Important note: Information in this article was accurate in April 2001. The state of the art may have changed since the publication date. IAVI Report - April / June 2001
Saul Walker
As delegates from around the world gather in New York for the United Nations Special Session on AIDS (UNGASS, 25-27 June 2001), efforts to establish a global fund to help bankroll international action against infectious diseases in developing countries are showing results.
While plans for such a fund are only now moving into the limelight, they have actually been evolving gradually over the past year, as various international forums have focused on the need for new financing mechanisms to combat disease and improve health in poor nations.
The idea began to gather momentum in July 2000 at the World AIDS Conference in Durban and the Okinawa meeting of G8 nations, who agreed to the proposal for joint action directed at HIV, TB, and malaria. Thereafter, similar ideas were proposed in several other arenas: the "Ottawa Group" (UK, US, Canada, and the European Union) began developing financing proposals directed at communicable diseases (which make up 60% of the disease burden in developing countries), while in February, Italy (the current G8 chair) announced its own proposal. In parallel, proposals for an HIV-specific fund have been advanced by the US, UNAIDS, and UN Secretary General Kofi Annan, who presented a version emphasizing AIDS in Africa at the April OAU summit (Organization of African Unity) in Abuja, Nigeria.
As people come together at UNGASS, there appears to be convergence on establishing a single Global Health Trust Fund focused initially on HIV, tuberculosis (TB), and malaria. Pledges to the fund have been made by the governments of the US (US$ 200 million) and France ($130 million); the UK has indicated probable support of $105 million, and Japan is also considering a contribution. Winterthur, an insurance subsidiary of the Credit Suisse financial services group, has made the first pledge from the private sector, for $1 million.
It is currently unclear how much the Fund will contribute towards the $7-10 billion which Kofi Annan estimates is needed from all sources to provide comprehensive HIV prevention and care in developing countries. (Present estimates range from $1-$3 billion.) Additional costs for TB and malaria are estimated at approximately $2 billion. The bulk of the financing for HIV/AIDS responses will continue to be channeled through existing national, bilateral, and multinational mechanisms.
The first meeting that brought together a broad range of players (developing and industrialized country governments, multilaterals, and a few NGOs) to discuss Fund proposals took place in Geneva on 3-4 June. Although this meeting was not designed to forge consensus on details of the Fund, there was agreement on some general principles:
As the IAVI Report went to press, there was still no consensus on exactly what the Fund should be used for or how it can add value beyond simply increasing investment in existing mechanisms. For example, some donors favor more of a focus on commodities, using high volume to leverage better prices, and possibly on technical assistance to use the medicines in an effective, sustainable manner. Equally essential development of healthcare systems would work through existing mechanisms. In contrast, others (including the US) support a broader focus on both medicines and healthcare infrastructure.
Nor is there consensus on who will control or administer the Fund and where money will be held. The World Bank has been proposed as the banking facility, but some donor countries oppose this suggestion. There is similar caution on the role of the UN. Support is building for a model based on GAVI (the Global Alliance for Vaccines and Immunization), which is run by a small "representative" board, a secretariat, and a larger stakeholder group.
As it now stands, the Fund would give a boost to vaccine efforts if it helps ensure increased, effective investment in health systems and better access to commodities in developing countries--outcomes that would help create a supportive environment both for HIV vaccine trials and for better use of effective vaccines once they are developed.
At present there is no commitment for a window specifically earmarked for AIDS vaccines. Yet a number of governments and public health officials have expressed support for such a window and are working to include it within the broader health fund.
In a report to be released at the UNGASS meeting, IAVI is calling for the creation of a vaccine sub-account to be used for the purchase and delivery of vaccines once they become available; no funds would be allocated until that time. According to David Gold, IAVI's Vice-President for Policy and Public Sector Support, "creation of a vaccine window would send an important message that vaccines, along with treatment, care and prevention, are crucial to overall efforts to end the epidemic. The account would also demonstrate to vaccine companies that there is a global commitment to purchase and deliver AIDS vaccines to those who need them without delay." The report, A New Access Paradigm: Public Sector Actions to Assure Swift, Global Access to AIDS Vaccines, also describes several key requirements for an effective fund and recommends other actions that should be taken by the public sector to ensure future access to AIDS vaccines.
While the Fund is likely to be a major topic of conversation among the delegates, it is not part of the official UNGASS agenda. It now appears that a new and broader working group of stakeholders will be formed to take the planning forward, up to, and beyond July's G8 meeting in Genoa. This group will include developing countries and an expanded roster of potential donors, including other OECD countries.
Saul Walker is currently Senior Policy Officer (International) at the National AIDS Trust in the UK, and leader of the NAT/IAVI vaccine advocacy program. He is a Trustee of NAM Publications (www.aidsmap.com) and was previously a board member of the Terrence Higgins Trust (UK), Europe's largest AIDS service organization.
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