The Future of Fast-Track Cities: A Q&A with
Fast-Track Health President/CEO Dr. José M. Zuniga
Over the past decade, the Fast-Track Cities network has made remarkable strides in advancing urban public health leadership, with a primary focus on accelerating the HIV response. As the network celebrates its 10-year anniversary, there has been a collective effort to reflect on the achievements, challenges, and vision for the future. Fast-Track Health reached out to a subset of Fast-Track Cities to gather insights about how they envision the coming decade. This outreach has revealed a desire among city leaders to sustain and broaden the network’s impact, aiming to achieve a wider range of health-related Sustainable Development Goals (SDGs). The feedback reflects an evolving understanding that the health of urban populations is interconnected, with communicable and non-communicable diseases, environmental health, and social determinants of health playing a critical role.
The cities’ responses to date underscore a shared commitment to tackling health challenges in a holistic way, particularly as urbanization intensifies worldwide. With projections showing that two-thirds of the global population will reside in cities by 2050, the need for resilient, adaptable urban health systems is more pressing than ever. City leaders have expressed optimism about expanding the Fast-Track Cities framework beyond HIV to encompass other communicable and non-communicable diseases, and the health impacts of climate change. This expansion aligns with the overarching goal of achieving universal health coverage (UHC) and the health-related SDGs, reinforcing the importance of local governance in building health equity and sustainability. The experiences of Fast-Track Cities, where impactful community partnerships, impact-driven health financing, and robust data systems have driven progress, serve as a model for addressing a wider range of health issues in complex urban environments.
In this interview, Dr. José M. Zuniga, President/CEO of Fast-Track Health and its affiliated Fast-Track Cities Institute, discusses the Fast-Track Cities network’s successes and aspirations. He highlights how the principles that have guided the network’s HIV response – political leadership, community engagement, innovative approaches, data infrastructure, and person-centered care – are readily adaptable to other public health challenges. Dr. Zuniga shares examples of cities that are already exploring integrated health models, providing a roadmap for how Fast-Track Cities can contribute to achieving the health-related SDGs. With more than 550 cities united under a common mission, he believes that Fast-Track Cities are positioned to be a formidable force in global health, using the next decade to leverage urban public health leadership to build healthier, sustainable, and inclusive cities and countries worldwide.
What are your reflections of the launch of Fast-Track Cities network in 2014 and its 10-year anniversary in 2024?
Dr. Zuniga: The Fast-Track Cities network’s launch on World AIDS Day 2014 was a pivotal moment for the global HIV response. At the Hôtel de Ville in Paris, 26 initial cities committed to accelerate their urban HIV responses and align with global efforts to end AIDS as a public health threat. Ours was a bold and aspirational vision, underpinned by a recognition that cities are uniquely positioned to lead on health innovation and equity. As one of the four global signatories of the Paris Declaration on Fast-Track Cities Ending the HIV Epidemic alongside the then-Executive Directors of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the UN Human Settlements Programme (UN-Habitat), as well as Paris Mayor Anne Hidalgo, I remember the energy and optimism of that day, with cities from every continent uniting behind a sense that we were beginning a transformative journey. I was then wearing my hat as President/CEO of the International Association of Providers of AIDS Care (IAPAC).
Fast-forward to 2024, and the 10-year anniversary Fast-Track Cities conference we hosted in Paris felt like a homecoming and a celebration of what this now 550-plus city network has achieved. We reflected on a decade of progress, including cities that have reached or surpassed the UNAIDS 95-95-95 HIV programmatic targets and others that have made significant strides towards universal access to HIV services. The conference also marked a turning point, as we expanded our scope to address broader health-related SDGs. It was a moment of pride but also one of humility, recognizing the challenges that remain and the need to sustain momentum as we approach 2030 and beyond.
The symmetry of launching and celebrating this one-decade milestone in Paris underscores the city’s leadership and enduring commitment to the Fast-Track Cities vision. Paris embodies the spirit of the network, which combines political courage, community engagement, and innovation. As I reflect on these two historic moments, I feel immense gratitude for the mayors, health leaders, and communities that have made this journey possible. The path ahead is challenging, but these milestones affirm that cities are essential to achieving global health equity.
