San Francisco Chronicle - Thursday, June 20, 2002
Sabin Russell, Chronicle Medical Writer

The bulk of the money would be directed toward 14 African and Caribbean nations where the highest rates of maternal infection have been found. Initial estimates suggest that it could spare 150,000 newborns from HIV infection per year.

"Medical science gives us the power to save these young lives," Bush said Wednesday in the Rose Garden. "Conscience demands we do so."

UNAIDS, an arm of the World Health Organization that estimates 800,000 babies worldwide were infected with HIV last year, called the announcement "a step in the right direction."

The proposal was praised by children's health and even some Democrats, but it was denounced by AIDS activists as grossly inadequate and a poor substitute for the Senate plan, which was expected to boost U.S. contributions to a global AIDS fund by $500 million a year.

That plan had been backed by a pair of Republican senators, Tennessee physician William Frist and North Carolinian Jesse Helms, but it was abruptly withdrawn on June 7 after the White House signaled it wanted to push its own program.

SENATE PLAN CALLED SUPERIOR

Advocates for increased international AIDS spending said it appears the president's plan falls far short of the goal that seemed within reach in the Senate.

"If $500 million was the floor, I think we are now in the basement," said Tom Coates, director of the UCSF AIDS Research Institute.

Indeed, the Bush plan would appear to divert to his program funds that were recently added by Congress to the international AIDS effort.

In a briefing after Wednesday's announcement, a senior administration official said the initial funding would be drawn from a $200 million supplemental appropriation passed by Congress after the Frist proposal was withdrawn. An additional $300 million supplemental appropriation in 2004 would round out the spending.

No matter how the funds for the Bush plan are appropriated, critics of the United States' contribution to the global AIDS fight said it falls far short of what is needed. When U.N. Secretary-General Kofi Annan proposed the Global Fund to Fight AIDS, Tuberculosis and Malaria a year ago, he estimated that it would need $7 billion to $10 billion a year to roll back these scourges. To date, international pledges are below $2 billion.

"President Bush has undercut, yet again, bipartisan momentum toward spending on global AIDS that would make a real difference," said Dr. Paul Zeitz, executive director of the AIDS Global Alliance.

The president stressed that the new program is designed to complement, rather than replace, the Global AIDS fund, and he hinted that an increased U.S. contribution to both efforts was likely if the programs prove their merit.

CONGRESSIONAL CRITICS SEEK MORE

The Bush administration has given the Global AIDS Fund a firm commitment of $500 million over the next three years, but congressional critics have been trying to increase the spending level.

Rep. Barbara Lee, D-Oakland, who has played an increasingly visible role promoting the Global AIDS Fund, said the president "has injected politics into the debate about how the U.S. should respond to AIDS, TB and malaria." She advocates that the United States contribute $2.5 billion annually to the global efforts.

But, she said, it was encouraging that the president has recognized the importance of using drug therapy to reduce mother-to-child transmission of HIV.

A single dose of the antiviral drug nevirapine to mother and child could cut almost in half the number of infants who become infected at birth. Tests show that the therapy reduces transmission by 47 percent. Worldwide, an estimated 2,000 babies are infected with HIV every day.

A short course of the antiviral drug AZT has been shown in Thailand to reduce transmission by 50 percent over six months. In the United States, programs using combinations of antiviral drugs have cut the transmission rate to less than 2 percent.

The Bush plan is modeled in part after a program by the Elizabeth Glaser Pediatric AIDS Foundation, which runs mother-to-child transmission prevention programs in 16 nations.

"We think this demonstrates leadership by the president," said Mark Isaacs, director of public policy for the foundation. "This will save the lives of children around the world, and we are enthusiastic about it."

Isaacs said that his program had worked closely with the White House to develop the plan and that he expects to cooperate with the new program soon. Isaacs said critics of the president lose sight of the fact that mother-to- child transmission programs, in addition to saving children, can serve as the foundation for programs that bring prevention and treatment to adults.

DEMOCRATS SPLIT ON BUSH PLAN

Sen. Ted Kennedy, D-Mass., who had co-sponsored the Frist bill, nevertheless called Bush's proposal a "welcome development in the battle against global AIDS."

But House Democratic Leader Dick Gephardt of Missouri sharply criticized the new plan. "President Bush has missed an important opportunity to demonstrate the bold U.S. leadership that is needed to turn this pandemic around," he said. "Fighting this pandemic is the moral issue of our time."

Plans call for the program to start initially in the African nations of Botswana, Ethiopia, Ivory Coast, Kenya, Mozambique, Rwanda, South Africa and Uganda, as well as Guyana and Haiti in the Caribbean. Two years later, Namibia, Nigeria, Tanzania and Zambia would be added.

Chronicle Washington Bureau chief Marc Sandalow contributed to this report from Washington. / E-mail Sabin Russell at srussell@sfchronicle.com.
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