While deaths from malaria have fallen by 29% since over the past two decades, mortality could rise again this year due to the cuts in global health funding seen recently, says Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
“There has been a significant impact…and I suspect that we may well see an increase in the number of children dying of malaria this year in part due to the reductions in funding,” Peter Sands, told reporters in Geneva as the organization released its annual Results Report.
Progress in reducing deaths from the disease, which still kills about 600,000 people a year, had already stalled during the pandemic. Meawhile, climate change drivers of more warm and wet weather are facilitating mosquito breeding and parasite transmission, while regional conflicts make drugs, vaccines and bed nets harder to distribute. And to make matters worse, more pockets of parasitic resistance to currently available drugs are emerging, according to the Global Fund’s 2025 report.
The net result could lead to more than 100,000 additional malaria deaths this year, Sands warned, a huge setback in the historic gains seen. Three-quarters of the 608,000 malaria deaths in 2022, the latest year for which data is available, were in children under the age of five, with Sub Saharan Africa bearing the brunt of the mortality, the report says.
Malaria infection rates can rise dramatically and abruptly, Sands noted, warning that “malaria is a disease that reacts very quickly.. and it doesn’t react in small percentage changes.”
For instance, Pakistan’s massive flooding in 2022, led to a whopping 2.6 million malaria cases that year – as compared to only about half a million in 2021.Fragile and conflict ridden states that are home to some 16% of the global population, bear nearly two-thirds of the global malaria burden, as well as one quarter of TB cases and 17% of new HIV infections.
Impressive results – so far
Despite the serious threats on the horizon, the recent report still reflects impressive results archived since the organization’s inception in 2002. In less than a quarter century, the combined death rate from AIDS, tuberculosis (TB) and malaria has been reduced by 63% – saving an estimated 70 million lives.
“This shows that with the right tools, strong partnerships and sustained investment, we can change the course of global health for the better,” Sands also said. “But in today’s fast-changing geopolitical environment, there is no room for complacency. The global health community must move faster to reduce fragmentation, eliminate duplication and make it easier for countries to work with us.”
As of 2024, a record number of people were on antiretroviral therapy (ARVs) for HIV, a record number of people were receiving treatment for TB, and the scale-up of malaria prevention efforts was at a peak, with new vaccines approved by regulators launched in high-priority Sub-Saharan African nations, the report states.
HIV and AIDS
In 2024, 88% of people living with HIV in Global Fund-supported countries knew their status, 79% were on ARVs, rising to 85% of pregnant women living with HIV – the highest levels ever recorded. Use of pre-exposure prophylaxis (PrEP) for HIV prevention surged, with 1.4 million people in Global Fund-supported countries receiving PrEP in 2024 – a 325% increase from 2023.
Since the Global Fund was founded in 2002, the AIDS-related mortality has been cut by 82% and HIV incidence rate by 73% in the countries where the Global Fund invests. Even so, in 2024, 630,000 people still died of AIDS-related causes, and there were 1.3 million new HIV infections globally – around 3.5 times more than the global target of fewer than 370,000 new infections by 2025. But amongst all the diseases covered, Sands sounded the strongest notes of optimism around teh possibility of making further progress on HIV and meet a key 2030 Sustainable Development Goal.
“We really have the oportunity to accelerate the elimination of HIV as a public health threat,” said Sands. “We now have tools available to really change the trajectory,” he noted, referring to the new long-acting injectable drug lenacapavir that can be administered every six months and is nearly 100% effective in preventing disease. At the end of 2024, the Global Fund committed to reaching 2 million people with lenacapavir, a promising injectable for HIV prevention.
And just last week, US Secretary of State Marco Rubio said the United States would make a pre-market commitment to purchase lenacapavir from the pharma manufacturer Gilead Sciences, to support distribution by Global Fund in some 8-12 high burden countries, with Undersecretary of State Jeremy Lewin, praising the partnership. The announcement, honoring a Biden-era commitment to support the drug’s distribution, represented one of the few global health “wins” since US President Donald Trump took over at the White House.
Tuberculosis
In 2023, treatment coverage for all forms of TB reached 75% in countries where the Global Fund invests – its highest ever level, up from 45% in 2010; 44% of people with drug-resistant TB started treatment. Of those starting TB treatment, 88% were successfully treated and 91% of people living with HIV who had TB were on antiretroviral therapy.
Since 2002, efforts to provide equitable access to prevention, testing and treatment services, find and treat “missing” people with TB, fight drug‑resistant TB and reduce prices for TB commodities have helped drive down the mortality rate by 57% and the incidence rate by 28%.
“In 2024, more people were diagnosed, more people were treated, and the treatment success rates were higher than ever before. So actually, 24 was a year of great progress, on TB,” Sands said. Here, too, innovation will prove crucial to further progress, he stressed, citing the development and scale-up of AI-powered TB detection and mobile digital chest X-rays stations, enabling faster and better diagnosis – a longstanding barrier to TB treatment.
