This year marks a decade since the creation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Fund’s impact on the TB fight has been extraordinary. Its continued success is fundamental to seizing new opportunities and confronting old challenges, and to finally conquering this disease that is as old as human history.

A decade ago, donor financing for TB was minuscule, and TB patients and programs were dying from neglect. Stock-outs of the inexpensive drugs needed to treat TB were common. When patients did have access to medicine, the long and sometimes difficult treatment course was too often poorly managed. And in sub-Saharan Africa, AIDS and TB raged as a lethal and largely unchecked co-epidemic.

To date, the Global Fund has approved over $3 billion in TB grants to countries; it currently provides over 80 percent of all donor financing for TB. It has fundamentally transformed the fight, and since its inception the Global Fund has helped countries detect and treat 8.6 million cases of TB.

With this enormous progress, the remaining challenges stand out even more starkly. And exciting new opportunities are ready to be taken to scale.

While the world has begun to wake up to the enormous toll of TB-HIV co-infection, TB is still the number one killer of people with HIV/AIDS. The World Health Organization just announced that in the past six years 910,000 lives have been saved worldwide thanks to improved collaboration between HIV and TB services. The number of people with HIV screened for TB increased from just 200,000 in 2005 to more than 2.3 million people in 2010, but that’s still less than 10% of all PLWHA; and we’re still failing to screen nearly half of those who are actually accessing HIV care. The Global Fund and PEPFAR have played crucial roles financing TB-HIV service integration, but we can and must do even better. If we accelerate these efforts, we can save an additional one million lives by 2015. 

Correctly diagnosing the disease, especially drug resistant forms, remains a major stumbling block. A new rapid test for TB called GeneXpert has potential to revolutionize TB diagnosis by returning accurate results within less than two hours, including detecting resistance to the most common drug used to treat the disease. GeneXpert is already being rolled out in South Africa, which has the second highest reported caseload of multi-drug resistant (MDR) TB in the world.

In addition to a fully-financed Global Fund, investments through the TB program at USAID are needed to seize these opportunities. USAID provides complementary support, including supporting the testing and validation of new tools needed to fight the disease. For example, USAID is supporting TB Alliance to develop the next generation of more effective, safer drugs.

It's been 130 years this week since Dr. Robert Koch announced his discovery of the bacterium that causes TB. It's only in the last decade that financing innovations like the Global Fund and technological innovation have converged to provide a genuine opportunity to conquer TB. The next decade, and even coming months, will reveal whether we have the political will to seize these opportunities.

With a new five-year strategy to save 10 million lives, the Global Fund is poised to build on the success of the last 10 years. This achievement will hinge on whether the U.S. and other donors can overcome budget pressure and political constraints to fully finance its implementation. As a part of ACTION, an international partnership working to mobilize resources to treat and prevent TB, I've seen how advocacy can secure funding, change policy, and ultimately expand the envelope of what we thought possible in global health.

This World TB Day was a reminder that the disease won’t stand still, so we have to keep moving forward together.