Bush plans $15 billion budget to treat two million people and prevent seven million infections in 14 countries – but meets criticism from activists
Graham McKerrow, HIV i-Base
President George Bush took the AIDS community by surprise at the end of January when he used his annual State of the Union address to say he would ask the US Congress to treble overseas spending on AIDS from $5 billion to $15 billion.
The White House explained that the new money would be targeted at 14 African and Caribbean countries with the intention of treating two million people with antiretroviral drugs, prevent seven million new infections – 60% of projected new infections in the 14 countries – and care for 10 million positive people and AIDS orphans.
The plan astonished observers and drew immediate criticism from some AIDS activists because it is limited to only certain countries and most of the money will bypass the Global Fund to Fight AIDS, TB and Malaria, which many people believe should be the main vehicle for funding the response to the pandemic. The Global Fund is struggling to raise money.
Mr Bush said: “Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year – which places a tremendous possibility within our grasp.
“I propose the Emergency Plan for AIDS Relief – a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent seven million new AIDS infections, treat at least two million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS.”
At a White House ceremony a few days after his address, Mr Bush expressed support for the Global Fund. However, the $15 billion, five-year plan will see less money being given annually by the US to the Global Fund; down from $380 million this year to $200 million a year for the next five years. The Global Fund “is being starved under the president’s proposal,” said Asia Russell of the Philadelphia-based Global Access Project.
The US seemed to indicate support for the Global Fund when Tommy Thompson, the US Secretary of Health and Human Services, was elected chairman of the Fund. Bush tried to counter criticism by saying, in February: “I’ve been asked whether or not we’re committed to the Global AIDS Fund. Well, first of all I wouldn’t put Tommy [Thompson] as the head of it if we weren’t.”
And the president continued: “It’s more than money we bring. We bring expertise and compassion and love and the desire to develop a comprehensive system… for diagnosis and treatment and prevention.”
Jeffrey Sachs, director of Columbia University’s Earth Institute and an economic advisor to UN general secretary Kofi Annan, called the appointment of Mr Thompson to head the Global Fund “bizarre” and said the Bush policy seemed to be saying “if American money was going to go for something, it needed to be under American control”.
Stephen Lewis, the UN envoy for AIDS in Africa, welcomed the new money saying it was “a dramatic signal from the US administration that it is ready to confront the pandemic.” He told the New York Times that other wealthy countries should follow the American example.
“My prayer is that when this funding comes, we’ll see a reduction of people being affected by AIDS,” said Prega Ramsany, the executive director of the Southern African Development Community, which represents most countries in the region.
In Botswana, officials said they hoped the money would be used to buy drugs and to hire doctors and nurses. Botswana is the only country in Africa to commit to providing ARVs to all its citizens. But HIV is killing Botswana’s medical staff. “This news is a very encouraging thing to us in Africa,” commented Abinel Whendero, the acting coordinator of the government’s National Aids Coordinating Agency.
Some activists criticised Mr Bush’s use of language in his State of the Union address in which he referred to “AIDS victims”, the “AIDS virus” and “innocent people”. These are inaccurate and value-loaded terms, said Omololu Falobi of Nigeria, which disempower people and imply a hierarchy of guilt.
In the same week as the State of the Union address, Mr Bush announced that he would ask Congress to approve the spending of $16 billion on domestic US HIV treatment and prevention for the year 2004, an increase of 7% on this year. The proposals include a $93 million increase in research spending and an extra $100 million to provide antiretroviral drugs to uninsured and underinsured Americans with HIV.
The countries that will be targeted by President Bush’s Emergency Plan for AIDS Relief are: Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. The $15 billion will be spread over five years, starting with $2 billion in 2004 and increasing annually.
Global Fund awards $866 million to projects in 60 countries
At the same time as the announcements in Washington about overseas and domestic spending on the response to AIDS, the Global Fund announced from its Geneva offices a series of grants amounting to $866 million over two years to projects tackling AIDS, TB and malaria.
