Harvard President Delayed Spending Millions for Nigerian AIDS Treatment Program To Review Legal Risks, Official SaysHarvard University President Lawrence Summers last year delayed for several months the spending of millions of dollars for an HIV/AIDS treatment program in Nigeria over concerns that the program could be a "legal risk" for the school, a senior university official has said, the Boston Globe reports. Harvard in February 2004 was awarded a five-year, $107 million grant from the President's Emergency Plan for AIDS Relief, $17 million of which was allocated for use in 2004 for programs in Nigeria, Tanzania and Botswana. The university already was involved in a government-run treatment program in Nigeria, and the PEPFAR funding was designated to immediately purchase bulk orders of antiretroviral drugs. However, Harvard did not order the drugs until September 2004, and the medicines arrived at sites in November and December 2004, according to Nigerian doctors involved with the program, the Globe reports. Treatment efforts in Tanzania have been delayed because of drug-purchasing issues between the U.S. and Tanzanian governments, and the Botswana program does not provide direct treatment but trains health care workers and monitors one of the continent's largest treatment programs.
Summers' initial concern about the program was how "quickly it was launched," according to Harvard Provost Steven Hyman, the Globe reports. "Precisely because this is about life and death, it is absolutely critical that we get this right," Hyman said. He added that during the time period between the award of the PEPFAR grant and the placement of the drug purchase order, he and Summers were reviewing the university's role in the program and ensuring that it was "properly managed," the Globe reports. He said that a "major concern" for Summers and members of the Joint Committee of Inspections, a Harvard audit board, was whether the U.S. government or patients could sue the university for any "perceived future problems," according to Hyman, the Globe reports. The U.S. government in 2000 sued Harvard for alleged misuse of funds in a Russian development grant. "That lawsuit sensitized [Summers] enormously for the need for Harvard to do this right," Hyman said. He added that Summers also raised questions about whether managing an African HIV/AIDS treatment program "was consistent with the university's strengths of teaching students and conducting research," according to the Globe. Summers called Columbia University President Lee Bollinger to review his concerns, who then consulted Dr. Allan Rosenfield -- dean of Columbia's Mailman School of Public Health, which also received a PEPFAR grant in February 2004. "I told [Bollinger] that I didn't think there was a large risk," Rosenfield said, adding, "I don't think the university is at any particular greater risk than any other funder." However, Summers decided to appoint an executive director to oversee the program's operations, and Richard Skolink, who worked for 25 years in health and education initiatives at the World Bank, replaced the program's interim director in January.
Doctors involved with the Nigerian program last week "criticized" Harvard officials for not "acting more quickly," saying that the university's delay in spending the funding "meant that some patients died," according to the Globe. "Unfortunately, we lost some of our patients who were waiting," Dr. Isaac Adewole, medical school provost at the University of Ibadan in Nigeria who oversees one of Harvard's treatment sites, said, adding, "It shows any delay in the commencement of the treatment program gives patients a sure certificate to the mortuary." Although the treatment program had made a "strong recovery" by the end of March 2005 -- enrolling 7,300 people, 700 patients short of its goal of 8,000 -- doctors running the program said that they would have had more than 10,000 people on treatment by the end of the first year without the delay, according to the Globe. They added that their "rush" to treat adults will delay for a "few more months" pediatric treatment and mother-to-child HIV transmission prevention programs, according to the Globe. "There's a world of difference between those on this side, in Africa, seeing people dying every day in and day out, and somebody who is in Boston, who cannot imagine what is happening here," Dr. John Idoko, who runs Harvard's program in Jos, Nigeria, said, adding, "I have in front of me the emotions, the passions and the pains of the people who are dying because they can't get the drugs."
Program Directors' Reactions
Some of the Harvard program directors also have "pressed" the university to review its "strict conditions" for running the project that they say "hampe[r]" the initiative, according to the Globe. Dr. Phyllis Kanki, an AIDS specialist at the Harvard School of Public Health who wrote the proposal for the PEPFAR grant, said she wants Harvard to abolish a requirement that she and three other project directors report to a Boston-based executive director. She added that project directors should be allowed to discuss the program outside Harvard without having to receive permission from the executive director. Hyman said he plans to rewrite the program terms but "declined to be specific," the Globe reports (Donnelly, Boston Globe, 4/24).