Bush Administration Policies Could Make PEPFAR Difficult To Implement, GAO Report Says
The Bush administration's policies on generic antiretroviral drugs and other issues could make the implementation of the President's Emergency Plan for AIDS Relief difficult, according to a Government Accountability Office report released Tuesday to conicide with the XV International AIDS Conference, USA Today reports (Sternberg, USA Today, 7/14). The five-year, $15 billion PEPFAR program directs funding to 12 African nations -- Botswana, Ethiopia, Cote d'Ivoire, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia -- as well as Haiti, Guyana and Vietnam in Asia (Kaiser Daily HIV/AIDS Report, 6/23). The GAO report, requested by Rep. Jim Kolbe (R-Ariz.), is based on interviews with USAID and CDC officials who work in the 14 Africa and Caribbean countries that were the initial focus of the plan. Although Kolbe said that the report shows that the program is "running very well," he said that there are "problems at all kinds of levels." For instance, most of the staff interviewed also said that they have not received specific guidelines on whether they can use PEPFAR money to purchase generic antiretroviral drugs. Such confusion has made it difficult for U.S. officials to develop national treatment programs in the focus nations, especially the four nations that already use generic drugs, according to USA Today. In addition, the report notes that a federal regulation usually used to control large purchases of items -- such as furniture -- limits the government's ability to make bulk purchases exceeding $100,000. The requirement means that larger drug purchases have to be approved by officials in Washington, D.C., which can take several months, according to USA Today. One of the greatest challenges seems to be coordinating government agencies and nongovernmental organizations, as well as providing technical assistance and drug provision without requiring large amounts of paperwork for developing countries, Kolbe said (USA Today, 7/14).
Joia Mukherjee, medical director of Partners in Health, which expects to receive at least $1 million in PEPFAR funding for fiscal year 2005, said that the requirements have been "very confusing," adding, "You're trying to figure out who can buy what with what money." To circumvent the policy, many countries have started using PEPFAR funding to train health workers, pay salaries and buy other equipment, and they have used money from other sources to buy generic drugs. An unnamed official from an organization that received a large PEPFAR grant said that such a solution is "a compromise that wasn't acceptable before." However, Ambassador Randall Tobias, head of the Office of the Global AIDS Coordinator, on Tuesday said that the United States "respect[s] local governments' decisions as to how best to manage their HIV/AIDS programs." He added, "In the event that a country elects to use non-U.S. funding to purchase copy drugs that have not been approved for quality and safety by the U.S., [PEPFAR] will support nonpharmaceutical aspects of the country's care, treatment and prevention programs, and will do whatever is necessary to maintain integrated systems of care" (Nakashima/Brown, Washington Post, 7/14).
The New York Times on Wednesday examined the progress of PEPFAR (Sontag et al., New York Times, 7/14). The complete article is available online.