Getting to zero: how do we keep funding flowing?

MARK DYBUL — Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

The greatest lesson learned from the AIDS epidemic about generating commitments for resources is the importance of political leadership. From President Festus Mogae in Botswana, who made the decision to fund antiretroviral treatment when the public health experts were saying it wasn’t possible, to United Nations Secretary-General Kofi Annan, who conceived of the Global Fund to Fight AIDS, Tuberculosis and Malaria and then convinced the Group of Eight (G8) to create it, to President George W. Bush, who stunned the world by launching the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the largest international health initiative for a single disease in history, the decisions of key national and international leaders drove the domestic and international funding that has fuelled the response to AIDS.

But leadership doesn’t exist in a vacuum, and leaders are confronted with many important issues every day. What are some of the key factors that drive them to make decisions? The most important ones are data that can convince leaders that not only is there a big problem, but that there also is a solution. The calendars of policy-makers are filled with a revolving door of people who bring them big problems, what political leaders want is a problem they can do something about. And to keep the funding flowing, it is essential to set clear targets and show progress towards achieving them.

Data on a problem and its solution have to get through the protective walls that surround leaders. It is essential to have advocates who have access to them, people with no vested interested in the topic, who still know how to take complicated data and explain it in five minutes in a way that is targeted to the particular sensibilities of each leader. For a public health person to push for HIV funding is expected; to have Bill Gates and Bono do it gets attention.

Data needs to be packaged for high-level advocates to be effective. That’s where the legion of civil society, faith- and community-based organizations, think tanks, advocacy groups, scientists and public health officials make all the difference. From the beginning, it was the community of affected people that created the foundation for financing. Even if these groups and individuals never had direct contact with a high-level political leader, they produced the data, experience and arguments that created the ground swell that became political action.

Looking to the future, the same factors need to be maintained. In fact, they need to be accelerated. We seem to be in a period of complacency and some, understandably, seem weary. But now is the time to get to zero — ending the AIDS epidemic as a public health threat. Nearly 15 years ago, the goal was to stop the dying and to reverse the epidemic. If we stay locked in that paradigm, however, we will win some battles but lose the war. The two key drivers for political leadership to increase funding — international or domestic — for the future will be: (1) reducing new infections on a slope to reach control, and (2) increased domestic finance. All effort needs to focus on those goals or we will not get to zero.