Washington, DC — President George W. Bush's surprise call urging an "Emergency Plan for Aids Relief" targeted at the "most afflicted" nations of Africa and the Caribbean has been applauded for the new attention it brings to HIV/Aids. But because most of the money will be applied bilaterally - directly from Washington to recipient countries - there is concern that the UN-sponsored Global Fund to Fight Aids, Tuberculosis and Malaria will be undermined.
The Global Fund encourages "the most effective players to work together to get the job done on the front lines of the epidemics," said Richard Feachem, executive director of the Fund at the conclusion of a Fund board meeting in Geneva last week. "It is also helping donors coordinate efforts, reduce waste and focus on achieving results."
The Bush administration still resists giving the Fund adequate support, say critics. "The Global Fund is finally up and running and the consensus is to take a multilateral approach to this [Aids] problem; so why don't they use the global fund?" asked the Global Aids Alliance executive director, Dr. Paul Zeitz, speaking to allAfrica.com.
UN Secretary-General Kofi Annan has repeatedly said that the Fund will need US$7-10bn annually for the next five years. President Bush is only requesting $200m for the Fund in his 2004 budget. And that, says Zeitz, "leaves the Global Fund on the verge of bankruptcy and unable to fulfill its mandate to scale up treatment and other vital services."
"The efforts of the Fund in the next few years will get Aids therapy to half a million people," said Global Fund board member Dr. Massimo Barra in Geneva, "[but] we have 5 million more who need it." At last week's meeting, the board awarded $866m in grants to 60 countries. "This is not enough," said Barra. Last year the Fund committed $616m for programs in 40 nations. The $1.422bn total for these two years will empty the Fund's coffers says Richard Feachem. He says that at the very least, the fund will need $6.3bn over the next two years.
Nothing like that is likely to come. The Bush administration is deeply suspicious of multilateral initiatives and so far seems unwilling to make an exception for the HIV/Aids fight. Nonetheless, administration officials deny they lack faith in the Fund. U.S. Health and Human Services Secretary, Tommy Thompson has just been elected as Chair of the Fund's board, they point out.
"We believe that multilateral approaches are effective," says the director of the White House Office of National Aids Policy, Dr. Joseph O'Neill. "But the Global Fund was never intended to be the sole mechanism by which the U.S. government achieves our goal strategically for HIV/Aids care."
The U.S. effort proposed by Bush requires one-to-one relations with the countries being assisted, he said. To achieve specific goals in specific regions, "it needs to be done through bilateral mechanisms."
Speaking to reporters Thursday, Dr. O'Neill described President Bush's proposal as "a very focused program on achieving a strong clinical treatment result in a focused part of the world." President Bush is "very concerned that we be able to identify results from this program...that we stay sharply focused on being able to be accountable for these funds," said Dr. O'Neill.
Furthermore, says the National Security Council's Senior Dirctor for African Affairs, Jendayi Frazer, the U.S. made the first and largest contribution to the Global Fund, and is still "out front" in the second round. "We were encouraging other countries also to contribute to the Global Fund, and then that will really demonstrate its effectiveness as a mechanism for raising funding globally."
The Bush administration gives the Global Fund the task of showing results, complains Salih Booker of the advocacy group Africa Action, but isn't giving it the means. Frazer's position, he argues, is a 'catch 22'; "while the Fund needs money to do its work effectively, it has to do its work effectively to get the money."
Writing in South Africa's Business Day newspaper, Harvard University development economist Jeffrey Sachs, commented: "As a recent convert to the war on Aids, the US administration has latched on to a simplistic vision of what to do, based on the example of a single country, Uganda. It knows little of the measures in place in different parts of the world, and has not recognised that each country needs to shape the best local response. It is here that the Global Fund plays an important role."
The Fund, says Sachs, is the more important model: "The fund is organised as a consortium of donors and recipient countries, civil society and business. It is set up to encourage rigorous and sensible plans that meet local needs."
