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Climate Change and Conflict Slow Down Progress Despite Record Results

Results in the fight against HIV, TB and malaria exceed pre-COVID-19 numbers; yet colliding crises keep the world way off track to achieve 2030 targets

18 September 2023

GENEVA – The Global Fund’s 2023 Results Report [ download in عربي | 中文 | Deutsch | English | Español | Français | Italiano | 日本語 | 한국어 | Português ] released today (full Report here) shows a remarkable acceleration of programmatic results in the fight against HIV, TB and malaria, after losses from the COVID-19 pandemic. However, multiple challenges, including climate change and conflict, as well as deepening inequalities and growing threats to human rights, have put the target to end AIDS, TB and malaria by 2030 increasingly at risk.

“Working together, the Global Fund partnership has saved 59 million lives over the past two decades,” said Peter Sands, Executive Director of the Global Fund. “Despite several record-breaking results achieved in 2022, we will not achieve the 2030 targets unless we take extraordinary steps.”

In 2022, thanks to the tireless efforts, adaptations and innovations by governments, communities and partners, the Global Fund partnership put an unprecedented number of people on antiretroviral treatment for HIV. We found and put on treatment more people with TB than ever before, and we distributed a record number of mosquito nets to prevent malaria.

Key results for 2022 in countries where the Global Fund invests include:

For HIV

• 24.5 million people on antiretroviral therapy for HIV.
• 53.1 million HIV tests taken (12.2 million by priority and key populations).
• 15.3 million people reached with HIV prevention services.
• 710,000 mothers living with HIV received medicine to keep them alive and prevent transmitting HIV to their babies.
• 831,000 voluntary medical male circumcisions for HIV prevention.

For Tuberculosis

• 6.7 million people treated for TB.
• 118,000 people on treatment for drug-resistant TB.
• 331,000 HIV-positive TB patients on antiretroviral drugs.
• 2.2 million people with HIV on antiretroviral therapy who initiated TB preventive therapy.
• 1.5 million people exposed to TB received preventive therapy.

For Malaria

• 220 million mosquito nets distributed to protect families from malaria.
• 321 million suspected cases of malaria tested.
• 37.1 million children received seasonal malaria chemoprevention.
• 14.6 million pregnant women received preventive treatment for malaria.
• 165 million cases of malaria treated.

Colliding Crises Slow Down Progress

In many of the countries in which the Global Fund invests, getting back on track against the three diseases has been made much more challenging by a combination of interconnected and colliding crises beyond COVID-19, including climate change, conflict, and debt, plus an alarming erosion of human rights, and deepening inequities within and between countries.

Climate change is already having an impact on the epidemiology of infectious diseases. For example, malaria is spreading to highland parts of Africa that were previously too cold for the Anopheles mosquito that carries the parasite. Cyclones, floods and other climate-related extreme events are causing dramatic upsurges in malaria infections, such as in Malawi and Pakistan. Food insecurity and water scarcity are displacing entire communities, increasing their vulnerability to diseases like TB. The Global Fund has stepped up in the aftermath of extreme weather events to mitigate their impact on malaria programs and ensure the continuity of HIV and TB services.  

Conflicts damage health infrastructure and overwhelm already overstretched health services, so people who become ill with disease are unable to access treatment, supply chains break down, and prevention interventions are interrupted. Across multiple countries, including Sudan, Ukraine, Afghanistan and Myanmar, the Global Fund partnership has to overcome immense challenges in striving to ensure the most vulnerable get the services they need.

Strengthening Health Systems to Fight and Prevent Outbreaks 

Resilient and sustainable systems for health underpin the fight against diseases and are the foundation for preventing, detecting and responding to existing and emerging health threats.

“By investing in key components of resilient health systems, the Global Fund supports countries to fight the deadly infectious diseases of today while preparing for future health threats,” said Sands. “For instance, we will continue to play a crucial role in supporting community health workers and in strengthening supply chains and laboratory networks.”  

In total, the Global Fund has awarded over US$5 billion to support countries in responding to COVID-19; approximately US$2.2 billion of this financing will be used to strengthen systems for health and enhance pandemic preparedness.

Accelerating Equitable Access to Game-changing, Innovative Tools

Accelerating equitable access to innovative tools is essential for regaining and sustaining momentum in the fight against HIV, TB and malaria.

“Despite all the challenges, the goal of ending AIDS, TB and malaria as public health threats remains achievable. We know what needs to be done, we have tools that work, and we can learn from successful examples,” says Sands. “We need to accelerate access to game-changing innovations, optimizing their deployment alongside existing tools to maximize the impact of every dollar. We need to eliminate the inequities that increase the vulnerability of young women, key populations and the very poorest.”

For HIV, the dapivirine vaginal ring – the first effective, woman-controlled HIV prevention option – provides an additional new tool to give girls and women the power to protect themselves from HIV infection. Pediatric HIV remains a global area of unmet need, but recent treatment innovations have the potential to be game changers. The Global Fund partnership is investing in pediatric dolutegravir formulation, which is more effective, cheaper and better tolerated by children.

Against TB, key innovations include new diagnostic tools, such as mobile X-rays and lower-cost molecular diagnostics, new treatments, such as the bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) combination therapy for drug-resistant TB (DR-TB) and the new short course tuberculosis preventive treatment called 3HP.

For malaria, there are a range of innovations in vector control, prevention, diagnosis and treatments that will help us combat the alarming trends in infections and deaths. For example, dual active ingredient bed nets, combining pyrethroid and chlorfenapyr, which will be available at scale from 2024, are dramatically more effective than standard pyrethroid-only bed nets. Trials showed a reduction of malaria infections by approximately 50% among children between the ages of 6 months and 10 years.

Optimizing the integrated deployment of such innovations, while accelerating efforts to end the stark inequities that fuel infectious diseases will be crucial to getting back on track. It is by empowering the communities most at risk that we ensure that lifesaving services reach the most vulnerable, including those marginalized by poverty, stigma, discrimination or criminalization. Putting people and communities at the center of our model helps build the trust that is the vital foundation for achieving our mission and ensuring no one is left behind.