沒有時間去推遲對全球基金的承諾
資料來源：http://www.thelancet.com/hiv Vol 9 November 2022 / 財團法人台灣紅絲帶基金會編譯
在《刺胳針愛滋病毒》的 9 月刊中，我們呼籲世界各國政府提供全額 180 億美元，用於全球抗擊愛滋病、結核病和瘧疾基金的第七次增資。幾週後，9 月 19 日至 22 日在紐約舉行的全球基金增資會議發出了積極的聲音和沮喪的聲音，在此期間，只有 143 億美元的認捐，兩個潛在的主要捐助者——意大利和英國（在第六次增資它們之間的認捐近 20 億美元）——未能投入。鑑於 COVID-19 的持續挑戰、在 SARS-CoV-2 大流行和國際金融危機之後重建愛滋病毒應對措施，一些最富有的人對世界各國作出貢獻的失敗是一個巨大的失望。
最近幾個月，意大利和英國都發生了政治變化。 9 月，右翼聯盟贏得了意大利政府的控制權。民粹主義的意大利兄弟黨的喬治亞·梅洛尼（Giorgia Meloni）將在馬泰奧·薩爾維尼（Matteo Salvini）的極右翼聯盟黨和西爾維奧·貝盧斯科尼（Silvio Berlusconi）的中右翼 Forza Italia 的支持下成為該國總理。該聯盟被描述為自 1945 年墨索里尼被廢黜以來意大利最右翼的政府，全球援助承諾不太可能成為這個民族主義聯盟的優先事項。如果有的話，英國政府更不可能將全球援助視為優先事項。新任命的英國首相（在撰寫本文時）Liz Truss 似乎是保守黨右翼的不幸傀儡。她早期在所謂的小額預算中重新設定國家財政議程的努力，結果證明是對沒有資金之減稅的幻想，該減稅從國家經濟中抹去了數十億美元。儘管隨著大多數預算提案的逆轉，該國經濟可能已經穩定下來，但財務影響、混亂和黨內內訌將導致國內資金嚴重短缺，對國際援助的興趣（甚至關注度）也很低。目前面臨愛滋病毒、肺結核和瘧疾高負擔的地區都有長期受到意大利和英國殖民介入的歷史：對他們來說，推遲全球基金的增資是可恥的。
意大利和英國的冷漠與撒哈拉以南非洲國家的貢獻形成鮮明對比。南非的認捐額從 1000 萬美元增加到 1370 萬美元，而肯亞的認捐額從 600 萬美元增加到 1000 萬美元。來自西部和中部非洲的布基納法索、中非共和國、象牙海岸、剛果民主共和國、幾內亞、尼日和多哥認捐總額為 1170 萬美元。其他愛滋病毒、肺結核和瘧疾負擔較重的國家，例如史瓦帝尼王國、馬拉威、奈及利亞、坦尚尼亞、盧旺達和辛巴到，儘管面臨嚴峻的財務狀況，但都做出了貢獻。來自低收入和中等收入國家 (LMIC) 的捐款尤其重要，因為它們有助於改變捐助國和受援國對參與者的概念。
在這些中低收入國家做出貢獻後不久，聯合國愛滋病規劃署於 10 月 11 日發布了他們的報告《大流行三會合：發展中國家的愛滋病毒、COVID-19 和債務》，該報告強調了許多國家由於數十年來不斷增長的債務、嚴重的愛滋病毒負擔和最近的流行病而面臨的日益嚴峻的挑戰。該報告強調了在應對 SARS-CoV-2 大流行期間惡化的健康不平等。在許多國家，愛滋病毒應對工作受到干擾，有可能破壞在應對愛滋病毒/愛滋病方面取得的進展，全球只有不到 60% 的愛滋病毒感染者接受抗反轉錄病毒治療，而大多數缺乏治療的人都在中低收入國家。關於 COVID-19，全球 64·5% 的人至少接種過一劑 COVID-19 疫苗，但在低收入國家這一數字僅為 14·5%，全球有 2·80 億人沒有接種疫苗，撒哈拉以南非洲地區的覆蓋率最低。 2019 年至 2020 年間，中低收入國家的債務佔國內生產總值的比例從 55% 上升至 64%，相當於 2·3兆美元。償還這些債務會使得從包括健康在內的其他關鍵職能之資源被轉移。健康對經濟繁榮至關重要，未能應對 HIV 和 COVID-19 等健康危機將限制各國在加劇不平等的負反饋循環中償還債務的能力。正如聯合國愛滋病規劃署報告中所強調的那樣，「增加國際資金來應對這兩種流行病並不是一種慈善行為：它是對全球公共衛生的一項高效投資。發展中國家龐大且不斷增長的債務負擔的破壞性後果加劇了為實現這一目標而調動多邊資源的緊迫性……」。在這種情況下，我們敦促尚未重申對全球基金承諾的政府慷慨地這樣做。
《刺胳針愛滋病毒 》
No time to defer commitment to the Global Fund
http://www.thelancet.com/hiv Vol 9 November 2022
In our September issue, we called on governments worldwide to deliver the full US$18 billion requested for the seventh replenishment of the Global Fund to fight AIDS, Tuberculosis and Malaria. Several weeks later there were both positive noises and despondency from the Global Fund replenishment meeting in New York on Sept 19–22, during which just $14·3 billion was pledged, with two potential major donors—Italy and the UK (which between them pledged almost $2 billion in the sixth replenishment)—failing to pitch in. Given the ongoing challenges of COVID-19, rebuilding HIV responses in the wake of the SARS-CoV-2 pandemic, and international financial crises, the failure of some of the richest nations in the world to contribute is a great disappointment.
