Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
San Francisco Chronicle - Thursday, July 3, 2003
Edward Epstein, Chronicle Washington Bureau
In a White House ceremony, Bush formally nominated Randall Tobias, former chief executive officer of Eli Lilly & Co. and a major Republican campaign contributor, for the position that requires Senate confirmation.
"Randy Tobias has a mandate directly from me to get our AIDS initiative up and running as soon as possible," said Bush, who leaves Monday on a five- country, five-day trip to Africa.
Tobias' position in the State Department was created as part of the new $15 billion initiative to combat AIDS in a dozen sub-Saharan African countries, Haiti and Guyana. The 14 countries account for 50 percent of international AIDS cases, the White House said, in a pretrip announcement designed to show African leaders that Bush is serious about his commitment to fighting AIDS.
Tobias, who has also been a high-ranking AT&T executive, would carry the rank of ambassador and be in charge of the program. He would have authority to act internationally, to transfer money among federal agencies, and contract with such nongovernmental organizations as faith-based and community groups.
A main focus of the expanded HIV/AIDS program in countries decimated by the disease is to make inexpensive drug treatments more available. Critics worried that Tobias' ties to a pharmaceutical multinational corporation such as Lilly could undercut that goal.
"This decision is another troubling sign that the president may not be prepared to fulfill his pledge to take emergency action on AIDS," said Dr. Paul Zeitz, executive director of the Global AIDS Alliance.
"This raises serious questions of conflict of interest and the priorities of the White House. Both the people of Africa and the people of the United States will lose if the president's AIDS initiative fails to use the lowest-cost, generic medications," he added.
While it can cost an estimated $10,000 a year in medications to treat an HIV/AIDS patient, generic medicines are available for only a small percentage of that price. Some drug companies have already started to make generic-priced drugs available.
Bush seemed to anticipate such criticism in his remarks in nominating Tobias.
"We'll work quickly to get help to the people who need it most by purchasing low-cost, anti-retroviral medications and other drugs that are needed to save lives," the president said. "We will set up a broad and efficient network to deliver drugs to the farthest reaches of Africa, even by motorcycle or bicycle."
White House spokesman Ari Fleischer said that despite Tobias' lack of direct experience with AIDS issues, he is a good choice. "The president wanted to appoint somebody to undertake a massive $15 billion five-year program who had sound business and management judgment," Fleischer said.
Tobias' appointment was praised by the Medical Institute for Sexual Health, a conservative group based in Austin, Texas, that teaches abstinence as a way to prevent AIDS transmission. Under Republican urging, the legislation creating the new AIDS program says that one-third of the money for prevention programs must go to teaching abstinence. Money will also be provided for condom distribution.
"The president is committed to the proper course. We are sure Mr. Tobias will be as well," said Dr. Joe McIlhaney Jr., the institute's president and a member of Bush's HIV/AIDS advisory council.
Tobias apparently has little experience in the AIDS policy field, so groups on all sides of the issue are seeking his ear.
Even the conservative Family Research Council expressed "concern" in a statement Wednesday that Tobias "does not have a proven track record" of support for the abstinence provisions of the AIDS program.
Federal Election Commission figures show that in 2000 through 2002, Tobias gave at least $94,000 to the Indiana Republican Party, Bush and a host of GOP candidates in the state.
E-mail Edward Epstein at eepstein@sfchronicle.com.
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