Global efforts to fight three of the world’s most harmful and widespread infectious diseases – AIDS, tuberculosis and malaria – are now threatened by dramatic cuts to global health financing.
In January, the United States – previously the largest funder of global health programs – announced a suspension and review of all international aid. Since then, the United States has not fulfilled nearly US$3 billion of the US$6 billion it had pledged to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2023 to 2025. Australia has announced its pledge for the Global Fund’s next three-year funding cycle, but the scale of today’s challenge goes far beyond current approaches.
Unless more substantial pledges are made in the coming weeks, there will be huge setbacks in decades-long efforts to reduce illnesses and deaths.
At the last Global Fund replenishment, Australia pledged A$266 million – falling short of the sector’s call for $350 million. That pledge was meaningful, but with US funding collapsing and regional programs losing World Health Organisation (WHO) and Centres for Disease Control and Prevention (CDC) technical support, the shortfall has only grown. The Global Fund has long played a fundamental role in the fight against HIV, tuberculosis (TB) and malaria in countries with fragile health systems. Grants from the Global Fund help purchase medications and diagnostic tests, pay health workers and sustain prevention efforts.
For Australia, this is not an abstract issue: the Pacific and Southeast Asia carry some of the world’s highest burdens of TB, HIV and malaria. Continued Global Fund support, alongside Australia’s bilateral contributions, helps safeguard the health of our closest neighbours. Unless more substantial pledges are made in the coming weeks, there will be huge setbacks in decades-long efforts to reduce illnesses and deaths.
Médecins Sans Frontières/Doctors Without Borders (MSF) provides medical care to tens of thousands of patients with HIV or TB and more than 3 million people with malaria each year. While our work is not financed by the Global Fund, we are deeply concerned about the impact of weakening support. The consequences will be greater illness, greater burdens on public health systems and greater levels of preventable deaths.
Across our own region, the picture is especially worrying. In Papua New Guinea – where TB and drug-resistant TB rates are among the highest in the world – the country still lacks a reference laboratory for diagnosing drug-resistant TB and relies on Australia for technical support. In the Philippines, HIV infections have skyrocketed from around 4,400 in 2010 to nearly 30,000 in 2024. Meanwhile, the loss of US funding has hollowed out TB surveillance and drug-resistant TB management, leaving major gaps in care regionally.
The reality of infectious diseases is that, when left unchecked, they worsen and spread. Cutting funding risks reversing years of hard-won progress. Millions now live healthily with HIV thanks to viral suppression, yet HIV still causes more than 600,000 deaths each year. Community-based organisations supported by the Global Fund are among the most effective at improving prevention and treatment outcomes. Their progress must not be undone.
In March this year, the WHO Western Pacific office warned that the loss of US funding is already undermining programs. In Cambodia and the Philippines, national TB plans are being delayed, HIV and hepatitis services in Laos and Cambodia risk losing core staff, and malaria surveillance and drug-resistance monitoring across the Mekong region have been slashed. In PNG, where TB and malaria remain rampant, mass drug administration campaigns face cancellation. These are not one-off program cuts, they are the start of a multi-year decline in Global Fund resources, and they directly weaken the capacity of our neighbours to manage infectious diseases and contain their spread.
At the same time, medical advances show extraordinary potential. New injectable pre-exposure prophylaxis (PrEP) can prevent HIV acquisition and protect people at high risk, lowering transmission more broadly. Tuberculosis, which still causes 1.5 million deaths each year, can now be detected earlier and treated with shorter, safer regimens – innovations that Australia helped pioneer through its funding of the TB Alliance. These breakthroughs can only be scaled with sustained investment.
Australia has also contributed to global TB innovation. Funding to the TB Alliance helped develop Pretomanid, a drug now central to shorter regimens for drug-resistant TB. Today, Australian-supported programs are helping roll out these regimens in PNG, Mongolia, Brazil and the Philippines. This is a success story: Australian taxpayer dollars, MSF clinical trials, WHO technical assistance and Global Fund financing combining to deliver safer cures for patients who once faced years of toxic treatment.
With the collapse of US government funding, the idea that governments in developing countries and fragile states can fill these global health funding gaps themselves and cover their own needs is not viable. As our recent report Deadly Gaps shows, the cost burden inevitably falls on patients who cannot afford care.
Fighting HIV, tuberculosis and malaria is a global, generational challenge, and it is far from over. Australia may need to carry a larger part of the global health funding burden to keep us and our neighbours safe and well. Beyond funding, Australia’s moral leadership will be increasingly important in persuading other states to maintain and strengthen efficient and effective multilateral approaches to global health challenges.