Both Italy and the UK have seen political changes in recent months. In September, a right-wing coalition won control of the Italian Government. Giorgia Meloni of the populist Brothers of Italy party will become the country’s prime minister, with support from Matteo Salvini’s far-right League party and Silvio Berlusconi’s centre-right Forza Italia. The coalition has been described as Italy’s most right-wing government since Mussolini was deposed in 1945, and it is unlikely that global aid commitments will be a priority for this nationalist coalition. The UK Government is, if anything, in a position even less likely to view global aid as a priority. The newly appointed UK Prime Minister (at the time of writing), Liz Truss, seems to be a hapless puppet of the right-wing of the Conservative Party. Her early efforts to reset the financial agenda of the country in a so-called mini-budget turned out to be a fantasy of unfunded tax-cuts that wiped billions from the country’s economy. Although the economy of the country might have since stabilised with the reversal of most of the budget proposals, the financial repercussions, confusion, and party infighting will leave a massive shortfall in domestic funding and little appetite (or even attention) for international aid. Both Italy and the UK have long histories of colonial interference in regions that now face high burdens of HIV, tuberculosis, and malaria: for them to defer Global Fund replenishment is shameful.
The indifference of Italy and the UK is thrown into stark contrast by the contributions of sub-Saharan African countries. South Africa’s pledge increased from $10·0 million to $13·7 million, while Kenya upped their contributions from $6·0 million to $10·0 million. From west and central Africa, Burkina Faso, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Guinea, Niger, and Togo pledged a total of $11·7 million. Other countries with high burdens of HIV, tuberculosis, and malaria, such as Eswatini, Malawi, Nigeria, Tanzania, Rwanda, and Zimbabwe, all made contributions despite challenging financial circumstances. Contributions from low-income and middle-income countries (LMICs) are particularly important as they help to change the concept of donor and recipient countries to participants.
Shortly after these LMICs made their contributions, on Oct 11, UNAIDS released their report A Pandemic Triad: HIV, COVID-19 and debt in developing countries, which highlighted the growing challenges faced by many countries as a result of decades of growing debt and high HIV burden and the more recent pandemic. The report highlights health inequalities that have worsened during the SARS-CoV-2 pandemic response. In many countries, the HIV response has been disrupted, threatening to undermine the progress made in the HIV/AIDS response, with fewer than 60% of people living with HIV receiving antiretroviral therapy globally, and most of those lacking treatment are in LMICs. With regards to COVID-19, worldwide, 64·5% of people have received at least one dose of a COVID-19 vaccine, but in low-income countries the figure is only 14·5%, and 2·8 billion people worldwide have not received a vaccine, with the lowest coverage in sub-Saharan Africa. Between 2019 and 2020 in LMICs, debt rose from 55% to 64% of gross domestic product, equivalent to $2·3 trillion. Servicing these debts shifts resources away from other key functions including health. Health is essential to economic prosperity, and failing responses to health crises such as HIV and COVID-19 will limit the abilities of countries to service debts in a negative feedback loop that exacerbates inequalities. As the UNAIDS report highlights, “increasing international financing to tackle both pandemics is not an act of charity: it is a highly effective investment in global public health. The urgency to mobilize multilateral resources towards this goal is heightened by the devastating consequences of the large and growing debt burden of developing countries…”. In this context, we urge governments yet to reaffirm their commitment to the Global Fund to do so generously. The Lancet HIV