“It’s a huge issue for countries, which see this next period of time as absolutely critical in terms of scale-up,” Carter said. She also said the decision sends the wrong signal to developing nations “in terms of encouraging their own ambitions” to more aggressively confront the epidemic.
The board’s decision reflects the grim recognition that its greater responsibility is to people already in Global Fund-funded programs who might die if the money ran out or was switched to other purposes.
“We do realize we have a very strong obligation to support these programs,” Benn said. “We can guarantee that programs that are currently running will continue.”
The fund’s directors also decided that China, Russia, Mexico and Argentina will no longer be eligible for Global Fund grants because they can afford to pay for the health programs on their own.
Grants are made for two years, with the possibility of extension for another three if performance benchmarks are achieved. At the end of the five years, however, a program can begin the process again — effectively making the Global Fund the permanent paymaster for state-of-the-art AIDS and tuberculosis therapy in places where that would be otherwise unaffordable. In all, 54 percent of the fund’s spending has gone to AIDS programs, 29 percent to tuberculosis and 17 percent to malaria.
In August, the fund solicited applications for new programs, the 11th round in its 10-year existence. The deadline for applications was to be March 2012, and about 90 countries were expected to submit requests for money. That round has now been canceled.
The United States is spending about $6.1 billion on overseas AIDS programs this year. Most of the money for antiretroviral treatment is delivered through bilateral agreements between the United States and recipient countries, often with universities and large charities acting as intermediaries.
Of that total, however, $1.05 billion went directly to the Global Fund for use in its awards. The Obama administration is seeking $1.3 billion for that purpose next year, although many observers say the fund will be lucky if Congress keeps the contribution at the old level.
In addition to paying for AIDS testing, treatment and prevention programs, the Global Fund over its lifetime has financed 8.2 million courses of tuberculosis treatment and the distribution of 190 million insecticide-treated mosquito nets for people to sleep under in malaria-endemic areas.