When the Global Fund to Fight AIDS, tuberculosis and malaria convened its eighth replenishment conference in Johannesburg, the symbolism was intentional. For the first time, a global health fundraising summit took place on African soil — the continent that bears the heaviest burden from the three diseases and stands to benefit most from their eradication.
However, the outcome exposed an uncomfortable reality. Despite some donors making pledges that reflect continued commitment, the replenishment fell short of its $18bn target. Even more concerning is the pattern behind this shortfall: four of the seven donors who provided almost 90 per cent of funding at the last replenishment have reduced their contributions. Three others — France, Japan, and the European Commission — did not pledge at all, although they have promised to do so in future.
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“While today’s pledges have fallen short of the $18bn total fundraising target, it is clear many world leaders have still chosen to prioritise lifesaving health investments,” said Ndidi Okonkwo Nwuneli, chief executive of the ONE Campaign.
She added: “In a world where progress is fragile and the most vulnerable bear the heaviest burden, we need leaders to step up and support life-saving programmes like the Global Fund. We have the innovations required to tackle these deadly diseases and create healthy lives for everyone — we just need the resources and political will to end them in our lifetime.”
The stakes are high. Since 2002, the Global Fund has saved 70 million lives and helped reduce AIDS, tuberculosis and malaria deaths by 63 per cent The $18bn target was designed to save 23 million lives between 2027 and 2029 and prevent approximately 400 million infections. These are not abstract projections; they represent communities transformed and futures secured through coordinated international action.
The timing of this funding gap is particularly unfortunate. Medical innovations — from long-acting HIV prevention tools to new tuberculosis treatments — have created unprecedented opportunities to accelerate progress. The constraint is no longer scientific, but financial and political.
Adrian Lovett, executive director for the UK, Middle East and Asia Pacific at ONE, speaking from Johannesburg, framed the challenge starkly: “This first-ever global health replenishment on African soil has been convened with resolve and purpose — a reminder of what determined leadership looks like in the fight against AIDS, TB, and malaria. But today’s outcome also exposes a worrying reality. Just as the world stands on the brink of an incredible breakthrough in reducing deaths from these devastating diseases, some partners have stepped back from the fight.”
The pattern Lovett describes reflects broader trends in development finance. As this publication noted earlier this week, official development assistance fell 7.1 per cent in 2024, with further reductions expected. When concessional lending contracts, countries face higher borrowing costs and must choose between servicing debt and funding domestic priorities, including health systems. The Global Fund operates precisely in this area, providing resources that many African governments cannot afford at commercial rates.
What makes the funding shortfall more troubling is that it has arrived at a time when the importance of health security as a shared global interest has never been clearer. The Covid-19 pandemic demonstrated that infectious diseases respect no borders, and that uncontrolled outbreaks anywhere eventually threaten health and prosperity everywhere. The Global Fund is one of the most effective mechanisms that the international community has developed to address this reality.
The replenishment is not yet complete. However, governments have indicated that they will make additional pledges, and there is still time to close the gap. “Today represents a vital step forward, but governments must go further to top up their pledges and finish the job,” said Lovett. “Millions of lives depend on leaders matching their words with action.”
Whether they will do so remains uncertain. While the Johannesburg summit showcased continued international cooperation, it also revealed fault lines in that consensus. As wealthy nations contend with domestic fiscal pressures and shifting political priorities, the question arises as to whether multilateral health partnerships will continue to attract the investment they require, or whether the progress achieved over the last two decades will slow down precisely at a time when acceleration is possible.
The answer will be determined not in Johannesburg but in capitals across Europe, Asia and North America, where budget decisions are made and priorities set. What was once a story of relentless progress against ancient scourges now hinges on whether donor fatigue will define the next chapter, or whether the momentum of the past two decades will prove durable enough to reach the finish line.
ONE is a global, non-partisan organisation that advocates for the investments needed to create economic opportunities and healthier lives in Africa. It uses data, grassroots activism, political engagement and strategic partnerships to influence decision-makers. Learn more at www.one.org.