As the Fast-Track Cities network celebrates its 10-year milestone, what would you say is its most significant achievement?
Dr. Zuniga: Over the past decade, the network’s most significant achievement has been the evolution of a resilient, committed, and forward-thinking network of more than 550 cities worldwide. These cities have demonstrated the transformative impact urban centers can have in addressing critical global health challenges. The network demonstrated that political will, community involvement, and strong data infrastructure can deliver tangible progress. Fast-Track Cities have reduced new HIV infections by enhancing HIV prevention and treatment accessibility and supporting implementation of the destigmatizing U=U (Undetectable = Untransmittable) message. In helping cities achieve these successes, we have laid a foundation that proves the value of focused urban public health strategies.
Cities such as São Paulo exemplify the transformative power of local leadership, for example by achieving the UNAIDS 95-95-95 targets ahead of the 2025 deadline, illustrating the effectiveness of its inclusive health strategies. São Paulo’s approach included a range of interventions from mobile testing units to targeted outreach in high-risk communities, highlighting how cities can be laboratories of public health innovation. This achievement is not isolated; it demonstrates the scalability and adaptability of the Fast-Track Cities model, which supports cities worldwide to tackle public health challenges in ways that reflect their unique contexts and populations.
The success of Fast-Track Cities is a blueprint for the future of urban health interventions, not just in the fight against HIV, but in addressing other pressing health issues. These cities represent a commitment to transforming how we deliver healthcare in urban environments, showing that cities can be powerful health advocates for millions of people, including those who are disenfranchised and marginalized. Looking back at this decade, the Fast-Track Cities network’s accomplishments affirm our collective strength and our potential to drive meaningful, sustained impact in global health.
How can the Fast-Track Cities network address the urbanization trend towards higher numbers of people living in cities?
Dr. Zuniga: The unprecedented rise in urban population provides both opportunities and challenges for public health. As cities grow, so does the demand for health services that address complex and often overlapping health needs, ranging from infectious diseases to chronic conditions exacerbated by urban lifestyles. Fast-Track Cities are strategically positioned to meet these demands by focusing on local interventions that scale quickly and respond dynamically to urban health trends. Cities are unique in their ability to integrate public health with other essential services, and we believe Fast-Track Cities can leverage these opportunities to create sustainable health ecosystems that adapt to urban pressures.
The Fast-Track Cities model is designed with scalability and adaptability in mind, qualities that are essential in rapidly urbanizing environments. As we think about expanding the network, we can look at successful case studies like Johannesburg, where the city is implementing integrated care platforms that tackle both HIV and tuberculosis (TB), as well as primary care needs. By building upon existing HIV infrastructure, these integrated approaches can be replicated in other cities facing similar health dynamics. The result is a holistic, scalable framework that addresses current health challenges and is also robust enough to accommodate emerging needs.
In the coming years, our goal at Fast-Track Health and the Fast-Track Cities Institute is to equip urban health leaders with the tools they need to address the growing and evolving demands of city life. As more people migrate to urban centers, data-driven strategies will guide cities in managing resources effectively and ensuring equitable access to healthcare. With the right leadership and support, we envision a future where cities not only meet the health needs of their populations but also set global standards for public health innovation and resilience, as well as engage in city multilateralism to address public health challenges jointly by municipal and national political and public health bodies.
What role does political leadership play in the success of Fast-Track Cities, and how can it be further leveraged?
Dr. Zuniga: Political leadership is a core pillar of Fast-Track Cities’ success. Mayors and municipal leaders wield considerable influence over local health policies and resources, making their support vital for achieving ambitious public health goals. Their commitment can translate into dedicated funding, inclusive policies, and the allocation of city resources for community health needs, including those related to social determinants of health. Cities such as Paris and New York City, where mayors took active roles in promoting HIV testing, treatment, and stigma reduction, highlight the power of municipal leadership in driving measurable progress.
