Why Invest Now
The Global Fund and its partners are now in the final months of replenishment efforts to secure funds for the 2014-2016 period. One critical message to donors – who must decide before the end of the year how much they can invest – is that there is a tremendous cost of inaction. Without aggressive investment to defeat HIV, tuberculosis and malaria, we will likely face staggering costs in the years ahead, both in human lives and in money. To highlight this view, advocates for the Global Fund released a report called The Cost of Inaction on 12 September that calls on all partners to seize the historic opportunity to control AIDS, TB and malaria and remove them as a threat to public health.
“There are not many times in history when you get a chance to defeat things such as HIV, TB and malaria,” said Mark Dybul, Executive Director of the Global Fund, to a tele-conference with partners and journalists. Dybul said scientific advances, a better understanding of the epidemiology and experience together allow the health community to build on recent investments. But he warned that acting too slowly would mean missing a special window of opportunity. “The investments of the last ten years have the diseases on the run, but they are running into pockets, and in those pockets is where they are getting a foothold from which they can begin to come back. If we start to see the infection rates rise, this historic window is going to close.” Dybul acknowledged the financial constraints on governments around the world. But he added: “Unfortunately, communicable diseases like HIV, TB and malaria don’t pay much attention to fiscal crises or financial cycles.”
The Cost of Inaction says timely investments could prevent 3.9 million new HIV infections during the 2014-2016 period, potentially saving up to US$47 billion in extra treatment costs over the lifetimes of the people affected. “The cost of inaction is far greater than the cost of action, from both a moral and an economic perspective," said Joanne Carter, head of the RESULTS Educational Fund in the United States and a former Global Fund Board Member.
The Global Fund has set a target of raising US$15 billion so that a transformative difference against the three diseases can be achieved in the 2014-2016 period. The Cost of Inaction also estimates that timely funding for malaria would prevent more than 430 million additional malaria cases and increase annual GDP in Africa by more than US$20 billion over five years, as well as saving 196,000 lives per year. “Our goal is to get down to near zero deaths by the end of 2015,” said Ray Chambers, the UN Secretary-General’s Special Envoy on Financing the Health Millennium Development Goals and For Malaria. “We can’t possibly do that unless the Global Fund is replenished with at least US$15 billion.” Lucy Chesire, a Kenya-based TB and HIV advocate who represents communities affected by the three diseases, spoke of “the joy and hope” the Global Fund had brought to communities across Africa since it was established. She said the choice before donors is clear: Invest now or pay forever.
Ukraine’s Value for Money
Offering value for money is the cornerstone of any good investment. In Ukraine, partners of the Global Fund acted on an opportunity to take a big step forward in fighting hepatitis C, a chronic liver disease that can be especially deadly when it strikes HIV patients. Alliance Ukraine, with the support of the Global Fund, negotiated a steep discount with a pharmaceutical manufacturer for medication, enabling treatment to be significantly expanded for highly vulnerable patients co-infected with HIV and hepatitis C. It is the first time the treatment, combining Pegylated Interferon and Ribavarin, will be available in a Global Fund-supported program in Ukraine, where the high cost of medication has until now been a serious impediment to treatment.
“It’s becoming increasingly clear that fighting HIV and TB in countries like Ukraine where the HIV epidemic is driven by injecting drug use is impossible without treating hepatitis C,” said Andriy Klepikov, Executive Director of Alliance Ukraine. Mortality rates from hepatitis C are significantly higher among people who inject drugs and are already HIV-positive. According to official statistics, every fifth person with HIV in Ukraine is infected with hepatitis C, yet experts say the true figure may be far higher.
The hepatitis C treatment initiative, led by civil society organizations, has stimulated action by the government. On 4 September, Ukraine’s Cabinet of Ministers approved a national program for hepatitis with US$4.2 million this year. Vice Prime Minister Konstantin Gryshenko publicly thanked non-governmental organizations for their persistence and cooperation. “Glad that the document we promoted and worked over so hard is signed,” he tweeted.
The agreement was achieved with the cooperation of drug maker MSD and facilitated by the Pledge Guarantee for Health, an initiative that facilitates private sector finance to speed up delivery of health products and medicines. Alliance Ukraine will acquire the drugs at a cost of US$5,000 for a single 48-week course of treatment, a dramatic reduction from the previous price of US$13,200. Klepikov said it was clear that the initiative had helped catalyze government support. He added that the Health Ministry acknowledged that the US$5,000 price would now be considered by the Ministry as a benchmark for governmental procurement of the medication.
