TOPICS > Health

Global Fund Attempts to Close Financial Gap

July 15, 2004 at 12:00 AM EDT
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SUSAN DENTZER: Mary Bardales looks like any other two-year-old, apprehensive about a trip to the doctor. In fact, Bardales comes to this hospital in her native Honduras because she has HIV, the virus that causes AIDS. She was infected while still in the womb, through her mother, Maria, who apparently contracted the virus from her husband.

Last year, the ailing mother and daughter started on a regimen of AIDS drugs called anti-retrovirals that the hospital gives out for free. Now they’re both healthy, and Maria Bardales is grateful.

MARIA BARDALES: ( Translated ): I tell them, “thank you so much.” God bless them. If she hadn’t gotten the medications, my daughter would be dead. Yes, thank you.

SUSAN DENTZER: The Bardaleses are among roughly 1,800 poor and HIV-positive Hondurans now getting these antiretroviral drugs. They’re being paid for by an entity most people have never heard of — The global fund to fight AIDS, tuberculosis, and malaria.

Those three diseases kill an estimated six million people around the world each year, and infect millions more. So in 2001, the world’s richest countries agreed to set up the fund to plow large sums of money into fighting them. Dr. Richard Feachem is the global fund’s executive director.

DR. RICHARD FEACHEM: We’ve raised, to date, $5.5 billion U.S., which is nothing like enough. But three years ago we had zero, so it’s a big step in the right direction. The goal is to get to what we call our cruising altitude, our steady state of income and expenditure. And our estimate of that cruising altitude is something like $8 billion per year.

SUSAN DENTZER: But at this week’s international AIDS conference in Bangkok, the fund’s performance has been a topic of both celebration and concern. The good news is that the fund has come as far as it has in just two short years.The bad news is that it’s falling far short of global health advocates’ original goals.

Dr. Paul Zeitz heads the Global AIDS Alliance, a nonprofit advocacy group. He says the fund may not be able to give out any money next year, and is unlikely to reach the target of granting $8 billion a year in assistance by 2007.

DR. PAUL ZEITZ: There is a serious risk now that the global fund may not provide any new grants during 2005 or 2006, and this is going to dramatically slow progress that’s been made to date in the expansion of programs for people to stop AIDS, TB, and malaria. It’s the moral question of our time. How could we let this dying go on when we have a mechanism that we know is working?

SUSAN DENTZER: Proponents like Zeitz say the shortfall is especially troubling since the global fund seemed to hold so much promise. Republican Congressman Jim Kolbe of Arizona heads a House appropriations panel that oversees U.S. contributions to the fund.

REP. JIM KOLBE: Well, I was a big supporter of the concept of the global fund from the very beginning, because I thought it was the best way we could get international support for HIV/AIDS, and I think in that sense, that it really has worked. It has mobilized the world community. It has brought attention worldwide to this, and it has brought a lot of other governments into it.

SUSAN DENTZER: Unlike most assistance programs, the global fund doesn’t give money directly to governments. Rather it works through committees, made up not just of government officials in a given country, but also nongovernmental organizations, faith based groups and private firms.

The global fund now works through these mechanisms in 128 countries and three territories. Zeitz describes how one came together in Zambia where he formally devised health programs.

DR. PAUL ZEITZ: When the country got together and applied for its first grant to the global fund, I got calls from Zambia of people saying, “Paul, you’re not going to believe this. We all got together for the first time ever and came up with one coordinated plan.”

That was a dream come true, that all the stakeholders would come together, get a strategic plan together, and then the funding was available to actually fund that plan.

SUSAN DENTZER: So far the fund has awarded $3 billion in grants. It says the money will eventually pay for anti-retrovirals for 1.6 million people; support more than a million AIDS orphans such as these in Rwanda; pay for insecticide-treated bed nets to fight malaria, as here in Senegal; and fund drug therapy for millions with tuberculosis, as here at this Cambodian clinic.

HEALTHCARE WORKER: This is her x-ray. We know that she’s on TB drugs, she’s on month three for TB therapy, and I don’t see any signs of active TB on the chest x- ray.

SUSAN DENTZER: All this has been possible through the support of 47 countries plus the European Commission, as well as a handful of private donors like the Bill and Melinda Gates Foundation. The largest single donor has been the U.S. Government, with $1.2 billion pledged through this year.

The U.S. contribution to the fund is part of the five-year, $15 billion plan for emergency AIDS relief that President Bush proposed and Congress adopted last year. This year, the fund has asked the U.S. for an additional $1.2 billion in 2005.

But the Bush administration and congressional leaders said no. Instead, the administration proposed $200 million for the fund in 2005. Congress now seems likely to raise that to $500 million.

Now a debate is flourishing over who’s being too parsimonious toward the global fund– the U.S., or other governments. Some AIDS activists in Bangkok this week blame the U.S.

President Bush’s global AIDS coordinator, Randall Tobias, said in Bangkok this week that the criticism was unwarranted.

RANDALL TOBIAS: This year, for example, the United States will commit almost twice as much to fighting international HIV/AIDS than the rest of the world’s donor governments combined. So in the context of the facts, it really makes no sense.

SUSAN DENTZER: U.S. officials say other countries should step up their contributions. They point out that Japan has pledged only $269 million so far to the global fund, Germany just $300 million, and Saudi Arabia only $10 million. Last year in fact Congress grew so concerned about low contributions from other countries that it capped the U.S. share at one-third of the fund’s total receipts.

REP. JIM KOLBE: It’s a kind of challenge grant, if you will. We’re saying to the rest of the world, “come on, you can surely put up two-thirds of this money. If we’re going to put up one- third of all the money in the world for this, you can put up some of this.” And at the moment they’re not quite meeting that.

SUSAN DENTZER: Kolbe says that if other countries hike their contributions to the fund, the U.S. will consider larger appropriations in future years. Meanwhile, he and Bush administration officials say the U.S. has other avenues of assistance– specifically, the direct aid to 15 HIV-affected countries under the president’s emergency plan.

REP. JIM KOLBE: We can move the money out on these by lateral programs in these focus countries very, very quickly, and that’s because we have mechanisms, organizations sets up there, we have been dealing with this for a long time in these countries.

SUSAN DENTZER: But in Bangkok, United Nations Secretary-General Kofi Annan said focusing so much on bilateral aid at the expense of the global fund was a mistake.

KOFI ANNA: If individual governments begin to set up their own initiatives, they start from scratch; it takes longer, the money that they hold will not be spent for quite a long time.

SUSAN DENTZER: International officials in Bangkok warned that the global fund shortfall was just one sign of a growing funding crisis in the fight against AIDS.