Open letter from health and humanitarian professionals on the consequences of HIV, TB and Malaria funding shortfall
Dear Prime Minister and Foreign Secretary,
CC: Vicky Ford MP, Rt Hon Lord Goldsmith
We are writing to you as health professionals and humanitarians to raise the alarm over the deterioration in the global fight against the HIV, tuberculosis (TB) and malaria pandemics – and to urge you to take action to remedy the situation.
Specifically, we are deeply concerned by the gaps we are seeing in essential care, and the consequences for patients and health care providers living in countries affected by funding shortfalls that are being forced to make cuts to effective medical interventions for these three diseases.
Against this background, it is alarming that, for the first time in two decades, the UK has yet to announce any commitment in response to the Global Fund’s request for support. We would therefore urge you to ensure that, at the very least, the UK plays its role in meeting the financial request made by the Global Fund.
As you are doubtless aware, global engagement on pandemic preparedness and response includes maintaining commitments to curb existing pandemics like HIV, TB, and malaria, which should go apace with action to prevent future outbreaks of emerging disease. In many countries the Global Fund is the main and often the only international financial source for prevention and treatment for people facing these three diseases – as a result, the current funding shortfall it faces is a major concern.
Fight against TB, HIV and malaria going backwards
Against the backdrop of the Covid-19 pandemic, combined with escalating social and economic crises, the fight against HIV/AIDS, TB and malaria has lost ground.
Illness and deaths from TB clearly show the reversal of gains made in previous years. As many people are dying from TB now as they did in 2017, with 1.3 million deaths per year. An estimated 10 million people become infected with the disease each year. Fewer people with drug-resistant forms of the disease are receiving treatment now compared to 2019-2020, with a 19% drop for multidrug-resistant TB, a 37% drop for extensively drug-resistant TB, and a 16% drop for people coinfected with HIV and TB.
Instead of meeting the 2020 objective to reduce the number of new TB infections worldwide by 20 per cent compared to 2015 figures, several countries – including Guinea, South Sudan and Mozambique – have actually seen increases in the number of infections. The 2020 objective to reduce global TB deaths has also not been reached.
It is a similar situation with HIV: the numbers of people getting tested for the disease have fallen by 22%, while prevention services have dropped by 11% from 2019 - 2020. Some 9.5 million people living with HIV are still not on treatment, while almost one-third of those who seek to start treatment already show signs of advanced HIV disease, putting them at high risk of imminent death. During the COVID-19 pandemic, large numbers of people living with HIV interrupted their treatment; now they urgently need to restart if they are to avoid the slide towards AIDS and an early death.
The number of people falling ill with malaria has regressed back to 2015 levels (at 59 per 1,000 people at risk). The number of people dying from malaria is up 12 per cent from 2019 numbers, with 627,000 deaths.
The reality of cuts on the ground
One obvious consequence seen by medical teams, is the loss of all those gains made over previous years. We are worse off on several fronts compared to a few years ago. The lost ground must first be recovered before renewed progress can be made.
As countries face insufficient funding for their medical programmes, they have to cut effective interventions from their plans. HIV programmes for pregnant women and their unborn babies are typically one of the first victims of such cuts, as are programmes targeting vulnerable groups such as men who have sex with men, sex workers and drug users.
Another effect of the funding shortfall is a substandard quality of care, which is counterproductive and potentially very dangerous for people with HIV, TB or malaria. Essential elements are left out of the standard package of care, such as tests for measuring the level of virus in the blood, medicines to treat people with opportunistic infections and complications linked to AIDS and adapted paediatric TB care.
Less support for patients through community programmes and much needed innovation
There is also less support for community health programmes, although they have proven to be highly effective. When money is tight, implementing innovative approaches and offering the most recent treatments are delayed, even though these are sorely needed and have proven their value in the past.
Ultimately, it is the patients who bear the brunt of the funding gaps. People can be forced towards harmful coping mechanisms, such as borrowing money at very high interest rates, pawning their assets or deprioritising other necessary household expenditures. This in turn increases their vulnerability and pushes them further into poverty.
