The Cost of Fighting AIDS, TB, and Malaria

We are on the verge of achieving several major public health breakthroughs. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, by 2015 we could virtually eliminate mother-to-child transmission of HIV and finally eradicate malaria as a public health problem. The International AIDS Society reports that if everyone who needed treatment for HIV received it, we could save millions of lives and reduce new HIV infections by up to a third. And we could meet the United Nations millennium development target of reducing tuberculosis prevalence by half, and contain the threat of multidrug-resistant tuberculosis.

We could do it. But will we?

As donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria meet in The Hague this week to discuss replenishing the Fund for 2011-2013, this is the choice they will make.

The Global Fund has just released three scenarios outlining what they will be able to achieve over the next three years depending on the amount of resources pledged:

• $13 billion ($4.3 billion/year) would allow the Global Fund to continue funding programs and services that it is already funding. While the Global Fund notes that there will be room for very limited scale-up of services to fight the three diseases, we would essentially be left with the status quo. About 2.7 million people will continue to be infected with HIV annually. At least 10 million people who need HIV treatment will not receive it. Malaria will continue to be a very real threat to the health and lives of millions in malaria-endemic countries.  And any progress would be limited.
• $17 billion ($5.6 billion/year) would allow the Fund to continue funding existing programs and services and scale them up, but at a rate lower than they have been supporting scale-up over the past two years. This would be better, but not enough to begin to reverse the trajectory of the three diseases.
• $20 billion ($6.6 billion/year) would allow the Fund and countries to accelerate the scale-up of programs. It would allow an additional 5 million people to access HIV treatment, 5.4 million to access TB treatment, and 156 million more long-lasting insecticide-treated bed nets could be distributed to prevent new malaria infections. But even at this level the world would not come close to meeting the Millennium Development Goals adopted by 189 nations in 2000.

To do what we now know is possible, to turn back the tide of these three diseases, it is going to cost significantly more.

In the scheme of things, these amounts are not a lot of money. In 2007, $2.6 trillion was spent on health care in the United States alone; in 2010 the UK will spend about $179 billion. In 2008, the U.S. government spent $711 billion on the military and fighting the wars in Iraq and Afghanistan and another $700 billion bailing out Wall St. bankers. The difference that more money for the Global Fund could make in improving health systems and saving lives is huge.

But instead of doing the right thing, behind closed doors public sector donors are currently sending all of the wrong messages: that any increases in funding over existing levels will be small and $13 billion may not even be feasible. In other words, maybe the Global Fund will be able to continue funding what it is already funding, but no more and definitely not at the level that is going to reverse the spread of AIDS, tuberculosis, or malaria.

Or more starkly, saving lives is just not worth the money.

Donors will make their pledges to the Global Fund at a pledging conference in New York in October. The question is: Will they make the right choice? We need to make sure that they do.