South Africa is one of only a few countries to raise its contribution to the Global Fund to Fight Aids, Tuberculosis and Malaria, which closed its replenishment drive on Friday with just $11.34bn in pledges — well below its $18bn goal.
The fund, credited with saving 70-million lives since its launch in 2002, now faces waning support as several major donors — including the US, Canada and key European economies — scale back contributions for its next three-year cycle beginning in 2027.
President Cyril Ramaphosa announced that South Africa’s government and private sector had committed $36.6m to the Global Fund at its eighth replenishment summit, co-hosted by South Africa and the UK alongside the G20. The pledge includes $5.5m from Goodbye Malaria and $4.5m from Anglo American.
Ramaphosa said further private sector pledges were expected to follow.
“At a time when multilateralism has increasingly come under strain and pressure, global co-operation in health is being sorely tested. This summit … is a milestone for global health.
“Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics, therapeutics and financing so that every country can protect its people and achieve health equity,” he said.
The South African government commitment of $26.6m is double the $13m undertaking it made to the Global Fund’s seventh replenishment round.
Several other countries, including Ireland, India, Spain and Nigeria, also increased their commitments, but the scale of their pledges does not offset the decline in funding from the Global Fund’s biggest contributors.
India increased its pledge from $25m to $30m, while Nigeria increased its undertaking from $13.2m to $15m. Ireland increased its pledge from €65.75m (R1.3bn) to €72m, and Spain raised its undertaking by 11% to €145m.
The US remains the Global Fund’s biggest donor but has reduced the $6bn pledged made under the Biden administration to $4.6bn.
The Trump administration sees the Global Fund as a critical partner in advancing its new “America First” global health strategy, said Jeremy Lewin, the US state department undersecretary for foreign assistance, humanitarian affairs and religious freedom.
“The Global Fund has long advanced key tenets of our approach, investing most of its resources into scaled procurement of critical healthcare commodities and support for frontline workers, and requiring co-investments from recipient countries with sufficient national income,” he said. The US pledge depends on other donors matching its commitments by 2:1.
Global Fund executive director Peter Sands said the organisation was committed to reducing its operating costs by 20%.
“Money will always be tight, so we must be smarter — strengthening countries’ self-reliance by boosting domestic resource mobilisation, improving public financial management, supporting the growth of regional manufacturing and leveraging pooled procurement,” he said.
UK Prime Minister Sir Keir Starmer said his government would continue to invest in the Global Fund because it delivered tangible benefits.
“In today’s volatile world, we must prioritise spending that makes a genuine difference and supports growth at home and globally,” he said. The UK has, however, cut back on its commitments to the Global Fund, undertaking to donate £850m (R19.3bn) instead of £1bn.
Several key donors, including France, Japan and the European Commission, have yet to announce their pledges, as they are still finalising their budgets.
International Aids Society president Beatriz Grinsztejn urged governments, the private sector and philanthropists to step up.
“Every dollar short of the Global Fund replenishment goals represents lives that could have been saved but now may not be,” she said. “Donors hold the power to save lives: they can still pledge funding for the 2027-29 cycle so that services and the latest technologies reach everyone who needs them.”
Several charitable foundations have already made pledges to the Global Fund, the largest of which came from the Gates Foundation, which committed $912m to the eighth replenishment.
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