Countries need to close the (massive) gap
We understand that the UK is facing challenging economic times. This pressure is being faced by countries around the world – yet the vast majority of the UK’s peers have still managed to make commitments to the Global Fund. The UK has stressed the importance of making challenging decisions in favour of long-term interests: we would argue that a failure to properly fund the fight against these global pandemics now will only buy short-term savings at the cost of a huge increase in the global burden of disease in the long term.
In your previous role as Foreign Secretary, the FCDO promised to “provide life-saving humanitarian assistance and work to prevent the worst forms of human suffering, prioritising our funding and being a global leader in driving a more effective international response to humanitarian crises.” The International Development Strategy (2022) highlighted the role played by the UK as holder of the 2021 G7 Presidency in “driving international commitments [to] strengthen health systems,” and pledged to invest in the Global Fund to combat HIV, TB and malaria in the years to come.
An estimated $130 billion is needed for HIV, TB and malaria for the period 2024-26. With the Global Fund supplying 14% of that budget – if $18 billion is raised. As of now the 7th replenishment conference has fallen short of this, raising US$14.3 billion —only US$250 million more than the 6th replenishment and 20% short of the target.
All eyes are on the UK to meet the ask of 30% increase on previous pledge—as others have done. Failure to go beyond flatlining pledges of three or six years ago corresponds to reductions in real terms. Considering current inflation, overall price increases and economic problems, interventions cannot be sustained with the same amount of money. The UK is currently one of only two G7 governments yet to renew their pledge and make a commitment.
Global Fund grant recipient countries pledged more than US$72 million at the 7th replenishment conference —despite being hardest hit by the failures of the global response to covid19 and the current economic crisis. These are valuable contributions which demonstrate the importance of the issue for many countries, but there is still a huge gap. Additionally, expectations of domestic funding have been over-optimistic.
There is another particular risk attached to not reaching the US$18 billion target: the USA’s US$6 billion pledge is conditioned to one third of the total. A shortfall in other donors’ pledges would proportionally cut into the US pledge. This will have a doubly negative effect, and for late pledging governments like the UK, double the responsibility.
In 2002, HIV/AIDS, TB and malaria seemed unbeatable. The UK came together with others to create the Global Fund to fight these three diseases and for twenty years has been dedicating ODA, time, and effort to build a partnership that has saved 50 million lives and reduced the combined death rate from HIV, TB and malaria by more than half since its inception.
ICAI reviewed the UK’s work with the Global Fund and found its organisational effectiveness, impact and value for money are highly rated by external bodies, and its replenishment model has been very successful with a significant increase in resources over the course of the Fund’s 20-year lifespan. By all accounts this is a successful and worthy use of UK ODA; to step away from 20 years of work risks seeing all the progress undone, and would be an unpardonable waste of UK investments to date.
Please continue UK’s support:
Therefore we, as medical practitioners, health professionals, and humanitarian aid workers, are writing to implore you to help us provide adequate care for patients, and regain lost ground against the HIV/AIDS, TB, and Malaria pandemics – principally by continuing the UK’s unparalleled support to the Global Fund and meeting the 7th replenishment ask of increasing the previous $1.7 billion pledge by 30%. This will help the world progress against targets to reach the 2030 Global Goals and put us on a path to bridge both the existing and expected gaps.
1 - Médecins Sans Frontières / Doctors Without Borders UK Kristen Veblen McArthur - Executive Director a.i.
