US pledges $4 billion to a fund that fights AIDS, other global ills

Countries and international organizations assembled at a United Nations conference on Tuesday pledged $11.7 billion for the global fight against AIDS, tuberculosis, and malaria over the next three years – an amount that represents a significant increase from pledges three years ago and a major shortfall from the amount organizers had hoped to reap.

The United States pledged $4 billion of the total, ensuring that it will remain the No. 1 donor to the Global Fund, a mechanism created in 2002 that has helped to bring down mortality rates associated with the three diseases.

US officials at the Global Fund’s pledging conference called on other countries – particularly those with booming economies like China – to give generously as well. But even as it announced the largest American commitment ever to the fund, the US pressed for reforms of the program – such as better coordination of national and civil society efforts – so that funding is used more effectively and more lives can be saved.

Global Fund officials hailed the increase in commitments at a time of pressures on national economies and foreign aid budgets. At the last pledging conference in Berlin in 2007, $9.7 billion was pledged.

But they also recognized that falling short of their goal means two things: A recent acceleration in poor countries’ programs for treating the diseases will slow, and the ambitious goals associated with the fund – including an elimination of mother-to-child transmission of HIV, and ending malaria as a cause of death – will be harder to achieve.

“Since the total pledged is indeed below what we had hoped for, the scaling up will slow down compared to what we were hoping for,” said Michel Kazatchkine, the Global Fund’s executive director, at a press conference following the conference at the UN in New York.

He nevertheless held out hope that the goal of eliminating mother-to-child HIV transmission can still be achieved. “If our effort is well-coordinated, we should be able to reach that goal by 2015,” Mr. Kazatchkine said.

That possibility of making up for insufficient funding through more effective delivery programs reflected a theme emphasized by the US delegation.

“We must build upon the successes of the Fund by ensuring that needed reforms are made that will result in smart investments that save more lives,” said Eric Goosby, the US Global AIDS Coordinator, in a conference call Tuesday with reporters. He said the US will press the fund’s board to develop an “action agenda” of “clear timelines and measures” for improving the fund’s accountability.

The Global Fund has since its inception in 2002 become the world’s leading funding source for programs in 145 countries fighting the three diseases, and it is credited with saving millions of lives through delivery of treatments and, in the case of malaria, distribution of 122 million insecticide-treated bed nets.

Nongovernmental organizations focused on global health and poverty-reduction initiatives acknowledged the 38 percent increase in US funding, but many of them also lambasted the Obama administration for not pledging more and enabling the Global Fund to reach the total it had sought. Noting that 101 Democratic members of the House of Representatives had asked President Obama to make a $6 billion pledge to the fund, Health GAP managing director Jennifer Flynn said in a statement, “We are gravely concerned that this [$4 billion] pledge … will mean that the Global Fund will have to virtually halt scale up in the fight against the three diseases and turn away high quality proposals for life saving HIV treatment.”

In post-conference comments, UN Secretary General Ban Ki-moon recognized the increase in the US pledge, noting that other countries – including France, Japan, Canada, and Australia – had also raised their pledges from three years ago. Faith-based organizations are also joining an expanding circle of donors, he said, pointing out that the United Methodist Church is one such “new contributor.”

Mr. Ban said the downturn in the global economy, in particular, means that “innovative sources of funding” beyond public treasuries should be investigated. He cited the idea of a small surcharge on international airline tickets.

Another idea is the proposed Financial Transaction Tax, supported by several countries including France and Germany. Supporters say a tiny levy on wholesale currency transactions – say, 0.005 percent – would raise more than $30 billion a year for global health and fighting global warming.