Thursday, January 23, 2020

Mark Dybul makes Global Fund’s USD 13 billion case

As the 2017-2019 replenishment conference approaches, Mark Dybul’s best hope may be to convince rich countries that it is in their own best interest to wipe out Aids, TB and malaria.

When he was appointed Executive Director of the Global Fund in 2012, Mark Dybul took over an organisation that had just come through a crisis of confidence that saw funding slashed and major internal reforms. With less than a year until the 2014-2016 replenishment meeting, Dybul had little time to prove that the Global Fund had its house in order and could be trusted to receive billions of dollars to combat the three deadliest diseases of the developing world: Aids, TB and malaria.

The result of that replenishment three years ago suggests that Dybul misread the donors. The Global Fund asked for USD 15 billion, but received just USD 12 billion.

On September 16, Dybul faces a replenishment meeting once again, this time in Montréal, for the 2017-2019 period. The fund-raising target is a more modest USD 13 billion.

“We may have aimed too high for a lot of the wrong reasons last time,” says Dybul to Development Today during a recent stop in Oslo. He explains that setting the target for the coming three years has been a methodical exercise, not a matter of guessing the donors’ pain threshold.

“We don’t just sit down and think ‘how much do you think donors will give us?’ and then come up with a number,” he says.

Rather, the Global Fund engaged modellers from independent technical agencies who meticulously examined the trajectory for the three diseases and tried to determine what it would cost to maintain the positive trends. This process resulted in the USD 13 billion target, says Dybul.


A recent Global Fund report shows that programmes supported by the fund have resulted in 20 million lives saved and, since 2012 alone, averted 146 million new infections from the three diseases. The task now is to maintain the positive trajectory.

“For the first time we actually looked at value-for-money investments, not doing everything everywhere but really focusing investments in the places where infections are occurring and the highest risk populations live,” he says.

Dybul says engaging youth and focusing on women and girls are key themes of the upcoming meeting.

“We can’t end HIV, TB and to some extent malaria unless we have a gender equal world. In fact we can’t achieve any of the SDGs without a gender equal world,” he says. 

Pointing to the link between education and health, he notes that HIV rates for adolescent girls and young women are 8-10 times higher than it is for young boys. “The data show that if you keep girls in school, you can reduce the rate by up to 60 per cent; 12 per cent per year in secondary school.” He underlines the importance of working with other actors, like the World Bank, and on coherence between sectors.

Eradicating the three diseases would bring tremendous benefits to some of the world’s poorest countries. But Dybul has another argument that may have even more weight for donors. He says the next three-five years are crucial:

“We are the generation that actually has the tools to bring these epidemics under control.  Or are we the generation that loses control because we took our eye off? ... If we don’t continue to invest, the epidemics will get off that trajectory, and they will come back in drug-resistant form because that is the nature of infectious diseases that you’ve treated.”

Dybul says treating drug-sensitve TB costs a couple of hundred dollars or less per patient, whereas treating multi-drug-resistant TB costs over 20,000 dollars per person.

“We simply don’t have the money for that,” he says. “Those are real risks to the world.”