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Financing the War on AIDS

Gretchen K. Aleks

Summer vacation is, for most MIT students, a break from normal routine: a time to travel, an opportunity to focus on research without the distractions of term, a period to relax and ignore the stresses of daily life. Unfortunately, this means many of us -- and many Americans in general -- have ignored the goings-on of the wider world and have neglected reading the news. And while we’ve been sipping iced tea and watching sunsets, our commander-in-chief has taken the opportunity to make more harebrained decisions than you or I will make in an entire lifetime, many of them falling outside the public radar. In case you’ve opted for running over Rather after a long day at work, here is a rundown on current developments in what Bush would like us to believe is his pet cause: the global AIDS crisis.

Way back in January, Bush promised to increase AIDS funding to developing countries by 15 billion dollars over five years. Never mind that this “new” money was going to mean cuts in other humanitarian and foreign aid, or that the United States’ contribution was not going toward the Global Fund for AIDS, Tuberculosis, and Malaria, an established, efficient, multilateral fund for fighting disease in the third world, the announcement represented at least a baby step forward for the Bush administration. Fast forward to July, and there are real doubts over whether the promised money will ever materialize, and if it does, whether it will be put to effective use.

Bush started the month by naming Randy Tobias, the former C.E.O. of Eli Lilly, to administer the 15 billion dollar fund. Eli Lilly, one of the top pharmaceutical companies in the U.S., has been a ringleader in Big Pharma’s crusade to deny generic and other low-cost antiretroviral medications to the individuals in developing countries. For Bush to appoint Tobias -- a man who has no experience with AIDS or with Africa -- to oversee the implementation of American aid to a group of people in whom he sees no value, is insulting and nonsensical. Many AIDS groups are concerned that Tobias will simply be a pawn to the pharmaceutical companies, who maintain that the AIDS epidemic in developing countries can be fought solely through educating people about the disease, even while experts in public health acknowledge that access to drugs needs to be a cornerstone in the fight against AIDS.

Moreover, Tobias is about as qualified for this job as James Traficant is to be a fashion consultant. He has worked only in the private sector, and has no experience in public health matters in the United States, much less in Africa and the Caribbean. Tobias’ lack of qualifications would not be as important if the United States were just writing a check to the UN’s Global Fund, a streamlined organization remarkably transparent and free of overburdening bureaucracy. However, since the U.S. is seeking to reinvent the wheel and set-up its own avenues for delivering the aid to developing countries, it is actually important that we have an administrator who has some measure of experience.

As it turns out, Bush’s choice of administrator may not be so important anyway, because Tobias might not even have any money in his fund to oversee. Democrats in Congress have recommended budgeting 3 billion dollars for the upcoming fiscal year to fight AIDS, but Bush and the Office of Management and Budget hoped to budget only 1.55 billion dollars for 2004 to combat AIDS, with a total budget of 2 billion dollars for health aid to developing countries if money to fight other diseases, such as TB and malaria, is included. Bush claimed in his recent press conference that any more money than this will be wasted because AIDS programs would not be able to effectively use additional funds. Yes, it may be true that AIDS programs cannot spend more than 1.55 billion dollars in any given year on the “abstinence only” brand of AIDS prevention that the Bush administration finds not only adequate, but exhaustive. AIDS, however, is a complex disease, and curbing its spread will require a more complex approach than simply spreading the good news about abstinence. The additional money could be spent on condoms or, heaven -- and Eli Lilly -- forbid, antiretrovirals and other medicines.

Bush has a special response to the point that more money should be budgeted to go towards purchasing medicine for AIDS patients in developing countries: the infrastructure is simply not in place to distribute these drugs. However, the Global Fund has already been putting money that other countries and private donors have contributed towards improving the network for drug distribution, and there are organizations that currently oversee the disbursement of these life-saving medicines in out-of-the-way clinics and that have developed a paradigm for making drug therapy successful in the least-technologically advanced societies.

If, in fact, the infrastructure for drug delivery is not in place, it’s hard to think of a better way for AIDS money to be spent than for establishing said pathways. Moreover, it’s hard to think of a reason why American money should be given to the wealthy in the form of tax breaks instead of to an AIDS fund, in particular the Global Fund. It is inefficient for Bush to attempt to administer his own AIDS fund when there’s a multilateral fund that would serve the needs of developing countries better, and it is selfish for Bush and Congressional Republicans to back down on their past promise to deliver three billion dollars a year towards fighting the global epidemic. Americans -- and students in particular -- need to hold the administration responsible for adhering to the details and the spirit of the promises that the President made in January.