About 60% of the new money will be used to combat HIV, including antiretroviral treatment for 500,000 people in developing countries as well as care and support for 500,000 AIDS orphans and vulnerable children. The funding will also expand prevention programmes especially among young people, and step up prevention of mother to child transmission, and voluntary counselling and testing.
Global Fund money is also being provided to combat malaria by providing 30 million African families with treated mosquito nets, and by purchasing more than four million courses of treatment of new and more effective medicines for people in Africa with resistant strains of malaria. The grants will also treat two million people with TB over the next five years.About 60% of the new money will go to Africa, with the largest amount, $93.3 million, paying for projects combating AIDS and malaria in Ethiopia. TB and AIDS programmes in India will receive $38.8 million.
This second round of grants awarded by the Global Fund brings the total disbursed and promised by the fund in 2003 and 2004 to $1.5 billion. If they meet performance standards the recipient projects could be entitled to up to another $2.4 billion after 2004. The Fund currently lacks the money to make a third round of grants scheduled for October. It estimates that at least $6.3 billion in additional contributions is needed over the next two years.
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Full text of the president’s speech
White House gets religion on AIDS in Africa
African nations applaud Bush plan to fight AIDS epidemic
Bush plan for $15 billion to combat AIDS in Africa stuns friends and foes alike
George Bush and the use of language
New York Times leader: A serious response to AIDS
Global Fund to Fight AIDS, TB and Malaria
President Bush’s decision to spend significantly more money combating HIV in the developing world sets a welcome example to other rich countries that have yet to respond adequately to the global crisis. Until now the UK has had a comparatively good record with the Chancellor of the Exchequer, Gordon Brown, and the Secretary of State for International Development, Clare Short, leading the arguments for greater action backed by greater spending. But their efforts are now dwarfed by the scale of the American response.
It is a shame that President Bush undermines the goodwill and respect his decision to treble overseas spending on the response to AIDS should earn by the decisions on how the money will be spent and serious unanswered questions.
Firstly, it is strange to decide that the spending will be limited to 14 nations over the next five years regardless of how the pandemic and our knowledge of it develop.
Secondly, it would have been sensible to channel the resources through the Global Fund to Fight AIDS, TB and Malaria, which is short of money, takes a global view of priorities and is committed to maintaining a slim bureaucracy capable of taking rapid decisions. It is pointless and wasteful for the US to create a parallel bureaucracy competing for the same resources.
The election of Tommy Thompson to chair the Global Fund should indicate a commitment by the richest nation to support the fund and might have suggested that financial support would follow. This is clearly not to be. It appears that America wants to control how it spends its money, and how money given by other nations is spent. This raises serious questions about Mr Bush’s motives. Since becoming president he has diverted funding from US and overseas projects that give advice on abortions, and the fear has to be that this devoutly Christian president may use his control of these huge sums to impose his views of morality on others.
While the new money is welcome and responds to the crisis on the scale required, the announcement also deserves to be met with scepticism because of Mr Bush’s record in confusing public health and private morality, because of the loaded language he used in his State of the Union address about “innocent people” – suggesting some are guilty and therefore perhaps less deserving? – and because he seems to have acted in a way that prioritises his administration having maximum power over the money rather than making sure the money goes where it is most needed.
The new Global Fund Observer should widen its remit and keep an eye not only on the Global Fund but also act as a watchdog on Mr Bush’s billions.
The New York Times points out that by saying that treating HIV can now cost as little as $300 per patient per year, a price only available from manufacturers of generic drugs, Mr Bush appears to endorse the spending of US tax dollars on generic drugs, a move that may upset the big pharmaceutical companies (which have close ties to Mr Bush) but which would see millions more people treated for the same amount of money.
The new funding throws down a challenge to other nations to respond. Had the American money been channelled through the Global Fund that challenge would have been all the more irresistible. The European Union has yet to give to the Global Fund. Europe could show the president the error of his ways by giving a similar sum to the Global Fund. And it must not delay further: in an exploding pandemic money is more effective the sooner it is spent.