Global Fund predicts funding shortages for MDR-TB, asks donors to fulfill their commitments

Despite increases in funding for some U.S. global health programmes, the world faces a “huge gap” for HIV, TB and malaria funding, especially with regards to MDR-TB, with some countries pegged to lose much of their international financial support in the coming months.

Dr. Amy Bloom of USAID told delegates of the 40th Union World Conference on Lung Health, which took place in Cancun, Mexico over the weekend, “this is a very exciting time for those of us in the U.S. government. Over the last few years we’ve seen an increase in our funding, especially for PEPFAR, our malaria fund and TB funding, but now we’ve entered a phase where we’ve reached a much more holistic approach as well.”

Bloom is especially optimistic about President Obama’s recently announced Global Health Initiative, which could offer up to $63 billion towards global health programmes over the next six years.

She claims that this initiative, coupled with an increase in funding and expanded mandate of PEPFAR, will allow for general health systems strengthening with a focus on HIV and TB integration.

While initially created primarily as an “emergency response,” PEPFAR is now broadening its mandate to include other health issues. TB, for example, is now a “priority area for PEPFAR programme work,” says Bloom.

Over the last decade tuberculosis programmes have seen an enormous increase in funding from the US government, going from no money allocated in 1998 to $176 million allotted for 2009.

Despite this, the Global Fund’s Dr. Rifat Atun warns that without continued commitment and increased funding, the progress made could be easily lost. “Next year is our replenishment year,” he says, “and it’s very important that the level of funding…not just be on par with what we’ve received from funders in the past, but go beyond for further scale-up.”

The bulk of US government and Global Fund money goes to sub-Saharan Africa and Southeast Asia, epicenters of the HIV and TB epidemics. Partially as a result, Eastern Europe and Latin America and the Caribbean—areas that have less generalised epidemics but still face large burdens of disease—are strapped for cash.

The funding situation for Eastern Europe is especially worrisome to Atun, as many countries in the region face high rates of MDR-TB but will soon be ineligible for Global Fund money as their status changes from “low-income” to “middle-income.” This change, however, is unlikely to be met with an increase in domestic funding, and programmes are predicted to face an even larger financial shortfall.

“Many countries with high MDR-TB, especially within Europe, will not be eligible for the Global Fund but need external funding,” he explains. While USAID efforts are increasing in the region, the money allocated is still “quite small,” adds Bloom.

According to Atun, “there’s no one to pick up this shortfall…It’s unlikely that we will find money [for the gap].” Many Latin American countries will also soon face exclusion from Global Fund grants.

“No one has really thought about this issue,” says Atun. “It’s a big problem. There’s no earmarked funding, and if we begin to think about it now, it will take two to three years to get this in place.”

On a global scale, Atun is encouraged by the increase in applications for TB grants during Round 9 of Global Fund funding. “For the first time the TB community has joined the ‘billion dollar club,’” he says, referring to the amount of money allotted for diseases. “That’s very good news.

“The best performing grants in our portfolio are TB grants,” he continues. “The TB community is doing something right. For Round 9, the applications have been less formulaic and more ambitious…particularly in relation to TB and HIV, [with] some thinking about integration with health systems.”

Atun encourages more TB-focused Global Fund proposals, as well as more advocacy and research into the economics of TB treatment and care. “It’s very important…that the TB community is not left behind,” he says.