Q&A: "Moment of reckoning" in fight against AIDS, TB, malaria

• Risk of reversing gains amid cuts, Global Fund chief warns
• Funding cuts "wake-up call" for disease-hit regions
• Health security at risk if momentum lost

BRUSSELS - The slashing of funds for life-saving health projects around the world could unravel decades of progress in fighting AIDS, tuberculosis and malaria, forcing a "moment of reckoning" for global health, the head of the Global Fund told Context.

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said his organisation, alongside other health groups, was working to fill urgent gaps after the U.S. government froze foreign aid, and other countries reviewed their donor budgets.

Context spoke to Sands to find out more.

International aid groups are grappling with a tough financial climate and increasing demand because of conflict and climate change. What is at stake for global health?

"We are at a moment of reckoning after extraordinary progress. In Malawi, life expectancy in 2000 was 46 and it was 65 by 2019. That's 19 years in 19 years. I don't think there have been many moments in human history when you've seen that level of increase in life expectancy.

"With HIV, we are so close to winning, particularly with these new long-acting injectable PrEP (HIV pre-exposure prophylaxis) which will be available later this year and have proven almost 100% effective.

"With that, we could dramatically reduce the number of new infections, and that changes the dynamic of HIV as an epidemic completely.

"But now we risk not just slowing down progress. There's a real risk of reversing it."

As funding dries up, is this an opportunity to innovate?

"There's this over-used phrase "never waste a good crisis". I do think that constraints are a catalyst to innovation. The pressures we're under now will undoubtedly catalyse even more innovation.

"But I don't think we should kid ourselves. If we end up with significant reductions in funding for global health, we won't miraculously find a way of totally mitigating that, particularly in the very poorest parts of the world."

"This crisis has been a wake-up call to many governments in some of these affected countries to reduce their reliance on external funding, and that's a good thing. But too abrupt a transition will derail progress, it will leave people behind, it will cost lives."

Why is it important for global health to continue funding?

"If we lose momentum in treating infectious diseases like TB, that's a real health security threat because drug-resistant TB is one of the nastiest things out there - and we don't have a grip on it.

"One of the biggest examples of antimicrobial resistance is drug-resistant TB, and TB is a good example of why you need to do things at scale and well-resourced and correctly, because a lot of drug-resistant TB has been caused either by substandard first-line treatments or by incomplete treatment."

European governments are prioritising security and defence budgets. Can health fall under security concerns?

"If you go to places that have very high rates of malaria, people can't work. Kids' schooling gets interrupted. People live under a constant fear of death. It's very difficult to build a functioning society.

"What happens to people in that situation, they move, they don't want to be there. If we want the world to be composed of places which are functioning, stable and peaceful, good health is a basic prerequisite for that."

This interview has been edited for clarity and brevity.

(Reporting by Joanna Gill; Editing by Ellen Wulfhorst.)