FIGHTING AIDS
February 10, 2003

Examining President Bush's recent $15 billion proposal to combat AIDS in Africa and the Caribbean. Background Report The NewsHour Health Unit is funded by a grant from The Henry J. Kaiser Family Foundation.

 

Online Special: AIDS in Africa Oct. 22, 2002: Thailand's fight against AIDS Oct. 1, 2002: AIDS as a threat to global stability Aug. 26, 2002: The repercussions of the continuing AIDS plague in Malawi July 8, 2002: Health experts explain the importance of donating more resources to stop the spread of AIDS. June 19, 2002: Bush's plan to curb mother-to-child HIV/AIDS transmission May 9, 2002: The plight of AIDS orphans in Zambia Dec. 3, 2001: Experts assess the 2001 AIDS statistics. May 17, 2001: A look at an effective AIDS prevention program in Senegal. May 16, 2001: Botswana's response to the AIDS crisis. April 25, 2001: Elizabeth Farnsworth reports on AIDS in Malawi. Browse the NewsHour's coverage of health and Africa.   News for Students: Dying Young: The Fight Against AIDS     UNAIDS The White House Africa Action	SUSAN DENTZER: President Bush's recent announcement in his State of the Union address of a new initiative on HIV and AIDS, signaled a marked increase in American assistance to fight the global pandemic. PRESIDENT GEORGE W. BUSH: Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many. We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the emergency plan for AIDS relief, a work of mercy beyond all current international efforts to help the people of Africa. SUSAN DENTZER: An estimated 42 million people worldwide are now infected with HIV. More than 20 million have already died, and as many as 68 million more deaths are forecast by 2020. To help fight the pandemic, Pres. Bush proposes spending a total of $15 billion over the next five years, $10 billion more than his administration had previously planned to spend. The money would be used in part for prevention programs to stem new infections from HIV, the virus that causes AIDS. It would also help speed anti-viral drugs and other treatment to AIDS sufferers. Under the president's plan, twelve out of 48 sub-Saharan African nations would benefit, and to two Caribbean nations, Haiti and Guyana. PRESIDENT GEORGE W. BUSH: There are whole countries in Africa where more than one-third of the adult population carries the infection. More than four million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims, only 50,000, are receiving the medicine they need. Many hospitals tell people, you've got AIDS, we can't help you. Go home and die. In an age of miraculous medicines, no person should have to hear those words. SUSAN DENTZER: Far and away the largest share of the money would be contributed directly by the U.S. to other countries, such as through programs sponsored by the U.S. Agency for International Development. The president signaled that much of that money would go to purchase generic versions of the so-called anti-retro viral drugs that have drastically cut AIDS deaths in developed nations. PRESIDENT GEORGE W. BUSH: Anti-retro viral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year, which places a tremendous possibility within our grasp. SUSAN DENTZER: But analysts say that broader use of generics also raises the possibility of conflict with U.S. trade policies; those have traditionally been aimed at protecting the patents of us pharmaceutical manufacturers. By contrast to the large sums of money the president wants to spend on direct bilateral assistance to other countries, he proposes to channel just $1 billion over the five-year period through the so-called global fund to fight AIDS, tuberculosis, and malaria. That's a multinational arrangement created two years ago to make grants supporting prevention and treatment plans put forward by affected countries themselves. The fund had earlier asked the U.S. for a much larger contribution of $2.2 billion over a two-year period. Separately, the Global Fund announced recently that U.S. Health and Human Services Secretary Tommy Thompson had been elected to head the fund's board of directors.
