‘If global fight against AIDS, TB and malaria is going to be won, it has to be won in India’

Peter Sands,
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Last month the government hosted a preparatory international meeting for the replenishment of the Global Fund to Fight AIDS, TB and Malaria, which is seeking to raise $14 billion for funding health systems globally over the next three years. Peter Sands, Executive Director of the Global Fund,spoke to Nalin Mehta on the issue:


What is your sense of progress India has made on AIDS, TB and malaria?

India is incredibly important to the global fight against AIDS, TB and malaria. On TB, India has the sad distinction of having the largest TB burden in the world – about 27%; on AIDS, it has the second largest and on malaria it’s less – about 4% – in terms of cases. If the global fight against AIDS, TB and malaria is to be won, it has to be won in India, and that is particularly the case with TB and AIDS.

On malaria, dramatic progress has been made. The latest WHO world malaria report singled out India for its progress – 24% reduction in cases in 2017 compared to 2016. But if you go back further, since 2000, the number of cases has been halved and number of deaths has come down dramatically.

On HIV, 81% of people know their status, 71% are on ARV (antiretroviral) treatment. Again, good progress but still a lot to do. We are still talking about 2.1 million people living with HIV and something like 88,000 new HIV cases a year.

TB is perhaps the greatest challenge for India with 27% of global TB cases and 33% of the global TB mortality in India. Roughly, there are about 27 million TB cases a year in India. About one million of those are not identified. There is a very high rate, relative to the rest of the world, of latent TB infection, at about 40% of the population.

Having said these, there has been a huge step up in commitment from India led from the top by Prime Minister Narendra Modi himself, with an ambition of ending TB by 2025 with the national strategic plan and significant commitment of incremental resources. India doubled its financial commitment to fight TB in this three-year cycle against the earlier one. We have been seeing the results of that coming through. For example, TB notifications in 2015 were 1.7 million and 2.15 million in 2018.

What about multidrug resistant TB?

Multidrug resistant TB is a deeply serious challenge. The world as a whole is not taking it seriously enough. This is a threat with very high fatality risk, very difficult to treat and it’s pretty contagious. Worldwide we have almost 600,000 people with MDR-TB and only about a quarter of those are being treated. Also, a quarter of that is present in India. If you think in terms of health security, this is probably one of the most potent threats in India and the world.

What is the importance of India hosting the Global Fund’s replenishment preparatory meeting ahead of the final replenishment conference in France in October 2019?

India is a very significant partner and it is the first time we have held one of these preparatory meetings in an implementing country as opposed to a donor country. That’s important because that is where the fight is happening. We see India showing demonstrable leadership in this fight. It is also showing a domestic commitment to increase resources in the broader context of building up its health system.

How do you see the broader global debate about international aid for countries as they become higher income countries?

It’s a debate that isn’t susceptible to pat answers. The Global Fund is engaged with a much broader range of lower and lower-middle income countries. Countries are taking ownership and becoming wealthier and also taking responsibility for taking care of their citizens. That’s the way you ultimately achieve sustainability. But it has to be done in a very planned and thoughtful way. The transition process has to be very carefully managed.

So, the transition for India is still a fair bit down the distance?

The transition as an endpoint is a fair bit down the distance. The transition as a process over time is about the government taking more ownership. That’s something we think the government should take responsibility from the beginning.

How differently do you see India and China as donors?

It is a different situation. The Global Fund is not funding grants in China. China has been a relatively modest contributor to the Global Fund. In India, in our current grant cycle, we are funding about $500 million and have put in $2.1 billion over time. India has simultaneously been a modest donor. So, it’s different, the fundamental difference being that we continue to make significant grants to India.

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