In 2001, when the late Kofi Annan, former Secretary-General of the United Nations was championed the creation of the Global Fund, he is famously quoted as saying “When I first mooted the idea of the Global Fund, people said I was dreaming… I love dreams. It always starts with a dream.” I wonder how he would have felt today about the US$11.34 billion dollars pledged for 2026-2028 funding cycle, against a replenishment target of US$18 billion to sustain momentum in the global fight against AIDS, tuberculosis, and malaria. Would he see the glass as half full or half empty?
It therefore timely that the Global Fund’s Eighth Replenishment is taking place in Johannesburg, coinciding with South Africa’s tenure as G20 president, the first time this leadership is held on African soil. Co-hosted by President Cyril Ramaphosa and United Kingdom Prime Minister Sir Keir Starmer, the meeting carries added significance not only for the continent, but for how the global health architecture at large is now shaped.
Testing Global Commitment and Solidarity
This replenishment served not only as an opportunity to reinforce global commitments but also as a litmus test for sustained support to established global health financing mechanisms. In emphasising this point, Dr. Aaron Motsoaledi, Minister of Health, South Africa, noted that “the success of this replacement on the sidelines of G20 will be a defining legacy proof that our commitment to partnership and progress is unshakable”.
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In his address, G20 President Cyril Ramaphosa acknowledged the growing pressures “multilateralism has increasingly come under strain and pressure“. Even so, he acknowledged that “this eighth replenishment summit of the Global Fund is indeed a milestone for global health, building resilient health system, scaling up local manufacturing of medicines and diagnostics and therapeutics and securing sustainable financing“. He also announced that South Africa is pledging US$36.6 million to the Global Fund, demonstrating the continent’s increasing leadership and agency in its own future.
Global Commitments and a Rolling Pledge Process
Sir Keir Starmer, who attended in person, while affirming the UK’s confidence in the Global Fund recognising its “clear ability to maximise the effectiveness of the money given to it“. He welcomed the Global Fund’s commitment “to reform, putting countries back in the lead, strengthening national health systems, keeping communities at its heart, and working ever more closely with multilateral partners“.
He also reminded the world that the major challenges of our time cannot be solved through bilateral agreements alone, echoing his words that “no one is safe from disease, until everyone is safe from disease”. The United Kingdom had previously pledged US$1.11 billion, reflecting its long-standing commitment.
The United States also made a strong showing, announcing a US$4.6 billion multi-year pledge. As one of the Global Fund’s highest donors, the US emphasised the strategic value of global health investment. Jeremy P. Lewin, Senior Official for Foreign Assistance, in a video statement stated that “The Global Fund is a critical partner in advancing the America First global health strategy“.
Overall, the Global Fund had set an ambitious target of raising US$18 billion to meet its proposed funding priorities. With US$11.34 billion pledged so far, and despite rising political pressures and competing priorities among the traditional donor countries, this can still be viewed as a relative success. This is particularly notable at a time when political pressures are driving countries to turn inwards and adopt nationalistic policies that undermine international cooperation.
However, unlike previous replenishments which culminated in a single pledging event, the eighth replenishment is being undertaken as a rolling process. Several countries, including France, Sweden, and the European Commission signalled their commitment but noted that final figures will be confirmed at a later date. This signals that the replenishment is not yet complete and that further contributions can still be expected.
Progress Achieved, But the Fight Continues
It is important to remember that the funds raised through replenishment are not an end in themselves, but a means to achieve the goals the Global Fund was created for. This is the dream Kofi Annan was referring to. While progress made has been significant to date, with approximately 70 million deaths prevented, and more countries moving closer to the UNAIDS 95-95-95 targets, there is a lot to celebrate. There have also been substantial declines in TB illness due to fewer infections and improved treatment. Despite these, the fight is far from over. Sustained funding remains essential to save an additional 23 million lives and reduce deaths from HIV, TB and malaria by 64 percent, as projected by the Global Fund.
The pledges come at a time when Africa remains at the centre of the Global Fund’s programming, with Sub-Saharan Africa accounting for around 73 percent of total Global Fund investments for the 2022-2025 cycle. During the replenishment event, partners reaffirmed their commitment to supporting the Global Fund’s lifesaving treatments, prevention efforts, and community-led health programmes, with strong interest in the innovations that are improving treatment and saving lives, from portable TB diagnostics to spatial repellents helping reduce malaria infections. The question on everyone’s mind is whether the Global Fund will also serve as a vehicle to drive the quest of the continent for increased local manufacturing. To date, not enough of the products procured through Global Fund investments have been manufactured on the African continent.
