AIDS Groups Ask Bush For More Money, Less Ideology

by Jim Lobe

(IPS) WASHINGTON -- As some 15,000 official delegates and representatives of civil society gather in Bangkok this week for an international AIDS meeting, one of the big questions is whether President George W. Bush is prepared to modify his more ideological positions on fighting the disease.

While Bush's administration has contributed substantially more money than any other donor government to the global anti-AIDS fight, the funds have been laden with conditions that AIDS activists say make it more difficult to defeat the disease which, according to the latest United Nations report released Tuesday, killed nearly three million people last year, about two-thirds of them in Africa.

AIDS activists also want Bush to contribute far more money to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a multilateral initiative launched in 2001 and designed to mobilise and quickly disburse billions of dollars a year to programmes proven to prevent, contain, or treat the disease.

Public-health experts and UN agencies initially called for donors to contribute five billion dollars annually to the Global Fund, increasing to $10 billion a year by 2007 -- the minimum they said would be needed to begin containing the spread of the disease.

But the facility so far has attracted a yearly average of less than two billion dollars, in part because Bush's reluctance to fund a multilateral agency over which Washington does not exercise complete control has discouraged others from contributing more..

"The U.S. set the bar so low as to make it impossible to raise the funds that are needed," said Salih Booker, executive director of Africa Action, a Washington-based group that has played a leadership role in pressing the administration to increase AIDS funding. "It's another, and particularly deadly, example of his unilateralism."

According to a statement to be released by the Global Aids Alliance (GAA) before the Bangkok meeting starts Sunday, "as of today, the Global Fund will not have enough funding to provide any additional grants next year and will likely not be able to initiate a new round of grants until 2007. Given that three million people die each year from AIDS, the several year delay in new grants will mean that many people will die that could otherwise have been treated."

But activists say withholding money from the Global Fund is only one way that Bush's unilateralism on AIDS has proved counter-productive.

His administration's efforts to prevent or delay the Global Fund and other international agencies from using U.S. aid money to buy generic anti-retroviral drugs that can sustain the lives of HIV/AIDS victims at one-quarter or even one-fifth of the cost of their brand-name U.S. competitors have greatly retarded progress in fighting the disease, say the critics.

Similarly, new trade agreements negotiated by the administration -- such as the Central American Free Trade Agreement (CAFTA), and other accords with Jordan, Chile and Singapore -- include a provision that makes it illegal for U.S. trading partners to market generic anti-AIDS or other drugs that are based on data acquired by U.S. manufacturers for a period of five years, which will also make access to those medicines much more difficult for poor people in those countries.

A similar provision is included in a pending deal with Thailand, one of the world's largest generic manufacturers, which also has, not coincidentally, one of the world's most effective anti-AIDS programs. If it signs a new trade agreement with that provision intact, its state-owned company will be barred from producing newer and more effective generic versions of anti-AIDS treatments developed by U.S. pharmaceutical companies for at least five years.

In this, as in other measures, Bush is accused of acting in the interests of "Big Pharma," the U.S. major drug companies, one of whose former directors, Randall Tobias, is in charge of the administration's global AIDS policy and will represent Washington at the Bangkok conference, along with Health and Human Services Secretary Tommy Thompson who also chairs the Global Fund.

Bush initially surprised and pleased activists in January 2003, when he unveiled his President's Emergency Plan for AIDS Relief (PEPFAR) during his State of the Union address. He promised to provide $15 billion -- including $10 billion in new money -- over five years to fight AIDS in 14 countries in Africa and the Caribbean.

But, as the program was spelled out in Congress, activists became increasingly concerned with its conditions. They included a limit of only one billion dollars, or $200 million a year, for the Global Fund; a gradual increase in contributions from only $1.8 billion in the first year, in spite of the "emergency" nature of the crisis; and an insistence that one-third of all funds for prevention be devoted to abstinence programmes that many public-health experts do not consider effective.

A coalition of concerned Republican and Democratic lawmakers has tried, with some success, to make the package more flexible over the last two years.

Congress increased total funding for the 2004 package to $2.4 billion and raised the amount going to the Global Fund to $500 million. For fiscal 2005, which begins Oct. 1, Bush requested $2.8 billion of which $200 million is allocated to the Global Fund, but Congress is expected to substantially increase the Global Fund contribution later this year.

But according to the GAA, "the administration has provided no detailed progress report showing numbers of people on treatment to date as a result of the initiative. GAA estimates that only one-tenth of one percent of the promised two million people are now receiving treatment with life-saving medicine. The Global Fund is currently treating as many people in one country, Rwanda, as the United States is treating around the world."

In a concession to activists on the generics issue, two months ago the administration said the Food and Drug Administration (FDA) would put in place a "fast-track" approval scheme that could OK "high-quality" fixed-dose combination (FDC) generic drugs for purchase by PEPFAR funds in as little two weeks.

Generic manufacturers of FDCs, which combine drugs from multiple sources into single pills that are taken twice daily, now charge as little as $140 per person a year, or about one-fifth the cost of the same combination of drugs -- which must be taken in the form of six pills a day -- manufactured by brand-name companies.

While the administration depicted the proposal as a major breakthrough, activists have argued it should not have been necessary as the World Health Organization (WHO), which has its own review process to determine the safety and effectiveness of medicines, had already approved a number of FDCs produced by generic manufacturers for use by the World Bank, the United Nations Children's Fund (UNICEF) and the Global Fund.

Recently, in fact, WHO temporarily suspended the purchase of two drugs produced by an Indian generic manufacturer because of concerns about their testing. The case was immediately seized upon by representatives of U.S. drug manufacturers as evidence that generics were not as reliable "as the gold-standard, patented form of the pills" tested by the FDA.

But AIDS activists said the incident proved that WHO's methods were indeed adequate, and complained that the administration's initiative appeared designed once again to undermine multilateral action.

"Setting up the FDA as a global, supra-national health authority is a very dangerous precedent," said Paul Zeitz, executive director of the Global Aids Alliance. "WHO was asked by its member states to establish an international standard called the pre-qualification process so that it could play the role of honest broker for both the global North and the global South."

"Now the U.S. is undermining the credibility of that international program," said Zeitz, who is attending the Bangkok meeting. "The world is looking to the U.S. to re-prioritise global cooperation over unilateralism," he added.