For political leaders, supporting the Fast-Track Cities network is about more than health outcomes – it is a demonstration of their commitment to their constituents’ overall well-being. The cities that have made the most strides are those where leaders have fully embraced the network’s goals, leveraging their platforms to raise awareness, secure partnerships, and involve community stakeholders. This level of engagement creates a ripple effect, encouraging other sectors within the city to support public health efforts. In Paris, for example, the city’s leadership in HIV response has inspired broader discussions on health equity for migrants, setting a standard that other cities in France, Europe, and beyond are beginning to adopt.
Looking ahead, we want to build on this momentum by creating mechanisms for even stronger political engagement, including through our partnership with UNITE, the parliamentarial network for global health. This includes encouraging and facilitating collaboration between Fast-Track Cities and national health ministries to align city-level and national health priorities, and enhancing municipal-national coordination of health responses. By bringing city and national leaders together, we can ensure that local successes contribute to broader national health targets. Ultimately, political leaders have the power to champion public health innovations that benefit entire countries, amplifying the reach and impact of the Fast-Track Cities model.
Could you share an example of how community engagement has driven Fast-Track Cities’ successes?
Dr. Zuniga: Community engagement is another core Fast-Track Cities pillar that has been fundamental to the success of Fast-Track Cities, enabling public health programs to specifically respond to community needs and reach marginalized populations that traditional health systems often overlook. Community-based organizations (CBOs) play an instrumental role in this effort. In cities like Bangkok, CBOs collaborate closely with local health authorities to engage key populations such as men who have sex with men, transgender individuals, and sex workers. This partnership has led to significant reductions in HIV transmission rates, showing how community involvement strengthens the reach and impact of public health interventions.
Through these partnerships, Fast-Track Cities benefit from the trust and rapport that community organizations have built with local populations. For example, in Bangkok, CBOs work as liaisons between the healthcare system and communities, providing education, testing, and treatment referrals. This integrated approach not only improves health outcomes but also fosters an environment of acceptance and understanding, reducing stigma and discrimination. In many ways, community engagement has transformed the public health landscape, allowing cities to serve populations that may otherwise remain disconnected from traditional healthcare services.
Moving forward, we want to deepen community engagement by supporting the strengthening of formal frameworks that empower CBOs to co-lead public health initiatives, aligned with the Meaningful Involvement of People living with AIDS (MIPA) principles and the commitments in the Sevilla Declaration on the Centrality of Affected Communities in Urban HIV Responses. This framework is not only effective but also sustainable, as it builds capacity within communities to take ownership of their health. By strengthening these partnerships, Fast-Track Cities can continue to provide inclusive and equitable health services that address the unique needs of each community. Our vision is to see cities where community-driven health initiatives are not the exception, but the rule.
How have communities influenced an expanded scope for Fast-Track Cities?
Dr. Zuniga: From the outset of Fast-Track Cities, placing affected communities at the center of urban responses to HIV, TB, and viral hepatitis was prioritized through meaningful engagement and involvement in planning, implementation, and monitoring. Community leaders have driven the underlying dialogue for how institutions – city and public health administration, clinical and service providers, and community-based organizations – advanced Fast-Track City objectives in their respective cities. Communities affected by HIV, TB, and viral hepatitis are playing a transformative role in shaping the future of the Fast-Track Cities network by highlighting the interconnectedness of health challenges and the need for integrated, person-centered care.
Communities have consistently advocated health responses that are less siloed, emphasizing the importance of addressing comorbidities, social determinants of health, and systemic barriers to care. Their lived experience-informed advocacy has underscored the value of an integrated approach that aligns with UHC principles to make health systems more equitable, accessible, and inclusive. Because individuals living with HIV, for instance, also face vulnerabilities to non-communicable diseases (NCDs), supporting the implementation of integrated care models is among Fast-Track Health’s priorities. Cities like Nairobi and Mumbai have already embraced this approach, demonstrating how integration can enhance health system efficiency while meeting the whole-health needs of diverse populations.
