When COVID-19 emerged in early 2020, the Global Fund took swift action to fight the pandemic and protect hard-won gains against HIV, tuberculosis (TB) and malaria. With the support of our generous donors, we have since awarded more than US$4.4 billion to help countries respond to the new virus, mitigate its impact on lifesaving HIV, TB and malaria services and make urgent improvements to health systems. While we were not able to prevent COVID-19 from having a massive impact on people living in low- and middle-income countries, including both the direct impact of the new virus and the reversal of hard-won gains against HIV, TB and malaria, it could have been much worse.
We saw the benefits of the interventions we made in 2021, with gains in key programmatic results across all three diseases. The Global Fund’s Results Report 2022 details how our partnership played a critical role in supporting countries and communities to respond to the pandemic and continue the progress in the fight against HIV, TB and malaria.
Health programs supported by the Global Fund partnership had saved 50 million lives as of the end of 2021.
50 million lives saved
The coverage of treatment and prevention interventions for HIV, TB and malaria in countries where the Global Fund invests has increased rapidly since we were created in 2002. However, while the growth in HIV coverage levels remains steady, TB and malaria coverage have both declined in recent years. Declines in TB coverage are mostly due to disruptions caused by the COVID-19 pandemic, and declines in malaria coverage in sub-Saharan Africa may partly reflect better targeting of mosquito nets. The Global Fund is investing to get the world back on track toward ending AIDS, TB and malaria, building resilient and sustainable systems for health and strengthening pandemic preparedness, making the world more equitable and safer from future threats.
We measure our progress against the targets in the global plans for HIV, TB and malaria and in the Sustainable Development Goal 3 of health and well-being for all. Our achievement is the result of efforts by a wide array of actors comprising the Global Fund partnership, including governments, multilateral agencies, bilateral partners, civil society groups, people affected by the diseases and the private sector.
Together with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners, our efforts to implement WHO’s “treat all” guidance and the UNAIDS “95-95-95” strategy have significantly increased the number of people diagnosed with HIV and started on antiretroviral therapy. In 2021, in countries where the Global Fund invests, HIV testing services for groups in greatest need started to recover. 23.3 million people were receiving lifesaving antiretroviral therapy, up from 21.9 million in 2020. The percentage of people in need of antiretroviral therapy who received it has significantly increased over the past decade, from 23% in 2010 to 75% in 2021.
In 2021, the Global Fund supported countries to mitigate the impact of COVID-19 and continue to grow their HIV programs despite the pandemic. Interventions to support those mitigation and recovery efforts have included multimonth dispensing and community antiretroviral therapy delivery, adherence support, community leadership, increased investments in biomedical HIV prevention and multimonth dispensing of pre-exposure prophylaxis (PrEP). In 2021, 12.5 million people were reached with HIV prevention services, including 5.8 million members of key populations and 6.1 million young people.
Adolescent girls and young women remain a key focus for the Global Fund’s response to HIV. We have significantly increased our investments, focusing on the 13 priority countries where HIV burden is highest. In these countries, the HIV incidence rate among adolescent girls and young women has dropped by 56% since 2010. We have supported interventions that increase the knowledge and power of adolescent girls and young women to access and use HIV prevention tools such as condoms and PrEP, as well as tackle cultural norms that make them vulnerable to HIV transmission. The Global Fund has also invested in HIV prevention targeting boys and men, including voluntary medical male circumcision programs and programs to address harmful cultural and social norms that influence HIV transmission.
In countries where the Global Fund invests, AIDS-related deaths have been reduced by 70% since the Global Fund was founded in 2002 and new infections have been reduced by 54%. This achievement reflects steady progress. In the absence of prevention measures and antiretroviral drugs, deaths would have increased by 240% and new HIV infections by 158% in the same period. If we are to reduce inequalities and prevent the disruptions caused by COVID-19 from having a long-term impact on the fight against HIV, we must urgently remove barriers to treatment and prevention and scale up adaptation and mitigation to regain lost progress.
The Global Fund provides 30% of all international financing for HIV programs and has invested a total of US$24.2 billion in programs to prevent and treat HIV and AIDS and US$5 billion in TB/HIV programs as of June 2022. Since 2020, the Global Fund has also stepped up to support countries to mitigate the impact of COVID-19 on the HIV response.
Since the Global Fund partnership was created 20 years ago, the world has made extraordinary progress in the fight against HIV, including in its efforts to mitigate the effects of COVID-19 on HIV programs. To continue that momentum and regain lost ground, we must expand successful programs to prevent and treat HIV.
In 2021, drug-resistant TB and the effect of COVID-19 remained major challenges. The impact of COVID-19 on TB programs has been significant: In 2020, the number of deaths from TB rose for the first time in a decade. But thanks to interventions by the Global Fund partnership, TB programs are starting to recover.
In the fight against TB, we are recovering from 2020 losses in the following key indicators: finding and treating people with the disease, including those with drug-resistant TB; improving access to quality diagnosis, treatment and care; and scaling up prevention and supporting “catch-up” activities to find and treat those who did not access care during the pandemic and accelerate those recovery efforts. To fight drug-resistant TB, the Global Fund is encouraging and supporting countries to transition to shorter oral regimens for drug-resistant TB, which are more effective.
