PARIS — As part of the United Nations Agenda for Sustainable Development, the international community set itself the ambitious goal of eradicating HIV, tuberculosis and malaria by 2030. Despite the extraordinary progress that has already been made, ending these pandemics and achieving the broader goal of ensuring the health and wellbeing of all will require ramping up efforts to support countries in building resilient and inclusive health systems.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership, has contributed substantially to this effort, by massively scaling up prevention and treatment. In countries where the Global Fund invests, 18.9 million people received antiretroviral therapy for HIV in 2018, 5.3 million tuberculosis patients were treated and 131 million mosquito nets were distributed.

These efforts have proved tremendously effective in reducing these pandemics’ death toll. The latest figures indicate that 32 million lives have been saved since the Global Fund’s creation in 2002. Over the last decade, the annual number of deaths from HIV, tuberculosis and malaria have been lowered by about half.

Yet we are still not on track to eliminate HIV, tuberculosis and malaria by 2030. To achieve this goal, we must not only expand access to treatment drastically; we also need to achieve a sharp reduction in new infections.

Success will require clear political leadership and sustained investment in critical capacities, such as well-trained community health workers, cost-effective supply chains, quality data systems and well-equipped laboratories. To ensure that health services reach the poorest and most marginalised, barriers to health access — such as user fees human rights-related impediments or gender inequalities — must be dismantled. Active community engagement will be essential here.

Of course, there is no one-size-fits-all solution. Countries and communities need to devise strategies that account for their residents’ needs and reflect the particular disease threats they face.

Moreover, no single external development partner can provide all of the necessary support. That is why we are calling for innovative coalitions comprising multilateral and bilateral development organisations that leverage their complementary strengths to strengthen national capacities. Such coordinated support is needed most urgently in regions — for example, the Sahel in Sub-Saharan Africa — that have weak institutions and infrastructure, and that are particularly vulnerable to security threats and environmental crises.

In Côte d’Ivoire, the Global Fund and the Agence Française de Développement (AFD) have invested in building, together with the Ivoirian government, a regional bureau for the national medical drug-supply centre. This will facilitate treatment delivery as close as possible to communities, thereby strengthening national health authorities’ capacity to reach the most vulnerable in a sustainable way.

In the same vein, the AFD and the Global Fund are supporting Niger’s Ministry of Public Health in its efforts to expand access to health products and strengthen the national laboratory network, thereby improving diagnosis, including for HIV/AIDS, tuberculosis and malaria. By ensuring synergy among activities and preventing duplication of efforts, we can support Niger in strengthening its health system, including at the community level.

Avoiding silo-based activity is the raison díêtre of the recent partnership agreement between the Global Fund and the AFD. Under the leadership of national health authorities, we are pursuing greater convergence and synergy among programs to fight HIV/AIDS, tuberculosis and malaria, such as those the Global Fund finances, and initiatives to strengthen health systems, such as those in which the AFD invests. Underscoring the extent to which these two areas are interconnected, the Global Fund is already the largest multilateral provider of grants for strengthening health systems, investing well over $1 billion per year in the cause.

By combining our organisations’ strengths, we are reaffirming our commitment to ensuring effective cooperation and coordinated action to eradicate HIV, tuberculosis and malaria, and to building strong and resilient health systems, particularly in the most vulnerable countries. The international community has a shared responsibility to fulfill its commitments without leaving anyone behind.

To end the HIV, tuberculosis and malaria epidemics by 2030, a business-as-usual approach will not suffice. We must step up the fight. That means investing more in health systems and forging effective new partnerships, such as the one between the AFD and the Global Fund.

Rémy Rioux is chief executive officer of the Agence Française de Développement. Peter Sands is executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

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The commitments were made on Thursday at the Global Fund’s Sixth Replenishment Conference held in Lyon, France.

“I welcome the commitment made by so many donors under the auspices of France to fully finance the Global Fund for the next three-year period”, said Tedros Adhanom Ghebreyesus, Director-General, of UN health agency, WHO.

“This is critical to provide individuals and communities with the health interventions they need to prevent, diagnose and treat HIV, TB and malaria and to build better and stronger health systems”, he added.

Peter Sands, Executive Director of the Global Fund, said that “everyone in the room today felt the power of a global community coming together to say in one voice: ‘We will end these epidemics’”.

The international partnership raises, manages and invests money to support programmes in more than 100 countries that address the three diseases, mostly in sub-Saharan Africa.

The Fund reported that many donors at the conference stepped up their pledges, citing the urgency to take decisive action.

For example, the United States will provide $1.56 billion a year, maintaining more than 30 per cent of all contributions. France’s pledge of $1.29 billion included an extra $60 million announced by President Emmanuel Macron in a final push to meet the overall $14 billion target.

Private donors also pledged more than $1 billion, which is a Global Fund first. The Bill & Melinda Gates Foundation led efforts with a pledge of $760 million, while (RED) pledged US$150 million, alongside supporters such as Comic Relief, prominent businessman Sri Dato Dr Tahir, and the global pharmaceutical company, Takeda.

