Reflections on Righting the Global Fund
February 29, 2012
J. Stephen Morrison
Senior Vice President and Director, Global Health Policy Center at CSIS
As 2011 wound to a close the drama around the Global Fund intensified, as did the angst and uncertainty of its future, and prospects for a durable recovery. I began at that time a series of conversations with my co-author and friend, Todd Summers, with whom I had written about the Global Fund at its creation a decade ago, and who has remained integrally involved in the Fund’s work. We agreed it would be valuable to compose a candid, fair-minded look back at the root causes of the Fund's travails, combined with a positive but realistic look forward, focused on the emerging, fragile path to the Fund’s restabilization.
The Fund had become inherently prone to crisis as it moved towards the end of its first decade, and as the global economic recession persisted. Most observers were slow to recognize these vulnerabilities. The Fund’s abrupt transition proved rocky – strategically, psychologically, managerially – as it moved from the hubris of its heady expansionary phase into the current era of scarcity, heightened scrutiny and accountability. Many key decisions on what would be needed to repair and sustain the Fund were ultimately bundled and advanced in the midst of a worsening crisis of confidence and trust at the end of 2011. Those decisions altered the Fund’s fundamental outlook and methods of operation, they were accompanied by a change of senior leadership, and they were reinforced by significant additional pledges of funding, most notably from the Bill and Melinda Gates Foundation and the U.S. government.
In this process, the United States has become even more conspicuously identified with the Fund. Its investments in the Fund have risen recently in surprising and significant ways, and the de facto interdependence of the bilateral PEPFAR programs and the Fund’s activities has become ever tighter. That marriage has not been without its tensions, and there is a certain degree of unresolved confusion over the rationale and long-term vision guiding the Obama administration’s decisions.
Behind all of these choices was a strong sense that the Fund simply could not be allowed to fail – certainly not in a period when the President has pledged to increase from 4 to 6 million the number of persons on life-sustaining anti-retroviral treatment by 2013. And when the global AIDS gathering, AIDS2012, returns to the United States, to Washington in July of this year, after a hiatus of 22 years.
In this next phase, a delicate challenge will be managing expectations, insisting upon a realistic appraisal of the complex challenges of righting the Fund, and ensuring in the Washington context that a bipartisan foundation of support is preserved.
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