	Analysis of the president's plan
	GWEN IFILL: Joining me to analyze the details of the president's AIDS proposal are Dr. Joseph O'Neill, the director of the White House office of national AIDS policy. Stephen Lewis, the United Nations special envoy for HIV/AIDS in Africa. And Salih Booker, the director of Africa Action, an organization which works for human rights in Africa. Dr. O'Neill, as Susan Dentzer just reported, $10 billion in new money the president talked about in his State of the Union speech, one billion of it to the global full for AIDS. Why is that, how did you decide to split it up that way? DR. JOSEPH O'NEILL: The global fund is an important tool for solving this problem globally. The one billion dollars that the president announced as new money is actually an enormous increase in our contribution to the fund. Now that that money is added in, the U.S. will contribute now 44 percent of all the committed money to the global fund. So the global fund is a very very important tool, but it was never intended to be the sole means by which the U.S. would respond to this epidemic. GWEN IFILL: Salih Booker in addition to this money that's going through the global fund, the money that’s going through USAID, this is also to twelve African countries, two Caribbean countries, what do you think about that there's countries they have chose to help and the ones they haven’t/ SALIH BOOKER: Well, it's not entirely clear what the criteria was for the selection of the countries and that does represent some problem. AIDS is a global pandemic, Africa is the epicenter, and it's important that the United States start providing the kind of leadership that the president has signaled. It's important, however, if we're going to call it an emergency plan that we treat it as the emergency that it is, meaning we need this funding this year, 2003 and 2004. That's when millions of people will be dying if they don’t have access to these medicines, and the global fund to fight AIDS is in fact the best mechanism, a vehicle that the United States helped establish two years ago but which is now almost bankrupt because the wealthy countries that should be providing the leadership and financing this simply haven't been coming for with the kind of contributions needed. So that's something wee also like to see changed in the president's initiative to get more funding to the global fund now this year. GWEN IFILL: Stephen Lewis, are you pleased with the president's, the decision to spend this money on AIDS in Africa, and is there something else you would have liked to see him do? STEPHEN LEWIS: How can you not be pleased. It's a dramatic break with the past. The staggering indifference towards the needs of Africa in the wake of the pandemic over the last ten years from the developed word has now been reversed, apparently, by the president's announcement. So I wouldn't cavil with it. I think there are two things which have worried a lot of international observers. One is that it's phased in, that as Salih Booker said, it's not really coming into play in 2003, and in 2004 only in modest installments, growing over the years. And listening to the president's word, he said four million people are in need of treatment now. And only 50,000 are getting it, and he repeated that dramatically. Well, if four million people are in need of treatment now and the American money doesn't begin to trigger significantly until the latter half of 2004, then a very great percentage of those four million will be dead, and not in any number of years would the president wish that. So obviously the money has to come forward into 2003. GWEN IFILL: We have the president's representative here, let him respond to that. DR. JOSEPH O'NEILL: We're talking fiscal year, as you know, the 2004 fiscal years begins in October of 2003. So we're prepared to get money out and to get money out quickly. But the important point to take home here is that the United States has taken bold leadership under Pres. Bush to do something about this global epidemic. And we're calling on the rest of the world to join us in this effort. We can't do it alone. But if the rest of the world, the developed world that has resources joins with us, and puts money out there, be it in the global fund or by lateral initiatives, we'll be able to solve this problem.
	The pharmaceutical industry
	GWEN IFILL: A lot of this plan is to make drugs more affordable. Yet because you're administering it through USAID are generic drugs which aren't manufactured in the United States eligible for this program? DR. JOSEPH O'NEILL: It's a difficult question. There's no generic answer to the generic drug question. We've tabled in the last trade negotiations in Geneva a proposal that would allow countries once they've negotiated with and gotten the best price to see what the best price is they could get from the pharmaceutical industry -- if the negotiations are done properly, yes -- to allow the purchase of generic drugs. But I wanted to remind us all that the pharmaceutical industry has taken deep, deep, deep cuts in their own cost making these drugs available. In fact, some drugs have been made available free of charge in Africa and other part of the world. So this is an important question; we're committed to getting the lowest possible price and using these dollars in the most efficient way to help them. But we also have to keep our eye on quality. I'm a practicing physician and I know very well that the quality of the drugs that we give to people are also very very important. Complicated question. GWEN IFILL: Salih Booker, are the decisions being made, these are complicated questions obviously, but are the priorities being set correctly? SALIH BOOKER: In order for the president to meet the