Global Fund policies impacting fight against AIDS, tuberculosis and malaria

Médecins Sans Frontières (MSF), or Doctors Without Borders, the Paris-based international humanitarian-aid organisation early last week called on the Board of Global Fund to Fight AIDS, Tuberculosis and Malaria to make urgent changes to policies and practices for countries transitioning away from donor support, which increase the risk of critical drug stock-outs and alarming drug quality issues in many countries.

Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by the three diseases. It raises and invests nearly $4 billion a year to support programmes run by local experts in countries and communities most in need.

As of July, the Global Fund had approved more than $40 billion in funding and disbursed approximately $38 billion to over 120 countries. These investments are said to have helped save more than 22 million lives in these countries.

Low- and middle-income countries, who receive donor support for HIV and TB drugs from the Global Fund, are gradually losing support. As these countries grow economically, they are expected to increase spending on health from their own resources, progressively moving away from donor financing toward domestically funded health systems.

But health NGOs and activists working in the area of AIDS and TB are worried that the countries that are losing, or ‘transitioning’ from support, are increasingly at risk of drugs being unavailable or of sub-standard quality.

The countries transitioning may lose the support of the Global Fund’s central purchasing of HIV and TB drugs, which secured affordable prices through high-volume orders from multiple competing suppliers.

The Global Drug Facility (GDF), which helps countries procure TB drugs, has documented a number of problems related to the Global Fund’s policies.

In the past 18 months, 15 countries in Asia, Africa and the Eastern Europe and Central Asia region have experienced stock-outs of TB drugs.

Additionally, 29 countries in these regions, along with Latin America, have purchased TB drugs of unknown quality, and 21 countries have purchased TB drugs and tests at prices that far exceed the lowest global prices they should be paying.

Costs of first line AIDS drugs have reduced to $75 per patient per year in 2017 from $10,000 in 2000.

TB is the most common opportunistic infection (OI) among HIV-infected individuals and co-infected individuals are at high risk of death.

Dr Els Torreele, Executive Director of MSF’s Access Campaign, said the current pace of Global Fund's country transitions was hastened by underfunding from donors.

"(It) is creating a ticking time bomb where people’s HIV and TB treatment is jeopardised by unknown drug quality and drugs simply not being there,” Torreele said.

Early this year, US, the largest donor, proposed $1 billion in funding cuts to both the President’s Emergency Plan for AIDS Relief (PEPFAR) and through multilateral arrangements like Global Fund.

For every $1 that the US contributes to the Global Fund, other donors invest $2. In its budget proposal for FY18, the Donald Trump administration proposed some $425 million in cuts to the Global Fund.

PEPFAR was started under the regime of former US President George W Bush in 2003.

In 2018, it proposed a cut of over 30 percent for three countries -- South Africa, India, and Mozambique -- with some of the highest HIV/AIDS disease burdens in the world.

To be sure, this development will have implications on India on two fronts. One our fight against AIDS, TB and malaria would be jeopardised as India is facing stock-outs of paediatric HIV drugs due to a lack of quality-assured suppliers.

Second, Indian drug makers who are major suppliers of antiretroviral (ARV) and TB drugs under Global Fund's programme may lose business.

Cipla, one of world's major supplier of ARV drugs, has already indicated in its Q2 FY19 earnings that the transitioning of countries and lower funding support is having an impact on its business.