Friends on the Frontline First Quarter 2015

Looking ahead: Setting priorities to achieve progress in the global fight

A Message from Deb Derrick, President of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Friends has hit the ground running this quarter with efforts to help secure robust funding for HIV, tuberculosis and malaria in fiscal year 2016. Working closely with the Global Fund and partners in global health advocacy, faith-based organizations and the private sector, we have developed a Congressional outreach strategy aimed at maximizing U.S. investments in the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), both for FY 2016 and for the rapidly approaching Fifth Voluntary Global Fund Replenishment, preparations for which are already underway. On March 16, the government of Japan announced it would host the Global Fund’s Replenishment Preparatory Meeting in December 2015, an important milestone in the three-year funding cycle.

We were pleased to host Dr. Mark Dybul, Global Fund Executive Director, as he visited Washington in mid-March to meet with Members of Congress, Obama Administration officials (including Ambassador Deborah Birx, U.S. Global AIDS Coordinator), and advocacy partners. During his visit, Dr. Dybul spoke to the importance of U.S. funding levels for Replenishment, as the U.S. government is looked to as a leader for investments in the Global Fund and global health at large. He particularly emphasized the need for $1.35 billion in U.S. contributions to the Global Fund in FY 2017, in efforts to reach $4 billion in funding for the upcoming Replenishment cycle. In addition to advocating for a robust U.S. contribution, Dr. Dybul provided updates on Global Fund initiatives such as domestic financing for health in implementing countries and procurement reform.

While U.S. investments remain key to Global Fund success, a sustainable approach to fighting the three diseases requires increasing investments by implementing countries in their domestic response. During the current Replenishment cycle, implementing countries have committed $3.4 billion in domestic financing for 2015-2017, a more than 60 percent increase from the 2012-2014 grant period. In addition, Friends launched a report on Feb. 10 entitled Innovation for Greater Impact: Exploring Resources for Domestic Health Funding in Africa. The report highlights the various approaches Global Fund implementing countries are pursuing to mobilize increased domestic funding for health.

This quarter, Friends participated in several big events in Washington. Among them, on March 25, I had the honor of testifying in a Public and Outside Witness hearing on the FY 2016 budget before the House Appropriations Committee’s Subcommittee on State, Foreign Operations, and Related Programs. It was an excellent opportunity to share examples of the Global Fund’s lifesaving work and discuss ways in which the United States can remain the global leader in the fight against these diseases. I also took part in amfAR’s March 24 Capitol Hill conference, “Women and HIV/AIDS: Fast-Tracking the U.S. and Global Response,” discussing Global Fund strategies to target women and girls in HIV programming, and to collaborate with partners on holistic health, education and social services to help prevent disease.

Finally, Friends commemorated World TB Day with a strong campaign, including an op-ed co-authored by Eli Lilly. It emphasized growing private sector collaboration in the fight against multidrug-resistant tuberculosis (MDR-TB). Such private sector involvement is crucial to collective global health efforts as we fight to end the public health threats of HIV, tuberculosis and malaria once and for all.

A View from the Hill

With the convening of the 114th Congress and the release of President Obama’s FY 2016 budget request, the past few months have been busy on Capitol Hill. This year, in an attempt to prevent the need for short-term funding measures, Congress has begun the budget and appropriations process much sooner than in recent years.

On Feb. 2, the Obama Administration released its FY 2016 funding request, which included $1.107 billion for the Global Fund – $243 million below the FY 2015 enacted level. Additionally, the request included: $4.319 billion for the President’s Emergency Plan for AIDS Relief (PEPFAR), essentially maintaining FY 2015 funding levels; $674 million for the President’s Malaria Initiative (PMI), a $4.5 million increase above the FY 2015 enacted level; and $191 million for USAID tuberculosis programs, a $45 million decrease below FY 2015 enacted levels.