targets he's laid out, treating two million people now, the only way to do that is through the purchase of the lowest price version of the anti-retro viral drugs, and it’s only generics through the competition introduced by generic producers that the price has been brought down to $300 a year for a full course of treatment that the President referred to. In order to do that we have to purchase generics. The pharmaceutical industry, the most profitable industry for the last 11 years running, spends only about 11 percent in research and development of its revenues, but 26 percent goes to marketing and public relations. So the pharmaceutical industry has to back off. The president's plan to be true to his words is going to have to provide a mechanism for the bulk purchase of generic versions, because it doesn't make sense when you can buy the cheapest version a drug and treat therefore many more people to go for patented drugs, and the U.S. Trade representative Bob Zoellick is off to the intellectual property rights discussions tomorrow, the TRIPS Council, and unfortunately the U.S. position there still at odds with the president's proposal. GWEN IFILL: Steve Lewis. STEPHEN LEWIS: May I make that back to the president's own word? The president said that the drugs had been reduced to $300 per person per year. That is a generic price. And the generic drugs are not a matter of quality with great respect, they are listed on the World Health Organization list of anti-retro viral drugs which can be used. If the money, if a greater amount of money, one hopes over a billion dollars a year, were channeled through the global fund for AIDS, then the purchase of those generic drugs would be possible and acceptable and I point out that it is an advisory board chaired by Tommy Thompson. GWEN IFILL: Let's talk about the president’s own words. Did he make the commitment to using generic drugs, and is there more money in the offing for the global fund? DR. JOSEPH O'NEILL: The president made several commitments; one was to essentially triple the U.S. investment in global HIV and AIDS. He made a commitment to focus his efforts and focus our efforts on the parts of the world where the epidemic is the most severe, the countries in Africa and central America and in the Caribbean that were mentioned and finally made a focus on doing everything we can do to get people interest treatment and to support them in treatment. This means that we are committed to finding way itself to get high quality medications to people that need them. We have made a proposal in the trade talks to find ways for countries that are particularly needy. And in particular situations if it's not possible to get the medication from the pharmaceutical -- from the manufacturers, the U.S. manufacturers, or the non-generic manufacturers to work with countries so these drugs can be made available.
	Which countries will benefit?
	GWEN IFILL: How did you decide which countries would benefit under this program? DR. JOSEPH O'NEILL: The countries were picked on several bases, one is obviously the need for the size of the epidemic; the second is the level of poverty. What are the scarcity of resources? And finally and very importantly the absorptive capacity, which is development talk, how quickly can the money be put to work. I'll tell you that with these countries pick, 50 percent of the cases of HIV in the world are in these 14 countries that we've picked and 70 percent of the cases of HIV in Africa. Again, the United States has said we're going to try to take care of half the people in the world that have HIV disease, but the call is to the rest of the developed world to say you got to help with the other half, help us do this. GWEN IFILL: Stephen Lewis, is that enough? STEPHEN LEWIS: Well, it's certainly an important and significant start. I'm not going to take issue with it. The point that is being mail is very valid. There simply has to than an equivalent response from the other rich countries of the world, and if the United States has opened the door, them the other countries must pledge equivalent amounts relative to their own treasury capacities, and the target for that would be the meeting of the G 7 in June in France so, they an at the up the money, I hope, a rather greater percentage through the global fund.
	Will other health care programs pay the price?
	GWEN IFILL: Salih Booker, are you confident that with this commitment of new funds that the Bush administration is making that other international health care programs will not be paying the price? SALIH BOOKER: That's one of the key concerns and members of Congress something have voiced this as well. We don't want to be robbing Peter to pay Paul --also because a lot of the commitments to health issues and health infrastructure issues are important to continue those investments because of the need to strengthen that infrastructure, to strengthen programs, to combat, for example, tuberculosis, people who have AIDS often die of tuberculosis. So it doesn't make sense to de-fund existing programs in order to fund this initiative. GWEN IFILL: Quickly, will there be robbing of Peter to pay Paul? DR. JOSEPH O'NEILL: Absolutely not. Since this administration has taken over, through the Millennium Challenge Grants have effectively doubled the amount of foreign assistance available. Before this initiative was even announced, this administration had nearly doubled the amount of assistance to global HIV/AIDS over with what it was handed when it came into the White House. And finally here's this new initiative. So there's a great opportunity to do great work here, but we're asking the rest of the world to join us. GWEN IFILL: Dr. Joseph O'Neill, Salih Booker, Stephen Lewis, thank you all for joining us.