2 - STOPAIDS Mike Podmore, Director
3 - Evelina London Children’s Hospital and Médecins Sans Frontières Belgium Tejshri Shah - Paediatric Infectious and Immunology Diseases & Medical Technical Manager
4 - Public Health, Yorkshire & Humber Stefanie Gissing
5 - TB Centre, London School of Hygiene and Tropical Medicine Finn McQuaid - co-Director
6 - Imperial College London James Seddon, Reader in Global Child Health
7 - University Hospital Bristol and Weston Stefania Vergnano, consultant paediatrician
8 - Primary Care International Mamsallah Faal-Omisore Clinical Director
9 - Evelina London Children’s hospital Alejandra Alonso Caprile, paediatric infectious diseases consultant
10 - University of Birmingham Gabriella Morley, Public Health Speciality Registrar and academic in drug-resistant Mycobacterium tuberculosis
11 - Hospital for Tropical Diseases, University College London Hospital; London School for Hygiene and Tropical Medicine Victoria Johnston, Associate Professor and Consultant Infectious Diseases
12 - University College London Hospitals NHS Foundation Trust Stephen Morris-Jones
Consultant Clinical Microbiology & Infection
13 - TB Centre, London School of Hygiene and Tropical Medicine Dave Moore
Professor of Infectious Diseases and Tropical Medicine
14 - Malaria Centre, London School of Hygiene and Tropical Medicine Peter Chiodini
15 - Mucosal Pathogens Research Unit, Division of Infection & Immunity, UCL Robert Heyderman, Professor of Infectious Diseases
16 - Hospital for Tropical Diseases, University College London Hospital; North Central London South Hub TB clinic, Whittington Health; London School for Hygiene and Tropical Medicine Michael Brown, Consultant Infectious Diseases Physician, Hon Associate Professor.
17 - STOPAIDS & Action for Global Health Nabila S Tayub, Project Manager, Policy & Operations
18 - Brighton and Sussex Centre for Global Health Gemma Aellah, Research Fellow in Anthropology and Global Health
19 - Chiva Amanda Ely (CEO) & Dr Amanda Williams (Chair)
20 - Faculty of Public Health Professor Kevin Fenton - President
21 - NAM aidsmap Matthew Hodson, Executive Director
22 - UK-CAB (HIV treatment advocates network) Alex Sparrowhawk, Chair
23 - Catholics for AIDS Prevention & Support (CAPS) (Dr) Vincent Manning - Director
24 - Dr. Ayman Jundi Consultant in Emergency Medicine, Senior Lecturer in Disaster Medicine, Chairman Board of Trustees Action For Humanity
25 - South West London and St George's Mental Health NHS Trust Jose Carlos Mejia Asserias, Peer Support and Lived Experience Lead
26 - Royal Free London NHS Trust/UCL/European AIDS Clinical Society Dr Sanjay Bhagani, Consultant Physician and Associate Professor
27 - Royal Free London NHS Foundation Trust Dr Tristan Barber, Consultant Physician and Associate Professor
28 - BASHH, British Association of Sexual Health and HIB Dr Claire Dewsnap, Consultant Physician, BASHH President
29 - Positively UK Silvia Petretti Chief Executive\Tristan Barber Chair
30 - BMA (British Medical Association) Dr Kitty Mohan, Chair of the BMA International Committee
31 - Doctors of the World UK Simon Tyler, Executive Director
32 - National AIDS Trust Deborah Gold, Chief Executive
33 - British Paediatric Allergy, Immunity and Infection Group,
Imperial College Healthcare NHS Trust Dr Elizabeth Whittaker, Convenor, Consultant Paediatric Infectious Diseases
34 - TB Alert Paul Sommerfeld, Executive Trustee
35 - TB Europe Coalition Paul Sommerfeld, Chair
36 - Great Ormond Street Hospital for Children NHS Foundation Trust Dr Alasdair Bamford
Consultant Paediatric Infectious Diseases
37 - Daisy Hill Hospital, Northern Ireland Dr Julie Lewis
38 - Queen Elizabeth Hospital, Gateshead Dr Jude Eze, Consultant Paediatrician
