It hasn’t been the best week for the Global Fund so far, to say the least. But perhaps this was to be expected in the new “Trumpean era”. With hindsight, the last replenishment round in Montréal, in September 2016, might have been the swansong of the old “MDG-style” Global Fund. At least financing in the SDG era and the relationship with major donors will need a thorough revamp in the coming years. So as the Global Fund is continuing its search for a new boss, somewhat desperately, here are a couple of short reflections.
Laurie Garrett expressed it eloquently in her global health newsletter a few weeks ago : “…Having hitched their wagons to globalization, broad humanitarian missions—chiefly financed by the U.S. and UK governments and U.S. private interests—were overly vulnerable to political change in the United States and United Kingdom.” Enter Brexit & Trump, and yes, it’s a brave new world now, she rightly emphasized.
Now that it gets clearer by the day that Trump means no good for foreign aid in general and global health in particular, I’d say it’s perhaps also time for the Global Fund to rethink its financing model – aka the replenishment rounds, which have been very successful over the last decade, but might no longer be so in the new times. At least not the way they have been planned and lobbied for till now. I have a hunch that the “fracas” in the hunt for a new Global Fund executive director also – at least partially – has to do with the new “donor situation”.
Of course, the Fund could continue the way it’s been doing, by mostly targeting the (few remaining) liberal Western governments that are still genuinely interested in global health, and “getting” global health (with Merkel as a prime example of late, but perhaps also Justin Trudeau and a few others – although in Europe at least, nowadays leaders seem mostly keen on “grandstanding” at high-level conferences, rather than putting real money in). Or they could perhaps go further in the direction of (more) performance-based replenishments, as the UK seems to be advocating for. ( I don’t expect much from BRICs countries, when it comes to GF financing, they have their own worries and agenda)
But we can forget about the US, for the near future at least. The Americans will be lucky to avoid a far-right regime, if things continue the way they’ve been going lately. America First “national security” will imply, under Trump, more walls and defense. Certainly forget about much signs of “enlightened interest” in the world elsewhere. The Trump computer says no.
Along the same lines, forget also about all these silly attempts to “reframe” global health so that it can appeal to “businessman” Trump or ‘keep/make America great (again)’. It’s humiliating (which is fine, and it was perhaps worth trying, with so many lives at stake), but sadly, it won’t work. (For a slightly similar debate, on how to ‘reframe’ climate change, and why it’s probably not worth trying, see Vox.)
So here’s my suggestion: why not finally (really) “target“ multinationals, big money from high-net worth individuals (the likes of Richard Branson et al) and other winners of globalization (like global football stars), to fill the Global Fund’s coffers and make sure that really no one is ‘left behind’? Not millions, this time, as in the old MDG days, no, but billions. Trillions is also fine :).
More in general, why shouldn’t the Global Fund – instead of the, sadly, continuing siloisation in global health- ally with organizations working for other global public goods, and let their causes finance – more consistently and systematically – by the winners of globalization (via global taxation)? The Starbucks, Facebooks, and other Silicon Valley tycons … of this world? They are so liberal and open-minded when it comes to migration (and rightly so), so let’s have them also pay for the (very necessary) global public goods to really show where their heart lies. In this way, you’ll also take away some of the prime “munition” of the Trumps, Le Pens & Farages of this world. So there could be very useful political spin-offs of this sort of disruptive financing model.
If we’re serious that another world is urgently needed, as compared to the “more walls, xenophobia & defense” ingredients that the far right is propagating, both in the US & Europe, and will most likely lead to war and endless suffering instead of more “national security”, it’s time for – let’s call it ‘the liberal side’ – to rally and seek the money where it can be found in the New Gilded Age. So the Global Fund should perhaps team up with other global public goods institutions and organisations (the UN first of all), and seek at least part of the money needed (more systematically) among the winners of globalization and the 0.01 % in particular. Especially the tax dodgers among them. Before I forget, preferably not of the “leveraging” kind… 🙂
The GF executive director who at least tries to shift the financing model in this way, gets my vote. (Not that the Board will be asking me 🙂 )