Canada’s decision to cut its pledge to the Global Fund, one of the world’s most important financiers of the fight against infectious disease, is reverberating far beyond the country’s borders and, health experts warn, may soon be felt inside them.
In November, the federal government quietly reduced its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria by 16 percent, a move that has drawn sharp criticism from physicians and public health researchers in a statement published this week in the Canadian Medical Association Journal.
The fund supports programs in more than 100 countries and has been credited with saving an estimated 65 million lives since its creation in 2002.
“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,” said Dr. Kirsten Patrick, editor-in-chief of CMAJ, and Helena Swinkels, the journal’s deputy editor. “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 now.”
The warning lands at a moment when Canada is grappling with a resurgence of tuberculosis, particularly among Indigenous communities and recent migrants, and when progress against HIV has slowed after years of steady improvement. According to federal data, tuberculosis cases in Canada have risen steadily since the pandemic, reversing a decades-long downward trend.
What happens in clinics in sub-Saharan Africa or Southeast Asia, the editors argue, does not stay there. Reduced investment in global disease surveillance, diagnostics and treatment weakens the early warning systems that help prevent outbreaks from spreading across borders.
“Unfortunately, HIV and TB control will not be the only casualties of the current global funding shortsightedness,” the authors wrote. “In public and global health, managing problems in silos may seem appealing, but health threats do not fit into neat containers; they affect systems.”
The Covid-19 pandemic offered a painful demonstration of that reality. Countries with fragile health systems struggled to contain outbreaks, allowing new variants to emerge and spread globally. Experts say cuts to the Global Fund risk repeating that cycle with diseases that, while older and less politically urgent, remain deadly.
Peter Sands, the executive director of the Global Fund, has repeatedly warned that declining donor commitments threaten hard-won gains. “The world is facing a convergence of crises,” Mr. Sands said last year in testimony to European lawmakers, “and pulling back now would not only cost lives abroad but undermine global security and economic stability.”
Public health scholars say Canada’s move is especially striking given its longstanding reputation as a champion of multilateral health initiatives. Dr. Madhukar Pai, Canada Research Chair in Epidemiology and Global Health at McGill University, has argued that tuberculosis control depends on sustained global financing. “TB anywhere is TB everywhere,” he said in a recent interview. “Cutting international funding while cases are rising domestically is a false economy.”
The CMAJ editorial also points to deeper structural issues that funding cuts are likely to exacerbate. Tuberculosis and HIV are closely tied to poverty, housing insecurity and access to health care, challenges that exist within Canada as well as abroad.
The editors urged the federal government not only to restore its Global Fund pledge but also to invest more aggressively at home in the social determinants of health that fuel infectious disease. Among their recommendations are the creation of a national tuberculosis body, improved access to real-time data and expanded availability of medications for both TB and HIV.
Those proposals echo calls from the World Health Organization, which has warned that global TB deaths rose in recent years for the first time in more than a decade. In a 2024 report, the agency said funding shortfalls were “directly contributing to delayed diagnosis, interrupted treatment and increased transmission.”
For advocates, the stakes extend beyond budgets and balance sheets. “Global health is not charity,” said Dr. Joanne Liu, the former international president of Médecins Sans Frontières. “It is a shared responsibility rooted in the simple fact that pathogens do not respect borders.”
As donor governments reassess their priorities amid inflation, war and domestic political pressure, the editors of CMAJ argue that Canada’s decision sends the wrong signal at precisely the wrong time. Reversing course, they say, would not merely reaffirm Canada’s global commitments but protect its own population from diseases that remain, stubbornly, unfinished business.
In an interconnected world, the cost of retreat may ultimately prove far higher than the savings it delivers.
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