As donations to the Global Fund for efforts against HIV/AIDS (Note 1), tuberculosis, and malaria show a declining trend, the control of these three major infectious diseases is in jeopardy.

On November 21, 2025, alongside the G20 leaders’ summit, a replenishment conference was held in Johannesburg, South Africa. This replenishment conference is convened by the Global Fund every three years, where donor countries announce target contribution amounts to the Global Fund. The pledges for 2026 to 2028 totaled approximately US$11.4 billion (Note 2), well below the Global Fund’s target of US$18 billion.

Major donors are part of the reason for this sluggish growth in contributions. In the United States, pledges fell from US$6.0 billion for 2023–2025 to US$4.6 billion for 2026–2028. In Germany, pledges declined from US$1.2 billion for 2023–2025 to around US$1.0 billion for 2026–2028. In Japan, pledges dropped sharply from roughly US$1.0 billion for 2023–2025 to about US$53 million for 2026–2028. Furthermore, pledged amounts are often not paid in full in the end.

Such declines in pledged and ultimately disbursed amounts could worsen the impact of these diseases. World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus warned that “sudden, unplanned cuts in both bilateral and multilateral aid are jeopardizing, in particular, efforts against HIV, tuberculosis and malaria.” Without sustained funding, prevention and treatment for each disease will be undermined. Researchers have also pointed out that with sufficient funding—through new HIV prevention medicines, improved malaria control, and innovations in tuberculosis treatment and vaccines—it would be possible to end these diseases as public health threats.

Since the Global Fund began in 2002, the number of people infected with HIV, tuberculosis, and malaria has halved over 20 years, illustrating the important role the Global Fund has played in combating infectious diseases.

In response to shrinking funding for infectious disease control, the U.S. government research institute, the Center for Global Development, has put forward a compromise proposal: provide grants only to low-income countries with the highest infection rates, and extend loans to other countries. This lays bare the severe cost-cutting pressures facing the response to infectious diseases.

Note 1: We abbreviate human immunodeficiency virus as “HIV” and acquired immunodeficiency syndrome as “AIDS.”

Note 2: Because Japan made its pledge after the replenishment conference, this figure does not include Japan’s pledged amount.

Learn more about HIV/AIDS → “The evolution of HIV/AIDS measures in Africa”

Learn more about malaria → “Malaria: Will the gains achieved in Africa be lost?”

Learn more about tuberculosis → “Tuberculosis: The infectious disease that kills the most people worldwide”

Scene from the Global Fund replenishment conference, Prime Minister of Norway (Photo: Statsministerens kontor / Flickr [CC BY-NC 4.0] )