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
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
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
"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
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.