenishment was to “Step Up the Fight”. The Investment Case focused on the risk of sliding back, and on the reality that the world was already off-track to meet the 2030 objectives of ending the epidemics. It sets the goal at $14 billion. The 6^th Replenishment was successful, in the sense that the Ask was met. We, at GFAN, knew that the Ask had not been ambitious enough – that $14 billions would not get us back on track.

This is all context. There were reasons to be hopeful in 2019, and reasons to be disappointed. In 2022, one has to look harder for reasons to be hopeful. On the three diseases, we slid backwards in some key results. HIV testing fell 22%, TB testing and treatment 18%, and these are key indicators we have become accustomed to see improve – hard-fought and sometimes agonizingly slowly, but we have become unaccustomed to losing ground. We lost millions worldwide to a new pandemic. Lack of international coordination and cooperation brought a lackluster, unequal response that has let the pandemic drag on to 2022 and beyond. Still, there are reasons to hope. Trillions have been invested in the response to the new pandemic. Global Health rose drastically in the international agenda. While the Global Fund did see some setbacks, we also watched as Global Fund supported programs pivoted to meet the needs of communities in the face of COVID. Technological leaps in vaccine and treatment are opening new avenues to treat and prevent HIV/AIDS, TB and malaria.

The Global Fund has played an active role in pandemic response, through ACT-A. It has also integrated pandemic preparedness in its new 2023-2028 Strategy. As pandemic preparedness remains an evolving objective for the Global Fund, the understanding and objectives of the GFAN secretariat and membership will evolve. This is why we so look forward to the Investment Case to help clarify some of the Global Fund Secretariat’s own understanding. 

We remain committed to the principle that the IC, and the 7^th Replenishment overall, must at its core be about fully funding the Global Fund to continue to play its vital role to end the three epidemics. At the same time, we recognize the Global Fund is poised to play an expanded role in pandemic preparedness founded on strong, equitable and accountable health systems, and that this expanded role could reinforce the responses to AIDS, TB and malaria. Through our Civil Society Ask document in the fall, we clearly articulated that it is a role that would build on the expertise of the partnership, on its 20 years experience fighting three deadly epidemics, and on the lessons of the last 2 years where we saw HIV/AIDS, TB and malaria programs supported by the Global Fund pivot to meet the challenges of COVID-19.

We need the Investment Case to clarify these questions, and many more and we need the Investment Case to be bold and ambitious.

I’m happy to share with you today, with 142 signatures from around the world, 7 asks for the 7^th Replenishment.

Katy Kydd Wright

Director, GFAN

Later this year, the Global Fund will hold its Seventh Replenishment Conference which will be hosted by the United States. This will be a pivotal moment. GFAN has already defined the full need to get back on track to end AIDS, Tuberculosis and Malaria in a COVID world at $28.5 billion, including $4.5 billion for community-led responses.

The Global Fund, at 20 years old, has the know-how,  partnership, and approaches that we need and its donors now need to step up. Otherwise, we risk further set-backs as we saw in the 2021 Results Report.

Next month, the world will gather virtually for the launch of the Global Fund’s Investment Case for the Seventh Replenishment.

These are our seven asks for the Investment Case:   

1. BOLDNESS & AMBITION: The Investment Case needs to include a bold and ambitious Ask. The Ask is at the center of the document, and needs to be commensurate with the task at hand, which is truly unprecedented. We estimated the need for response to the three diseases over the upcoming implementation period to be $28.5 billion in our Civil Society Ask. In order to meet this need, public and private donors need to increase their commitments significantly. 
2. PEOPLE-CENTERED APPROACHES: Centralized, top-down responses to COVID-19 have been in the limelight for two years. We know these approaches do not work to effectively respond to HIV, tuberculosis and malaria. Health issues are best addressed holistically, and in a spirit of partnership. This is the spirit the Global Fund must  keep putting forward, even if it means going against global trends. This is why GFAN advocates for at least $4.5 billion to strengthen community-led responses for the next replenishment.
3. TOWARDS SUSTAINABLE DOMESTIC RESOURCE MOBILIZATION: Robust Domestic Resource Mobilization (DRM) predictions, grounded in realistic and explicit assumptions. Implementing countries face a triple COVID economic threat – a rise in COVID-related health costs, a COVID-created economic recession, and increased debt burdens. Any DRM projection needs to be cognizant of these stresses. DRM projections were a weakness of the last Investment Case that needs to be addressed in the upcoming one.
4. CLARITY ON PANDEMIC PREPAREDNESS: the object of the Replenishment is to raise funds to end AIDS, tuberculosis and malaria. The Investment Case should not include additional funding to help the Global Fund fulfill a dedicated role in the emerging pandemic preparedness consensus; regardless of how important this role can be. It has to be funded separately, and there should be no room for ambiguity on the matter. At the same time, under COVID, the same funds for HIV, TB and malaria do not get us as far as they could. The cost of service delivery has been higher during the pandemic and that challenge needs to be discussed in the Investment Case.
5. PROTECT THE RIGHTS OF KEY & VULNERABLE POPULATIONS: The strength of the Global Fund is its partnership, featured prominently in its strategy for 2023-2028. Central to the success of the partnership has been key and vulnerable populations. In a global context where health is talked about as a security issue, we want to see the Global Fund’s commitment to partnership with marginalized and vulnerable folks reaffirmed. In the same vein, civil society needs to know it can count on the support of the Global Fund, especially in hostile and unsupportive environments. The past two years have seen rising threats against human rights, in particular those of LGBTQI+ people. Many need to know the Global Fund would stand behind them even if no one else would.
6. HEIGHTENED FOCUS ON PRIVATE SECTOR AND FOUNDATIONS: The Investment Case needs to clearly spell out the value proposition to the private sector of eliminating infectious diseases; there are many lessons from the last two years to underscore this point. It is critical that existing private sector and foundation partners of the Global Fund step up and face the challenge to raise a much more significant portion of the $28.5 billion. It is also critical that new partners join their ranks. 
7. ATTAINING THE 2030 AGENDA: The 2023-2028 Strategy discussions highlight the importance of aligning Global Fund objectives and needs with global plans, reflected by the Sustainable Development Goals and reaffirmed for each of the three diseases in international commitments. Alignment with these plans and objectives needs to be reflected in the Investment Case, which means that the ask must account for the full need and demand to achieve the goals we have set for ourselves for the three diseases.

We need an Investment Case that makes an unprecedented ask of the world. We need an Investment Case that lives up to the targets we have set for ourselves. We need an Investment Case that matches the ambition that we had at the founding of the Global Fund: a war chest to end the world’s deadliest infectious diseases.

Download the pdf of the letter here.

Also available in: Japanese; German ; French