Bush, Tobias Could ‘Change Nature of AIDS in Africa,’ Lancet Editorial Says
President Bush and recently named Global AIDS Coordinator Randall Tobias could "change the nature of HIV/AIDS in Africa," according to an editorial published in the July 12 issue of the Lancet (Lancet, 7/12). Bush last week named Tobias, former chair and CEO of drug maker Eli Lilly, as head of a new State Department office assigned to oversee the global AIDS initiative (HR 1298), which authorizes $3 billion a year over five years for HIV/AIDS programs in Africa and the Caribbean. As global AIDS coordinator, Tobias would work under the secretary of state, and he would be able to distribute funds directly to nongovernmental organizations and transfer funds between government agencies. The appointment, which must still be approved by the Senate, will carry the rank of ambassador (Kaiser Daily HIV/AIDS Report, 7/3). Some critics have questioned Tobias' knowledge of AIDS and Africa, as well as his connections to the pharmaceutical industry, the editorial says. In order to address those concerns, Tobias needs a "[r]apid appointment of a team behind him with proven African public-health and HIV experience," the Lancet says, adding that a "detailed plan of how the Bush AIDS initiative will work with the [Global Fund] ... would help." In addition, Tobias "needs quickly, and publicly, to support purchasing of low-cost generics to provide ammunition against those who charge that he is no more than a stooge of the drug industry," the editorial says. He could also "go as far as to counter" U.S. opposition to the 2001 Doha declaration that would allow developing nations to override patent protections to produce or import generic versions of drugs to combat public health epidemics, according to the Lancet. "If all Tobias' targets are met, which is likely only if the full $15 billion is appropriated by Congress, then he will have proven himself a worthy Global AIDS Coordinator," the editorial says, concluding, "Tobias' task then, surely, as befits his job title, will be to combat the emerging HIV pandemic in Asia" (Lancet, 7/12).
The Right 'Kind of Leader'?
Although Bush's decision to "increase the United States' role in [the] international fight [against AIDS] is a good sign," his naming of Tobias as Global AIDS Coordinator "gives ... pause," a Billings Gazette editorial says. The fight against HIV/AIDS "deserves a leader who can relate to those most in need, the castaways in the global society who need medicine, education and clean drinking water, not just a compassionate glance from another guy in a suit," the Gazette says, questioning whether Tobias -- "with no discernable track record of field work" -- is "really the best advocate for millions of people who cannot afford the necessary medicines to survive." The editorial says that AIDS is not "another problem-solving exercise for a retired CEO to tackle. It is a worldwide public health epidemic that requires a unique leadership skill. It requires a person who can relate to those living with the disease on all levels, not just as part of an annual report." The Gazette concludes, "We're certain Tobias is an outstanding leader," as evidenced by the success of Eli Lilly during his tenure; however, "[w]e're not certain that Tobias is the kind of leader the AIDS issue needs" (Billings Gazette, 7/10).