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Op-Ed

Canada’s Next Act of Global Health Leadership

John McArthur

Canada’s global health contributions remain underappreciated in our national debates. Amid flashpoint foreign policy topics of conflict and military deployment, the quieter business of delivering health services usually affects a far greater number of lives around the world. In recent years, Canada’s contributions have been nowhere more evident than in its founding support for the Global Fund to Fight AIDS, TB, and Malaria. Over the coming week, Canada has an opportunity to provide decisive leadership for the institution’s critical next phase of expansion.

The Global Fund’s Fourth Replenishment conference begins in Washington next Tuesday, Dec. 3. It will cover the three year period 2014 through 2016, including the final stretch of the Millennium Development Goals through to end-2015. As a pioneering blend of government, non-profit and private sector partners, the Global Fund has played a pivotal role in transforming minimum global health standards.

Canada has long been in the middle of this global health revolution. The 1996 Vancouver International AIDS Conference was the watershed moment presenting evidence that antiretroviral medicines could convert AIDS from a death sentence to a treatable disease. But by 2000, treatment still remained essentially inaccessible throughout the developing world. At the time roughly 30 million people were HIV infected, mostly in Africa, where the disease was killing more than a million people year. In 2001, then-UN Secretary-General Kofi Annan called for the launch of a new global fund to make treatment possible at scale. Canada joined the Gates Foundation, the United States and a handful of other countries to seed the institution.

Many individual Canadians have been centrally involved in the global effort. For example, Stephen Lewis served with passionate distinction as UN Special Envoy for HIV/AIDS in Africa. James Orbinski was a leader in advancing academic research and access to essential medicine. Stephanie Nolen vividly documented the personal journeys of individuals struck by the AIDS pandemic. Ernest Loevinsohn played a crucial role helping to shape and govern the Global Fund itself. By 2010, Prime Minister Stephen Harper had assumed a personal leadership role on global health accountability, especially on areas linked to maternal, newborn and child survival.

Today the Global Fund has racked up a stunning track record of success. It has made AIDS treatment possible for more than five million people, including an extra million people registered in the first part of 2013 alone. Thanks to the Fund and its partners, nearly 300 million malaria cases have been treated, and nearly half of at-risk African households are using modern anti-malaria bednets, compared to less than three per cent in 2000. Amid perhaps inevitable growing pains, the institution has also continuously innovated in its procurement methods to cut costs and leverage dollars.

I believe most Canadians would be proud to invest an extra $5 per year toward the world’s most transformative multilateral health institution.

Under its highly respected leader, Dr. Mark Dybul, the Global Fund has established a Fourth Replenishment budget of $15 billion, or $5 billion per year. They anticipate this will be enough to save 5.8 million lives and improve hundreds of millions more. Crucially, the Fund also sees the opportunity for a decisive “tipping point” in slashing underlying infection rates of major diseases.

How much should Canada contribute? Earlier this year, the Obama Administration pledged $1.65 billion for 2014, or roughly $5 per American, through a challenge whereby the U.S. matches every $2 of other countries’ funding with $1 of its own. However, the U.S. situation is unique, since it also has major bilateral disease control programs and makes only a small share of its global contributions through the Global Fund.

For Canada’s purposes, more comparable pledges have recently been made by the Nordic collaborative of Denmark, Iceland, Finland, Norway and Sweden. These countries have a combined population of around 26 million and committed $250 million per year, or nearly $10 per person. Meanwhile the United Kingdom pledged $533 million per year, more than $8 per citizen. A similar annual commitment of $8 to $10 per Canadian works out to roughly $280-350 million per year. This represents an important increase on our most recent contributions of roughly $175 million per year, or $5 per Canadian. I believe most Canadians would be proud to invest an extra $5 per year toward the world’s most transformative multilateral health institution.

Canada has not yet announced how much it will pledge at next week’s conference, but the timing matters almost as much as the amount. In addition to the 50 American cents unlocked by each Canadian dollar, campaigners feel that an early Canadian commitment can also help to crowd-in additional funds from other countries that have not yet formally pledged. An announcement before the end of this week can still have a significant multiplier.

At a September global health event in New York, Harper eloquently stated that, “Degrees of failure are not measured in dollars. They are measured in thousands of lives.” Moreover, “Before 2015, and in pursuit of what are urgent and noble Millennium Goals, therefore let us give one final vigorous and decisive effort.” Over the coming week, Canada can decide to offer such measurably life-saving global leadership. If we do so, it will mark the next rung in a ladder of global health contributions, one in which all Canadians can rightfully be proud.