By advocating equity, these communities are also acutely aware about the direct and disproportionate impacts of climate change on vulnerable populations, including those living with or affected by HIV, TB, viral hepatitis, and other health conditions. Communities have highlighted how climate change exacerbates health inequities, increasing the burden of respiratory illnesses, vector-borne infections, and mental health disorders while disrupting access to essential health services. By engaging in climate action, Fast-Track Cities can address the intertwined challenges of health and environmental sustainability, preparing urban health systems to respond to climate-induced risks. Communities have made it clear that disease-specific challenges do not exist in isolation, and their influence can pave the way for Fast-Track Cities to champion a comprehensive, systemic approach to urban health.
How has the network used data as a cornerstone of the Fast-Track Cities strategy to drive progress?
Dr. Zuniga: Data serves as the backbone of the Fast-Track Cities network, enabling cities to monitor their progress, identify gaps, and adapt strategies based on real-time information. Cities that have embraced data-driven approaches, like London, illustrate the power of data to guide public health interventions. In London, consistent HIV status reporting and anonymous data sharing allow the city to monitor trends, assess the effectiveness of interventions, and identify areas where additional support is needed. This data infrastructure has enabled London to respond dynamically to emerging challenges, helping the city to make targeted, informed decisions that maximize impact.
The use of data in Fast-Track Cities goes beyond monitoring HIV indicators; it also provides insights into social determinants of health that influence HIV outcomes. In cities with diverse populations, data collection is essential for understanding the unique needs of different demographic groups. In New York City, for instance, data analysis has been used to address disparities in HIV care among racial and ethnic minorities, guiding the development of tailored interventions that promote equity in health access. This emphasis on data ensures that Fast-Track Cities can respond effectively to the unique health profiles of their residents.
As we continue to expand the network (cities are still signing on in 2025), we will enhance data-sharing platforms and analytic tools to support cities in tackling a broader range of public health issues. By investing in data infrastructure, Fast-Track Cities can not only accelerate their HIV response but also build resilience against other public health threats. Data-driven strategies allow cities to adapt to changing health landscapes, making them better equipped to meet the needs of their populations. The future of urban health lies in the ability to turn data into action, and Fast-Track Cities are leading the way.
What is the Fast-Track Cities focus in relation to HIV from 2025 to 2030 and beyond?
Dr. Zuniga: For 2025 to 2030, Fast-Track Health recently recommended that Fast-Track Cities focus on sustaining and building upon progress made in the HIV response while addressing emerging challenges. Published jointly with IAPAC, our “Re-Imagining the Global HIV Response for 2030 and Beyond” recommendations emphasize integrating HIV services within broader health systems to ensure sustainability. This includes leveraging HIV infrastructure to address comorbidities like viral hepatitis, TB, and NCDs. Cities will also work to close the remaining gaps in HIV testing, treatment, and prevention so that the most marginalized populations are reached.
Stigma and discrimination remain significant barriers to achieving the UNAIDS targets and will be central to the network’s focus. Expanding U=U message and integrating it into public health campaigns will remain critical. Additionally, cities will prioritize innovative approaches such as long-acting antiretroviral drugs for pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), ensuring equitable access to these advancements. Digital health tools and artificial intelligence (AI) are also poised to play an increasingly significant role in improving the efficiency and reach of HIV and other health services. However, as we embrace these innovations, we must remain committed to addressing equity concerns and ensuring that technological advancements benefit all communities.
Beyond 2030, the focus must remain on maintaining the gains achieved while addressing the structural determinants of health that perpetuate vulnerabilities and continue to fuel new HIV infections and contribute to AIDS-related deaths. Fast-Track Cities also will have a critical role to play in actioning robust urban health governance to embed the HIV response into resilient health systems aligned with UHC principles. By advancing a data-driven, equity-based, and community-centered approach, the Fast-Track Cities network – to the degree it is supported to sustain its urban public health leadership role – will continue to ensure that no one is left behind in any city of the world with an equal commitment to those who live in peri-urban and rural areas.
How can the network’s model for the HIV response be adapted to other public health issues?
Dr. Zuniga: The principles guiding the Fast-Track Cities network – political leadership, community engagement, and data-driven, equity-based decision-making – can be adapted to address a wide range of health challenges. For example, our approach to HIV, which emphasizes a holistic response, translates effectively to other health conditions, including NCDs. Austin, TX, USA, for example, is using the Fast-Track Cities framework to integrate mental health and homelessness services with its HIV response, demonstrating that a comprehensive public health strategy can improve overall urban resilience.
