MANCHESTER, NH - January 20 - One year has passed since President Bush pledged $15 billion over five years to fight global AIDS. So far, no funds have been disbursed to the new bilateral program, and most of the details about program implementation remain to be worked out -- except that most of the funds are to be backloaded far into the future. However, the already- operating multilateral Global AIDS Fund faces massive funding shortfalls and pressure from the Bush Administration to reduce the number of grants in the coming year.
In the budget that will be discussed in tonight's State of the Union Address, President Bush plans to request only $2.7 billion for AIDS for 2005 - *less* than was authorized for 2004. For the third year in a row, Bush will attempt to cut funding for the efficient and effective but now cash-strapped Global Fund from the levels appropriated the previous year.
Activists and people with AIDS worldwide have called on President Bush to request at least $5.4 billion in funding for FY 2005 and $30 billion by 2008 in order to pay a fair-share of what is needed by the Global Fund to reach the World Health Organization's plans to treat 3 million people with AIDS by 2005.
There are currently 43 million people with AIDS. The CIA's National Intelligence Committee reports up to 100 million cases of AIDS worldwide by the end of the decade. The WHO reports that, at the current levels of funding, it will be another 30-40 years before the global epidemic begins to plateau, at which point the globe could face over a billion infections.
"In the year since President Bush's pledge of funds to fight AIDS, not a dollar has been released, and not a single pill has reached the hands of a person with HIV in developing countries because of the President's AIDS plan," states Allison Dinsmore of Health GAP, "However, three million people have died from a treatable illness. By fighting bipartisan efforts to appropriate the funds authorized by Congress that were supported by the White House, President Bush is lying to America and lying to 43 million people with AIDS."
"In an election year, President Bush must regard the electorate and the media as pretty stupid if he thinks he can score compassion points on AIDS while undercutting Congress and cutting money for the Global Fund for a third time," said Dinsmore.
Despite the fact that Congress authorized $3 billion for FY 2004, President Bush only requested $2 billion in last year's budget - a cut from the prior year. "While appearing compassionate, the Bush Administration has undermined its own meager AIDS program, undercutting the funding levels authorized by Congress by a billion dollars." Says Brook Baker of Health GAP, "The $1 billion difference between Bush's spending target for FY 2004 and the $3 billion the U.S. promised, could treat an additional 400,000 people who are facing death in as little as 24 months, and prevent an additional 1.6 million women, men and children from becoming infected with HIV."
This year, President Bush's 2005 budget request of $2.7 billion for global AIDS in FY 2005 is again less than congress approved for FY2004. The Administration's request for $200 million for the Global AIDS Fund is a 71% decrease from 2003 funding levels. At the same time, State Department officials admit that the Bush initiative is not going to deliver significant results for another 1-2 years.
"The Bush Administration has severely undercut the multilateral Global Fund for AIDS, TB and Malaria. In doing so, Bush has defunded and undermined the only program operational and that is providing life saving treatment and prevention for people with AIDS in developing nations," Stated Health GAP's John Iverson. Because U.S. contributions to the Global Fund leverage the contributions of other wealthy country donors, U.S. antipathy to multilateral aid means other donor countries scale back their commitments proportionately. Iverson calls this "a prescription for disaster for millions of sick and dying people."
Experts from UNAIDS and the WHO's Commission on Macroeconomics and Health estimate much larger sums are necessary in order to mount a credible fight to stop AIDS. The US is contributing the least to AIDS of any G8 country on the basis of percentages of GDP.
All of the Democratic Presidential contenders for 2004 have pledged to at least double the inadequate Bush contribution and pledge at least half of their promise of $30 billion by 2008 to the Global Fund. A broad network of AIDS, development, health, human rights and faith-based organizations has supported the health experts request for at least $5.4 billion for AIDS for 2005. Trish Siplon of Health GAP states, "We applaud the candidates that have recognized the gravity of the global AIDS crisis and are responding with bold, action-oriented plans. It is tragic that President Bush is not one of these candidates."
All Democratic candidates have also pledged to fight, defeat and reverse President Bush's bilateral and regional trade negotiations raise barriers to generic competition and exceed the international standards agreed to at the WTO. States Siplon, "It is refreshing that the Democratic candidates have plans to stop AIDS based on science and true compassion. The elusive Bush so far is merely unfunded promises with political strings attached."
The Bush Administration has also taken steps to block access to life- saving generic medications. Generic competition has resulted in dramatic price cuts in combinations of life-saving HIV medicines. After President Clinton issued an Executive Order in 2000 that prohibited the USTR from levying sanctions against developing countries that introduced generic versions of patented medicines, the costs for the cocktail of AIDS medicines plummeted from $12,000 per patient, per year to $350. The Clinton Foundation has since secured triple combination anti-AIDS drugs for as little as $140 per patient, per year<and the cost is still falling. Health GAP's Brook Baker stresses, "Generic competition is a cornerstone of sustainable HIV treatment scale-up in resource poor settings. On behalf of Drug company campaign contributors, the Bush Administration pressures countries to adopt drug monopolies that delay or prohibit cheaper, generic medicines. This has the devastating impact of driving medicine prices up in the poorest regions of the world, and could threaten the Clinton Foundation's new prices in some cases."
During the World Trade Organization (WTO) Ministerial in Doha in 2001, the Bush Administration launched the Doha Round by agreeing to sign the Doha Declaration on TRIPS and Public Health, wherein WTO member countries stated that public health takes precedence over the monopoly rights of drug companies. The Bush Administration has worked since that time to dismantle the pledge of the Doha Declaration with trade agreements in Latin America, Africa, the Caribbean, and Southeast Asia.
In addition, the Bush Administration is requiring its new bilateral AIDS initiative to purchase name-brand drugs. This policy will result in fewer people gaining treatment, as the funds necessary to purchase brand name drugs have not been pledged or appropriated. The program's coordinator is Randall Tobias, who is a substantial Republican donor and a former CEO of the major pharmaceutical company Eli Lilly.
The cheapest generic combination of WHO assured-quality is $140 per year (a combination of 3TC, d4T, and nevirapine) - a price negotiated by the Clinton Foundation. The best discount available to least-developed countries for a similar brand-name combination that the U.S. would support procuring of AZT, 3TC and efavirenz is $584 per year. For the same price, five times would receive life-saving drugs if the U.S. permitted procurement of WHO-certified generics.
The Administration claims that the quality tests used by the WHO to assure quality of generic HIV medicines are not rigorous enough. However, WHO standards are endorsed and accepted by rich and poor countries around the world, and by multilateral programs such as the Global Fund. Moreover, generic single-pill combination regimens are an integral part of rapid treatment scale-up, as they simplify patient treatment regimens and facilitate medicine adherence.