But TB is still the world’s deadliest infectious disease. It killed an estimated 1.3 million people in 2023, and drug-resistant TB remains a major threat to global health security. Fragile health systems, conflict and economic pressures threaten to reverse the gains made over the past two decades, Sands warned.
Malaria
As for malaria, the target of elimination of malaria as a public health problem is now within reach, as demonstated by the experiences of both Suriname and Timor-Leste – both countries with wet, tropical “mosquito friendly” climates that were certified as malaria-free by the World Health Organization in 2025.
“With sufficient political will and sufficient resources, We can, end malaria,” Sands said.
In countries where the Global Fund invests, access to an insecticide-treated net reached 61%, with 53% of people at risk using a mosquito net in 2023 – the highest levels to date. More than 95% of people with signs and symptoms of malaria were tested.
Strengthened access to testing, treatment and prevention options, as well as the scale‑up of dual active ingredient insecticide‑treated nets to fight drug and insecticide resistance have contributed to the reductions in disease incidence and the death rate.
But rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides are also complicating those efforts, raising risks of resurgence in the most vulnerable groups – such as children under 5 and pregnant women.
“With sufficient political will and sufficient resources, We can, end malaria,” Sands said. “However, in the places where malaria is biggest, and that’s almost all in, Africa, we’re not making the kind of progress we need to.
“In fact, progress has stalled, and we are facing significant challenges due to a combination of climate change, conflict in some of the most malaria-affected places; resistance, the malaria mosquitoes have become resistant to some of the most commonly used insecticides, and we’re increasingly seeing resistance, to some of the most commonly used treatments. And frankly, inadequate funding.
“Because to beat malaria, you have to have a concentration of investment across a multiple set of tools in order to drive down, transmission,” he pointed out, citing newer, and the dual active ingredient bednets as an example.
“They’re 45% more effective than conventional insecticide-impregnated bed nets, and they only cost 70 cents more. The challenge we face is that we’re still in a position where only two-thirds of the people who could benefit from having a bed net actually have a bed net. So a third of the population in the malaria-endemic places are, sleeping without that basic protection.”
Health systems strengthening and global health security
While the story is “rather different” across the three diseases, the Global Fund has also stepped up its investments in health systems – for a total of $2.7 billion in 2024. Those investments yield cross-cutting benefits that “go way beyond HIV, TB and malaria,” Sands said.
For instance, strengthened laboratory and diagnostic networks have not only enhanced national responses to HIV, TB and malaria, but also enabled better detection and management of co-infections such as hepatitis B, hepatitis C and human papillomavirus, the Global Fund says. In addition, they have increased countries’ capacity to safely test for high-risk diseases including mpox, Ebola, Marburg virus and Crimean-Congo hemorrhagic fever.
“Over the last few years, and triggered by the experience of COVID, we have [also] invested over $600 million in improving the provision of medical oxygen in low- and middle-income countries. And this is often investing in what are called pressure swing absorption plants, PSA plants, which, about the size of this room, which essentially create medical oxygen out of the atmosphere,” he said that during the pandemic, 9 out of 10 hospitals did not have medical oxygen prior to the pandemic. Now, they have access for other services such as neo-natal treatmetns, material health, acute trauma and surgery.”
Eighth Replenishment drive
The Global Fund’s Eighth Replenishment – launched in February 2025 – is a defining moment for the organization. It aims to raise some $18 billion by the end of November for the next three-year funding cycle, which runs from 2027 to 2029.
So far, the Global Fund has raised close to $700m from countries, including Australia, Luxembourg, Norway and Spain, as well as private sector donors like the London-based Children’s Investment Fund Foundation. At the same time, the US retreat from most global health funding commitments, and the downsizing of contributions from other traditional donors, is adding to an already challenging fiscal environment.
In July, the Global Fund confirmed that it was cutting $1.43 billion from the remainder of its 2025-2026 budget. And further adjustments are now being made to the “realities of the funding situation,” Sands admitted. Although the organization has released no data on staff cutbacks, Sands tacitly admitted these are happening, including termination of staff on short term contracts or COVID-related contracts in the Geneva headquarters, where some 1000 people have been employed.
From the early days, the organization also made national self-reliance an integral part of its funding strategy. Since 2002, 52 HIV, TB and malaria disease programs across 38 countries have transitioned from the Global Fund. By 2026, another 12 programs from eight countries are expected to transition away from Global Fund support.
With a successful Replenishment, the Global Fund projects that it could help save up to 23 million lives between 2027 and 2029 and reduce the mortality rate from AIDS, TB and malaria by 64% by 2029, compared to 2023 levels, while strengthening health and community systems to fight new outbreaks and accelerate pathways to self-reliance.
At the same time, Sands admits, “this has been, a volatile year, let’s say, and there have been… has been significant disruption, to global health funding. And I think it’s important to recognize that we have a lot to gain and a lot to lose. We have made enormous progress, in improving the health of the poorest communities in the world. But that… those gains are fragile and could be reversed.”
Image Credits: Vincent Becker/ Global Fund, Global Fund , Direct Relief/Felipe Luna, The Global Fund/ Saiba Sehmi, TB Alliance, Brian Otieno /Global Fund.
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