Climate change presents new challenges for urban health, affecting air quality, vector-borne diseases, and even mental health, while also deepening socioeconomic disparities. In response, the Fast-Track Cities Institute is developing urban resilience programs that address these interconnected issues. Accra, Ghana, is among the cities leading this effort, incorporating climate adaptation measures into its public health infrastructure. By preparing for climate-related health impacts, Accra is setting an example for other cities facing similar challenges, showing that the Fast-Track Cities model can be a blueprint for resilience in the face of climate change.
Looking to the future, Fast-Track Health aims to support a global network of urban health leaders equipped to address complex health and environmental challenges. By broadening our scope to include climate change mitigation and adaptation within public health responses, we can help cities become more resilient and responsive to the evolving needs of their populations. The Fast-Track Cities model is flexible and adaptable, making it a powerful tool for cities seeking to protect and improve public health in an era of unprecedented environmental change.
Can you elaborate on how Fast-Track Cities can tackle NCDs as part of an expanded mandate?
Dr. Zuniga: Fast-Track Cities can expand their mandates to address NCDs, which are a growing concern in urban populations. As cities increasingly face a dual burden of infectious and chronic diseases, there is a pressing need for integrated health services. To meet this demand, cities like Nairobi and Mumbai are piloting NCD initiatives where HIV services are now being combined with screenings for diabetes, hypertension, and other chronic conditions. This model of integrated care not only improves efficiency but also provides people affected by a range of NCDs with a more comprehensive approach to their health. In this regard, our partnership with C/Can (City Cancer Challenge) and other NCD-focused urban initiatives offer opportunities for Fast-Track Health to amplify best practices and augment efforts across a range of NCDs, including breast and cervical cancer.
The inclusion of NCDs in its mandate is a natural extension of the Fast-Track Cities model, notably because they have already been addressing many NCDs as HIV comorbidities and syndemic conditions. By building on the infrastructure and partnerships established through the HIV response, cities can quickly scale up their capacity to address NCDs. This approach is particularly relevant in urban settings, where lifestyle factors such as diet, stress, and pollution contribute to high rates of chronic disease. By tackling these issues alongside HIV, Fast-Track Cities can create a more resilient health system that meets the diverse needs of urban populations.
Our goal is to see Fast-Track Cities become hubs for holistic healthcare, addressing the full spectrum of health issues that affect urban residents. By integrating NCD care with our existing HIV infrastructure, we can ensure that urban health systems are prepared to address the complex health needs of the future. This expanded mandate aligns well with our commitment to health equity, making high-quality healthcare accessible to all, regardless of disease type or socioeconomic status.
Can you also expand upon how Fast-Track Cities can engage in climate-informed health action?
Dr. Zuniga: Fast-Track Cities are uniquely positioned to address the health impacts of climate change due to their ability to leverage local governance, data-driven strategies, and community engagement. Urban centers are often on the frontlines of climate-related health challenges, from extreme heat and air pollution to the spread of vector-borne diseases and the mental health impacts of climate-induced displacement. The Fast-Track Cities network’s ability to implement localized, scalable solutions ensures they can protect vulnerable populations while contributing to global climate and health goals.
Fast-Track Cities can engage in both mitigation – reducing the health effects of climate change – and adaptation – building resilience to those effects – through a range of integrated strategies. For example, investing in green infrastructure can improve air quality and reduce urban heat islands while supporting mental and physical health. Cities like Copenhagen, Lagos, Lima, and Melbourne are already setting an example by integrating climate action with public health initiatives, showing how urban areas can lead in creating sustainable, climate-resilient health systems by mitigating and adapting to the health impacts of climate change.
To achieve maximum impact, all urban health initiatives must be engaged and aligned with climate action. Urban health initiatives should share data, resources, and best practices, creating a collaborative ecosystem that amplifies their collective impact. Fast-Track Health and the Fast-Track Cities Institute, in partnership with organizations such as C40 Cities and the Global Covenant of Mayor for Climate and Energy, can play a role in advocating climate-smart health policies. By uniting urban health and climate agendas, we can demonstrate health and sustainability are intrinsically linked, setting a global example for addressing the interconnected challenges of climate change and public health.
