IHP news 543 : “We need a Greta as well !” ( 18 October 2019) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, This week, with many of you probably already looking forward to the World Health Summit in Berlin, we come back on the Global Fund replenishment from last week (among others, with a Featured article from Stéphanie Tchiombiano, Coordinator of the French think tank Santé mondiale 2030 ) ; cover the start of the IMF/WB annual meetings ( The Bretton Woods conference took place 75 years ago, so this is sort of an ‘anniversary’, albeit a gloomy one); World Food Day (16 Oct) and of course provide you with the usual digest of the main other global health policy news & publications (including a new Global TB report ). With multilateralism in crisis (the UN’s current cash- flow crisis is a rather wry symbol of our times - the 75th anniversary of the UN in 2020 looks grim, for now ) and people all over the world protesting in the streets (at least if they’re allowed to, and police & government don’t crack down on them ), many in the development & aid sector are wondering what we can learn from the impact of Greta Thunberg and the global climate strikes. Check out for example this analysis on Open Democracy, What INGOs can learn from Greta Thunberg and the global climate strikes. A quote: “ While Greta Thunberg has mostly targeted governments and multilateral bodies for their failure to tackle the climate crisis, the global Climate Strike Movement her Friday protests have inspired may also have inadvertently exposed the shortcomings of international non-governmental organisations (INGOs). With the kind of global reach and popular mobilisation of which most INGOs can only dream, the climate strikes have succeeded in catapulting the climate crisis to the top of the political and media agendas. In the process, this movement has exposed the lack of critical interrogation by INGOs of government and corporate inaction to reduce global warming, and shed light on the growing inertia of an INGO sector that trades in incremental change rather than systemic political and economic transformation. …” In global health circles, you often hear nowadays “We need a Greta as well” – for this or that lofty cause, whether it’s AMR, NCDs, …. Presumably, to raise awareness and start a global movement on ‘their’ cause as well. But as the abovementioned quote makes clear, ‘being a Greta’ has rather “disruptive” implications in terms of the transformative change one should advocate for, the ‘partners’ one should (perhaps better not?) seek, and the likelihood of ‘win-wins’ while fighting for global health. Perhaps a good question to dedicate an abstract or even session to, in Dubai? What does being a Greta for global health, HPSR, the SDGs … really imply? What would a global health Greta think of the Global Fund replenishment, by the way (PS: the GF PR team seems to take a sardonic pleasure in widely advertising its collaboration with Coca Cola )? And more importantly, how can we all become more like her, uncompromising when evidence asks us to, in order to really get to Health for All on a now rapidly warming planet ? 1 Or, as Billie Eilish would probably sing, “All the Gates girls (& Bono boys) go to hell ... ‘Cause even God herself has enemies. “ Enjoy your reading. Kristof Decoster Featured Article What can we learn from the 6th Global Fund Replenishment Conference in Lyon? Stéphanie Tchiombiano, Associate Lecturer, Paris 1 Pantheon Sorbonne and Coordinator of the French think tank Santé mondiale 2030 Funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria is based on the organization of conferences during which various donors (States and private actors) make financial commitments for the next three years. After Canada (in 2016), France just hosted the latest edition, on October 9 and 10, 2019, at the Centre de Congrès in Lyon, under the slogan "Step Up the Fight". A financial mobilization unprecedented in the history of health Never before has an international organization dedicated to health succeeded in mobilizing such a large amount of money. This mobilization is all the more important as it takes place in a context where the United Nations system, including WHO, has difficulty in securing funding. The target was to mobilize at least USD $14 billion (€12.7 billion), which the Global Fund estimates will save an additional 16 million lives. This financial target (considered insufficient by some) has almost been reached, with USD 13.928 billion in commitments at the conference and an additional USD 100 million to be sought by December. The slogan of a 15% increase in contributions over the previous conference in Canada was generally heard (USD $12,9 billions were pledged in Montreal). A real happening Delegates from all over the world will have been on the alert throughout the conference. In the morning, Emmanuel Macron