The Global Fund and the WHO Pandemic Agreement
19 March 2024
With investments of over US$5 billion per year in HIV, tuberculosis (TB), and malaria programs and health systems strengthening, the Global Fund plays a vital role in financing pandemic prevention, preparedness and response (PPPR). Our two decades of experience fighting the world’s deadliest infectious diseases and our unique capabilities make us a crucial partner to support countries in responding to existing and future health threats.
Introduction
The Global Fund is a worldwide partnership to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all. Since 2002, the Global Fund has invested more than US$60 billion, saving 59 million lives and reducing the combined death rate from the three diseases by more than half in the countries where we invest.
When the COVID-19 pandemic hit, the Global Fund was one of the first to respond. Thanks to our speed and agility, we quickly established the COVID-19 Response Mechanism (C19RM), through which we have awarded over US$5 billion to date to support low- and middle-income countries respond to COVID-19, mitigate the pandemic’s impact on HIV, TB and malaria programs, and strengthen health systems.
The Global Fund procures at scale. During the COVID-19 pandemic, we procured over US$1 billion in diagnostic tests, US$767 million to protect health and community health workers with personal protective equipment (PPE), US$617 million for medical oxygen, and US$261 million for therapeutic treatments and hospital equipment. Given the efficiency of our Pooled Procurement Mechanism (PPM), the Global Fund was able to procure and deliver these lifesaving health commodities ahead of or alongside the peaks of COVID-19 waves.
Through our market shaping abilities, the Global Fund has the ability to lower prices, raise the quality of lifesaving tools, and promote innovation. For instance, we achieved significant price reductions for COVID-19 diagnostic tests, lowering the price from US$5 to under US$1 per test. Countries were able to reinvest these savings to further bolster their national diagnostic systems.
As the pandemic context evolves, the Global Fund has strategically shifted focus to best serve the countries and communities we work with. We have now made approximately US$2.2 billion of C19RM funding available to be reinvested in strengthening health systems and bolstering pandemic prevention, preparedness and response in five priority areas:
- Human resources for health, including community health workers and community systems.
- Laboratory systems.
- Supply chains and waste management.
- Early warning surveillance and response.
- Oxygen and respiratory care systems.
Thanks to our well-established networks and partnerships in the countries where we work, the Global Fund is able to integrate new disease detection and responses holistically within existing disease response programs.
The Global Fund is the world's largest multilateral grants provider for health systems strengthening in low- and middle-income countries. Over the next three years, we are making the most significant increase in investments in this area in our history: we are investing US$6 billion between 2024-2026 to support countries in strengthening health systems – which represents over one third of all Global Fund investments in this period.
The Global Fund’s 2023-2028 Strategy "Fighting Pandemics and Building Healthier and More Equitable World" responds directly to the dramatic changes in the global health context. Our approach is led and owned by countries. We channel financing directly to governments and their PPPR and health systems entities, including National Public Health Institutes, as well as their laboratory, surveillance, and community health directorates. In addition, the Global Fund partners with the communities we serve in order to maximize health equity and ensure a focus on gender equality and human rights. We are the only financing mechanism for PPPR that works directly with both government and community partners while delivering at scale, setting the right conditions to support effective pandemic prevention, preparedness and response.
The Global Fund and the WHO Pandemic Agreement
The Global Fund stands ready to draw upon our expertise and scale to implement the WHO Pandemic Agreement and support low- and middle-income countries to prepare for future pathogens by investing in their infectious disease responses and PPPR capacities today.
Given the increasingly challenging financing environment for global health, PPPR financing going forward must be integrated into existing health systems and disease control interventions to maximize efficiency and sustainability.
Uniquely positioned to do such integrated financing and strengthening of PPPR capacity effectively, we are the logical partner of choice. Integrating PPPR capacity-building within our existing health systems/disease interventions is cost-effective and yields greater efficiency. In addition, our two decades of cultivating strong relationships and trust not only with governments but also with communities and civil society means that we are able reach the most affected populations all the way to the last mile, leaving no one behind.
The Global Fund strongly advocates for health equity to remain at the center of the Pandemic Agreement. Health equity is not only the right choice, but it is also the safest – in fact, the only – way to protect all of us from future pandemics. Until everyone has equitable access to lifesaving health tools and services, diseases will continue to spread beyond borders and develop resistance to the tools we use to fight them.
We also call for the meaningful engagement of all stakeholders, including civil society partners, in the negotiation process and operationalization of the Pandemic Agreement. Inclusive governance is embedded within our model of operating. The Global Fund follows a country-owned and country-led approach, and we ensure that representatives of all sectors involved in the response to diseases are engaged in the grant decision-making process, including, and mostly led by, governments, with academic institutions, civil society, faith-based organizations, multilateral and bilateral agencies, nongovernmental organizations, people living with the diseases, the private sector and technical agencies.
The Global Fund welcomes the proposal in Article 20 of a Coordinating Financial Mechanism to support the implementation of both the WHO Pandemic Agreement and the International Health Regulations, and we are ready to engage and contribute with our 22-year experience in supporting low- and middle-income countries to fight infectious diseases.
We support the normative and convening role of WHO in global health and advise to keep any coordinating mechanism flexible enough to adapt to different needs and geographies which cannot be anticipated, and encourage the Mechanism to leverage the respective strengths, processes and networks of existing financing instruments and mechanisms.
The Global Fund urges caution against a new pooled fund with a broad mandate on PPPR, for the sake of efficiency and effectiveness. We cannot afford to spend the significant time and financial resources required to build an effective mechanism that can work at scale. In a time when global health financing will be even more constrained, it also creates further overlaps. Instead, we recommend the Mechanism to leverage existing financing mechanisms already investing in PPPR capacity strengthening, and to mainly focus on gaps and on surge financing for pandemic responses when other resources are not accessible through existing financing instruments. Building on financing mechanisms that have demonstrated capabilities to deploy funds and operate rapidly and at scale is a way to channel funding efficiently and deliver impactful results. We recommend explicit language referring to the role of existing financing instruments as part of the Mechanism.
In addition, the Global Fund urges Member States to consider leveraging new financial resources to avoid undermining broader and critical health investments as per a principle of additionality and complementarity. PPPR financial resources should be additional and complementary to current investments, and not take away from existing and future funding for immediate life-saving needs, other domestic public health priorities and progressive realization of universal health coverage.
In the revised draft text of the WHO Pandemic Agreement, the Global Fund recommends the inclusion of explicit language on the ways relevant agencies that are financing health and PPPR will be involved in drafting and approving the Financing and Implementation Strategy.
The Global Fund strongly recommends the proposed governance of the Coordinating Financial Mechanism, including its Governing Board to include a clear membership role for specialized agencies financing health and PPPR such as the Global Fund and Gavi, and a clearly defined role for civil society and communities.
Finally, we call for clarifying the role of specialized agencies and international organizations as Cooperating Parties in Article 19.