39 - Barnsley Hospital, South Yorkshire Dr Diarmuid Kerrin, Consultant Paediatrician
40 - Royal Hospital for Children, Glasgow Dr Rosie Hague, consultant paediatric infectious diseases
41 - MRC Centre for Medical Mycology, University of Exeter Prof Adilia Warris, paediatric infectious diseases specialist
42 - Department of Paediatrics, University of Oxford & Oxford University Hospitals NHS FT Dr Stéphane Paulus, Consultant in Paediatric Infectious Diseases
43 - Health Poverty Action Martin Drewry, CEO
44 - Find Your Feet Bangyuan Wang, Head of Programmes
45 - University of Oxford Dr. Else Bijker, paediatrician
46 - University of Oxford Dr Peter O’Reilly, Paediatrician
47 - Joint Tuberculosis Committee, United Kingdom Professor Onn Min Kon, Chair
48 - UK Academics & Professionals to End TB Dr Jessica Potter, Co-Chair
49 - British HIV Association Dr Laura Waters, Chair
50 - University of Glasgow Prof Mike Barrett, Director of Diploma in Tropical Medicine and Hygiene course
51 - University of Birmingham Dr James Scriven, Consultant Physician and Senior Clinical Lecturer in Infectious Diseases
52 - London North West University NHS Trust Dr Laurence John, Consultant Infectious Diseases and Acute Medicine
53 - London School of Hygiene and Tropical Medicine Dr Amel Alfulaij, GP
54 - Manchester Foundation Trust Dr Paddy McMaster, Consultant in Paediatric Infectious Disease
55 - Dean, Faculty of Travel Medicine, Royal College of Physicians & Surgeons of Glasgow Dr Sam Allen, Consultant in Infectious Disease & Tropical Medicine
56 - Imperial College London Dr Samuel Channon-Wells, Clinical PhD Fellow in Paediatric Infectious Diseases, Paediatric ST2
57 - London School of Hygiene and Tropical Medicine, University College London Dr Clare Warrell, Consultant in Tropical Medicine, Infectious Diseases & Acute Medicine.
58 - University College London Hospital, Find & Treat Carmen Sumadiwiria, Clinical Nurse Specialist - Inclusion Health
59 - Royal Free London NHS Foundation Trust Dr Ian Cropley. Consultant in Infectious Diseases and HIV
60 - St George’s University Hospitals NHS Foundation Trust Dr Simon Drysdale, Consultant in Paediatric Infectious Diseases
61 - University of Birmingham Dr Semira Manaseki-Holland, Reader and Honorary Consultant in Public Health,
62 - Great Ormond Street Hospital, London Dr Andrew McArdle, Paediatric Infectious Diseases and Immunology Registrar
63 - Public Health Wales Dr. Lorcan O’Connell Infectious Diseases and Microbiology Registrar
64 - Royal Free London NHS Foundation Trust Dr Karen Job, Consultant Paediatrician
65 - University Hospital Bristol and Weston Dr Jane Metz Paediatric Infectious Diseases and Immunology Registrar
66 - University of Oxford Dr Matilda Hill, Paediatric Registrar
67 - University Hospitals Birmingham Dr Martin Dedicoat, Infectious Diseases Consultant
MSF Briefing Paper; Bridging the Gaps—The Neglected Pandemics: HIV/AIDS, Tuberculosis, and Malaria; Sept 2022 Countries must re-engage on HIV, TB and malaria | MSF
Policy paper; The UK government’s strategy for international development; Published 16 May 2022 https://www.gov.uk/government/publications/uk-governments-strategy-for-international-development/the-uk-governments-strategy-for-international-development
Miriam Lewis Sabin; Global Fund secures $14·3 billion from donors; The Lancet; VOLUME 400, ISSUE 10358, P1091-1092, OCTOBER 01, 2022
Global Fund; Seventh Replenishment Investment Case: Fight For What Counts; Seventh Replenishment Investment Case - The Global Fund to Fight AIDS, Tuberculosis and Malaria
ICAI ; Information note: The UK’s work with the Global Fund; Published: 20 Sep 2022 https://icai.independent.gov.uk/review/the-uks-work-with-the-global-fund/information-note/