This is a joint post with Rachel Silverman.
Through our Value for Money working group, we’ve spent much of the past year immersed in the world of global health funding agencies. With so many new agencies, particularly in the last quarter century (Figure 1), understanding the intricacies of the global health family can be daunting, even for the most devoted observers.
This is a joint post with Mead Over and Denizhan Duran.
In mid-2011, one of the biggest developments in HIV/AIDS research took place. The HPTN 052 study found that early antiretroviral therapy treatment could reduce HIV transmission by 96% in couples where one partner is HIV positive and the other is HIV negative. The study was heralded as the breakthrough of 2011 by Science, and was hailed as a game changer by many others, including UNAIDS, The Economist and The Lancet. The World Health Organization wrote a comprehensive guideline for TasP, or treatment as prevention, in June 2012, asserting that “TasP needs to be considered as a key element of combination HIV prevention and as a major part of the solution to ending the HIV epidemic.”
Around this time last year, world leaders called for “the beginning of the end of AIDS” and an “AIDS-free generation”, and committed to reaching the ambitious disease-specific targets for HIV/AIDS: the virtual elimination of mother-to-child transmission; 15 million people on treatment and a reduction in new adult and adolescent HIV infections — all by a rapidly approaching 2015. And this year, US Secretary of State Hillary Clinton recommitted to these ambitious goals in the release of the PEPFAR Blueprint, saying “An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach”. While the overarching World AIDS Day message remains clear – we have made tremendous progress thus far, and there is still a long way to go in the fight against AIDS – one question remains: is this really the beginning of the end of AIDS?
After a year-long period of upheaval and reform, the Board of the Global Fund for AIDS, TB and Malaria today named Mark R. Dybul as its new Executive Director.
This week the Global Fund Board will determine whether to “expand, accelerate, terminate or suspend the Affordable Medicines Facility – malaria (AMFm).” Ideally, the Board would make an evidence-based decision. However, both the sufficiency and the relevance of available technical evidence have been questioned (see here and here). The role of political and process evidence is also not very transparent. Below, we lay out our understanding of the potential options and the factors the Board should consider.
This is a joint post with Heather Lanthorn.
The Global Fund Board’s decision over the Affordable Medicines Facility – malaria (AMFm) rapidly approaches, and tensions within the malaria community are acute. In her global health blog for The Guardian, Sarah Boseley characterizes the rift as one of
“huge arguments and intense passions…[because] it is about the belief on one side that the private sector is the most effective way to get medicines to those who need them – and the certainty on the other side that bolstering the public sector to diagnose and treat people is a fairer and safer way to go. These are not just practical matters, but highly political.”
This year, Revista Epoca reported that a man named Rafael Favaro sued the government of Brazil to obtain public subsidy for lifetime treatment of a rare form of anemia (PNH). His treatment—Soliris—costs Brazilian taxpayers approximately $440,000 per year and is among the most expensive medicines in the world. Most US insurers do not cover the medicine, only Quebec funds the medicine in Canada, and Scotland does not provide any subsidy.
As the Global Fund’s November board meeting approaches – where the future of the Affordable Medicines Facility for Malaria (AMFm) hangs in the balance – there is much anxiety that AMFm will be terminated in 2013. The reason for such anxiety is clear: no donors have pledged funding commitments for after December 2012. But there’s another elephant in the room: the US government’s apparent lack of support, particularly its legislated “opt-in” stance on AMFm: “the Global Fund should not support activities involving the ‘Affordable Medicines Facility-malaria’ or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.” (Conversely, an opt-out stance would be to support AMFm unless no compelling evidence is presented.) This very specific and strict provision makes the AMFm’s continued survival all but impossible without an explicit endorsement by US Global Malaria Coordinator (currently Rear Admiral Tim Ziemer) who leads the US President’s Malaria Initiative (PMI) housed in the US Agency for International Development (USAID).
UNITAID: maybe you’ve heard of it, or maybe not. Launched in 2006, UNITAID has lived in the shadow of its older and bigger global-health siblings (the Global Fund, GAVI, and PEPFAR, to name a few). Perhaps due to its relative obscurity and late entry to a crowded global-health field, UNITAID has proactively worked to differentiate itself through a focus on commodities, market shaping, novel funding sources, and innovation. To wit, UNITAID’s stated mission is “to contribute to scale up access to treatment for HIV/AIDS, malaria and tuberculosis for the people in developing countries by leveraging price reductions of quality drugs and diagnostics, which currently are unaffordable for most developing countries, and to accelerate the pace at which they are made available.”
There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. The announcement of these cuts came with an explanation that PEPFAR was “free(ing) up resources by reducing programs in lower HIV prevalence countries” (see blog). Further, Global Fund monies have gone almost completely undisbursed in 2012. These cuts in spending might be warranted due to epidemiological trends and improved efficiency, or might cripple progress as health programs dependent on external donors are cut back. The truth is, with the current poor status of basic information on beneficiaries and costs, it’s difficult to judge whether these cuts are good or bad.