In countries where the Global Fund invests, TB deaths (excluding people living with HIV) since the Global Fund was founded two decades ago have been reduced by 21% as of 2020, while new TB cases (all forms) have dropped by 5%. In the absence of TB control measures, deaths would have increased by 121% and TB cases by 35% in the same period.
The Global Fund provides 76% of all international financing for TB and has invested US$8.5 billion in programs to prevent and care for people with TB and US$5 billion in TB/HIV programs as of June 2022. The Global Fund has also stepped up to support countries to mitigate the impact of COVID-19 on the TB response. We increased TB grants by 14% on average in the sixth cycle (2021-2023) compared to the fifth cycle (2018-2020). Through the COVID-19 Response Mechanism (C19RM) in 2021, US$159 million was approved for activities to support people with TB and TB programs in the Global Fund’s 20 high-priority TB countries.
To end TB as an epidemic, we must increase investments in evidence-based tools, health workers and systems for health needed to fight TB, keep COVID-19 and any of its long-term effects at bay and prepare for other future airborne pandemics.
A child dies of malaria nearly every minute. Great progress has been made in malaria control with a reduction in overall cases and deaths, but that momentum has stalled in recent years. COVID-19 has exacerbated that challenge, knocking us further off track, while resistances to insecticides and treatments show signs of spreading. The Global Fund partnership response has been to innovate, by investing in tools such as dual active ingredient nets and to continue what has worked, such as funding the mass distribution of long-lasting insecticidal nets, seasonal chemoprevention, rapid diagnostic tests and quality-assured treatment; supporting regional manufacturing; and strengthening national efforts to make testing as widely available as possible. In 2021, Global Fund-supported programs recovered from declines in 2020, with testing and treatment for malaria registering gains.
In countries where the Global Fund invests, negotiating directly with manufacturers, the cost of a pyrethroid-piperonyl butoxide (PBO) net, which provides better malaria control in areas of pyrethroid insecticide resistance, is now less than US$2.60. The cost of antimalarial treatment (AL 24) dropped to US$0.58 in 2021, allowing the Global Fund to procure 145 million artemisinin-based combination courses.
Since 2010, the highest malaria burden countries have achieved significant declines in the overall number of deaths and have been able to drive down incidence rates. In countries where the Global Fund invests, malaria deaths have reduced by 26% between 2002 and 2021. The incidence rate has declined by 28% and the mortality rate by 47% since 2002. In the absence of malaria control measures, deaths would have increased by 84% and malaria cases by 70% in the same period.
The Global Fund provides 63% of all international financing for malaria programs and has invested more than US$16.4 billion in malaria programs as of June 2022. The Global Fund increased malaria grants by 23% in the sixth cycle (2021-2023) compared to the fifth cycle (2018-2020). Since 2020, the Global Fund has provided additional funding through C19RM to countries to mitigate the impact of COVID-19 on the malaria response.
Despite the challenges of COVID-19, the pandemic has produced a wave of innovations and adaptations to continue the fight against malaria. As proved by El Salvador – certified malaria-free in 2021 – the target of eliminating malaria is still within reach. But we must work even harder to regain lost progress and ensure that crises such as COVID-19 and climate change do not destroy our efforts.
Resilient and sustainable systems for health are the foundation for defeating today’s infectious diseases and the basis for preventing, preparing for and responding to future pandemics. The Global Fund is the world’s largest multilateral provider of grants for strengthening systems for health. Over the 2021-2023 implementation cycle, we are investing US$4.9 billion, or US$1.5 billion a year, in formal and community health systems through our core grants and through C19RM – about one-third of our total investments. Learn more
In addition to the COVID-19 pandemic, people in low- and middle-income countries have been confronted with escalating conflicts and climate change. Since 2002, the Global Fund has provided US$15 billion to support crucial HIV, TB and malaria prevention and treatment services and strengthen health systems in countries faced with crises. We refer to these countries or regions as challenging operating environments. To end HIV, TB and malaria as public health threats and address emerging dangers to global health security, we need to reach the most vulnerable people with prevention and treatment services, wherever they are. Learn more
The Global Fund galvanizes the world to invest in the fight against the deadliest infectious diseases while challenging the injustice that continues to fuel them. Since our founding in 2002, the Global Fund has disbursed more than US$55.4 billion to respond to HIV, TB, malaria and COVID-19 and for programs to strengthen systems for health across more than 100 countries as of June 2022. In 2021, we accelerated our investments in the fight against infectious diseases, bringing our annual disbursement to US$5 billion – the highest disbursement since our founding.
The Global Fund’s programmatic results and impact are calculated using the data for HIV, TB and malaria in countries where we invest in a given year. The Global Fund uses the programmatic results directly reported by the supported countries as well as official disease burden and impact estimates developed and published by our technical partners, including WHO and UNAIDS, as the basis for measuring impact. Learn more