The Global Fund: no longer a frontrunner in the SDG era (and what to do about it)

It’s been a while since the Global Fund was considered a splendid innovation allowing global health funding to go from millions to billions, at the start of the MDG era. So it’s sad (though perhaps not entirely surprising) to see that the Global Fund leadership doesn’t recognize times have changed.

I was reading Peter Sands’ case, this morning in a Stat  Op-Ed, in which he (rightly) claims the private sector should shoulder some of the responsibility for improving global health, but fails to draw the obvious conclusion.  

I understand his argument that the private sector can bring quite some expertise and resources, in a number of areas (and so global health would indeed be dumb not to make use of them).

On “SDG era / holistic global health thinking”     (see for example the rather “interesting” relationship of the GF with Big Alcohol – till recently? - and Big Soda), the Global Fund is certainly not a trailblazer anymore (as has been pointed out in detail by many, elsewhere), with superior service delivery expertise as one of the weak excuses used for these sorts of partnerships. Let’s hope that with time, the GF will become wiser in this area.

But here I’d like to focus on the fact that Sands fails to see the writing on the wall, in many countries, in terms of mobilizing resources. He still seems to think corporate “peanuts” will suffice: “  While in Davos, I called on private sector leaders to mobilize at least $1 billion (i.e. out of 14 Billion) of that target.” 

It’s worth quoting his final paragraph in full:

“…we also need private sector leadership in mobilizing financial resources. The Bill and Melinda Gates Foundation is by far the largest of the private foundations supporting the Global Fund, and (RED) has raised more than $600 million for its fight against AIDS in Africa. Business leaders should heed Bill Gates’ words that the foundation’s investments in global health funds (including Gavi, the Vaccine Alliance; the Global Fund; and the Global Polio Eradication Initiative; [Gates also added the GFF]) are “the best investments that Melinda and I have made in the past 20 years, and they are some of the best investments the world can make in the years ahead.” Gates said these investments have generated returns of 20 times the amount invested….”

So why, on earth, do Peter Sands (and also Bill Gates, for that matter) then not draw the obvious conclusion? That it’s high time, for (global health) public-private partnerships to mobilize a big part of the money via taxing of the private (and global finance) sector? Put differently, let’s take ‘partnerships' to the next level 😊.

I heard Sands say, in response to a similar quote from Sania Nishtar, at the Davos session on ‘financial innovation for global health’ that ‘tax’ is “actually his favourite innovation”. Why not put this, explicitly, on the table then, also at global level (now, Sands & others mainly seem to consider tax key for domestic revenue mobilizing), for global corporations? As in: taxing the winners of globalization, and so let them really be ‘stakeholders’ in/towards a better future, and really “shoulder some of the responsibility for improving global health”.

A suggestion for the replenishment of the Big Global Health Funds (& then one more)

The same goes for Bill Gates. If, as he rightly states, replenishment of these Big Four Funds is very important to prevent  global health (outcomes) backsliding in the years to come, why not seize the current momentum in countries like the US (with AOC’s tax proposal) or many European countries, where many citizens understand damned well (and totally agree with) Oxfam’s  third key message in its annual Davos report,   to “End the under-taxation of rich individuals and corporations. Tax wealth and capital at fairer levels. Stop the race to the bottom on personal income and corporate taxes. Eliminate tax avoidance and evasion by corporates and the super-rich. Agree a new set of global rules and institutions to fundamentally redesign the tax system to make it fair, with developing countries having an equal seat at the table.’”

Jeffrey Sachs & others made an interesting suggestion in this regard, a few weeks ago, ahead of the Global Fund Replenishment – “hundreds of the super-rich could easily pledge $5 billion per year for the period 2020-2022”.  But it’s not going far enough (as he linked it to the Giving Pledge, and refrained from using the word ‘tax’, still a “toxic” term in Davos I understand). I also don’t understand why it should be limited to the GF replenishment only.

Why, instead, not explicitly, as part of the SDG 3 Global action plan, foresee taxing of multinationals ( or a similar proposal) as a way to (help) fund “the Big Four”? And of  course, WHO as well, no doubt the biggest global public health good of all?

It’s not rocket science. All global health leaders of big organizations actually believe in (more and progressive) taxing (and even Bill Gates does so, in his latest reincarnation).

The time seems certainly more than ripe. And trust me, if Global Health fails to do so in the years to come, it will suffer, funding wise and in terms of legitimacy. That would be a shame.  Conversely, global health (funding) could once again be an inspiration for other (SDG relevant) sectors.

How it needs to be worked out in detail, that’s something for (health) economists, tax experts (and lawyers), I’m not qualified 😊.

I suspect, though, that the current global health leadership is too close to Davos men & women to draw this – in my opinion, rather obvious – conclusion on “global health funding for the new SDG era”…    Let’s hope they prove me wrong in the years to come.