AIDS Treatment News Issue #379, April 12, 2002
John S. James

Every day 8,000 people die of AIDS, thousands more of tuberculosis, and thousands more of malaria. Leading experts agree that all three could be effectively controlled around the world with a total investment of about $10 billion per year, and the political will to match. This is not much money compared to the global economy; in theory at least, a number of individuals could write the check themselves.

But last year President Bush proposed $200 million for the Global Fund for AIDS, Tuberculosis, and Malaria (later raised to $300 million) -- about a tenth of the U.S. share of the total cost to control these diseases, based on the size of the U.S. economy. This year Bush proposed $200 million again. Coming from the world's only superpower, this has set the bar low, and donor countries and others around the world have followed accordingly. If the U.S. does not take global infectious disease seriously, other rich countries are unlikely to do so. (Total U.S. foreign aid for all purposes is about 0.1 percent of the U.S. gross domestic product -- a fraction of what European countries contribute. Recently President Bush called for increasing this by 50% over several years -- an important positive development.

Also, conservative Senator Jesse Helms recently called for an additional $500,000 from the U.S. for international AIDS control, especially targeted for prevention of mother to infant transmission. (We have not heard criticism of this targeting, probably because mother-to-infant transmission is indeed a major part of the epidemic, and there is no doubt that the money could be well spent there. And some of these programs treat the whole family.)

Later this month (April 2002), the Global Fund will have to turn down many of the more than 300 projects from developing countries that have requested funds in the current cycle. The requests from the first round of proposals total about $1.15 billion now, or $5 billion if five-year commitments are made -- and the Global Fund has only about 15% of that currently available. And these initial requests were done under great time pressure, and under pressure to scale back the amounts asked for.

Comment

Political mobilization to get a reasonably adequate U.S. response for the control of these major infectious diseases is completely doable. There is lots of potential public support. What then are the obstacles that have kept it from happening so far? We see the following:

• Widespread public mobilization has been slow. For example, church groups are natural sources of support, but AIDS activists have been slow to get them involved. Some churches even have staff or volunteers assigned to look for opportunities to help in the world, but usually no one has prepared them on this issue or explained that what is most important is letting Congress, the media, and others know that many Americans care about illness and death in developing countries.
  


• After September 11, many government officials are serious only about war.
  


• The pharmaceutical industry is not on the same page. Its major concern is intellectual property, and any precedents that might be set abroad that might someday limit its freedom to charge high prices in the U.S. So it has leaned toward charity programs negotiated separately and usually secretly between each company and country (where the countries of course give up freedom of action) -- and also toward selective price reductions where companies make no profit according to their own accounting, then wash their hands -- establishing a case that they are not profiteering, instead of working together to solve the problem. There is nothing like the U.S. domestic program where company and patient representatives have gone to Congress together to support funding for treatment access in the U.S. (Incidentally, we believe that developing or manufacturing treatments for developing countries *should* be profitable -- though clearly the U.S. model of making the patient pay will not work. But companies could work together with communities, officials, and others to raise government and other monies to pay for the needed drugs and medical infrastructure.)
  


• Donors and communities alike want assurance that money is well spent on programs that work. But measuring results is difficult -- not only here, but in nonprofit programs in all fields.
  

Of all these obstacles, the biggest one so far has been lack of public mobilization. Members of Congress need to hear that their constituents care about global health and infectious diseases. You can help by writing or calling your representatives, especially when these issues are in the news or have come to Congress for a vote.

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