Newsday - April 7, 2001
Laurie Garrett, Staff Writer

His press conference came two days after a Harvard University group called for spending billions of dollars to treat 3 million Africans and residents of other poor countries, using drugs prescribed for AIDS patients in the United States. And it came the morning after the U.S. Senate voted to double spending on global AIDS initiatives to $1 billion by 2003. The Senate vote may undergo changes before final appropriations are made.

There is no disagreement about the scale of the global AIDS epidemic, which by 2011 may kill 80 million people. But brewing is a dispute over how best to spend the billions that the United States, Europe, Japan and Canada are being asked to cough up.

In the Senate on Thursday, Foreign Relations Committee Chairman Bill Frist (R-Tenn.) said that the United States is "confronting one of the most important moral, humanitarian and foreign policy decisions of the new century."

Friday, Gates said, "It's fantastic to see the AIDS crisis getting the increased visibility that it deserves. But the amount of money being spent today is so inadequate compared to the size of the crisis- that's No. 1. The No. 2 point is that prevention is tremendously under-funded."

The Harvard plan, endorsed by 128 faculty members, calls for spending to treat residents of poor countries with highly active anti- retroviral drugs, or HAART. With those drugs, many American and European AIDS patients have lived up to five years longer than expected. Activists have demanded that the drugs be made available to AIDS patients in countries that cannot afford their price.

Several drug manufacturers recently have agreed to lower the costs, but the price tag remains too high for poor countries forced to rely on their own resources. The Harvard team estimates about 3 million people could be treated if wealthy countries supplied $3 billion.

Thursday, United Nations Secretary-General Kofi Annan met in Amsterdam with the chief executives of six of the world's largest pharmaceutical companies, urging them to lower their drug prices further for hard-hit African countries. Annan, who described the AIDS pandemic as his "personal priority," told them he respected their concerns about patent protections and profits, but expected the pharmaceutical industry to become "partners in the fight against AIDS."

But increasingly, Gates and his colleagues warned, treatment is taking precedence over prevention.

"In any political system, the pressures for funding come from people who are already sick," warned Timothy Wirth, a former senator who is now president of Ted Turner's $1-billion United Nations Foundation. "We spend half our health dollars in the United States on the last year of life. I'm concerned that all of the pressure on treatment issues will squeeze out prevention."

Together with Gordon Conway, president of the Rockefeller Foundation, Wirth and Gates said 16,000 people get infected with HIV everyday.

The Rockefeller Foundation said it is committed for the next five years to spending $15 million on AIDS programs, chiefly in support of vaccine research efforts. The United Nations Foundation is subsidizing $46 million worth of global HIV prevention efforts. And the Bill and Melinda Gates Foundation has committed $126 million to vaccine research and another $133 million to other prevention goals.

In addition to that philanthropic combined commitment of $320 million, the U.S. National Institutes of Health is spending about $30 million this year on microbicides research, $282 million in search of a vaccine and $133 million on basic HIV research overseas.

That combined effort comes to $765 million. Adding in the $460 million that Congress sends to United Nations agencies and the United States Agency for International Development brings the total to more than $1.2 billion. The UN estimates about triple that sum is needed to fund prevention efforts.

"The resources that are really necessary here to address the needs...go far beyond the scale of what the currently active philanthropies could possibly provide," Gates said. "If this is going to be addressed, all the wealthy country governments are going to have to step up in an unprecedented way."

On that point economist Jeffrey Sachs, who spearheaded the Harvard proposal, agreed. Of the Senate measure, Sachs said, "Good start, but it's still too late. I believe that we should aim for $1.5 billion for Africa in [fiscal year] 2002-matched by another $3 billion from abroad-based on the evidence that we've been putting together."

But that's just for treatment funding.

"The main goal is to combine prevention and treatment," Sachs said. "They are complementary, even synergistic."

Activist Paul Davis, of ACT UP-Philadelphia, insists that prevention, in the absence of treatment, will fail, because "if the only thing you get out of prevention is testing, stigma and a death sentence, why would you like to listen to a prevention pitch?"

010407
ND010402

Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2001. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .