MSF warns pending Global Fund replenishment crisis threatens decades of progress against HIV, TB and Malaria
Investments must be sustained to prevent catastrophic cuts and soaring patient costs.
Ahead of the Global Fund’s Eighth Replenishment Summit in Johannesburg, Doctors without Borders/Médecins Sans Frontières (MSF) calls for world leaders to fully fund the Global Fund’s 18 billion USD ($25 billion Canadian) target.
Failure to meet this goal risks catastrophic cuts to essential services, threatens the resurgence of HIV, tuberculosis (TB) and malaria and forces the financial burden of healthcare onto the world’s most at-risk patients.
The high-level fundraising meeting, co-hosted by the United Kingdom and South Africa, will take place on Friday, Nov. 21, 2025, on the margins of the G20 Leaders’ Summit. For this three-year funding cycle (2027–2029), there is a high risk the Global Fund may receive pledges several billion below the target required to respond impactfully to HIV, TB and malaria, possibly even billions below the last replenishment of 15 billion USD ($21 billion Canadian), which still fell drastically short of the funding needed to tackle these diseases.
“The international community cannot afford to falter now,” says Tess Hewett, MSF health policy advisor. “We are seeing major traditional donors signalling deep cuts, even as the need for sustained investment grows. When funding falls short, it is the patients – those least able to afford care – who pay the price.”
The consequences of failing to meet the 18 billion USD ($25 billion Canadian) target will be severe and immediate. If pledges are insufficient, essential work, such as support for data collection systems which monitor disease incidence and service delivery, will suffer, leading to the loss of momentum gained during the previous two replenishments. Cuts could severely impact the global TB response, as the Global Fund currently supports 76 per cent of the worldwide donor response for TB. In addition, the adoption of promising new tools, such as new TB vaccines, existing malaria vaccines and new HIV prevention tools like lenacapavir, will be limited.
Delays in finalizing pledges after Nov. 21 could compromise effective program planning.
When funding is insufficient, the financial burden is often shifted onto communities in vulnerable situations through an emphasis on increasing “domestic resource mobilization.” While this is envisaged as an increase in health spending by national governments, in reality this shift frequently results in a hike in out-of-pocket payments by people themselves. This is particularly true in low-income countries where patients’ spending is already the most important source of health financing.
Initial pledges for this replenishment have been deeply concerning. Germany and the UK, the only major traditional donors to pledge so far, have both decreased their commitment compared to the last cycle. Specifically, Germany has pledged $1.6 billion instead of $2.1 billion and the UK has pledged $1.5 billion instead of $1.8 billion. No donor has increased their pledge when considering inflation.
If major donors follow Germany and the UK’s example, the results will be catastrophic for people worldwide impacted by TB, HIV and malaria – the world’s top three deadliest, but completely preventable, infectious diseases.
“We urge the remaining big donors to heed the evidence contained in MSF’s Deadly Gaps report and commit fully on Nov. 21,” says Tess Hewett. “To accelerate progress toward Sustainable Development Goal 3 and end TB, HIV and malaria as public health threats, the Global Fund needs the full 18 billion USD ($25 billion Canadian). With the right resources, the Global Fund believes it can save 23 million lives and halve the death toll in just six years”.
