ABSTRACT
Introduction The Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments to support countries in their response to the COVID-19 pandemic. Recently, the Global Fund’s Board approved global pandemic preparedness and response as part of their new six-year strategy from 2023-2028. Methods Prior research estimated that US$124 billion is required, globally, to build sufficient country-level capacity for health security, with US$76 billion needed over an initial three-year period. Action-based cost estimates generated from that research were coded as directly, indirectly, or unrelated to systems strengthening efforts applicable to HIV, TB, and/or malaria. Results Of approximately US$76 billion needed for country level capacity-building over the next three-year allocation period, we estimate that US$66 billion is needed in Global Fund-eligible countries, and over one-third relates directly or indirectly (US$6 billion and US$21 billion, respectively) to health systems strengthening efforts applicable to HIV, TB, and/or malaria disease programs currently supported by the Global Fund. Among these investments, cost drivers include financing for surveillance and laboratory systems, to combat antimicrobial resistance, and for training, capacity-building, and ongoing support for the healthcare and public health workforce. Conclusion This work highlights a potential strategic role for the Global Fund to contribute to health security while remaining aligned with its core mission. It demonstrates the value of action-based costing estimates to inform strategic investment planning in pandemic preparedness. What is already known on this topic The costs, globally, to build country-level public health capacity to address these gaps over the next five years has been previously estimated as US$96-$204 billion, with an estimated US$63-131 billion in investments required over the next three years. Research conducted prior to the COVID-19 pandemic indicated that over one-third of Global Fund’s budgets in 10 case-study countries aligned with health security priorities articulated by the Joint External Evaluation, particularly in the areas of laboratory systems, antimicrobial resistance, and workforce development. What this study adds We estimate that over 85% of investments needed to build national capacities in health security, globally, over the next three years are in countries eligible for Global Fund support. Areas of investment opportunity aligned with the Global Fund’s core mandate include financing for surveillance and laboratory systems, combating antimicrobial resistance, and developing and supporting robust healthcare and public health workforces. How this study might affect research, practice or policy In aggregate, global-level data highlight areas of opportunity for the Global Fund to expand and further develop its support of global health security in areas aligned with its mandate and programmatic scope. Such investment opportunities have implications not only for existing budgeting and allocation processes, but also for implementation models, partners, programming, and governance structures, should these areas of potential expansion be prioritized. This work emphasizes a role for targeted, action-based cost estimation to identify gaps and to inform strategic investment decisions in global health.