Wall Street Journal - Tuesday, July 9, 2002
David Bank, Staff Reporter

Global AIDS fund chief Richard Feachem is expected to deliver a message Tuesday at the international AIDS conference in Barcelona, Spain, that many activists won't want to hear: Misspending money may be just as damaging as not spending enough.

Dr. Feachem, the incoming head of the independent Global Fund to Fight AIDS, Malaria and Tuberculosis, enraged many AIDS activists last month when he played down the impact of the Bush administration's effort to effectively reduce next year's global AIDS funding by $300 million, in part by diverting funds that had been pledged to the Global Fund.

Dr. Feachem, a 55-year-old Englishman, said then that the fund had more than enough money to move ahead.

"Resources are very important in the future. But we've got to demonstrate we can deliver," he argues now. "The key thing is to create a system that is fair, that is transparent, that focuses the money where the greatest amount of human suffering can be alleviated. There's an overriding moral duty to insure that's the case."

His point, Dr. Feachem insists, isn't that the global AIDS pandemic doesn't cry out for more funding. It's that the fund is perhaps the last, best hope for progress against the most serious human health disaster in history -- and can't afford to fail. To be able to attract the truly massive funds required to mount a comprehensive global effort, the fund must first establish credibility and accountability, he says. Treasury Secretary Paul O'Neill has already criticized some of the fund's early decision making.

The fund was created last year after United Nations Secretary-General Kofi Annan called for an increase in global spending, to between $7 billion and $10 billion a year, to tackle three diseases that kill more than six million people annually. So far, the fund has received a total of only $2.1 billion in pledges.

In April, after receiving more than 300 proposals, the fund announced grants totaling $616 million to programs in 31 countries. A second round of grants, to be announced in January, will effectively deplete the fund unless more money is raised. To make matters worse, only two countries, the U.S. and Italy, have sent any money; the fund's account, held at the World Bank, has less than $300 million.

With needs so far outstripping resources, some of those confronting the spreading devastation of AIDS see any suggestion that more money isn't needed as a betrayal. Several activists called for Dr. Feachem's resignation before backing off, and he heard from many proponents of higher AIDS funding who telephoned to criticize what they called a tactical mistake. Dr. Feachem also startled some UN officials with his salary package of at least $200,000 a year.

"He's off to a little bit of a rocky start," says economist Jeffrey Sachs, an adviser to Mr. Annan and the director of the Earth Institute at Columbia University. Mr. Sachs advocates even higher spending on global health care than Mr. Annan. In Barcelona Tuesday, he will call for an increase of at least $26 billion a year to meet basic health needs. "The fund needs a tremendous amount more resources," Mr. Sachs says. "[Dr. Feachem] knows that."

Dr. Feachem says he has assurances that more funds will flow when effective systems are in place. He also says he relies on lessons learned climbing some of the world's highest mountains. A wall in his office here is reserved for photographs of him, ice ax in hand, at the summit of snow-capped peaks. "If you set a very steady pace and focus on what's immediately in front of you, you'll actually get to the top," he says.

He faces a tough climb. Without a huge global mobilization, the AIDS epidemic is expected to peak in about 2060, when hundreds of millions of people will have been infected. The epidemic in India, for example, appears to be on a trajectory similar to that in southern Africa, where some countries have infection rates of 25% or more. The disease also is spreading, though a bit more slowly, in China.

Dr. Feachem, director of the Institute for Global Health at the University of California at San Francisco, was chosen to head the fund by its 18-member board, overcoming a last-minute effort by the Bush administration to name a senior U.S. diplomat. Dr. Feachem previously served as dean of the London School of Hygiene and Tropical Medicine and as a senior World Bank health official. He will lead the fund from its offices in Geneva.

The fund's mission is to finance proven techniques of disease prevention and treatment, such as ones that have cut infection rates in countries like Uganda, Thailand and Brazil. Competitive proposals, filtered through country-level committees, are evaluated by experts for potential effectiveness, and those who receive grants will be monitored closely.

Dr. Feachem fashions himself a hard-nosed moderate on the contentious issues facing the Global Fund. In the debate between those who argue more money should be spent on treating sufferers of AIDS with life-extending drugs and those who favor prevention programs to slow the spread of the epidemic, his position is that the two approaches are complementary.

Dr. Feachem also hopes to sidestep the thorny issue of drug pricing in developing countries. Deals will be cut directly between countries and drug makers, with only financing help from the Global Fund. And he advocates a balance between financing government-run programs and those proposed by private nonprofit groups.

More difficult is the stark reality that not every country in need will receive funding. The fund doesn't have the capacity to work in all 150 low and middle-income countries. A more realistic target is 50 or 60 countries, Dr. Feachem says. Some countries are so beset by war, natural disasters and corrupt leadership that no progress is likely.

Take malaria, which is getting worse across sub-Saharan Africa in both relatively well-run countries and failing states. With help, Tanzania, for example, is likely to be able to reduce malarial deaths and is therefore an attractive investment.

"That's going to be really hard and difficult work over 10 years to achieve," Dr. Feachem says. "It's just easier than in some other countries, where it might be impossible."

Write to David Bank at

020709
WJ020709

Copyright © 2002 - The Wall Street Journal. Reproduction of this article (other than one copy for personal reference) must be cleared through the WSJ Permissions Desk.

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2002. 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, 2002. 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. .