What potential do Fast-Track Countries hold in advancing national public health goals?
Dr. Zuniga: Fast-Track Countries refers to countries such as Australia, Brazil, South Africa, the United Kingdom, and the United States, which are home to a critical mass of Fast-Track Cities. Under this new designation, Fast-Track Countries represent a new frontier in advancing public health, and have the potential to drive national health agendas by demonstrating the effectiveness of localized, city-driven responses. By aligning city-level initiatives with national health policies, Fast-Track Countries can achieve results on a larger scale, contributing to national HIV and other health targets in a way that would be difficult to achieve through centralized efforts alone.
The impact of Fast-Track Countries is especially significant in regions where national health systems may lack the flexibility to address diverse urban health needs. In Brazil, for example, multiple cities and states have joined the Fast-Track Cities network, creating a network of local interventions that contribute to the country’s overall HIV response. This coordinated effort enhances resource efficiency, improves data sharing, and enables the adaptation of successful strategies across cities. The result is a synergistic effect that amplifies the impact of individual city efforts, driving progress at both the city and national levels.
Our vision is to strengthen coordination between Fast-Track Cities and national health ministries to create a seamless public health framework. By uniting the efforts of cities and countries, we can double the impact of our HIV response and extend our model to address other public health challenges. Fast-Track Countries exemplify the power of urban health leadership, showing that cities can be engines of national health transformation when given the right tools and support.
How can the urban public health responses address peri-urban and rural health needs?
Dr. Zuniga: Urban public health responses offer valuable lessons that can influence and support peri-urban and rural health systems. Cities often function as hubs of innovation, piloting scalable interventions that can be adapted to rural settings. For example, mobile health units and telemedicine – initially developed to expand urban reach – are now bridging healthcare gaps in peri-urban and rural areas. Urban centers also play a critical role in training healthcare workers and facilitating resource sharing, which can benefit rural communities when partnerships are established.
Collaboration between urban and rural areas is essential to creating a more equitable health landscape. Urban centers often have more robust health data infrastructure, which can inform resource allocation and planning for rural health needs. Peri-urban and rural regions can benefit from technical assistance provided by cities, such as expertise in managing HIV, tuberculosis, and non-communicable diseases. Moreover, cities can advocate national policies that prioritize rural health equity, recognizing that health outcomes in these regions directly impact urban populations.
The Fast-Track Cities network is uniquely positioned to bridge the urban-rural divide. Cities like Nairobi and Johannesburg are already implementing integrated health strategies that include outreach to surrounding peri-urban and rural communities. By fostering partnerships and sharing best practices, urban health leaders can extend the impact of their work so that advancements in urban health contribute to national and regional health equity.
In what ways has the Fast-Track Cities network’s model of collaborative action driven?
Dr. Zuniga: Collaboration has been a defining feature of the Fast-Track Cities network, allowing cities to leverage collective expertise, resources, and data-driven strategies to accelerate progress towards shared health goals. From its inception, the network has demonstrated that municipal governments, civil society, healthcare providers, and international organizations can achieve far greater impact when working in concert rather than in silos. This collaborative model has been particularly effective in the HIV response, ensuring that services are responsive to the needs of the most affected communities. With the network’s opportunity to expand its focus to include other communicable and non-communicable diseases, as well as climate-informed health action, partnerships will be strategically important.
To address urban health challenges beyond HIV, we have forged partnerships with the Stop TB Partnership and the Coalition for Global Hepatitis Elimination to support cities in strengthening their responses to TB and viral hepatitis. These collaborations provide technical, advocacy, and data-driven frameworks that help cities integrate and strengthen TB control and hepatitis elimination efforts into their public health systems. Similarly, we have joined forces with City Cancer Challenge (C/CAN), the International Society for Urban Health (ISUH), and the Sabin Vaccine Institute to advance broader health-related SDGs. These partnerships will help cities tackle rising rates of various cancers, cardiovascular diseases, diabetes, and other NCDs, and share best practices for making urban health systems more capable of addressing multiple health priorities simultaneously.