(RED) in A(u)ction
On November 23, Sir Jonathan Ive and Mark Newson, two of the world’s foremost design pioneers, are joining musician and philanthropist Bono to organize a (RED) auction in New York. (RED) was founded in 2006 and has contributed more than $US 200 million to the Global Fund in order to fight AIDS in Africa. At this auction, to be held by Sotheby’s, items as diverse as space travel, lighting design, contemporary art and rare automobiles will be on sale; proceeds will go to the Global Fund. “It’s been a fantastic honor to curate this collection,” said Sir Jonathan Ive, Senior Vice-President of Design at Apple. “(RED) is making a difference in the lives of millions of people and we’re humbled to make this contribution to such an important and worthy cause.” Innovative items up for auction have been designed by Jony and Marc, Hermes, Range Rover, FLOS, Valextra, Corning, Louis Vuitton, Dom Perignon, and others. “Each bang of the hammer will be raising critical dollars to fight AIDS, by getting medication to mothers with HIV which means they will not pass the virus on to their newborns,” said Bono.
The Power of Two
Awalia looked at Dieng as he spoke about HIV prevention work in Jakarta, Indonesia. She often helps him find the right words in English, sometimes finishing his phrases, and they glance and smile at each other easily. Dieng works with the Indonesia Planned Parenthood Association, and Awalia recently joined the health unit of an international development agency, both active partners of the Global Fund.
Awalia and Dieng met volunteering at a program that counseled people in prison. “We started dating after the AIDS Candlelight Memorial event in Jakarta in 2008, and he proposed three weeks after that!” said Awalia. “It is rare in Indonesia for men to understand when women want to work, so it was a very easy and quick decision for me. Especially when we both shared the same passion for helping others!”
Awalia was trained in psychology and has more than ten years experience. She gets energized by the direct impact of educating school girls, guiding them to open up and talk about HIV and AIDS, and to gain the confidence to talk to friends about it. “I have seen these girls change their attitudes and behaviors,” she said. Dieng has also focused his work on young people, spreading information and recruiting those who are receptive to become volunteers themselves: “It makes me really proud to see them empowered and more involved in HIV prevention activities,” he said. “It takes them off the streets, and makes them part of a group pushing for the same objective.”
Awalia and Dieng recognize that Indonesia still faces big challenges fighting stigma and discrimination. Wherever HIV is considered to be connected with bad behavior, the most vulnerable groups feel encouraged to stay hidden, and are harder to reach. It does not dampen Awalia and Dieng’s determination. Dieng said: “Sharing information is the key to fight stigma and discrimination. I have worked with many HIV-positive children and I want to do more to help them and educate the community to not stigmatize and discriminate. Children need to live safely, free from peer-bullying.” Awalia and Dieng again glanced at each other as they talked about work at the grassroots level, trying to change attitudes and behaviors. “We are happy that we are in this together. We share with each other the stories of the people we meet, which encourage us to continue our work. We hope we are making a difference.”
People Power in Eritrea
Eritrea, a small country in the Horn of Africa, is making terrific gains on the road to reducing the burden of HIV and AIDS, TB and malaria, underlining the power that common people can bring to development initiatives. Eritrea has cut the incidence of malaria by 90 percent in the last 15 years, and adult HIV prevalence by 68 percent since 2007. “Eritrea is a real success story,” said Musoke Sempala, Fund Portfolio Manager for Eritrea at the Global Fund.
For a country where few international aid organizations operate, the success reflects the determination of ordinary people who are making health a priority and who are working hard to operate the country’s health infrastructure with high efficiency. “Eritreans are driven by a strong sense of nationalism,” said Sempala. “Their level of commitment is amazing.” Active participation by UN agencies has been important, Sempala believes, and so has a strong collaboration with the Global Fund that is rooted in the shared ideal of country ownership. “Eritrea has a very strong sense of country ownership of projects,” said Sempala.
“They feel well-understood by us,” added Ana Alvarez Nieto, who also works on the Eritrea country team at the Global Fund. Her colleague, Job Muriuki, chimed in: “The villager down the road is involved in treating other villagers as a community health agent.” People in Eritrea seem to exhibit a highly nationalistic motivation to save the lives of their own, and it translates into a smaller proportion of grant funding going to recurrent costs. “The key focus is saving lives,” said Muriuki. Alvarez Nieto said: “If Eritrea, a country that has been independent for only 20 years, can invest in the health of its people amidst significant economic and geopolitical challenges, surely most countries we support can.”