Global AIDS Coordinator Nominee Randall Tobias Says Drug Industry Ties Could Help ‘Get a Better Deal’ on Antiretrovirals
Former Eli Lilly CEO Randall Tobias, President Bush's nominee to head the new State Department office created under the global AIDS initiative, said Tuesday during a Senate confirmation hearing that his connections to the pharmaceutical industry will not pose a conflict of interest if he is confirmed and suggested that his ties could help in negotiating lower prices for antiretroviral drugs, the Indianapolis Star reports (Groppe, Indianapolis Star, 10/1). President Bush on July 2 nominated Tobias to head the new Office of the Global AIDS Coordinator created under the five-year, $15 billion global AIDS initiative. As 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 position will carry the rank of ambassador. The new office will oversee U.S. international assistance in the fight against HIV/AIDS and coordinate the activities of the various agencies and departments that will deliver the aid (Kaiser Daily HIV/AIDS Report, 8/18). Speaking before the Senate Foreign Relations Committee, Tobias said he will "represent the interests of the United States" and use the "most cost-effective way" to help HIV/AIDS patients throughout the world, according to the Star. "I'm hopeful my experience in the pharmaceutical industry might enable me to get a better deal," Tobias said. The committee could vote to confirm Tobias as soon as Thursday, the Star reports. Committee Chair Richard Lugar (R-Ind.) said Tobias had not been confirmed sooner because lawmakers wanted to "review his extensive business ties" to avoid any conflict of interest, the Star reports.
Tobias has said that he will resign from his position on Eli Lilly's board and sell his stock in all other drug companies except Eli Lilly, the Star reports. The Indianapolis-based drug company does not make any HIV/AIDS drugs but does produce two drugs that treat some forms of tuberculosis, which the global AIDS initiative is also targeting. "That's a conflict of interest in the court of public opinion," Paul Zeitz, director of the Global AIDS Alliance, said, adding that Tobias' links to Eli Lilly could be problematic because the company contributes to the pharmaceutical trade group that has "taken every measure they possibly can with their great wealth to block access to life-saving, generically manufactured drugs" (Indianapolis Star, 10/1). AIDS Healthcare Foundation President Michael Weinstein said that Tobias "must hit the ground running to meet the Bush administration and Congress goal of bringing half a million people into treatment by October of next year, so Senate confirmation is urgent," adding, "We are literally behind schedule already if we're to meet such goals, and appointment of the coordinator can't wait any longer." Weinstein also said that the foundation "applaud[s] ... Lugar for moving the nomination forward and urge[s] a vote this week by the full committee as well as quick approval by the full Senate" (AHF release, 10/1).
During the hearing, Tobias said that he supports Bush's plan to direct most of the funding for global AIDS initiative projects through U.S. programs instead of through the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Financial Times reports. He said that of the $1.55 billion the fund has amassed, only $118 million has been disbursed, adding, "Right now, if we gave more money to the Global Fund, it would go straight into its World Bank account" (Beattie, Financial Times, 10/1). According to a Global Fund release, the group had disbursed $131 million as of Sept. 22 and plans to bring that number to $200 million by the end of 2003 (Global Fund release, 9/22). Tobias also said that the "main obstacle" to implementing an antiretroviral program in sub-Saharan Africa is a lack of infrastructure "on the ground," not the lack of available drugs, according to the Times. But some HIV/AIDS advocates disagree, saying that the "U.S. administration's inability to spend money quickly and efficiently ... [is] the real problem," the Times reports. David Bryden, communications director for the Global AIDS Alliance, said, "We keep hearing these myths about the lack of capacity and how we can't spend all the money that has been authorized. It is becoming embarrassing" (Financial Times, 10/1).
Physicians for Human Rights said that one of Tobias' first tasks if confirmed will be to figure out how to allocate funding for prevention programs "within the framework" of HR 1298, the measure authorizing the global AIDS initiative, according to a PHR release (PHR release, 9/30). The law endorses the "ABC" HIV prevention model -- abstinence, be faithful, use condoms -- which has had success in lowering HIV prevalence rates in Uganda. The law recommends that 55% of direct aid go to treatment programs, 20% go to programs aimed at preventing HIV infections, 15% go to palliative care and 10% go to programs assisting children who have lost one or both of their parents due to AIDS-related causes. The measure also specifically allocates one-third of the bill's HIV/AIDS prevention funding for abstinence programs (Kaiser Daily HIV/AIDS Report, 5/28). PHR U.S. Policy Director Holly Burkhalter said, "The AIDS pandemic is too serious for Mr. Tobias and the U.S. government to waste time and money by throwing away tax dollars on prevention programs that are not based on science." The group calls for Tobias to apply the "'one-third' provision only to programs preventing sexual transmission and not to take [funding] from other AIDS prevention programs," including vertical transmission programs or "safe health care" programs to eliminate HIV/AIDS transmission from unscreened blood transfusions or reused needles, according to the release (PHR release, 9/30).
Opinion Piece Offers 10 Step Plan
Sen. Lamar Alexander (R-Tenn.) in a Washington Times opinion piece offers Tobias a 10-point list of "suggestions ... to get a quick start" in implementing the global AIDS initiative:
- "Go to Africa": Tobias should travel to Africa to "be where the action is" and to "understand the disease that has delivered a death sentence to 29 million Africans, to make good spending decisions and to cut red tape," Alexander writes.
- "Make needles and blood transfusions safe": Unsafe health care practices will lead to at least 175,000 new HIV infections this year, according to Alexander.
- "Save the babies": Tobias should prioritize the prevention of vertical HIV transmission, as Congress has already appropriated millions of dollars to "create an AIDS-free African generation," Alexander says.
- "Make inexpensive drugs widely available": According to Alexander, the availability of antiretroviral drugs in South Africa could determine "whether five million [HIV-positive] people die in the next five years or in 20 years."
- "Encourage rapid tests and routine tests": Access to inexpensive antiretroviral drugs will serve as an incentive for Africans -- most of whom do not know their HIV status -- to be tested for HIV, Alexander says.
- "Teach the ABCs": By using this method, Uganda has lowered its HIV prevalence rate from 20% to 8%, according to Alexander.
- "Form an AIDS Corps": Because the "greatest need is for manpower and training," Tobias should create a "private-sector clearing house for Americans to go to Africa" for three months to two years, Alexander says, adding, "Hospitals need doctors, clinics need nurses, nonprofits need counselors to recruit patients and to hold the hands of the dying."
- "Dig some water wells": According to Alexander, some diseases are carried to individuals by "unclean water," and HIV/AIDS patients "of all ages live longer with clean water."
- "Focus on logistics": Tobias should "ride the horses already running" to avoid overplanning, because faith-based programs and U.S. government personnel are already on the ground, Alexander says.
- "Move fast, but don't spend the $15 billion too fast": Alexander urges Tobias not to spend the authorized $15 billion too quickly because current health care infrastructures "cannot absorb too much money too quickly." Alexander adds, "There are treatment guidelines to prepare and teach, staff to recruit, patients to find and persuade, health organizations to establish" (Alexander, Washington Times, 10/1).