Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
Newsday - April 26, 2002
Laurie Garrett, Staff Writer
The grants are expected to reach $616 million once 18 other proposals, earmarked for fast-track approval, are reworked.
Now, fund advocates say, the real test begins. As the money filters out, recipient nations and the global fund will have to demonstrate that the resources are properly used -- and that they actually make a difference in slowing HIV, TB and malaria. If the first round proves promising, pressure is expected to increase on wealthy nations to reach a funding target of $7 billion to $10 billion per year for the coming decade.
The fund was created just last year, and the disbursement is notable for its swiftness. In the three months since grant proposals were requested, more than 300 applications totaling $5 billion were submitted.
"Out of $2 billion pledged to the fund we have now confirmed $1.2 billion," Sweden's Dr. Anders Nordstrom, interim director, said yesterday in a teleconference. "And something around $700 to $800 million could be available this year."
The 18-member board that manages the fund met this week at the Mailman School of Public Health at Columbia University. It will reconvene in September.
Forty grants will be issued immediately, said Dr. Chrispus Kiyonga of Uganda, board chairman. Just over half the recipient nations are in sub-Saharan Africa, 13 percent are in the Americas, 8 percent in eastern Europe and the former Soviet Union and 12 percent in south Asia. About 60 percent of the grants address HIV and AIDS; the remainder focus on tuberculosis and malaria.
Nordstrom said about 45 percent of the AIDS-related money will purchase anti-HIV drugs and drugs that treat opportunistic infections that threaten weakened immune systems.
Kiyonga said Tanzania will get $20 million for a campaign to combat malaria, purchasing new anti-malaria drugs and pesticide-soaked mosquito netting to protect children as they sleep. The southern African nation of Zambia was awarded $93 million to tackle HIV, most of which will be used to purchase anti-HIV drugs.
The purchase and use of such drugs was the biggest controversy during deliberations, said board members. The drugs, taken in combinations called cocktails, have revolutionized AIDS care in the wealthy world. Treatment advocates, including two HIV-positive board members, insisted the fund ensure that Africans, Asians, Latin Americans and eastern Europeans share in the drugs' life-extending benefits.
Drug purchasing has its own set of controversies. Treatment advocates from humanitarian organizations have pushed the fund to challenge global patent laws and support generic manufacturers, to lower prices. Manufacturers, worried they won't earn back research and development investments, have opposed such moves.
The board sidestepped the issue when the World Health Organization on Monday added several generic versions of anti-HIV drugs to its Essential Drugs List, which is used as a basis for regional discount buying of patented pharmaceuticals.
The grant process itself also was a topic of controversy. Several countries charged last week that they were pressured by European and North American donors to reduce their requests. Malawi initially sought more than $1 billion, but ended up asking for $600 million over five years. Nordstrom did concede pressure was exerted.
"We said, 'Yes, be ambitious, but be realistic as well,'" he said. "It [the grant proposal] needs to be feasible."
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