March 26, 2025
How the Global Fund makes the U.S. safer, more secure and more prosperous
By Chris Collins
The United States’ global leadership in the fight against HIV/AIDS, tuberculosis (TB) and malaria has saved tens of millions of lives around the world while making this country safer and stronger. A powerful instrument of that leadership is the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), a public-private partnership that raises about $5 billion per year from governments and the private sector to invest in local partners to fight infectious diseases and strengthen health systems in countries that are key to U.S. foreign policy interests.
The Global Fund works in some places that U.S. agencies cannot, helps build global support for U.S. health goals and mobilizes international funding to share the burden of winning the fight against HIV, TB and malaria.
Detection abroad, protection at home
Disease outbreaks continue to pose an enormous and urgent threat to the United States. TB cases have recently surged in places like Kansas. In 2023, Florida recorded the first cases of malaria to be transmitted within the United States in twenty years. In addition, biological threats continue to proliferate globally, including recent outbreaks of Mpox, Marburg virus disease, Ebola and H5N1 avian influenza. Strong health surveillance and laboratory systems are essential for keeping Americans safe and healthy and preventing and responding to all forms of biological threats, whether they are deliberate attacks, accidental outbreaks or naturally occurring events.
For more than two decades, the Global Fund has funded HIV, TB and malaria programs that strengthen health systems to not only control these three epidemics but also enable them to better detect and contain outbreaks of all kinds. In 2023 alone, the Global Fund invested almost $100 million in augmenting disease surveillance systems. These investments also promote U.S. biodefense by improving the efficacy and safety of laboratories around the world.
The Global Fund’s long-standing support to Uganda’s laboratory services and the National Health Laboratories and Diagnostic Services (UNHLDS) supported the country to develop one of the best national laboratory networks on the continent, with experience in quickly identifying and stopping disease outbreaks. Uganda’s robust laboratory system has been essential to the country’s response to mpox, quickly identifying cases and working to prevent, detect and respond to the outbreak.
The Global Fund has invested US$36 million in Uganda’s laboratory systems since 2020 and is investing US$8.8 million more from 2024 to 2026. This includes US$2 million supported by the Laboratory Systems Integration Catalytic Fund, which is funded by private sector partners. With these funds, National Health Laboratories can hire more laboratory technicians, procure essential medical supplies such as reagents and bring in top-of-the-line equipment to help scientists investigate and prevent deadly diseases.
The HIV, TB and malaria epidemics also pose an enduring threat to the safety, readiness and operational effectiveness of U.S. and partner countries’ military forces. The 2023 National Biodefense Posture Review establishes that the Department of Defense “requires a resilient force enabled by capabilities that also address emerging disease threats.”
Healthy states are stable states
Epidemic outbreaks can erode social cohesion and drain resources, leading to social unrest and civil conflict. It is in the interest of the United States to prevent violent conflict and strengthen fragile states by addressing the root causes of instability. HIV, TB and malaria programs can be a valuable part of those efforts. High rates of HIV, TB and malaria are associated with severe macroeconomic downturns. Illness reduces the size and productivity of the workforce and is a barrier to foreign direct investment. One study estimates global economic losses due to TB deaths will amount to $17.5 trillion between 2020 and 2050. Another report found that achieving the global target of reducing malaria incidence by 90% by 2030 could boost economies by more than $142 billion.
The microeconomic impacts are also profound. Epidemics strain resources such as healthcare, food and water, leading to competition and conflict between communities. Lack of economic opportunity can lure people to join violent extremist or criminal groups for income, according to the U.S. Strategy to Prevent Conflict and Promote Security.
The Global Fund prioritizes health needs in conflict zones and otherwise unstable states. The Global Fund’s programs are designed and implemented by vetted local actors, meaning it can continue to operate in areas where other bilateral and multilateral agencies may not. In fact, more than 30% of Global Fund allocations go to these countries.
Economic returns to U.S.
The Global Fund, which has partnered with U.S. companies like Coca-Cola, SC Johnson and Microsoft, has procured $3.5 billion in goods and services from U.S. corporations since 2010.
The Global Fund’s efforts to improve access to products and increase innovation is expected to lead to $9.8 billion in savings between 2027 and 2029. In fact, the current yearly cost per patient for life-saving HIV treatment is only $37 — down from $10,000 since the Global Fund’s inception.
In addition, Global Fund investments have averted 5.5 billion outpatient visits and freed up 2.9 billion hospitalization days, generating $103 billion in cost savings.
Health programs: A powerful tool for competition with China
The Global Fund and the U.S. HIV, TB and malaria bilateral programs are some of the best tools for demonstrating U.S. global leadership, making America stronger and safer, and cultivating partners in an increasingly competitive world. In Africa, this task is more urgent now than ever before. While China offers opaque infrastructure loans, the U.S. leverages its distinct medical and innovation advantages as tools of soft power. With clear and measurable results, health assistance is our most visible, enduring and effective form of diplomacy in many low-income countries.
U.S. investments help governments across Africa work toward self-sustaining health programs that create better health outcomes and strengthen state capacity. Certainly, U.S. competitors see global health programs as a strategic advantage for the U.S. China has sought to emulate the U.S. by establishing its own health diplomacy and assistance initiatives. As part of its Belt and Road Initiative, China created a “Health Silk Road” program to establish health cooperation across funded countries, and government strategy documents have emphasized controlling infectious diseases such as HIV, TB and malaria as objectives of China’s health diplomacy.
The Global Fund also has strong partnerships with countries that are critical to U.S. efforts to counter China like India, Vietnam, Philippines and Indonesia. Global Fund support helps keep their people healthy and contributes to their stability and economic growth.
Key U.S. allies like Japan, Australia and South Korea are major backers of the Global Fund. They understand that the Global Fund contributes to their own security and appreciate the support the United States provides to the Global Fund.
U.S. leadership in the Global Fund and in bilateral HIV, TB and malaria programs makes America safer, stronger and more prosperous. For decades, these programs exemplified American generosity and leadership. Now—as biological threats draw closer, violent conflicts spread wider and competitors grow bolder—investing in these programs is essential for strengthening national security and maintaining American influence. To retreat from these commitments would jeopardize progress toward epidemic control of the three largest infectious disease killers, make U.S. citizens more vulnerable to disease and undermine U.S. leadership on the world stage.