Strong Global Fund replenishment presents opportunity to bolster country malaria elimination efforts

Last week in Montreal, Canada, donors pledged over US$12.9 billion in the fifth replenishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Geneva-based organization designed to finance and accelerate the end of the world’s three most devastating diseases. The newly replenished funds represent an extraordinary commitment from governments, corporations, foundations, and individual donors, raising almost US$1 billion more than the previous replenishment conference and nearly reaching the ambitious US$13 billion goal set by the Global Fund for the 2017-2019 cycle. The pledges will be used to implement the Global Fund’s new strategy over the next three years.

The replenishment was led by the US (US$4.3 billion), the UK (£1.1 billion), and France (€1.08 billion). Many donors, including Canada, Germany, Japan, Norway, and the European Commission increased the generosity of their pledges from past replenishment efforts. Commitments from private sector and innovative financing initiatives more than doubled to US$250 million. Some funding contributions came from low- and middle-income countries, including the governments of India, Kenya, Nigeria, and South Africa. New donors included Qatar, Benin, and Togo, who pledged a total of US$13 million. The Bill and Melinda Gates Foundation (BMGF) also pledged US$600 million, a US$100 million increase over their contribution for the 2013-2016 replenishment. The Global Fund will continue to raise money over the next three years in an effort to meet the estimated financing required to end the three diseases.

The Global Fund has been the largest external financial supporter of malaria, providing necessary resources to effectively drive down the disease while also catalyzing increased domestic resources through counterpart financing requirements. Investment in the fight against malaria saves lives, averts infections, and brings high value: every US$1 spent on malaria globally brings economic and social gains of US$28-40. The alternative—failing to secure funding for malaria—would jeopardize the positive trajectory of the last 15 years and raise the threat of a resurgence of the disease, with potentially huge economic and social costs. Recent investment cases by the Malaria Elimination Initiative (MEI) in two malaria-eliminating countries, Sri Lanka and the Philippines, demonstrated that investment in malaria is a “best buy,” generating a return on investment of 13:1 and 8:1, respectively. The MEI also estimated that, in addition to reversing previous investments, the first year of a 6-year resurgence in Sri Lanka would cost US$169 million. In the Philippines, the MEI estimated that the first year of a 5-year resurgence would cost US$1 billion.

According to projections by the MEI, nearly 30 countries and territories are poised to eliminate malaria by 2020. Based on the Global Fund’s 2016 eligibility list, 17 of the 29 countries that the MEI believes will likely eliminate by 2020 are eligible for national malaria allocations. Elimination success is, in part, tied to the malaria financing envelope that these 2020 countries will receive from the Global Fund, as well as the country’s willingness to mobilize additional domestic resources. Several eliminating countries are ineligible or will soon be transitioning from Global Fund support due to middle-income status. In these cases, sustained and well-paced investments during the transition from donor to domestic financing will ensure financing for elimination is adequate. For countries that have already successfully eliminated malaria, such as Sri Lanka, sustained funding is required to prevent reintroduction despite diminishing opportunities for external funding. Regional grants for multi-country programs have become a greater focus for the Global Fund in recent years. These catalytic funds, separate from the Global Fund’s country allocation formula, can supplement eliminating countries’ funding packages; however, regional grants are designed to support activities not otherwise covered by country grants.

Qualitative adjustments to the allocation formula for the 2017-2019 grant cycle are still being finalized, and it remains to be seen how changes to eligibility and allocation will affect malaria-eliminating countries in the coming three years. However, the news from the Fifth Replenishment Conference indicates that a robust Global Fund and sustained dedication from the global community will support countries to eliminate malaria—as well as TB and AIDS—in the coming years.