Fighting  AIDS  and COVID-19  depend on a firm foundation   

Twenty years ago, the world faced a devastating pandemic that was spreading rapidly around the world. Then, 5 million people were being infected with HIV and 3 million were dying from AIDS each year. In 2020, an estimated 1.5 million people were infected with HIV, and AIDS killed an estimated 680,000 people. This progress did more than save lives; it built the public health foundations that many countries now use to confront the COVID-19 pandemic.

These foundations exist, in large part, because of historic U.S. leadership and investment in the global AIDS response over the last two decades. President George W. Bush pledged the first U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in 2001. And nineteen years ago today, he launched the President’s Emergency Plan for AIDS Relief (PEPFAR), in his 2003 State of the Union address. Since then, the U.S. government has invested nearly $100 billion in these two landmark programs, enabled by strong bipartisan leadership from Congress and the compassion and generosity of the American people.    

In addition to transforming the trajectory of the AIDS pandemic, U.S. global health investments have supported countries to better prevent, detect and respond to other health threats, and increased global health security. As President Biden said on World AIDS Day 2021: “By strengthening countries’ abilities to fight AIDS, we’ve also improved our collective ability to fight other diseases.” 

With PEPFAR and Global Fund support, partner countries have increased the reach and resilience of their health systems, with the capacity to adapt, innovate and respond rapidly to significant shocks. Combined, PEPFAR and the Global Fund invest more than $2.2 billion annually in strengthening health systems. PEPFAR supports programs at more than 70,000 facility and community health clinics linked to 3,000 laboratories, nearly 300,000 health care workers, expansive supply chains for health care commodities, and strong local systems for health data collection and use. Both efforts have invested substantially in community health systems, empowering affected communities to design and deliver services tailored to their needs.

These same systems have been vital in the global COVID-19 response, much as they proved previously in containing Ebola and H1N1. As Secretary of State Antony Blinken noted last year in Nigeria: “PEPFAR has saved millions of lives, brought the world to the edge of the first AIDS-free generation — and transformed public health infrastructure … where the investments we made years ago in labs and clinics formed the backbone of this nation’s COVID response.” 

Working together, PEPFAR and the Global Fund have supported countries in the following ways:

• to conduct tens of millions of COVID-19 tests;
• utilize surveillance capabilities built for HIV detection to identify and address COVID-19 hot spots;
• use health management information systems for HIV programs to collect and use data on COVID-19 cases, deaths and vaccinations;
• deliver COVID-19 test kits, personal protective equipment, laboratory reagents and other essential commodities through HIV health care supply chains; and
• administer millions of COVID-19 vaccinations, including by addressing vaccine confidence.

HIV programs have proven remarkably resilient in the face of COVID-19. In the past year, PEPFAR and the Global Fund have not only protected access to life-saving antiretroviral therapy for tens of millions of people but also added millions more in need to the treatment rolls. While HIV prevention services in many countries were disrupted by the COVID-19 pandemic, rapid adoption of digital and other innovative approaches mitigated the interruption and enabled continued — and, in many cases, expanded — access for millions of people. 

Yet, our work is far from finished. COVID-19 continues to pose a significant global health threat, including to the 37.7 million people living with HIV worldwide. In the poorest countries of the world, the trickle-down impact of the COVID-19 pandemic on HIV, tuberculosis and malaria programs is causing additional harm, particularly to the most vulnerable.     

Reaching the U.N. Sustainable Development Goal target of ending AIDS as a public health threat by 2030, as well as controlling the COVID-19 pandemic, will take sustained effort and investment, as will preparing for the next big global health threat. U.S. leadership in hosting the Seventh Replenishment of the Global Fund this fall is one step toward a global mobilization that is needed to prevail in fighting AIDS and building back better. PEPFAR and the Global Fund have helped countries build firm foundations for combating infectious disease as well as broader pandemic preparedness and response. We are poised to continue supporting them to meet these evolving challenges well into the future. 

Dr. Angeli Achrekar is the acting U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, leading the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) at the U.S. Department of State.

Peter Sands is the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.