This is an edited version of a keynote speech delivered to the 2024 Australasian AID conference by Lady Roslyn Morauta, chair of the Global Fund’s board.
Today, I want to share my passion for the Global Fund to Fight AIDS, Tuberculosis and Malaria – an organisation that exemplifies how performance-driven, multilateral aid can be both effective and transformative. Through its unwavering commitment to serving people living with or at risk of infectious diseases, the Global Fund has demonstrated that smart, collaborative, and evidence-based approaches can deliver extraordinary results.
Twenty-four years ago, at the turn of the millennium, AIDS, tuberculosis (TB) and malaria appeared unstoppable. AIDS devastated an entire generation, leaving countless orphans and shattered communities. TB unfairly afflicted people living in poverty, as it had for millennia. Malaria killed young children and pregnant women who were unable to protect themselves from mosquitoes or access lifesaving medicine.
The Global Fund was created in 2002 as a worldwide partnership of governments, civil society, the private sector, academia, bilateral and multilateral agencies and communities affected by the diseases. We pool the world’s financing to invest strategically in ending AIDS, TB and malaria as epidemics, ensuring a healthier, safer and more equitable future for all.
We raise resources every three years – next year is our Eighth Replenishment. And we provide grants to countries; again, in three-year cycles. Since 2002, the Global Fund has disbursed over US$63 billion to over 100 countries.
These investments are working. Over the last two decades, the Global Fund partnership has saved 65 million lives and cut the combined death rate from AIDS, TB and malaria by 61%. But our impact goes beyond saving lives. Investments in the three diseases have driven substantial improvements in universal health coverage, ensuring more people worldwide can access quality health services without financial hardship. Furthermore, global inequality in life expectancy declined by one-third between 2002 and 2019, with reduced mortality from the three diseases accounting for half of this progress.
The Global Fund’s effectiveness is a function of its unique, partnership-based approach – reflected in both its equitable and inclusive governance model and in the operation of “country coordinating mechanisms” – as well as several other key features.
First is our clear and focused mandate. The Global Fund’s mission to combat AIDS, TB and malaria while strengthening health systems ensures resources are concentrated in ways that foster greatest impact. It means our attention and efforts are not spread too thinly, and we can specialise in doing what we do – and doing it very well.
Second is our skilled and capable staff. The Global Fund is highly professional, with expertise spanning finance, diseases, health systems, community rights and gender, grant management, legal, governance and risk management. As a leading development agency with a strong mission, we can attract and retain exceptional staff who drive performance.
Third is our strong commitment to accountability. We raise funds every three years, and our donors insist that every dollar is accounted for and results are rigorously evaluated. Implementers, including NGOs and communities affected by AIDS, TB and malaria, also demand high levels of accountability and transparency – especially since millions of lives depend on the continuity of these programs.
Fourth is our scale. Operating at scale, the Global Fund manages US$2.5 billion in annual procurement. By pooling demand across more than 80 countries, we secure lower prices for essential medicines and health commodities, enabling countries to save more lives with the same resources and lowering barriers to innovation. The price of HIV antiretroviral drugs has fallen from over US$10,000 per person per year in 2000 to just US$37 in 2024, artemisinin-based combination therapies for malaria saw a 39% price reduction between 2014 and 2022, and TB treatments have also seen dramatic cost reductions, including a 55% price drop for bedaquiline, the primary treatment for drug-resistant TB.
The Global Fund’s investments in the Indo-Pacific region have supported significant health outcomes. Since 2002, the Fund has invested US$12.6 billion in 30 countries across the region, including US$560 million in the Pacific. These investments have contributed to saving 26.4 million lives in the region, with 210,000 lives saved in the Pacific alone.
In the last grant implementation cycle (2021-2023), the Global Fund invested US$2.6 billion in the Indo-Pacific, including US$120 million in the Pacific. These investments contributed to impressive results. In 2023, three million people were on anti-retroviral therapy, five million people were treated for TB, and 9.6 million mosquito nets were distributed. AIDS-related deaths in the region have declined by 51% since 2010, TB treatment coverage increased from 41% in 2010 to 71% in 2023 and the incidence of malaria has decreased from 15 per 1000 people in 2010 to 5 per 1000 in 2022 – with several countries well on the way to elimination.
However, challenges persist. The region still accounts for 25% of new global HIV infections annually, with 6.7 million people living with HIV in 2023. The Indo-Pacific bears the highest TB burden globally, with countries like India, Indonesia and PNG facing high rates of multidrug-resistant TB. Despite overall progress in the last twenty years, PNG and Solomon Islands have the highest malaria incidence rates outside Africa, with PNG accounting for 94% of all malaria deaths in the Western Pacific in 2022.
Recognising these ongoing challenges, a further US$2.2 billion has been allocated to the Indo-Pacific in the 2024-2026 period, including US$100 million to the Pacific, to continue to address challenges and sustain results.
The success of the Global Fund depends on robust and sustained resource mobilisation, and the Asia-Pacific region has demonstrated remarkable commitment to this effort. In 2022, during the seventh replenishment conference, countries in the region collectively pledged over US$1.45 billion, about 9% of the US$15.7 billion raised globally and equivalent to about two-thirds of the Global Fund is investing in the region.
Japan pledged US$1.08 billion in 2022, a 30% increase from its previous contribution. Australia has been a steadfast supporter of the Global Fund since its inception, pledging A$266 million for 2023-2025, representing a 10% increase from its prior commitment. The Republic of Korea significantly scaled up its contribution, quadrupling its previous pledge to US$100 million.
Several countries in the region are both donors and recipients of Global Fund grants. India increased its contribution to US$25 million, Indonesia made its first-ever pledge of US$10 million, and Thailand maintained its prior pledge of US$3 million.
As we look toward the Eighth Replenishment, continued leadership and contributions from the Indo-Pacific region will be critical. With Australia’s strong and enduring partnership, I’m optimistic that we can address the challenges facing our region. Together, we can drive progress against HIV, TB, and malaria, strengthen health systems, and build resilience to future threats. This isn’t just a moral imperative – it’s a smart investment in the health, stability, and prosperity of our shared region.