'Too little, too late'
Despite worries about the Global Fund there is general agreement that the Aids pandemic has gained greater visibility. Jeffrey D. Sachs of the Columbia University-based Earth Institute has called Bush's proposal "a major breakthrough." Aids has imposed a "death sentence" on Africa, the President said in his State of the Union address. "Seldom has history offered a greater opportunity to do so much for so many," he said, proposing that the U.S. Congress approve his plan to commit US$15bn over the next five years to combat the pandemic; US$2bn of that is in the FY2004 budget just submitted to Congress.
However, in a statement released last week, The Global Aids Alliance expressed "disappointment" and said the program was "too little and too late". According to them, the two billion allocated by the budget this year is still a billion dollars short of the US$3bn it should be, if the president plans to spend US$15 billion over the next five years. They also say that the phase-in of money is too slow. "If it's an 'emergency,' why is he waiting for 2004?" wonders Paul Zeitz.
President Bush's plan focuses on twelve African nations - Botswana, Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia - and two Caribbean nations (Haiti and Guyana). Between them, these countries account for almost 70 percent of HIV infections, according to the White House.
The Bush plan aims to prevent seven million new infections and treat at least two million people in Africa and the Caribbean with life-extending drugs, as well as provide care for 10 million people infected with AIDS and with HIV. The United States would pay for the drugs, such as nevirapine, which blocks transmission of HIV to unborn children, and sometimes provide anti-aids medication for children.
The program will be administered through a State Department-based "Special Coordinator" at ambassadorial level, appointed by the President. USAID "will play a significant role," said Anthony S. Fauci, director, National Institute of Allergy and infectious Disease at the National Institutes of Health (NIH), briefing reporters last Thursday. "But the accountability and leadership of it will be a direct report to Secretary of State, Colin Powell." Fauci is reportedly one of the key architects of the Bush proposal.
This worries critics too. "Neither the Department of Health and Human Services (HHS) which is home to the Centers for Disease Control and National Institute of Health nor the U.S. Agency for International Development (USAID), has a record of supporting treatment and care" said the Physicians for Human Rights (PHR) in a statement.
USAID holds "an anti-treatment position," says the physicians' group. "Thus, it is unclear how or whether these agencies can actually meet the President's commitment to provide anti-retroviral therapy to two million people with HIV/Aids."
How much new cash?
The FY2004 budget President Bush has submitted to Congress proposes $1bn in new money and another $1bn in "old" money for the Aids fight. But these numbers are a little fuzzy. At first glance, the 2004 budget seems to earmark just US$450m for Aids.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
"It's actually $2bn in total funding, of which $450m from the State Department and another $200m at HHS represents the $650 million new money that the President has added in there," explained Assistant Secretary of State for Resource Management, Christopher B. Burnham.
"In the past couple of years, we have historically funded our fight against Aids and other diseases at around the billion dollar level. When you add in the other programs around the government such as Mother-to-Child-Transmission, as well as the Global Fund on AIDS and add this money in, it comes out to about $2bn," said Burnham
But critics like Global Action's Zeitz and Africa Action's Booker worry aloud at what seems to them a case of Peter being robbed to pay Paul. Child survival and orphan care programs have been cut in the 2004 budget, says Zeitz. "Should we stop immunizing children while we mount an expanded Aids program?"
Politics is never very far away and sure to intensify as still unsettled issues like using funds for generic drugs emerge. In the U.S.Congress, there have been bipartisan efforts to push for a higher level of funding for the Global Fund. According to the Global Aids Alliance, White House arm-twisting forced postponement of Senate markup -- a sometimes closed committee session where a piece of legislation is readied for the floor -- of a bill authorizing $2.5bn for the global aids fight in FY 2004. Administration officials apparently want consistency with the US$2bn proposed by Bush.
Asked to justify that, White House Aids Policy director, Dr. O'Neill ducked: "I think that it is sort of interesting that it seems that every silver lining has to have a cloud, and some people will look very, very hard to find that cloud. We expect criticism, and we are used to it, but it is not going to dissuade us from doing what we think is the right thing to do, and what we think is the right way to do it."
