Canada's reduced Global Fund pledge threatens health at home and abroad

Canada should rethink its reduced pledge to the Global Fund to protect the health of people in Canada as well as around the globe, argue authors in an editorial published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.252036.

In November, Canada reduced its pledge by 16% to the Global Fund, which fights AIDS, tuberculosis (TB), and malaria and strengthens pandemic preparedness. Two related commentaries in the same issue describe increases in tuberculosis in Canada and the backsliding in addressing HIV/AIDS around the world and potential solutions.

"Canada's reduced pledge to the Global Fund reflects shortsighted political thinking that fails to appreciate the complexity of global health threats and long-term health consequences," write Drs. Kirsten Patrick, editor-in-chief, CMAJ, and deputy editor Helena Swinkels. "If the anticipated shortfall in pledges to the Fund is not offset, Canada should anticipate reduced success in domestic TB and HIV control in forthcoming years, rather than the progress toward elimination that is hoped for now."

Reduced funding will also open the door to other infectious disease threats.

"Unfortunately, HIV and TB control will not be the only casualties of the current global funding shortsightedness," write the authors. "In public and global health, managing problems in silos may seem appealing, but health threats do not fit into neat containers; they affect systems. As the COVID-19 pandemic revealed plainly, surges in rates of 1 infectious disease can ultimately affect health systems' ability to manage others. A decrease in resources for disease management adds complexity to this problem."

The CMAJ editors urge Canada's government to invest in improving social determinants of health that underly TB and HIV infection, and to implement disease-specific suggestions outlined in the related commentaries published in CMAJ, such as creating a national body to address TB and providing better access to data and medications for both diseases.