Reinventing Wheels

By Josh Ruxin, TomPaine.com - April 14, 2003

Now that the war is settling down, President Bush will return to some of the initiatives he outlined three months ago in his State of the Union address. His historic announcement of $10 billion in additional U.S. aid to fight AIDS is sure to get a second wind. But it seems as if the White House's skepticism of multilateral institutions is causing it to undervalue existing efforts.

While the specifics of the President's plan are still shrouded and will ultimately have to clear Congress before any dollars are distributed, it sets the AIDS battle on an uneven, bilateral course.

It calls for $9 billion out of the $10 billion in additional financing to be spent on programs in 14 countries, mostly in Africa. The most striking element is that it sets aside only the remaining $1 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria which has been gaining traction in 13 out of these 14 countries.

The Global Fund is the new multilateral institution designed to rapidly provide money for countries fighting these diseases. Its leadership has spent the better part of a year setting up an administrative infrastructure.

The United States is currently the largest donor to the Global Fund, and Secretary of Health and Human Services Tommy Thompson was just elected to chair its board. So the U.S. has played a key role in creating it, we are influential in running it and it draws on the best expertise in the world. It seems reasonable then to ask why we aren't going to use more funds to make sure it succeeds.

How does the Global Fund operate? It does not coordinate the countries' programs; instead, consortia of local governmental and non-governmental players carry out the work. These consortia -- which are tightly monitored -- also offer local resources from donors, governments and the private sector and are plugged into the efforts of USAID.

Take Botswana, for instance. It's the hardest-hit country in the world -- nearly 40 percent of the adult population is HIV positive. The Fund is providing $18.5 million during the next two years for recruiting and training workers, strengthening treatment, care and support activities, scaling up prevention programs and reducing stigma and discrimination. That's nearly a 50 percent increase in spending. A range of stakeholders including the National AIDS Coordinating Agency, Home Based Care Program, Community Based Organizations, Ministry of Health, Ministry of Finance and Development Planning are leading the effort. The program is rapidly being ramped up, but imagine what advocates there could do with triple the amount of money.

Or look at Nigeria. The modest $10 million to be disbursed in the next year will help provide anti-retroviral drugs to 900 children and 6,000 adults, offer free counseling and testing at 25 centers across the country, and train hundreds of doctors, pharmacists and laboratory scientists.

In Mozambique, the $30 million committed over the next two years will provide for a prevention campaign that will reach three million adolescents and youth and will improve protection for 150,000 orphans. There are dozens more proposals that await adequate financing.

The critical constraint the Global Fund faces today is not a lack of high-quality leaders and programs in the field, but sufficient finances to back them.

Yet, as it is with most of his international dealings, President Bush is unwilling to deeply commit to multilateral institutions. In this case it's because his advisors fear U.S. tax dollars will be misspent. Those of us who work on global public health issues share such concerns. But the Global Fund has yet to stumble -- indeed, it continues to shine more brightly.

That's why Bush should not waste time and money recreating the wheel here, but instead dedicate the vast majority of the remaining $9 billion to the Global Fund.

The AIDS epidemic must be struck hard and struck quickly. This is truly a situation where every month counts. Countries are pounding at the Global Fund's door with requests for programs that are ready to start today. The president has made a bold commitment that risks being tragically snagged on the White House's go-it-alone mentality. In this case, that mentality won't just upset our allies, it'll needlessly cost countless lives.