A Legacy of Dreams and Global Health Commitments
In 2001, when the late Kofi Annan, former Secretary-General of the United Nations, championed the creation of the Global Fund, he was famously quoted as saying, “When I first mooted the idea of the Global Fund, people said I was dreaming… I love dreams. It always starts with a dream.” This sentiment echoes through the current efforts to secure funding for the Global Fund’s Eighth Replenishment, which aims to raise US$18 billion for the 2026-2028 funding cycle.
The recent replenishment, taking place in Johannesburg, coincides with South Africa’s tenure as G20 president, marking the first time this leadership is held on African soil. Co-hosted by President Cyril Ramaphosa and United Kingdom Prime Minister Sir Keir Starmer, the meeting carries added significance not only for the continent but also for how the global health architecture is now shaped.
Testing Global Commitment and Solidarity
This replenishment served not only as an opportunity to reinforce global commitments but also as a litmus test for sustained support to established global health financing mechanisms. Dr. Aaron Motsoaledi, Minister of Health, South Africa, noted that “the success of this replacement on the sidelines of G20 will be a defining legacy proof that our commitment to partnership and progress is unshakable.”
G20 President Cyril Ramaphosa acknowledged the growing pressures multilateralism has increasingly come under strain and pressure. He also announced that South Africa is pledging US$36.6 million to the Global Fund, demonstrating the continent’s increasing leadership and agency in its own future.
Global Commitments and a Rolling Pledge Process
Sir Keir Starmer, who attended in person, affirmed the UK’s confidence in the Global Fund, recognizing its “clear ability to maximize the effectiveness of the money given to it.” He welcomed the Global Fund’s commitment to reform, putting countries back in the lead, strengthening national health systems, keeping communities at its heart, and working ever more closely with multilateral partners.
He also reminded the world that the major challenges of our time cannot be solved through bilateral agreements alone, echoing his words that “no one is safe from disease, until everyone is safe from disease.” The United Kingdom had previously pledged US$1.11 billion, reflecting its long-standing commitment.
The United States also made a strong showing, announcing a US$4.6 billion multi-year pledge. As one of the Global Fund’s highest donors, the US emphasized the strategic value of global health investment. Jeremy P. Lewin, Senior Official for Foreign Assistance, in a video statement stated that “The Global Fund is a critical partner in advancing the America First global health strategy.”
Overall, the Global Fund had set an ambitious target of raising US$18 billion to meet its proposed funding priorities. With US$11.34 billion pledged so far, and despite rising political pressures and competing priorities among the traditional donor countries, this can still be viewed as a relative success. This is particularly notable at a time when political pressures are driving countries to turn inwards and adopt nationalistic policies that undermine international cooperation.
However, unlike previous replenishments which culminated in a single pledging event, the eighth replenishment is being undertaken as a rolling process. Several countries, including France, Sweden, and the European Commission, signalled their commitment but noted that final figures will be confirmed at a later date. This signals that the replenishment is not yet complete and that further contributions can still be expected.
Progress Achieved, But the Fight Continues
It is important to remember that the funds raised through replenishment are not an end in themselves, but a means to achieve the goals the Global Fund was created for. While progress made has been significant to date, with approximately 70 million deaths prevented, and more countries moving closer to the UNAIDS 95-95-95 targets, there is a lot to celebrate. There have also been substantial declines in TB illness due to fewer infections and improved treatment.
Despite these, the fight is far from over. Sustained funding remains essential to save an additional 23 million lives and reduce deaths from HIV, TB and malaria by 64 percent, as projected by the Global Fund.
Strengthening Systems and Local Ownership
Beyond the three diseases lies the broader challenge of strengthening Africa’s health systems. While vertical programmes save lives, it is ultimately the health system that delivers outcomes. The same system that ensures an HIV-positive mother receives antiretroviral therapy must also be equipped to provide emergency obstetric care when she presents in labor.
Peter Sands, CEO of the Global Fund, captured this clearly: “We must align with country needs and support countries to transition to self-reliance based on domestic resources.” The continent will look for this commitment to be fulfilled.
The Accra Reset and the Lusaka Agenda offer roadmaps for this transition. The Accra Reset calls for financing models that endure beyond the SDG era, position health as an economic catalyst, crowd in private-sector participation, and build a Community of Practice for shared learning. The Lusaka Agenda urges stronger domestic leadership, investment through primary healthcare, equity-based outcomes, joint action by global health partners, and regional manufacturing capacity.
Nigeria’s Progress and Regional Leadership
Nigeria remains a priority country for the Global Fund and is making real progress toward the UNAIDS 95-95-95 goals, now at 90-90-86, and steadily getting closer to bringing the epidemic under control. The Global Fund has invested more than $4.8 billion in Nigeria since 2002, making it their largest country portfolio.
Professor Muhammad Ali Pate delivered Nigeria’s pledge to the Global Fund. As one of the major recipients of Global Fund resources, Nigeria’s US$15 million pledge demonstrates genuine “skin in the game.”
Other African countries also stepped forward with commitments, including Côte d’Ivoire (US$2.5 million), Morocco (US$1.5 million), Tanzania (US$1 million) and Namibia with (US$1 million), further signaling the continent’s growing commitment to shared responsibility in global health.
Private Sector Engagement and Future Goals
Private sector engagement was made very clear with $1.34 billion pledged, including $135 million from the Children’s Investment Fund Foundation (CIFF) and $912 million from the Gates Foundation. In his remarks, Bill Gates, Chair of the Gates Foundation, highlighted how the Global Fund had “worked with the private sector, has reduced treatment costs dramatically and sparked incredible new tools, including portable TB diagnostics and drugs that prevent HIV infection with just two doses per year.”
In closing the eighth replenishment meeting, and in announcing the pledges received so far, President Cyril Ramphosa reminded the audience that “the pledge amount is no mere number. It is an amount that has an impact. It is a solid foundation for impact and a renewed impetus for transformation and change, millions of lives will be saved, stronger, more resilient health systems will be built.”
“It always seems impossible until it is done” — Nelson Mandela.
