Ending AIDS, malaria and tuberculosis (TB) is within reach. But the gains we have made against these diseases over the last two decades, the lives saved, the health and community systems built, are now in jeopardy as the U.S. government looks poised to retreat from its leadership in global health. This is precisely the wrong time to step back; instead, it is the moment to double down.
A decade ago, world leaders committed to ending AIDS, malaria and TB as public health threats by 2030 as part of the Sustainable Development Goals (SDGs). Despite the remarkable progress we have made, we are not on track to achieve those goals. New challenges in global health threaten to undermine our efforts and could reverse decades of progress.
As African health advocates, we are acutely aware that we are living in uncertain times with competing priorities of resources stretched thin. The crippling confusion surrounding the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the implementation of “Stop Work Orders” have already thrown health programs in Africa into disarray. In Kenya alone – according to amfAR, the Foundation for AIDS Research – more than 35,000 health workers supporting HIV and TB programs funded by USAID lost their jobs, leaving millions of patients stranded. In Cameroon, where 14,000 people die each year from malaria, the U.S. President’s Malaria Initiative (PMI), which enabled testing and treatment in villages, has come to a grinding halt. If a child has a fever in a village in the regions covered by PMI/USAID in Cameroon right now, a community health worker will be unable to test or treat the child. We are likely to see a spike in malaria-related deaths, as 30% of the funding to help save lives was lost abruptly. This situation is replicated in many African countries, and millions of lives are at stake if the aid cuts across donor nations continue. Global aid complements the efforts of our national governments, but we can’t do it alone. Domestic resources can’t take over the role of international financing overnight. For now, our health goals can only be achieved if our national health investments are reinforced by coordinated global contributions.
The world is sitting on a ticking time bomb if it does not commit to investing in health in Africa. Investing in health is a moral and strategic imperative. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), which invests US$5 billion a year to defeat the three diseases, understands the cost of inaction and continues to be one of Africa’s biggest partners in the fight against infectious diseases. In the last two decades, the Global Fund partnership has cut the combined death rate from AIDS, TB and malaria by 63%, saving 65 million lives.
It is crucial to maintain that progress. As advocates, we support continued investments in international financing for health and galvanize civil society partners to mobilize more domestic resources, calling on African leaders to play their part in fighting major infectious diseases that continue to kill millions. We believe that every life, every minute, and every dollar counts in our efforts to bring an end to this battle.
It’s essential that African advocates raise up their voices this time to ensure that our leaders don’t step back from the fight against these diseases before the battle is won. Part of the effort means they can continue to champion and support the work of the Global Fund, which will hold its Replenishment this year.
On 18 of February 2025, as the Global Fund launched its Eighth Replenishment, it made the case for why we cannot afford to slide back. The stakes are high: The end of AIDS, TB and malaria is within reach, but only if we keep our foot on the pedal. With the Replenishment target of US$18 billion, the Global Fund partnership seeks to save 23 million lives between 2027 and 2029, reduce deaths from these diseases by 64% compared to 2023 levels and build stronger health and community systems to fight new outbreaks and pandemics.
The Global Fund can meet the funding target with sustained and consistent political and financial support from the international community. Its 2025 Replenishment is an opportunity for the world to close in on the goals of ending AIDS, malaria and TB and save millions of lives at a time of immense challenges.
It is a great demonstration of leadership that South Africa and the United Kingdom have come together to lead the effort to replenish the Global Fund. AIDS, malaria and TB are not solely “African” diseases, even though the continent bears a disproportionate burden. Diseases know no borders. Infectious diseases anywhere pose a threat to global health security everywhere. The fight against these deadly infectious diseases is not one we can afford to let up on. If we stop now, the diseases will come roaring back – we will have lost nearly 30 years of progress. To succeed, we are counting on the world to remain committed to this crucial fight.
Rosemary Mburu is Executive Director of WACI Health, an African regional civil society advocacy organization.
Olivia Ngou is Executive Director at Impact Sante Afrique, based in West Africa.
Both WACI Health and Impact Sante Afrique co-host GFAN Africa, a network of advocates that champions greater investments in health in Africa.
