The Global Fund to Fight AIDS, Tuberculosis and Malaria, started three years ago with hopes of raising $10 billion a year to combat disease in the developing world, today finds itself short of its goals and on the defensive with its largest patron, the Bush administration.
At a meeting Thursday in Tanzania, Global Fund backers fended off what they contend was a bid by the United States to postpone a new round of grants by the fund in 2005.
In an apparent compromise reached at the meeting, the fund's board unanimously approved a plan to provide up to $1 billion for new grants in 2005. The money for the programs would not start flowing until September, three months later than advocates had hoped.
It was a victory for those who feared a total cutoff of new funds next year -- yet disappointing for those who had higher expectations for the Global Fund. The organization to date has raised $3 billion in three years, far short of the goal set by United Nations Secretary-General Kofi Annan when he first envisioned the Geneva-based organization.
The Bush administration has cited as evidence of its support the fact that U.S. Secretary of Health and Human Services Tommy Thompson is chairman of the fund. But even as Thompson was announcing from Tanzania that new grants would be offered next year, Congress was reducing the amount the United States would allot to the international organization.
Two subcommittees responsible for Global Fund contributions are paring next year's appropriation to $350 million, nearly $200 million less than last year's amount.
"This is a horrible confirmation of our fears of what the second Bush administration will bring,'' said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington, D.C., group that staunchly supports expansion of international efforts to combat the epidemic.
In fact, the Bush administration has proposed for the past two years that the U.S. contribution to the Global Fund be frozen at $200 million. Last year, Congress overrode the president's wishes and appropriated $547 million.
"I do think that the U.S. government has it in for the Global Fund,'' said Gregg Gonsalves of Gay Men's Health Crisis in New York. "My sense is that the U.S. is trying to kill it.''
Thompson spokesman Bill Pierce on Thursday said that such charges are absurd. The Health and Human Services secretary was "instrumental" in brokering a deal to carry out a new round of grants in 2005, according to Pierce.
He characterized as "erroneous" reports preceding the meeting in Tanzania suggesting that the Bush administration wanted to put off new grant-making throughout the coming year.
Pierce acknowledged that Thompson's aide, Dr. William Steiger, director of the Office of Global Health Affairs, has raised concerns in Congress about the Global Fund's efficiency and accountability.
"No one should mistake criticisms for lack of support,'' said Pierce, who pointed out that the United States remains the largest single contributor to the Global Fund.
Because of the time it takes to entertain grant proposals, approve them, and begin disbursing funds, it is unlikely that any of the money approved for new projects in 2005 will actually begin flowing that year.
Disbursements from the Global Fund's bank accounts have lagged fund- raising, one of the criticisms leveled against the organization. Out of $3 billion committed to 128 countries worldwide, payouts have been less than $700 million.
For many Global Fund supporters, the disappointment of a delay in the timing for a new grant-making round was tempered by relief. "It's not perfect, but given where we were, it could have been much worse,'' said Joanne Carter, legislative director for RESULTS, a Washington, D.C., advocacy group.
Carter remains concerned, however, with the lack of congressional support for more robust contributions to the Global Fund.
She expects that money left over from last year's appropriation may be added to the $350 million it now appears Congress will approve for 2005. But that total would still be $100 million less than what lawmakers approved for the Global Fund last year.
"What we are seeing is a reflection of the administration's policy. They want only $200 million, so Congress has to fight its way up from that,'' Carter said.
The bulk of the Bush administration's overseas spending against the epidemic is currently weighted toward the President's Emergency Plan for AIDS Relief -- the audacious plan to spend $15 billion over five years first announced in his 2003 State of the Union address.
Unlike the Global Fund, which is paid for by many countries and is independently run, the president's program targets 15 countries that have been selected by the United States to receive direct assistance from Washington. Dr. Mark Dybul, chief medical officer for the president's initiative, said the program is on track to bring antiviral drug treatment to 200,000 people in the "focus countries" by June.
But critics note that the original plan by the Bush administration called for treating 500,000 by the end of September 2004. In August, the program reported that a total of 24,900 HIV-infected men, women and children were under treatment in nine of the focus countries.
Dybul said that the August report does not reflect the real progress being made, and that a more accurate picture of the growth of the program will appear in the annual progress report due in January.
Dybul said the U.S. initiative has also paid for blood tests for 378,000 pregnant women, and a short course of antiviral drugs for infected mothers and their newborns to prevent the children from contracting the AIDS virus.
More than 34,000 HIV-positive women have received the drugs, averting 4, 800 infections among newborns, according to Dybul.
Meanwhile, he said a program designed to speed Food and Drug Administration approval of generic AIDS drugs is progressing.
"We are still confident that, before the end of this calendar year, we will have approvals for true generics,'' he said.
© 2004 San Francisco Chronicle