announced in his speech that the situation was critical, that the full amount wasn’t there yet, but that "no one would leave Lyon until we reach 14 billion", calling on delegates to "put pressure", announcing that he was going to make relentless phone calls and even citing by name certain States that "could do better": "Call in your capitals. Harass the countries I mentioned. Go help me get the money within three hours.” With the finish line in sight, several countries made an additional gesture (including France, which finally increased its contribution by 20%, under strong pressure from the NGO sector, which demanded a 25% increase), following the momentum of "Peter, Bono and Bill", as all three of them went on stage calling for increased funding: Peter Sands, the director of the Global Fund, Bono (the singer of U2, co-founder of the initiative (Red) and Bill Gates, the American billionaire who added $60 million in the final sprint. This symbolic staging 2 and last-minute donation obviously helped to reinforce Bill Gates' (problematic) weight in the global health ecosystem. Strong engagement of civil society and the scientific community One of the particularities of this replenishment conference was the mobilization of many actors, beyond the official delegations (several African heads of state were present): the organization of about fifteen side events, a "Die In" by the French association “Aides” in front of the Congress Centre, various stands, etc. The official ceremony was marked by a strong tribute to Kofi Annan (considered one of the founding fathers of the Global Fund) and by the intervention of several Nobel Prize winners, including Françoise Barré-Sinoussi (Nobel Prize in Medicine in 2008 for discovery of the HIV virus), who made a strong appeal to strengthen links between researchers, political decision-makers and field actors: "We need science". Several African countries decide to finance the Global Fund One of the highlights of this replenishment conference was the decision of many African countries to help finance the Global Fund. While some countries such as Côte d'Ivoire and Senegal were already donors, others such as Niger, Chad and the Central African Republic now also committed to financing the Global Fund (USD 1 million for the first two and USD 500,000 for the third), becoming both donors and recipients of the Global Fund. Several international NGOs, such as Catholic Relief Services, Cordaid or Plan International, are now also members of the Global Fund's donor club (from which they in turn receive many funds in the countries of intervention). The financial flows of international aid sometimes make surprising detours. Inability to mobilize beyond the G7 countries & failure to get a substantial financial contribution from the private sector (minus the Gates Foundation) The Global Fund remains very dependent on the US government, which is responsible for exactly one third of its budget (USD 4.680 billion) for the next three years (the US Congress having set itself the firm rule of not financing more than one third of the global budget). Next, come the United Kingdom (USD 1.716 billion), France (USD 1.429 billion) and Germany (USD 1.102 billion). The general dynamic of the event and the personal investment of Emmanuel Macron (who was said in the corridors of the congress centre to have "done the job", together with Peter Sands’ team) did not succeed in mobilising new countries, beyond the G7 countries, and in particular the BRICS, which remain absent (Brazil, Russia) or very cautious (China, India, South Africa). Similarly, private sector actors remain very marginal funders, accounting for only 5% of the overall budget ( and they are almost non-existent if the Gates Foundation is removed) even though the Global Fund systematically emphasizes its "public- private" nature and the word "innovation" was certainly the word most often mentioned at the conference (together with the word "Bill"?). In any case, the bet has paid off for France, which, by hosting this conference, seems to have regained its place among the "countries that count" within the Global Fund. It will have to move into action and support this financial effort with a mobilization at the highest level for global health issues in the coming months. The dynamic created by the replenishment conference should not only launch a new French dynamic in global health but also lead to a more in-depth reflection on the future of the Global Fund. 3 Highlights of the week Annual meetings IMF/WB week (14-20 October) & 75 years “Bretton Woods” Analysis ahead of the IMF/WB meetings Devex - 5 questions for the World Bank and IMF Annual Meetings Devex; “David Malpass and Kristalina Georgieva [will] preside over their first World Bank and International Monetary Fund Annual Meetings as the heads of their respective institutions this week.