Canada recently announced a 16% reduction in its 2026-2028 pledge to the Global Fund, which fights HIV/AIDS, tuberculosis (TB), and malaria and strengthens worldwide pandemic preparedness. It is Canada’s first-ever decrease in contributions to the fund.

The Global Fund collaborates with national governments and local organizations to design and implement prevention, treatment, and care programs. Canada has supported the fund for more than 20 years.

“Evidence-based strategies such as treatment, prevention, and preexposure prophylaxis have dramatically reduced new HIV infections and AIDS-related deaths and must be scaled up nationally and globally,” stated a December 15 article in CMAJ. “However, at a time when the world is close to ending HIV/AIDS as a global public health threat, major global funding cuts have stalled international progress. Canada and other high-income countries would be wise to reinvigorate their efforts to end the HIV/AIDS epidemic, as G8 leaders committed to in 2002.”

Experts Oppose Cut

Public health experts oppose the reduction in fund contributions, stating that it ignores long-term considerations and will affect domestic health. “Canada’s reduced pledge to the Global Fund reflects shortsighted political thinking that fails to appreciate the complexity of global health threats and long-term health consequences,” wrote Kirsten Patrick, MBBCh, and Helena Swinkels, MD, editor in chief and deputy editor of CMAJ, respectively, in an editorial outlining the change in policy.

“If the anticipated shortfall in pledges to the fund is not offset, Canada should anticipate reduced success in domestic TB and HIV control in forthcoming years rather than the progress toward elimination that is hoped for,” they added. The editorial urged the Canadian government to reconsider its pledge for the benefit of global health, noting an increase in TB in Canada and the backsliding in addressing HIV around the world.

“Most new TB disease in Canada occurs among people born in high-risk countries, with 85% acquiring TB infection before immigration,” they wrote. “In many cases, disease develops decades after people are well-established members of Canadian society.... About 22% of foreign-born residents of Canada have TB infection.”

A separate CMAJ editorial on the rising rates of TB in Canada stated that despite being preventable and curable, TB affects nearly 11 million people worldwide per year, more than 2000 of whom live in Canada. “To facilitate progress to TB elimination, political will and leadership should support the implementation of four key solutions: creation of a national body to lead the TB response, improved availability and usability of national TB surveillance data, increased access to essential TB medications, and better funding for TB research and development both domestically and internationally,” wrote Nancy Bedingfield, PhD, postdoctoral TB research fellow at York University in Toronto, and colleagues.

The Cuts’ Implications

Although a much lower proportion of newcomers to Canada have HIV at entry, the chronic nature of the disease requires lifelong treatment to reduce the risk for transmission. TB and HIV both carry major stigma and socioeconomic consequences, according to the editorial.

“The Global Fund is one of the best examples of international collaboration to address infectious disease. There are challenges in doing so, but any effort at the global level is going to face challenges because of the vast differences in the economic and political realities in the countries you’re trying to support,” Ian Culbert, executive director of the Canadian Public Health Association in Ottawa, told Medscape News Canada.

“This reduction carries domestic consequences. It’s quite likely that the [reduced] capacity of the Global Fund to address HIV, TB, and malaria will result in an uptick in their numbers internationally and domestically,” said Culbert.

“Historically, the surge of any infectious disease affects the global health system and potentially leads to greater outbreaks of other diseases,” Culbert continued. “This means operating in a greater ecosystem of uncertainty. When you’re trying to make a substantial improvement in any condition, it takes a long-term concerted effort, which is what the fund has done. When you stop investing or slow down investment, you lose many of the accomplishments you’ve achieved over the past decade or so, so it’s short-sighted. It’s disappointing that the government of Canada has made this decision. It will end up costing more.”

Patrick reported being a member of the Scientific Planning Committee of the College of Family Physicians of Canada. Swinkels, Bedingfield, and Culbert reported having no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.