Three questions to Peter Sands, Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria

Interview with Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Focus 2030: You lead the Global Fund to Fight AIDS, Tuberculosis and Malaria—an international partnership that has helped save 70 million lives and reduce the combined mortality rate from these three diseases by 63% since 2002. How can such an impact be accounted for?

Peter Sands: The Global Fund partnership is a proven model for turning donor dollars into impact at scale. Combining local leadership with global expertise, the knowledge and passion of communities with the agility of the private sector, and the power of governments with the reach of civil society, this unique partnership is unequaled in its efficiency, effectiveness and adaptability. We are extremely grateful for the generosity of our donors – including France, the largest European donor to the Global Fund and the second largest public donor overall – who have committed to support our partnership since its inception.

Our impact stems from our unique community- and country-centered model. Communities affected by the disease are at the heart of everything we do. They participate at all levels of the response, and by strengthening their leadership we ensure the response is better tailored to their needs. Countries take the lead in determining where and how to best fight AIDS, tuberculosis, and malaria, tailoring their own response and taking into consideration their political, cultural and epidemiological context.

Another key driver of impact lies in our ability to leverage innovation to ensure new tools reach people quickly, affordably, and equitably. The Global Fund identifies breakthroughs—from new drugs and diagnostics to AI-powered tools—and brings them to scale. For example, investments in AI-enabled tuberculosis screening, new HIV prevention and treatment approaches, next-generation mosquito nets, digital health platforms and other cutting-edge interventions help countries optimize health service delivery and improve health outcomes.

We also play a critical role in shaping markets to make lifesaving commodities more affordable and accessible. Through pooled procurement, strategic partnerships, and negotiations with manufacturers, we have dramatically reduced the cost of essential medicines and prevention tools. The annual cost of HIV treatment, for instance, has dropped from thousands of dollars in the early 2000s to just a few dozen today, enabling large-scale treatment and accelerating progress toward epidemic control.

But progress is fragile. Gains are threatened by underfunding, drug resistance, climate shocks, and conflict. Epidemics don’t end when attention fades; they end when we sustain urgency, invest in what works, and hold ourselves accountable. Sustained funding, innovation, and partnership are essential. The Global Fund’s Eighth Replenishment Summit, taking place in a few days in Johannesburg, is a once-in-a-generation opportunity to curb the spread of infectious diseases and strengthen health and community systems in the world’s most vulnerable countries.

Focus 2030: Many countries have announced reductions in their budgets allocated to international solidarity. The OECD anticipates a decrease of between 9% and 17% in net Official Development Assistance in 2025, following a 9% drop in 2024. To what extent could these cuts impact the activities of the Global Fund?

Peter Sands: The cuts to global health funding present real challenges to the Global Fund’s work, but also serve as a catalyst for significant transformation. We are actively evolving and adapting our model to be even more impactful, equitable and sustainable while striving to remain cost-efficient.

To address financial constraints, we have revised our allocation model to direct more resources toward the poorest countries—where the need is greatest and the capacity to pay is lowest. This ensures that every dollar is targeted for maximum impact and equity.

At the same time, shrinking donor funding underscores the urgency for countries to progressively transition toward nationally led and financed health systems. The Global Fund supports this shift through enhanced transition planning, strengthened co-financing requirements, and expanded technical assistance in areas such as domestic resource mobilization, supply chain management, and public financial systems. But this transition is carefully managed – it’s a pathway, not a switch. We must ensure that progress is not jeopardized and that vulnerable populations are not left behind.

We are also accelerating access to biomedical and technological innovations—from new prevention tools and treatments to AI-powered diagnostics. A recent example is our access agreement with Gilead Sciences to procure lenacapavir, a long-acting injectable for HIV prevention, for low- and middle-income countries.

Finally, we are deepening and expanding our partnerships with the World Bank, the Asian Development Bank, the African Union, and other global health partners such as Gavi and Unitaid.

By making changes to the way the Global Fund works, and by playing our part in the transformation of the global health ecosystem, we can enhance efficiency and effectiveness, become more responsive to countries’ needs and deliver on the promise of health and wellbeing for all. Our commitment to saving lives and ending the epidemics of AIDS, TB and malaria as public health threats remains unwavering.

Focus 2030: In July, the Global Fund announced that it would ensure access to Lenacapavir—a highly promising injectable for HIV prevention—in low- and middle-income countries at the same time as in high-income countries. This would be a world first, as medical innovations often reach the poorest countries years later. Under what conditions could this scientific breakthrough help change the trajectory of the HIV epidemic?

Peter Sands: The arrival of long-acting PrEP lenacapavir has the potential to be a game-changer — not just for individuals, but for public health. This is a pivotal moment — not just for the fight against AIDS, but for the fundamental principle that lifesaving innovations must reach those who need them most — whoever they are, and wherever they live.

Together with our partners, we aim to make lenacapavir available to 2 million people over the next three years. We are working with countries, communities and technical partners to prepare for a rapid and equitable rollout — supporting regulatory readiness, delivery infrastructure, and community engagement. But we can only do that if the world steps up with the resources required.

We should also bear in mind that biomedical innovation only changes the trajectory of an epidemic if it reaches the people who need it most. With 70% of new HIV infections occurring among key populations and their sexual partners, we must confront the barriers these communities often face – stigma, discrimination and criminalization. Without action on these fronts, we will not realize the full potential of lenacapavir.

This applies across all three diseases we fight: Barriers to health services – including human rights violations and structural gender inequalities – directly undermine progress against AIDS, TB and malaria. They are not peripheral issues; they are central to global health. In response, the Global Fund invests in programs that reinforce human rights for health. Our investments help build sustainable systems that enable people to overcome the human rights-related barriers, gender inequalities and other structural inequities that prevent them from seeking care.