Replenishing the Global Fund is critical, said the World Health Organization chief: “It’s not just an investment in one organization or three diseases; it’s an investment in our shared vision of a healthier, safer and fairer world. Ultimately, it’s an investment in people”.

Maurine Murenga, who was diagnosed with HIV in the early 2000s, and who serves on the Global Fund Board, thanked all partners for recognizing the need to focus investments in programmes that specifically address the disproportionate effects of HIV on women and girls.

“Those of us who survived HIV are here thanks to the Global Fund, but millions are still dying unnecessarily because they cannot access these life-saving programs,” she said.

“Young women and girls have to be at the center of the response to HIV in Africa. It is unacceptable that young women and girls are still twice as vulnerable to HIV in sub-Saharan Africa and six times more vulnerable in the worst hit countries. We know change is possible and we have to act now.”

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Tuberculosis and HIV—two of the world’s deadliest infectious diseases—are far worse when they occur together. Now, Texas Biomedical Research Institute researchers have pinpointed an important mechanism at work in this troubling health problem. And, their discovery could lead to a new mode of treatment for people at risk. The results were published in the Journal of Clinical Investigation, a top-tier venue for critical advances in biomedical research.

“We were a little surprised at the extent of clarity in our data,” Professor and Southwest National Primate Research Center Director Deepak Kaushal, Ph.D., said. “I am actually very excited to move forward trying different treatment approaches on co-infected monkeys.”

The scientific community has long assumed the reason people with HIV are more likely to develop TB is a depletion of immune cells called CD4+ T cells. However, Dr. Kaushal’s team was able to show that other effects of viral co-infection play a crucial role in this process.

Using about 40 rhesus macaques, researchers determined that lung-specific chronic immune activation is responsible for the progression of disease. Chronic immune activation is a dysfunction of immune pathways that generate molecules (cytokines and chemokines) which fight off pathogens like bacteria, viruses and fungi.

Dr. Kaushal used an analogy to explain what this dysfunction caused by HIV infection does in the body. “It’s like all the taps and faucets in your house are turned on full blast all the time,” he said. “You are going to lose a lot of water. With this dysfunction, all cytokines ad chemokines are constantly being produced to the highest levels. This dysregulates the body’s ability to fight off other infections.”

Even with the gold standard antiretroviral therapy (ART) for people with HIV, chronic immune activation still persists. Dr. Kaushal said his study shows “we need to develop approaches to target chronic immune activation,” perhaps with a drug that would be an additional therapy along with ART.

Dr. Kaushal said the implications of a new method of treatment are enormous. Up to a fourth of the world’s population is infected with tuberculosis. Most of the time, the bacterial disease remains latent (dormant). In otherwise healthy people with latent TB, only 5% will go on to develop active tuberculosis. In HIV/AIDS patients, the risk of developing active TB increases ten-fold to 50%. TB and HIV co-infection is considered a global syndemic, meaning the diseases are pandemics infecting people all around the world, and they promote each other. In parts of Sub-Saharan Africa, the rate of TB/HIV co-infection is “astronomically high,” according to Dr. Kaushal, citing statistics that show it’s 100 times higher than the rest of the world.

This discovery was 12 years in the making, starting with the creation of a nonhuman primate model for TB/HIV co-infection. Dr. Kaushal said he is hopeful new treatment strategies could reach the clinic within a decade.

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Britain is pledging almost half a billion pounds a year to fight Aids, malaria and tuberculosis around the world.

Announcing the funding at the G20 summit in Japan on Saturday, Theresa May will call on leaders of the world’s largest economies to step up their own efforts to tackle the deadly diseases.

The UK’s three-year pledge will see around £467m a year given to the Global Fund, which provides medication for over 3 million people living with HIV, as well as treatment and care for 2 million people with tuberculosis, and 90 million mosquito nets to prevent malaria.

The prime minister is to tell G20 leaders: “We need urgent international action and a truly collective response if we are to tackle threats to global health security, prevent infections spreading across borders, and halt the continued spread of deadly diseases.

She will ask them to “follow the UK’s lead in supporting the vital work of the Global Fund and its relentless efforts to tackle Aids, malaria and tuberculosis around the world”.

The Global Fund says it needs to raise another £11bn at a conference in Lyon, France, in October, if it is to keep its work on track.

In 2016, Britain pledged to contribute £1.1bn over three years to the Global Fund to fight Aids, malaria and TB.

Since 2002, the fund is believed to have helped save more than 27 million lives in over 100 countries and to have reduced the number of deaths from the three diseases by more than a third. 

But Aids, malaria and tuberculosis continue to claim around 2.5 million lives a year, with a child dying from malaria every two minutes.

Billionaire philanthropist Bill Gates said the UK’s pledge was “a positive step forward in the global fight against these diseases, and will help to save millions of lives”.

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