Last week, Michel Kazatchkine tendered his resignation as executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Regardless of whether you've heard of the French AIDS scientist, or even of the fund, you should keep reading. This is a crucial, dangerous moment for global health.
Kazatchkine made clear the political struggle that forced his resignation. "The Global Fund has helped to spearhead an entirely new framework of international development partnership," he wrote in his resignation letter. But under stress during the world economic crisis, with radically declining support from donors, a battle developed. "Today, the Global Fund stands at a cross-road. In the international political economy, power-balances are shifting and new alignments of countries and decision-making institutions are emerging or will have to be developed to achieve global goals. Within the area of global health, the emergency approaches of the past decade are giving way to concerns about how to ensure long-term sustainability, while at the same time, efficiency is becoming a dominant measure of success," he wrote.
It is almost possible to hear Kazatchkine spitting out the words 'sustainability' and 'efficiency'. Since the financial crisis of November 2008, a storm has been brewing over these concepts, one that affects everything from humanitarian responses to projects that distribute malaria bed nets. It is a fight, and on one side are those who believe that crises in general, and the AIDS pandemic and allied diseases in particular, constitute global 'emergencies' that must be tackled with full force, mistakes be damned. On the other are those who feel that AIDS is now a chronic disease that can be managed with medication and therefore requires investment in permanent infrastructure of care and treatment that can eventually be operated and funded by the countries themselves.