Global Fund disease czar warns of limits to shifting foreign aid to private capital

In a statement issued after this article was published, the Global Fund said that Sands was speaking generally about private funding and tuberculosis and was not criticizing the Canadian government.

Sands gave an exclusive interview Tuesday to The Canadian Press during a visit to Ottawa — his first since Prime Minister Mark Carney announced last fall that Canada would be pulling back funding for global health initiatives and would link aid dollars to economic spinoffs for Canadians.

Ottawa’s $2.7 billion cut to foreign aid over the next four years follows the near-collapse of USAID, the United States’ international development agency, and cuts from other countries which play key roles in international development.

Those cuts include Canada’s first-ever cut to the Global Fund — a 17 per cent drop from the amount Ottawa pledged three years prior. The federal government is promising $1.02 billion for the fund from 2026 to 2028.

Since 2002, the Global Fund has helped to fight the spread of diseases in poor countries that are entirely preventable.

“There’s been a lot of really quite sharp prioritization,” Sands said.

“We’re in a situation where we’re quite likely to see significant gaps in coverage of certain key services, in a number of countries, because of the funding reductions.”

Sands said the cuts are affecting the services, training, research and other infrastructure needed to eradicate disease, and could force his organization to make choices of its own.

“If the trade-off is between keeping somebody on antiretroviral treatment or doing a survey, you’re going to keep somebody on anti-retroviral treatment,” he said. “So there’s been a lot of really quite sharp prioritization.”

Despite Ottawa’s cut to Global Fund aid, Sands said, Canadian public money is still helping to save lives abroad.

“Canada has been one of our strongest and most consistent supporters,” Sands said.

“The contributions Canada has made have played a large role in the fact that the Global Fund has now saved over 70 million lives and that we’ve seen a really significant reduction in mortality and infection rates across HIV, TB and malaria.”

Sands said the loss of aid funding has forced his sector to be “very smart in the way that we deploy resources” and to lean more on new technologies.

Those technologies include an HIV-prevention drug that can be injected every six months — an alternative to daily pills — and X-ray tests that use artificial intelligence to provide faster TB screening.

Sands is said he is most concerned about the spread of drug-resistant strains of malaria.

Sands said cuts to aid from western countries are being partially offset by contributions from developing countries themselves and from private capital.

Randeep Sarai, the secretary of state for international development, has sought a larger role for private capital in aid by, among other things, having Ottawa back investments to make them less risky to private lenders.

“Given the scale of today’s global challenges and the (fiscal) constraints that donors are facing, it is essential that we leverage our aid dollars strategically to mobilize new sources of financing for development,” Sarai testified Wednesday to the Senate foreign affairs committee.

“Many private foundations and civil society groups are stepping up,” Sarai added.

Sands said his sector welcomes the creativity but warned it won’t help those most in need.

“The ability of the private sector to invest in and, in a sense, make a business out of health provision is certainly there,” he said. “But for many of the people that we are most focused on serving — who tend to be the poorest communities, the most marginalized — that’s less of an option.”

Sarai acknowledged Wednesday there are limits to how much private funders and developing nations’ own governments can contribute. “Those like Sudan that are the most vulnerable still will require our assistance, and we’ll do it,” he said.

Sands also said tuberculosis seems to still be circulating in Canada’s Far North for the same reasons that drive the disease’s spread in the Global South, such as poor living standards and unreliable access to health services.

His organization welcomed the government’s announcement last month of $27 million for Inuit-led TB elimination initiatives, while noting the disease can be eradicated.

“Ultimately, the thing that drives improvement on TB is the political will to make it happen,” he said. “It’s curable, it’s preventable. We can get rid of it. So that’s why I say it’s fundamentally a question of political will and real focus.”

He gave the example of Japan taking a “whole-of-society” approach to TB after the Second World War, when the country co-ordinated a response among health officials, the private sector and schools.

Japan then built its national health system around the infrastructure created to fight TB, which was the country’s leading cause of death at the time, according to the academic journal Health Systems and Reform.

“It wasn’t just addressing the biomedical aspects. It was looking at what the underlying drivers were,” Sands said.

This report by The Canadian Press was first published March 26, 2026.