Fragile progress in the fight against HIV, tuberculosis and malaria

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The Global Fund to Fight the Three Pandemics has just released its report on the past year. The organization notes notable progress in the fight against HIV, tuberculosis and malaria, but the Covid-19 pandemic could wipe them out. Françoise Vanni is the Director of External Relations for the Global Fund.

RFI: The Global Fund against HIV / AIDS, Tuberculosis and Malaria publishes its report on the past year. What are the main elements ?

Françoise Vanni: We have had good results. Since the creation of the Global Fund in 2002, we estimate that 38 million lives have been saved. On the 2019 results alone, 6 million more lives were saved compared to the previous year. We have made significant progress in the fight against HIV, tuberculosis and malaria.

In this report, we therefore highlight the progress made in terms of access to anti-retrovirals for people living with HIV / AIDS: almost 20 million people, which provides 69% coverage. This is remarkable progress over the past few years.

Likewise, we have made significant progress in terms of people treated against tuberculosis. In 2019 we arrived at 5.7 million people diagnosed and treated. We are on track to meet the targets set by the international community at the high-level summit on tuberculosis a year and a half ago.

Finally, with regard to malaria, we are also making progress, with 160 million insecticide-treated mosquito nets distributed. This allows around 320 million people to be affected by this distribution and represents a population coverage of 58% against 34% in 2010.

We are very satisfied with these results but at the same time we are extremely worried, as they risk being wiped out in a few months with the Covid-19 pandemic. It is therefore both a report of positive results and a cry of alarm. The international community must mobilize very quickly to both fight against Covid-19 and protect the results obtained by decades of efforts in the fight against HIV / AIDS, tuberculosis and malaria.

You are announcing good results, particularly in the fight against HIV / AIDS. However, in its annual report, UNAIDS once again sounded the alarm : the objectives set will not be achieved. Where is the cursor located?

We have the same data as UNAIDS. Our progress is compared to 2019. A number of the challenges that we had have seen significant progress, for example in the prevention of HIV / AIDS among young girls in sub-Saharan Africa. On the other hand, we are far from the objectives set by the international community, that is to say the 90-90-90. 90% of sick people need to know their status, 90% of them need to be on treatment and 90% of them need to check their viral load.

We said last year that we were off the hook. We still are the UNAIDS report is correct. However, we have been able to carry out a number of interventions with our partners which have yielded results. In terms of prevention, in terms of targeting the most vulnerable populations such as young people, young girls, key populations, etc. We have made significant efforts.

We are now in the context of Covid-19 and we are fully in line with our partners in UNAIDS. The pandemic threatens very directly the progress that has been made in the fight against HIV / AIDS. We conducted a survey in around 100 countries in which the Global Fund invests. About 75% of service delivery in the programs the Fund supports have experienced some form of significant or very significant disruption in recent months.

HIV programs are the first to be affected, in particular prevention programs: this often involves door-to-door contact, and personalized prevention discussions. All this is threatened by the Covid-19 and people no longer dare to go to health centers. Community health workers who have no protection can no longer do prevention work.

There is therefore a great danger that all progress will be destroyed in a few months. The most pessimistic forecasts see the number of HIV / AIDS deaths doubling in the next twelve months if we do not react in time.

We must fight against Covid-19 itself and ensure that the programs against HIV / AIDS adapt. Community associations must have access to technologies to communicate if they cannot travel. Patients need to have access to longer treatment if they cannot return to the health center as regularly as usual and so on. We know what to do, but funding is sorely lacking.

In this context, how is the Global Fund adapting its programs ?

The Global Fund reacted fairly quickly, in March. We had some flexibility in the already existing grants, which allowed us to deliver $ 500 million that countries could deploy to respond to Covid-19. Subsequently, we released an additional $ 500 million. In total, $ 1 billion was therefore put on the table fairly quickly. They have now been very widely deployed: $ 722 million has been used by countries as needed.

They served to achieve mainly three things. On the one hand, fight against Covid-19 itself with diagnosis, tracing and protection of health personnel. The Global Fund has supported them for years, especially the community health workers who are on the front lines. We are used to working alongside our local partners in this type of intervention. This represents half of the funding we have deployed since the start of the pandemic. A large third has been used to adapt programs to fight HIV, tuberculosis and malaria.

This consists, for example, in changing the methods of distribution of mosquito nets: we can no longer distribute them in village squares, we must ensure that this distribution does not put people at risk of catching Covid-19. We have adapted the deployment of treatments for people who have one for the long term, giving them doses for 3 to 6 months rather than for the short term. All these adaptations could be financed by the Global Fund and be implemented by its partners.

Finally, there is a whole aspect concerning the strengthening of the health system itself. Typically, laboratories have been overloaded; we have enabled our partners to access additional funding to complete their equipment. For example, the Covid-19 diagnostic machines are the same as for tuberculosis. To prevent programs against the latter from being deprived with a machine that could be redeployed for Covid-19, it was simply necessary to buy new ones to meet all the needs.

The goal was to deal with the most urgent. We calculated that to continue this work we needed an additional $ 5 billion. Unfortunately, we are very far away at this point, and we will reach the end of this billion at the end of September. We are concerned about the continuation of these actions.

Less than a year ago, the Global Fund replenishment conference took place in Lyon. States have pledged $ 14 billion over the next three years. Are you worried that this promise will not be kept and that countries will ultimately keep the money to deal with Covid-19?

The States which have made a commitment to Lyon are loyal to us, they know that the Global Fund is an effective tool to fight against the three pandemics and to counter the effects of Covid-19. We therefore have no indication that our donors will not honor their promises. But the needs have increased. We were on the right track with the results obtained last year. This $ 14 billion was the target for working at the right scale for the next three years. The Covid-19 shattered these working hypotheses.

The Global Fund, but also the various partners, need more money. We are united in the ACTA coalition for the deployment of new tools to fight Covid-19. As part of this coalition, we have put together the financing and deployment needs in terms of vaccines, treatment, diagnostics, protective equipment for health workers.

We are therefore seeing that the funding on the table is not at all up to the challenges and the urgency. If we look at all the dimensions of the fight against Covid-19, we would need $ 35 billion for the next 12 months. The question of financing therefore remains open and we believe that given the scale of the current crisis, we will have to go beyond the mechanisms of development aid. To implement innovative and more ambitious mechanisms to meet the needs we face.

Can we consider the creation of a Global Fund against Covid-19 ?

We are in the midst of a crisis. All health stakeholders agree that creating a new institution is not a good idea at all. On the contrary, we are trying to bring together all the actors involved. There have been two major donor conferences convened at the initiative of the European Union. They have given a certain number of results in terms of funding, but which remain far below the stakes.

We will mobilize with our ACTA coalition partners to call on donors to go further. In this sense, we are going to use the already existing platforms: the G20, the United Nations General Assembly, or even the meetings next month of the World Bank and the International Monetary Fund. We have to go beyond the usual paradigm where we take Paul to dress Jacques in official development assistance. In any case, that would be seriously insufficient to put an end to this epidemic. We know that if we do not end the epidemic everywhere, no one will be safe. We need a coordinated global response to effectively tackle this virus and ensure that the most vulnerable are not left behind.

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