BARCELONA - The four power brokers of global AIDS policy huddled minutes
before their news conference. Hours before, activists had shaken up the 14th International
AIDS Conference by drowning out a speech by Tommy Thompson, the US health and
human services secretary.
Jeffrey D. Sachs, the scholar and UN adviser, wanted to shake up last week's
conference even more. He pulled aside Peter Piot, director of the Joint United
Nations Program on HIV/AIDS. Sachs said he was about to announce that within 60
days the UN would lay out a plan to finance the battle against the pandemic.
Piot, a pioneer in the world of AIDS fighters, was flabbergasted: It would
be his responsibility to draft and implement such a plan.
He considered walking out of the news conference even before it started, according
to UN officials.
Finally, he said, ''I need at least 90 days.''
Thus unfolded on Tuesday what is likely to become the biggest development
from the conference: a promise by Oct. 7 to forge a financing plan. There was
no thought-out discussion. It was the impatience of one person known for springing
big ideas without warning, and who, like many delegates, was worried that the
conference would end as a dud.
The episode offered telling insight into the makings of global health policy
in times when little money is coming in to fight a pandemic that killed 3 million
people last year, and that continues to kill 8,000 people a day. Often now, global
health experts say, the decisions are not made around seminar tables at the World
Health Organization in Geneva, but among savvy politicians and economists who
say the only way to confront a crisis of such magnitude is to keep strong pressure
on world leaders.
''I figured out later that in 90 days half a million people will die in Africa
from AIDS,'' said Stephen H. Lewis, a special adviser on HIV and AIDS in Africa
to the UN secretary general, Kofi Annan.
''We can't lose time,'' Lewis said. ''Time is running out for so many. We'll
need to know soon whether we can persuade the rich countries to contribute.''
Lewis and Richard G. A. Feachem, the new head of the Global Fund to Fight
AIDS, Tuberculosis and Malaria, were the other two people in the huddle with Sachs
and Piot. They know that the pressing problem is simple economics: Need outstrips
supply. The solution is political: Pry money out of governments, corporations,
Rich countries spend $2.8 billion on global AIDS efforts. Of the 28.5 million
Africans infected with HIV - nearly three-quarters of those afflicted by the pandemic
- fewer than 30,000 have received costly antiretroviral treatment. It would cost
at least $10 billion to fight AIDS in the developing world, including treating
about 3 million Africans.
Sachs, the former Harvard economist, is now a senior adviser to Annan on poverty-related
issues and head of the Columbia University Earth Institute. He wants to take confusing
and conflicting numbers on the cost of financing the fight against AIDS, tuberculosis,
and malaria, then agree to one set of figures. Then he wants to write the bills
for each rich country.
For now, according to Sachs's preliminary math, next year's need would be
$9 billion, $6 billion for AIDS and $3 billion for TB and malaria. After that,
the total would reach $13 billion, $10 billion of it for AIDS.
''In 90 days,'' Sachs said at the news conference, ''we will have a plan of
action with specific funding numbers, which will eliminate the massive confusion''
and which will give each donor a figure.
While some suggest that the amounts should follow the UN system, in which
the United States pays about 25 percent of project costs, Sachs wants the United
States to pay about a third, or closer to its proportion of the world's gross
national product. That is 40 percent, or about $10 trillion, of a global economy
of $25 trillion.
Assigning each country a percentage, Lewis said, would allow countries other
than the United States to take the lead.
Sachs disagrees. ''That's not how the world actually works,'' he said. ''The
US pulls back other donors and sets the pace.''
For now, the Bush administration has no intention of increasing its funding,
which is about $1 billion annually for global AIDS efforts. That includes $500
million for the Global Fund, or 25 percent of all pledges.
The demonstration on Tuesday prevented the audience from hearing Thompson's
remarks. Afterward, he said the United States ''will be committing more resources
in the future,'' but he added: ''If we are ever going to get to $10 billion, other
countries are going to have to step up.''
He said that the United States also expects to see positive results from the
Global Fund's initial round of fund-raising, which took place in April. ''We want
to see some accomplishments,'' he said.
Asked whether the US commitment to the Global Fund should remain at 25 percent
of the total, Thompson said: ''It's a valid assumption to make, if other countries
do their part.''
Now UNAID's Piot, and Feachem, the Global Fund director, will be working on
separate financing plans. Neither could be reached for comment as the conference
ended, but UN officials in New York and Barcelona said there was much confusion
about the contents of the plans and who would do the work. The World Health Organization
also may get involved.
''It's not going to be easy to do a detailed plan in 90 days,'' said Jim Yong
Kim, an infectious disease specialist at Harvard who has worked on reducing costs
for global purchasing of hard-to-find tuberculosis drugs. ''Economists will tell
you that there's a lot of costs that are hard to figure out on a country-by-country
basis, even done to the level of how many microscopes are needed and who pays
Sachs, who chaired a WHO panel on macroeconomics and health that made several
global cost estimates, said in an interview that he believed the UN economists
would meet the deadline with a strong plan.
''I really wanted 60 days, but this will work out,'' he said. ''There's a
great need to move as quickly as possible. Here we are still, two years after
the Durban AIDS conference, and only 30,000 people are on treatment in Africa.
It's a sorry indictment of the US government and other governments around the
After being stunned at last week's press conference, both Piot and Feachem
became angry about Sachs's maneuver, according to UN officials who asked not to
be identified. UNAIDS officials contacted Annan's office in New York and complained
about what they described as a lack of process.
Annan, one official said, also disapproved of the lack of consultation. The
official added, ''That's why he brought in Sachs and Stephen Lewis - to shake
Next on the financing front comes a period of calculation. Then Sachs wants
to give the United States 30 days to respond.
''Jeffrey said that the United States will be backed into a corner because
of this,'' Lewis said. ''I disagree. I think the United States will be backed
into a corner by truth and death.''
© Copyright 2002 Globe Newspaper Company