December 19, 2011

Dr. Unni Karunakara, international president of MSF, calls on the board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria to organize an emergency donor conference to renew commitment in the wake of the cancellation of the new round of funding applications.

Dr. Unni Karunakara is international president of Doctors Without Borders/Médecins Sans Frontières (MSF), an independent medical humanitarian organization that works in more than 60 countries. In 2010, MSF provided HIV treatment to more than 180,000 people in nearly 20 countries, tuberculosis treatment to 30,000 patients, and malaria treatment to 1.6 million.

When the Global Fund to Fight AIDS, Tuberculosis, and Malaria announced it had to cancel its new round of funding because it was running out of funds, it felt like a punch in the face for me and for thousands of other health workers at Doctors Without Borders/Médecins Sans Frontières (MSF). The news could not have come at a worse time. Just when years of hard work, coupled with new scientific advances, bring hope that we can push back the three diseases that kill millions every year, donors drop their commitment to the Global Fund. So instead of continuing on a path toward reversing the epidemic killers, health ministries in the hardest-hit countries may have to witness a reversal of hard-won progress itself.

MSF’s treatment programs are mainly funded by the contributions of private individual donors, but ministries of health rely heavily on the Global Fund. Set up in January 2002, the Fund has become a lifeline to millions of people in the countries where MSF works, estimating that its funding stream has directly contributed to preventing an average of one million deaths per year. We have seen ministries of health successfully run ambitious programs that they never could have imagined without outside support.

But donors have left the Global Fund in the lurch, with some withholding or delaying their promised contributions, and others not giving anything at all. With no resources to pay for any new proposals until 2014, the Fund has told hard-hit countries they can’t scale up effective HIV treatment for three years, unless they have already approved grants. TB and malaria will also suffer. This effectively means health ministries will be forced to ration care, and make the difficult decision to provide less than optimal treatment because the better treatment simply costs too much.

And this at a time when scientific advances could successfully be pushing back all three diseases:

Take AIDS. Ten years ago, in countries like Thailand and South Africa, MSF piloted programs that challenged the very notion that treatment couldn’t be rolled out in poor communities. This year, thirty years into the epidemic, research has delivered the evidence that HIV treatment itself can be a decisive tool for fighting AIDS. A person put on treatment earlier is 96 percent less likely to pass the virus on to others. Yet today, the majority of people tested positive continue to go untreated.

With HIV treatment now a key tool for HIV prevention, we have a historic opportunity to reverse AIDS. At this crucial time, donors should be funding the Global Fund, so countries are empowered to seize this opportunity and implement bold programs that can turn the tide on the epidemic. But instead, countries have been told to hit the brakes.

Take tuberculosis. For the first time, the number of TB cases worldwide is on the decline, although it remains shockingly high for a curable disease, with more lethal, drug-resistant forms on the rise. Here, too, treatment is prevention: if people are on treatment, they are less infectious. A new advance in diagnostic technology has improved our ability to determine who has drug-resistant TB and therefore to put them on the right treatment. Scaling up is now a matter of urgency.

Take malaria. The combination of providing bednets to prevent malaria and effective combination therapy to treat the disease have significantly reduced incidence. A landmark clinical trial in 2010 showed that better treatment for severe forms of malaria in children can dramatically reduce death rates. But kids continue to be treated with quinine, which is cheaper, but far less effective. And malaria continues to kill hundreds of thousands of people every year, most of them young children. While prevention remains the mainstay of the fight against malaria, MSF has estimated that switching treatment for severe forms would cost around $30 million more, but can save 200,000 lives per year.

There has never been a better time to push forward, build upon progress, and use new scientific evidence to rein in these epidemics. Affected countries should take responsibility. Many of them want to be ambitious, and also want to take on a bigger role in footing the bill. Uganda, for instance, wants to double the rate at which people are put on HIV treatment, and Uzbekistan wants to significantly increase the number of people receiving treatment for drug-resistant TB.

But countries can’t do this alone. So where will the funding come from, with a “closed for new business” sign hanging on the front door of the Global Fund?

It’s time for the Global Fund Board to end its passivity and raise the alarm about the urgency of the situation—it must refuse to settle for rationed care and stalled ambitions caused by donors turning their backs. The Board needs to hold an emergency donor conference within the next half-year to raise the resources needed to finance a new funding opportunity for countries in 2012. Donors that have promised funding need to pay up. Old and new donors, including emerging economic powers like China, India, and Brazil, who have yet to give this year, need to step up to the plate. It is unacceptable and unconscionable that as the Global Fund turns ten in January, its bitter gift to the world is a three-year hiatus in the fight against the three killer diseases. Donors must deliver on their promises.

In my work with MSF, I have seen people die from AIDS, from TB, and from malaria. But in recent years, I have most of all seen people survive these diseases. The Global Fund is a crucial part of the most ambitious health project in history, and millions of people alive today are testimony to its success. We simply can’t afford to squander the opportunity we have now to deal these diseases a final blow.

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