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UK's Global Health Powerplay

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This week's news that the UK government would contribute £1billion to the Global Fund to fight AIDS, Tuberculosis and Malaria for the next three years surprised many Global Fund lobbyists who didn't expect to get what they asked for.

It is a truly remarkable outcome - and could prove to be a turning point in the history of global health. Since the announcement the Department for International Development (DFID) has been tweeting:

"Every 3 minutes, for the next 3 years UK aid will save a life by backing the Global Fund to beat 3 of the world's biggest killers: AIDS, TB and malaria."

DFID - known to be an exacting donor - is clearly convinced that there is a strong business case for substantial investment. By more than doubling its previous contributions, the UK is sending a very strong message to other donors that the Global Fund has taken on board significant changes under the leadership of its new Executive Director Mark Dybul.

The Global Fund can already boast a remarkable track record: saving nine million lives since its creation in 2002.

Its most recent reports show that countries have used Global Fund money to double the numbers of people on HIV treatment to over 10 million over the past five years. The number of TB cases detected and treated has also doubled, reaching 11 million people. Malaria programmes have treated more than 260 million cases of malaria, and distributed over 340 million insecticide treated bed nets - resulting in one third fewer malaria deaths in Africa over the past decade.

The new UK £1billion won't just expand those numbers, it will also be part of a far more profound effort - the big push to finally defeat the three diseases on the back of the huge scientific advances in recent years.

The Global Fund's target for this replenishment - US$15billion - could reach 85 per cent of people in need of HIV, TB and malaria interventions (when combined with other global resources). And that could mean finally turning the curve of the epidemics so that a real decline is possible within our lifetimes.

The UK is the world's largest economy committed to spending 0.7 per cent of GDP on aid - and that means it needs to find good organizations to spend the money for it. It has high standards as well as a high target.

The confidence in the Global Fund - and the acknowledgement that defeating the three diseases should be a priority - happened because of an intelligent, savvy coalition of advocates with smart tactics. DFID met the ask because of the diversity of askers: politicians from all parties backed the Global Fund's ask - and pushed it forward in public and behind the scenes. So too did celebrities - with Sir Elton John and Bono being the most visible - as well as NGOs, people living with HIV and TB (many from Africa) and other donors, including Bill Gates, making the case over and over again.

The UK met this smart advocacy with a smart solution. £1billion is a remarkable commitment but it comes with heavy strings attached: the UK promise will only be realized on the condition that the Global Fund reaches its full target of US$15billion. Australia, Germany, Japan, Canada still haven't confirmed their pledges - now they know that the more they give, the more the pounds will flow.

So, the pressure is on in the build up to the final pledging conference that John Kerry just announced the U.S. will host in December. The UK-US special relationship now extends to being the top two Global Fund donors - with the UK leapfrogging the French, who were happily in 2nd position. Within minutes of the UK announcement French activists were demanding that their government give more and reclaim second place.

For the remainder of the year we can expect lots of back and forth as each government seeks to prove they care about global health more than the other.

The UK's £1billion is not only very generous; it's also very clever.