Bush Administration Offers Details of Five-Year, $15B Global AIDS Initiative Plan, Releases First $350M in Grants
The Bush administration on Monday submitted to Congress a report detailing a plan for its five-year, $15 billion global AIDS initiative and released the first $350 million in grants, USA Today reports (Sternberg, USA Today, 2/24). Bush in May 2003 signed into law a bill (HR 1298) authorizing the initiative, which seeks to prevent seven million new HIV infections, provide care for 10 million people living with the disease and provide treatment to two million HIV-positive people living in some African and Caribbean countries (Kaiser Daily HIV/AIDS Report, 2/23). The 99-page report, titled "President's Emergency Plan for AIDS Relief," allocates $9 billion in new funding over the next five years to AIDS programs in 14 countries in Africa and the Caribbean (USA Today, 2/24). The "focus" countries include Botswana, Ethiopia, Cote d'Ivoire, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia in Africa, and Haiti and Guyana in the Caribbean (Wright, Washington Post, 2/24). Officials said that another country will be added to the list later, the New York Times reports (Marquis, New York Times, 2/24). The United States also plans to grant $5 billion through "existing agreements" with countries and $1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, USA Today reports (USA Today, 2/24).
The first installment of grants under the initiative will provide antiretroviral treatment for an additional 50,000 HIV-positive people and help provide care for AIDS orphans (Lueck/Phillips, Wall Street Journal, 2/24). The grants also will help HIV/AIDS prevention messages reach 500,000 people (Washington Post, 2/24). In the initial phase of the program, four AIDS groups will share a total of $92 million in grants in 2004 to provide treatment to the 50,000 patients, according to the San Francisco Chronicle. The Elizabeth Glaser Pediatric AIDS Foundation, the Harvard School of Public Health, Columbia University's Mailman School of Public Health and a consortium of groups headed by Catholic Relief Services proposed five-year programs that together would provide access to antiretroviral treatment for about 400,000 HIV-positive people at a cost of about $683 million (Russell, San Francisco Chronicle, 2/24). The Maryland-based consortium led by CRS -- which includes the University of Maryland's Institute of Human Virology; the New York-based Catholic Medical Mission Board; and the Futures Group, a Washington, D.C.-based not-for-profit that will "evaluate and monitor the effort" -- was awarded $335 million over five years, the Baltimore Sun reports (Bor, Baltimore Sun, 2/24). Another $107 million over five years will go to the Harvard School of Public Health, which in the first year of its plan calls for treating 8,000 people in Nigeria, 4,000 in Botswana and 3,000 in Tanzania, the Boston Globe reports. The Harvard plan also calls for improving laboratories and increasing training for health workers to oversee antiretroviral treatment programs (Donnelly, Boston Globe, 2/24).
Global AIDS Coordinator Randall Tobias said, "Our intent has been to move as quickly as possible in order to bring immediate relief to those suffering the devastation of AIDS. And by initially concentrating on scaling up existing programs, that is exactly what we believe we are able to do." He added, "With our next round of funding, we expect to place an additional focus on also attracting new partners who can bring expanded capacity and who can bring innovative and new thinking to this effort" (Office of Global AIDS Coordinator release, 2/23). HHS Secretary Tommy Thompson said, "The release of this money is a landmark achievement that builds on our nation's historic efforts to fight global AIDS by delivering the hope of modern medicine to those who need it most around the world" (HHS release, 2/24). Thompson added, "It's one thing to say we're going to do something; it's another thing to write a check" (Wall Street Journal, 2/24). Sen. Mike DeWine (R-Ohio) lauded the administration "for cutting through the bureaucracy and moving quickly to distribute funding to countries and programs." DeWine added, "This is exactly the kind of action and leadership that is needed if we are to win the war against HIV/AIDS" (Chatterjee, Philadelphia Inquirer, 2/24). EGPAF Executive Director Kate Carr said, "The money's now available, the teams are in place and the dollars are going to flow" (USA Today, 2/24).
Global Fund Money
Some AIDS advocates expressed concern about the plan's contribution to the Global Fund, the Journal reports (Wall Street Journal, 2/24). In his fiscal year 2005 budget proposal, President Bush requested $200 million for the Global Fund. However, Congress appropriated $550 million for the fund in FY 2004 (Kaiser Daily HIV/AIDS Report, 2/9). Jamie Drummond, executive director of the debt, AIDS and trade advocacy group DATA, said, "It makes little sense to pay for the bilateral AIDS program by cutting the U.S. contribution to the multilateral Global Fund." But he added, "It's great this cash is now getting out the door to African countries devastated by AIDS" (Wall Street Journal, 2/24). Global AIDS Alliance Executive Director Paul Zeitz said, "The big issue in this report is the ideological battle underway: whether the United States should program money through a go-it-alone approach or work through the Global AIDS Fund." He added, "While recognizing the problem in 14 countries, they're actually making the problem worse by setting up a parallel program rather than working through existing partnerships that are already up and running" (Washington Post, 2/24). AIDS Healthcare Foundation President Michael Weinstein said, "In light of the fact that over three million people have died of AIDS in the 13 months since the president first unveiled his Emergency Plan for AIDS Relief, today's announcement is very disquieting" (AHF release, 2/23).
Some advocates also expressed concern that the administration may not allow funding to go toward the purchase of generic antiretroviral drugs, the Journal reports (Wall Street Journal, 2/24). Tobias at two different news conferences has said that the administration is "open" to the use of generics, but the administration's plan appears to "lean heavily on patented drugs," according to the Chronicle. The plan states that procurement of drugs for the initiative "will have to fit within the parameters of existing federal and international law for the protection of intellectual property rights" (San Francisco Chronicle, 2/24). Sharonann Lynch of Health GAP said, "U.S. taxpayers should be saying that if you can keep four times the number of people alive [using generic medicines], then do it" (Wall Street Journal, 2/24). Tobias said that the U.S. policy will be to "buy drugs that are safe and effective at the lowest possible price." He added that "if those happen to be drugs that are manufactured by generic companies, fine. If those are drugs that are manufactured by brand-name companies, fine. But it's very important that there be some standard, some principles by which we can make those decisions." Tobias said that FDA, the World Health Organization, UNAIDS and other groups are scheduled to meet in March to discuss "some principles" that can be used to "examin[e] the alternatives in the market" (Office of the Global AIDS Coordinator release, 2/23). Zeitz said, "It was disappointing to hear that a decision on generics would have to wait until the FDA could convene a conference to study the matter, even though a safe generic is already available and is being widely used" (GAA release, 2/23).
NPR's "All Things Considered" on Monday reported on the plan details. The segment includes comments by Tobias, Zeitz and Richard Cizek, vice president for governmental affairs at the National Association of Evangelicals (Wilson, "All Things Considered," NPR, 2/23). The complete segment is available online in RealPlayer.
A webcast of the press conference is available online from kaisernetwork.org.
A fact sheet outlining federal funding for HIV/AIDS in Bush's FY 2005 budget request is available online. The fact sheet includes an overview of the total federal budget request for HIV/AIDS as well as key highlights of domestic and international allocation requests.