At a national level, the emergence of Fast-Track Countries offers an opportunity for even greater coordination and impact. By aligning urban and national health priorities, Fast-Track Countries can drive progress towards SDG 3 (Good Health and Wellbeing for All) while strengthening national health governance and infrastructure, which is a key area of focus for our partnership with UNITE. The Fast-Track Cities network’s collaborative model ensures that no city or country will operate in isolation, but rather benefit from shared knowledge, technical assistance, and strategic advocacy to accelerate health outcomes. Through 2030 and beyond, these partnerships will be crucial to shaping the future of urban health, ensuring that cities remain at the forefront of efforts to achieve UHC and health equity for all.
What role will Fast-Track Health play in the next phase of the Fast-Track Cities network’s evolution?
Dr. Zuniga: Fast-Track Health, in collaboration with the Fast-Track Cities Institute, will continue support Fast-Track Cities, as well as Fast-Track Countries, as they tackle evolving public health challenges. We are committed to providing technical assistance, data infrastructure, capacity building, best practice sharing, and policy advocacy. We recognize that cities are at the forefront of public health innovation, and we aim to empower them with the tools, resources, and knowledge they need to drive impactful change. Fast-Track Health will also help cities expand their focus beyond HIV to address a broader range of health issues in a hub-and-spoke approach that also addresses peri-urban and rural needs and striving for national impact.
One of our key areas of focus is the enhancement of data infrastructure, which enables cities to make informed decisions based on real-time insights. Fast-Track Health will work closely with cities interested in strengthening their data capabilities, allowing them to monitor health trends, assess the effectiveness of interventions, and make data-driven adjustments as needed. This commitment to data infrastructure is essential for cities to meet the complex and shifting demands of urban health, from communicable and non-communicable diseases to emerging health challenges linked to climate change.
As we move into this new phase, Fast-Track Health is also prioritizing collaboration and knowledge-sharing between cities. By creating a global network of urban health leaders, we can support a culture of innovation and resilience that benefits cities worldwide. Our role is to facilitate connections, provide expertise, and champion the successes of Fast-Track Cities so that they remain at the forefront of public health. We are dedicated to supporting cities on their journey to create healthier, more sustainable futures, aligned with UN-Habitat’s New Urban Agenda.
Do we need a new investment case to counter the waning financial commitment to public health?
Dr. Zuniga: The investment case for public health must emphasize its value not only in improving health outcomes but also in sustaining economic stability, improving social wellbeing, and building health system resilience. For every dollar spent on public health, there are substantial returns in terms of reduced healthcare costs, increased productivity, and enhanced social cohesion. The Fast-Track Cities network provides concrete evidence of this impact, with cities that have achieved the UNAIDS 95-95-95 targets demonstrating better overall health outcomes and economic benefits by reducing late-stage AIDS-related expenses.
For corporate and foundation stakeholders, the case can be made that public health investment aligns with corporate social responsibility (CSR) goals and long-term business interests, including scaling access to lifesaving innovations. Healthier populations are more productive and economically active, benefiting businesses and economies alike. Governments, on the other hand, need to be reminded that public health investment is a cornerstone of national security and economic development. The COVID-19 pandemic underscored the risks of underfunding health systems, making it clear that proactive investment is more cost-effective than reactive crisis management.
The Fast-Track Cities network can play a leadership role by demonstrating the return on investment of urban health initiatives. Through case studies and data-driven advocacy, cities can showcase how sustained financial commitments lead to measurable progress. Additionally, the network can advocate for innovative financing mechanisms, such as public-private partnerships and impact bonds, to ensure a diversified and sustainable funding base for public health into the future.
What is your vision of what Fast-Track Cities will have contributed to global public health by 2030?
Dr. Zuniga: By 2030, I envision Fast-Track Cities being recognized as a transformative force in global public health, having contributed significantly to the United Nations goal of ending AIDS as a public health threat and fast-tracking progress across the health-related SDGs. Fast-Track Cities will have highlighted how urban health systems can address HIV while simultaneously building capacity to tackle other pressing health challenges. The network’s unique approach – grounded in political leadership, data-driven strategies, and community engagement – will have demonstrated that cities are not just participants but catalysts in global health innovation.
