The funds to stop deadly diseases are drying up. Where does that leave global health?

A malaria patient rests on a bed after being discharged in Kiryandongo, northwestern Uganda, on April 11, 2017. AFP

The Geneva-based organisation, The Global Fund, since it was established in 2002, has undoubtedly been a force for good. But its worldwide impact in the future is clouded by global political shifts, like that of the Swiss city itself.

Two big donor governments collapsed in a week, just as the organisation is trying to secure billions in new funding. The French and Japanese prime ministers had gone for different reasons but it was bad timing.

It is a sensitive moment for the Fund, which was set up to tackle the scourge of three deadly diseases: Malaria, HIV and Tuberculosis or TB.

The Fund has mobilised billions of dollars to reduce not only the incidence but the death toll of these pernicious infections. Its upcoming funding round has been launched to go further, capitalising on progress in some of the world’s poorest and most marginal countries.

Peter Sands, the former Standard Chartered Bank boss who oversees the Fund, says its investment of $6.1bn over three years between 2024 and 2026 not only tackles infections but strengthens healthcare systems, where there are precious little other resources available.

In raw figures, the Global Fund is aiming to help cut the death rate from the three diseases by 64 per cent over its funded cycle. Since its establishment more than two decades ago, the death rate has fallen by 63 per cent and the incidence across the three diseases is down 42 per cent.

While Washington has cut USAID and big donors such as France or the UK have also driven swingeing cuts, there is some hope the Fund can prove to the US that it has an innovation-centred agenda that chimes with new US priorities. Mr Sands talks about a mobile scanner with AI diagnosis that it is using against TB in Ukraine and is working wonders.

Since the Global Fund was established in 200, the death rate has fallen by 63 per cent

The Fund has made a commitment that shows it can work with the new strictures of the Trump administration, which is to roll out the US-made HIV prevention drug Lenacapavir for up to two million people by 2028.

Marco Rubio, US Secretary of State, has not shielded the President’s Emergency Plan for Aids Relief (Pepfar) from cuts but he has said the programme will continue until it can be reduced over time as they are impactful in achieving their mission.

A whole class of global philanthropic or public good organisations is clustered in Geneva, where the UN’s second home is based. Most, like the Global Fund, are finding their environment a lot more challenging as funds dry up. Insiders talk of two in five staffers going at many of the UN organisations themselves.

A panel at Chatham House last week pondered the future role of Geneva as a platform for working with and highlighting the concerns of the Global South countries.

Is it a historical anomaly that the Alpine city, with its high cost-of-living and European sensibilities, plays such an outsize role as a host for global co-operation?

Even the UN General Assembly had voted permission for parts of its high-level meeting, the annual set of addresses by heads of state and government, to be held not in New York but in Geneva.

Geneva's Palais Wilson, once home of the UN’s predecessor, the League of Nations, could yet take over some of the functions residing for decades on New York’s East River.

The reason lies at the Trump administration’s door. By restricting diplomatic access and outright refusing to grant visas to some delegations, the host agreement with the UN has been violated.

Previous high-profile staffers such as Mark Malloch Brown, a former deputy secretary general of the UN, have called for wider changes at the UN that could decentralise its operations. Cutting costs by getting closer to partners on the ground and using its charter as a vehicle for oversight would allow the UN to reinvent itself.

Geneva boasts of a whole set of UN ancillary organisations that are vulnerable in this new world. Adjusting to multipolar power means looking to the east and south.

Last weekend, when the British think tank Institute for Public Policy Research looked at relations with Global South countries, it noted the centre of gravity of gross domestic product has shifted from the Atlantic to the Hindu Kush. This is a trend unlikely to reverse.

IPPR says western powers such as the UK must mobilise differently to recognise the strength of competition from rising powers. It called for a mindset change to adjust to new realities. Looking at Geneva’s head start, some would see a “piecemeal diffusion” on the cards.

At the session, Alberto Groff, deputy head of mission at the Switzerland embassy in London, acknowledged the shifting sands and Chatham House dubbed the session Is Geneva heading south? As an advocate for the city’s advantages, Mr Groff cautioned many will take a longer view.

The delivery of programmes for the public good would still need a hub. Geneva’s stock of expertise would still be shared with the world. He argued that the city was a custodian of the value system that is embedded in the UN and that could not be easily replicated.

There is no doubt that a fork in the road has been reached. Swiss tax advantages or the unique legal and regulatory system remain important for the organisations the city hosts.

If not in this funding round, then the next, is the message. The wider question of how to address changing times isn’t going away.