13 Months Late, Bush Dribbles Out AIDS Funding

by Jim Lobe

(IPS) WASHINGTON -- President George W. Bush's new, five-year, $15 billion strategy for fighting the global HIV/AIDS pandemic provoked dismay among health activists here February 23, just hours after the 103-page document was released and the first disbursements -- totalling $350 million -- were announced.

Activists charged that the strategy, which will be overseen by Bush's global AIDS coordinator, Ambassador Randall Tobias, offered little new in the way of ideas, and severely underfinances the Global Fund to Fight AIDS, Tuberculosis and Malaria.

''It's a go-slow, go-it-alone approach'', noted Paul Zeitz, head of the Global AIDS Alliance (GAA). ''And it's amazing that more than 13 months after the president announced the plan, only now is the first dollar being spent''.

The new strategy paper also failed to clarify a key question -- whether Washington will buy life-preserving, anti-AIDS drugs from generic producers, which are mostly made in poor countries such as India, Thailand and Brazil, as opposed to western, brand-name drugs that generally are more expensive.

Many activists are concerned the administration will buy only brand-name drugs. The fact that Tobias, former chairman and chief executive officer of pharmaceutical giant Eli Lilly, was chosen as the global AIDS czar, has enhanced those concerns.

Tobias himself was non-committal on the issue Monday, stressing that brand producers have reduced their prices so much that the question is no longer particularly relevant.

The administration, he said, is committed to ''buying drugs that are safe and effective at the lowest possible price''. The standards to be adopted in determining those criteria remained to be worked out, added Tobias.

But the activists said key anti-retroviral drug treatments from brand companies were four times more expensive than comparable ones from generic manufacturers currently recommended by the World Health Organization (WHO).

''Tobias' assertions are factually untrue'', said Zeitz who added that the strategy document is curiously silent about both debt relief for AIDS-affected countries and any follow-up on administration pledges two years ago to exempt certain life-saving medicines from intellectual property rights provisions in new trade agreements.

''Both are absolutely essential to any strategy for dealing with AIDS, but the administration has nothing to say'', he added.

''Candidate Bush is AWOL -- absent without leave -- on AIDS'', said Asia Russell of the Health Global Access Project (Health GAP) in a reference to the upcoming presidential election.

''Compared to opposition Democrats John Kerry and John Edwards, who are campaigning on a 30-billion-dollar pledge to fight AIDS and a commitment to use affordable generic drugs, the Bush White House has proven itself to be a subsidiary wholly owned and operated by big drug companies'', she added.

The strategy document, developed over the four months since Tobias was appointed, lays out how the administration intends to spend the 15 billion dollars, which Bush first pledged 13 months ago, over the five-year life of the program.

Activists had hoped the president would allocate three billion dollars a year to the program, but were disappointed when his initial request, for fiscal year (FY) 2004, came to only two billion dollars, of which only $200 million was allocated to the Global Fund.

In a rare display of independence, Congress approved $2.4 billion for 2004, and increased the fund's share to $550 million.

But under the strategy released Monday, Bush is proposing the United States commit only one billion dollars to the Global Fund over the five years. He has again requested only $200 million for the fund for fiscal year 2005.

The other $14 billion, says the strategy paper, would be used for bilateral programs only -- nine billion dollars for programs in 14 African and Caribbean countries -- and another five billion dollars in ongoing bilateral programs, most administered by the U.S. Agency for International Development (USAID), in more than 100 countries worldwide.

The targeted African and Caribbean countries, which have been previously announced, include Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia.

The fifteenth country, which must be located in another region, is to be named shortly, according to Tobias.

The strategy says that in the 15 focus countries the nine billion dollars will be used to provide treatment to two million people through 2008, prevent seven million new HIV infections, and provide care to some 10 million people infected or affected by HIV/AIDS, including AIDS orphans and other vulnerable children.

Worldwide, some 13 million children have lost at least one parent to HIV/AIDS, 11 million of them in Africa, creating a crisis the United Nations Children's Fund, the World Bank and UNAIDS called ''unprecedented in the history of mankind'', in a report released Saturday.

The 350 million dollars in grant awards announced Monday will provide care to 60,000 AIDS orphans in Africa in the coming year, according to Tobias. In addition, it will nearly double the number of people in Africa who now receive life-saving, anti-retroviral drugs -- from roughly 50,000 to 100,000.

But he was distinctly defensive about the administration's proposed contributions to the Global Fund, stressing that the president could propose, but Congress would have the last word, as it did in 2004.

Tobias declared Washington has so far provided more money to deal with the global pandemic than all other donor governments combined and that it remains the largest single donor to the Global Fund, having pledged, with Monday's announcement, nearly two billion dollars to the agency through 2008.

''There's a perception that the Global Fund is the old, established organisation and what we're doing is new, but that's a reversal of the facts'', he said, noting the fund ''is just getting started while the U.S., on the other hand, has almost 20 years of experience''.

The bilateral approach is more efficient in many cases because it ''gets the middleman out of the middle'', Tobias said, stressing that the two ways of delivering assistance should not be seen as competitive. ''I think we need to stop spending our energy on beating up on each other'', he added.

But Zeitz noted that a major selling point of the Global Fund was precisely to establish one global coordinating mechanism for donors that would greatly ease the burden of monitoring and reporting, particularly for front-line agencies that receive assistance.

''For the first time, everyone is at the table with a coordinated strategy, and now the Bush administration is setting up a parallel coordination mechanism that will be overseen by a U.S. ambassador. That's not improving the situation.''

To many activists, what was most disappointing about the new strategy was how much time it had taken to put together.

''Three million people have died waiting for a new bureaucracy to be set up at the State Department, while Bush denies the already existing Global AIDS Fund the cash needed to actually fight AIDS and save lives'', said Paul Davis of Health GAP.

"The plan released today by the president is a vastly under funded initiative that favors corporate interest over public health and undermines multilateral efforts to fight the AIDS pandemic," said Sherry Ayres of Africa Action, another advocacy group.

"It is an insult to the nearly three million Africans who died of AIDS during the time it took the administration to come up with it."