Newsletter Edition #396 [The Files In-Depth]
Readers,
As you would know, last week, the Global Fund elected Mark Dybul, a highly regarded technical leader and expert, to lead the institution, for a non-consecutive second term.
There are two parts to this comprehensive edition: first, we have a quick, but thoughtful update from my colleague Merlin Ince, on the election that took place last week. Second, I also had the opportunity to speak with Dr Dybul late last week, over an exclusive interview.
In an insightful conversation, he spoke about the challenges facing global health, the wider transitions that are affecting the field, and the future of the largest financing mechanism in global health that he will lead, once more.
I hope you find this timely and informative! (I had to skip my child's soccer tournament on Sunday, to get this to you on time.)
More from us this week, from what I hope will be (sizzling) developments from the WHO, where countries are convening this morning for crucial two-week negotiations on the Pathogen Access Benefit Sharing system.
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Best,
Priti
Priti Patnaik, Founder & Publisher, Geneva Health Files
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Presenting our weekly in-depth analysis on global health that captures the big picture and the nuances like no one else does. This is an exclusive edition for our subscribers.
PART I: UPDATE GLOBAL FUND ELECTIONS
Thirty-Five Countries, One Decision: The Global Fund Picks Its Next Leader as Transition Begins
By Merlin Ince
On Wednesday, 28 October 2026 in Geneva, the Global Fund’s Board chose Mark Dybul as its next Executive Director. He ran the institution once before, from 2013 to 2017, built PEPFAR before that, and sits on the high-level panel of the Accra Reset, which presses for countries to finance and run their own health systems.
He will lead on, among other defining decisions, what happens to the people in 35 countries where 63 programmes in HIV, TB and malaria are receiving their final Global Fund grants. Those countries are expected to take over the funding themselves, on terms they did not set.
Such communities have already been through a version of these disinvestments. When funding was abruptly withdrawn last year, governments were left to decide how they cope. For example, some were forced to focus solely on treatment programmes, while prevention measures had to be compromised. The number of people receiving pre-exposure prophylaxis, the medication that prevents HIV infection, fell from 1.4 million to 1.1 million in a year. In a written response to this publication, the Fund traced most of that decline to disruptions in community-based service delivery, in countries across every region.
Community-based services are usually the first to go. Since they operate outside hospitals and clinics, reaching people who are structurally isolated, they are ironically the easiest to stop paying for. The people who lose access are therefore the ones already hardest to reach.
Infections that could have been prevented become infections that must be treated, and treatment is the more expensive of the two. In this way, a country moving off Global Fund support is taking over a bill that grows each year where prevention is not funded, while at the same time it is expected to prove it can manage without help.
It is an example, among many, of the kind of granularity a Board decision could glide over.
The Board sets an allocation and a transition schedule, and it does so against a replenishment that raised $12.68 billion of an $18 billion target, leaving the institution $5.32 billion short of what it set out to raise. The space between that decision and what follows from it depends very much on whoever is running the institution between one Board meeting and the next.
This often means deciding how a schedule is applied to a country that is not keeping pace with projected timelines, how much flexibility a programme is given before it closes, and whose account of the situation on the ground reaches the Board the next time it meets.
The same disconnect opens up again in the conditions of transition itself, where the terms are set in one place and lived with in another. The 35 countries have not set the terms on which they are being moved off support. They were informed of them by letter, setting out the allocation, the co-financing requirements and the transition timelines. They also do not yet know whether they will retain any say over how they buy medicines.
(Read more about this central tension – one of the challenges on country transition facing the Fund, in the interview with Dybul - see below.)
Jirair Ratevosian, a former Global Fund Board member who was acting chief of staff for PEPFAR, is clear about the weight of the job. “Over the coming years, I believe the Global Fund will have greater influence on the direction of global health than WHO,” he told us.
“It can move money, shape markets, bring governments, funders and communities together with a flexibility few institutions can match. That gives its next leader enormous influence over which services survive, which innovations reach people and whose priorities receive funding.”
No account has been given of how the Board chose the person who will hold it. The five finalists were named a month before the vote, and no public forum was held at which they could be questioned. (No responses or acknowledgements were received from the five candidates when we tried to reach them to understand their visions for the Fund ahead of the election.)
Within that opacity, Dybul has stepped up to navigate the role. What he drives with it, and what he pushes against, will shape what these programmes look like in the 35 countries exiting the Global Fund’s support. (See full interview with Dybul below)
Sources and References
Global Fund Board Appoints Mark Dybul as Next Executive Director (The Global Fund, 28 October 2026); Global Fund Results Report 2026 (The Global Fund, 16 September 2026); Global Fund Results Report 2026 press release (The Global Fund, 16 September 2026); written response from the Global Fund Secretariat to Geneva Health Files on HIV prevention figures in the 2026 Results Report (30 October 2026); Sustainability, Transition and Co-Financing (The Global Fund); Key Considerations, Grant Cycle 8 applications (The Global Fund, 2026); Global Fund Board Welcomes Final Eighth Replenishment Outcome of US$12.64 Billion (The Global Fund, 18 February 2026); “BREAKING: Global Fund Appoints Mark Dybul as Executive Director Amid Mandate and Funding Challenges” (Health Policy Watch, 28 October 2026); “Global Fund Leadership Shortlist Unveiled Amid Donor Friction and Push for Reform” (Health Policy Watch, 1 October 2026); Devex CheckUp (Devex, 29 October 2026); Jirair Ratevosian, statement to Geneva Health Files (October 2026); interview with Mark Dybul, Geneva Health Files (30 October 2026); A Sovereign Future For Health, Accra Reset High-Level Panel on the Reform of the Global Health Architecture and Governance (September 2026).
Priti Patnaik
PART II
Mark Dybul at The Global Fund: Back To First Principles; Focus on Controlling Epidemics; Cautious on The Expansion of Scope; Signals Collaboration With Gavi
By Priti Patnaik
Upon election to become the next Executive Director, Mark Dybul spoke with Geneva Health Files, in a comprehensive interview, sharing his perspectives on the priorities of the Global Fund in an altered financing landscape in global health.
He responded to several questions on how he sees the future of the Fund in the backdrop of reforms in the sector, how he would deal with donors such as the United States, and his assessment on the transition towards greater country ownership.
He also responds to the question on the lack of transparency in the elections process. This interview has only been edited lightly to improve readability.