The importance of Fast-Track Cities’ contributions being diagonal rather than vertical lies in their ability to strengthen health systems holistically while addressing disease-specific targets. A vertical approach focuses solely on specific diseases, such as HIV, often in isolation, whereas a diagonal approach integrates these efforts into broader health systems to maximize efficiency and impact. This diagonal approach ensures that health investments benefit multiple populations and health outcomes, amplifying their long-term value.
By 2030, the legacy of Fast-Track Cities will not only be the lives saved through their HIV efforts but also the robust urban health ecosystems they leave behind. These ecosystems will be equipped to address the interconnected health, social, and environmental challenges of the future. Fast-Track Cities will have proven that an integrated, data-driven, equity-based model is the most effective way to achieve the health-related SDGs and build resilient, inclusive communities. Our diagonal approach will ensure that the network’s contributions endure and adapt, setting a new global standard for urban public health.
Are there three words you would associate with the successes achieved by Fast-Track Cities?
Dr. Zuniga: Resilience captures the Fast-Track Cities network’s ability to adapt to evolving challenges, from emerging infectious diseases to climate-related health risks. The COVID-19 pandemic underscored the importance of resilient health systems that can withstand shocks while maintaining essential services. Fast-Track Cities have demonstrated resilience through their sustained HIV response, and this capacity will be critical as the network expands its focus to other health issues, including new and emerging diseases and other health-related SDGs.
Equity is central to the Fast-Track Cities vision, as the network seeks to ensure that no one is left behind. Urban health systems must address disparities in access to care, particularly for marginalized populations. The future of Fast-Track Cities lies in their ability to equitably bridge gaps in health access and outcomes, ensuring that all residents, regardless of socioeconomic status, gender, race, or geography, can live healthy lives. At the heart of this future is a profound commitment to equity operationalized through inclusive, holistic, community-centered approaches that elevate the voices of communities disproportionately affected by ill health.
Innovation reflects the Fast-Track Cities network’s commitment to leveraging innovative technologies, data systems, and partnerships to drive progress. From digital health and health AI tools to community-led models of person-centered care, innovation will be a key driver of success. Fast-Track Cities have already shown that urban settings can be laboratories for health innovation, and the future will see even greater adoption of innovative approaches to improve health outcomes and sustainability. Innovation will ensure that the network can sustain and accelerate its progress into the future, empowering Fast-Track Cities to lead the way in creating equitable, sustainable, and health-focused urban environments through 2030 and beyond.
What makes you the proudest of what Fast-Track Cities have accomplished in this last decade?
Dr. Zuniga: What fills me with the deepest sense of pride is what the Fast-Track Cities have achieved through their relentless commitment to improving the health and lives of their residents. These cities have turned ambition into action, transforming bold promises into measurable progress. The mayors, health department officials, health workers, service providers, community leaders, and, most importantly, people living with and affected by HIV deserve all the credit for making this network a global success. They have demonstrated what is possible when local leadership prioritizes public health, community voices are elevated, data guides decision-making, and equity is the guiding principle.
What stands out most is the collective impact of these efforts. In the past decade, we have seen cities such as Bangkok, London, and São Paulo surpass the UNAIDS 95-95-95 targets, showing the world what can be achieved with strategically focused, data-driven, equity-based strategies. In each of these successes, the power of collaboration has been evident. Municipal governments have worked together with civil society to craft responses that are both inclusive and effective. These cities have become beacons of hope and inspiration, not only in the HIV response but as models for addressing broader health inequities.
Above all, I am proud of the humanity that underpins the Fast-Track Cities network. Fast-Track Cities have shown that health is not just about numbers or targets; it is about dignity, equity, and leaving no one behind. The people of these cities have proven that by working together – with compassion and determination – they can overcome the most complex challenges. I am humbled to be part of this journey and inspired every day by the extraordinary work being advanced across the network. The real heroes of this story are the cities and communities themselves, and it is their vision and perseverance that will continue to lead the way forward.