Strengthening Systems and Local Ownership
Beyond the three diseases lies the broader challenge of strengthening Africa’s health systems. While vertical programmes save lives, it is ultimately the health system that delivers outcomes. The same system that ensures an HIV-positive mother receives antiretroviral therapy must also be equipped to provide emergency obstetric care when she presents in labour. This reinforces the need for integrated, resilient systems that reflect national priorities.
Unfortunately, this has not been consistently achieved, and as many countries lost funding from the US earlier this year, they struggling to sustain services, making “integration” the buzz word.
These replenishment moments are a good opportunity to take stock, of how we are actually measuring progress in the health systems of African countries. It would be unfortunate to survive HIV treatment only to face life-threatening risks during childbirth.
Peter Sands, CEO of the Global Fund, captured this clearly: “We must align with country needs and support countries to transition to self-reliance based on domestic resources”. The continent will look for this commitment to be fulfilled.
The Accra Reset and the Lusaka Agenda offer roadmaps for this transition. The Accra Reset calls for financing models that endure beyond the SDG era, position health as an economic catalyst, crowd in private-sector participation, and build a Community of Practice for shared learning. The Lusaka Agenda urges stronger domestic leadership, investment through primary healthcare, equity-based outcomes, joint action by global health partners, and regional manufacturing capacity. The world is not used to a shift from aid dependency to a narrative of agency, yet this is the growing reality across the African continent. This year has offered hard lessons on what happens when a benevolent benefactor suddenly withdraws support.
Both frameworks call for reframing development assistance as strategic investment rather than charity, recognising the value African countries bring through local expertise, indigenous knowledge and clinical research capacity.
Nigeria’s Progress and Regional Leadership
Nigeria remains a priority country for the Global Fund and is making real progress toward the UNAIDS 95-95-95 goals, now at 90-90-86, and steadily getting closer to bringing the epidemic under control. The Global Fund has invested more than $4.8 billion in Nigeria since 2002, making it their largest country portfolio. This includes $1.2 billion from the last funding cycle and new grants signed in 2024.
Professor Muhammad Ali Pate delivered Nigeria’s pledge to the Global Fund. As one of the major recipients of Global Fund resources, Nigeria’s US$15 million pledge demonstrates genuine “skin in the game”. This also aligns with the principles of the Accra Reset and Lusaka Agenda, particularly the emphasis on domestic leadership and country-driven priorities. These agendas call for financing models that can endure beyond the SDG era, channel more investment through primary healthcare, elevate country ownership, and integrate private-sector capacity to build resilient, equitable health systems. They also emphasise accountability, regional manufacturing, and reframing development assistance as strategic investment rather than charity, principles that Nigeria’s pledge helps to advance.
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Other African countries also stepped forward with commitments, including Côte d’Ivoire (US$2.5 million), Morocco (US$1.5 million), Tanzania (US$1 million) and Namibia with (US$1 million), further signalling the continent’s growing commitment to shared responsibility in global health.
Private sector’s growing engagement was made very clear with $1.34 billion pledged, including $135 million from the Children’s Investment Fund Foundation (CIFF) and $912 million from the Gates Foundation. In his remarks Bill Gates, Chair of the Gates Foundation highlighted how the Global Fund had “worked with the private sector, has reduced treatment costs dramatically and sparked incredible new tools, including portable TB diagnostics and drugs that prevent HIV infection with just two doses per year.” This was a reference to the Lenacapavir, an injectable that prevents HIV infection, recently introduced in Eswatini and Zambia points to the need to ensure that these tool reach everyone who needs them. He further stressed why the Gates Foundation was supporting the Global Fund “we believe that when we have these great tools to save tens of millions of lives, we should make sure they get to everyone who needs them”
In closing the eighth replenishment meeting, and in announcing the pledges received so far, President Cyril Ramphosa reminded the audience that “the pledge amount is no mere number. It is an amount that has an impact. It is a solid foundation for impact and a renewed impetus for transformation and change, millions of lives will be saved, stronger, more resilient. health systems will be built”.
“It always seems impossible until it is done” — Nelson Mandela