Following the release of the President’s budget request, Secretary of State John Kerry testified before the House and Senate Appropriations Committees, the Senate Committee on Foreign Relations, and the House Foreign Affairs Committee to review the FY 2016 budget request for the U.S. Department of State and related agencies. During those hearings, Sen. Lindsey Graham (R-SC) noted that cutting global health funding would jeopardize the progress made in fighting AIDS and malaria around the world and that, so far, this has been a good return on investment for the American taxpayer.

Given the expedited Congressional appropriations timeframe and an increasingly challenging fiscal environment, Friends has continued its outreach to key Congressional offices and stepped up advocacy and educational efforts with a bipartisan group of freshmen Members of Congress.

Malaria in Myanmar: Artemisinin Drug Resistance Grows

On Feb. 20, NPR highlighted a new study that has found a growing threat of artemisinin-resistant malaria in Myanmar, also known as Burma. The study, published in the Lancet, found resistance to the highly effective malaria drug in new parts of the country’s northwest region, which shares a border with India.

Artemisinin resistance is a grave concern, and one that the Global Fund has been targeting in recent years. In December 2013, the Global Fund approved a three-year, $100 million grant to create the Regional Artemisinin Resistance Initiative (RAI), a collaborative, five-country response to drug resistance in the greater Mekong sub-region. The funding specifically targets Burma (40 percent), Cambodia (15 percent), Vietnam (15 percent), Thailand (10 percent) and Laos (5 percent), with 15 percent allotted for inter-country coordination.

This work focuses on malaria interventions, including insecticide-treated nets and targeted indoor residual spraying, as well as case management in areas that are demonstrating a delayed response to artemisinin-based combination therapy (ACTs) or are at heightened risk for drug resistance. The Global Fund’s regional effort also emphasizes: a focus on migrant populations near country borders; halting the use of oral artemisinin mono-therapies; surveillance of malaria outbreaks; and therapeutic efficacy studies.

The new study demonstrated the critical need for focused malaria interventions such as the regional initiative. As the Global Fund has stated, if artemisinin resistance reaches India or sub-Saharan Africa, where most malaria cases occur, the public health consequences could be disastrous. Artemisinin-based therapy is the primary treatment for uncomplicated P. falciparum malaria, and their implementation has been vital to the 47 percent drop in global malaria mortality rates between 2000 and 2013.

Highlights from the Fight

On March 28, Friends of the Global Fight was represented for the third consecutive year at the Unite for Sight Global Health & Innovation Conference. This year, President Deb Derrick spoke to the Global Fund’s efforts to protect and leverage donor investments through improvements made under the funding model, including procurement mechanisms.

In addition to the aforementioned op-ed, co-authored by Deb and Dr. Evan Lee, Vice President of Eli Lilly’s Global Health Programs and Access, Friends’ campaign for World TB Day on March 24 included:

Also in March, as a way to complement the launch of a Global Health Briefing Book for the 114th Congress, the Global Health Council compiled a repository of impact stories highlighting U.S.-funded interventions. Friends contributed a piece focused on the Global Fund’s Procurement 4 Impact initiative.

On Feb. 26, aidspan highlighted the need for increased domestic funding in implementing countries, referencing case studies from Friends’ Feb. 10 publication, Innovation for Greater Impact, that show African governments’ efforts to mobilize resources through innovative and new financing mechanisms.

Friends hosted a Feb. 24 webinar on domestic financing for health with the Global Fund’s Johannes Hunger, Head of Strategic Information, and George Korah, Senior Specialist in Health Financing. They provided background and on-the-ground examples of efforts to increase domestic health investments in implementing countries.

In February, Friends published an interview with Tatjana Peterson, the Global Fund’s Fund Portfolio Manager for Tanzania. Tatjana discussed some of the innovative public/private partnerships that are helping the fight against HIV/AIDS in Tanzania.

On Jan. 13, Friends published a Q&A with Board member Jonathan Orszag, Senior Managing Director and member of the Executive Committee at the economic consulting firm Compass Lexecon, about what drives his support in the fight against AIDS, tuberculosis and malaria.