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Global plagues and the Global Fund: Challenges in the fight against HIV, TB and malaria

Darrell HS Tan1*, Ross EG Upshur2 and Nathan Ford3

Author Affiliations

1 Department of Medicine, University of Toronto. University Health Network, Toronto General Hospital Site, R. Fraser Elliott Building 3-Suite 805, 190 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada

2 Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre, Departments of Family and Community Medicine and Public Health Sciences, Joint Centre for Bioethics, University of Toronto. Room E349B, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada

3 Médecins Sans Frontières, 67–74 Saffron Hill, London EC1N 8QX, United Kingdom

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BMC International Health and Human Rights 2003, 3:2  doi:10.1186/1472-698X-3-2

Published: 1 April 2003



Although a grossly disproportionate burden of disease from HIV/AIDS, TB and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches.


The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) represents an important step forward in the struggle against these pathogens. While its goals are laudable, significant barriers persist. Most significant is the pitiful lack of funds committed by world governments, particularly those of the very G8 countries whose discussions gave rise to the Fund. A drastic scaling up of resources is the first clear requirement for the GFATM to live up to the international community's lofty intentions. A directly related issue is that of maintaining a strong commitment to the treatment of the three diseases along with traditional prevention approaches, with the ensuing debates over providing affordable access to medications in the face of the pharmaceutical industry's vigorous protection of patent rights.


At this early point in the Fund's history, it remains to be seen how these issues will be resolved at the programming level. Nevertheless, it is clear that significant structural changes are required in such domains as global spending priorities, debt relief, trade policy, and corporate responsibility. HIV/AIDS, tuberculosis and malaria are global problems borne of gross socioeconomic inequality, and their solutions require correspondingly geopolitical solutions.