The debate about the quantity of Britain's aid budget was settled earlier this year when the government delivered on its promise to invest 0.7% of our national income in fighting poverty and disease - a decision that, contrary to what the cynics insist, had the support of the majority of British people. That was a divisive argument. But now the focus turns to what both sides agree is an even more important challenge: how should the money be spent?
The 0.7% target was never meant to be an end in itself. It's important because of what it allows you to do. Decisions about where and how the money is spent can mean the difference between life and death for the millions of people.
The British secretary of state for development, Justine Greening, knows this only too well. While the rest of us can only play Fantasy Development with a hypothetical aid budget, she does it for real. Right now, with David Cameron, she faces one of the most important decisions she will make as secretary of state: how much to allocate to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
It is rare that such an opportunity comes along to illustrate the difference that can be made by British aid. Since 2002, the Global Fund has treated 4.2 million people living with HIV/AIDS, prevented 1.7 million HIV-positive pregnant mothers from passing HIV to their babies, distributed bed nets to 310 million families to protect them from malaria and helped stop the spread of drug-resistant TB. It has saved millions of lives. This is what international development can be: dynamic, human and real.
In the British government's own review of multilateral aid agencies, the Global Fund was rated among the best value-for-money organisations that there are. Ministers have promised that the UK's aid budget will be allocated with a ruthless focus on efficiency and results. By that measure, the Global Fund is one of the best possible ways to spend it.
But why does the Global Fund need commitments now? The Fund is coming to the end of its latest three-year programme and needs support from the international community to continue, and step up its efforts, from 2014. The need is greater than ever. In any fight against infectious diseases there is a window of opportunity that must not be missed; that moment is now. We have new tools to diagnose, prevent and treat these diseases more effectively and our scientific understanding of how to fight them has therefore improved substantially. For the first time we can see a pathway first to controlling these three killers, and ultimately, to defeating them.
History has shown us that, when we reach a tipping point, if we then become complacent we risk a reversal. In Zanzibar and Swaziland there has been a rapid resurgence in malaria cases and deaths, when coverage of insecticide-treated bed nets was not maintained. In regions like Eastern Europe and Central Asia, new HIV and TB infections are on the rise, particularly among marginalised populations who face stigma and barriers to treatment. We cannot let up now.
So what difference would British support make? Well, if the UK delivers a contribution of at least £1 billion over the next three years, as we hope it will, the Fund and its partners will be able to provide:
• antiretroviral therapy for more than 650,000 HIV-positive people;
• more than 51 million bed nets;
• treatment for nearly 27 million cases of malaria;
• care and treatment for almost 300,000 TB patients .
But British leadership can do even more than that. UK money will unlock more for the Global Fund from other countries. The US, already the biggest donor to the Fund, has promised that for every two dollars other donors give, it will add a further dollar. That's even more value for money for British taxpayers and even more results in the fight against these diseases.
And other countries are watching the UK too. The UK's Department for International Development is recognised as one of the best in the world, so if DFID decides an investment makes sense, that decision can influence others. France and Germany have already promised to maintain their contribution and both could go further. Others could then follow. Britain's contribution will be around 10 to 13 per cent of the total expected to be raised. That's surely a fair share.
So it's decision time and Britain, like other countries, faces a choice. Do we hold back, preserve the status quo with a modest contribution and increase the risk that these diseases rebound and spread again, wasting more than a decade of investment and putting lives on the line? Or do we seize this moment, be bold, back a proven success and help set a path to achieving what once seemed impossible--the defeat of AIDS, tuberculosis and malaria in our lifetime? Justine Greening and David Cameron will make their choice. What would you do?