President Bush on Monday unveiled a detailed five-year $15 billion emergency plan for turning the tide in the global fight against the AIDS pandemic. The plan, called the President's Emergency Plan for AIDS Relief, which Bush first announced during his 2003 State of the Union address, describes itself as "the boldest international health initiative ever undertaken by a single country." But critics said they were disappointed and described the plan's funding process as marked by continuous delays.
The plan targets $9 billion in new funding to speed up prevention, treatment, and care services in 14 of the most affected countries representing at least half of HIV infections worldwide.
All but two of the countries--Haiti and Guyana--are in sub-Saharan Africa. One more country outside Africa and the Caribbean is to be named later. The plan also devotes $5 billion over five years to bilateral programs in more than 100 countries and increases the U.S. pledge to the Global Fund to Fight AIDS, Tuberculosis, and Malaria by $1 billion over five years.
Introducing the plan that was sent to Congress, Secretary of State Colin Powell said it demonstrated "bold U.S. leadership in the fight against HIV/AIDS, but much more needs to be done."
With the release of the first funds for the program--$350 million--Health and Human Services Secretary Tommy Thompson said the U.S. government "will provide unprecedented resources" to combat AIDS. But he said the pandemic was "too big for any one country, and others must get involved."
The announcement of PEPFAR's details drew praise from Administration officials and Republican lawmakers, but raised the ire of AIDS activists who say it specifically prevents the United States from buying and dispersing generic anti-HIV medications, which can be bought for about one-fifth the cost of brand-name drugs. The plan states that procurement of drugs for the initiative "will have to fit within the parameters of existing federal and international law for the protection of intellectual property rights." Asia Russell of the Health GAP Coalition says Bush's insistence on using more expensive name-brand antiretroviral medications shows that he is "AWOL on AIDS. The Bush White House has proven itself to be a subsidiary wholly owned and operated by big drug companies," she said. Sharonann Lynch, also of Health GAP, said, "U.S. taxpayers should be saying that if you can keep four times the number of people alive [using generic medicines], then do it."
Randall Tobias, head of the newly created Office of the Global AIDS Coordinator and a former CEO of pharmaceutical company Eli Lilly, said it is possible Bush's plan will include generic medications. "But it's very important that there be some standard, some principles by which we can make those decisions" on which drugs to distribute, he said. Tobias added that the Food and Drug Administration, the World Health Organization, the Joint United Nations Programme on HIV/AIDS, and other groups are scheduled to meet in March to discuss the "principles" that can be used to "examine the alternatives in the market."
Activists also criticized PEPFAR's "token" support for the global AIDS fund. "It makes little sense to pay for the bilateral AIDS program by cutting the U.S. contribution to the multilateral Global Fund," said Jamie Drummond of the debt, trade, and advocacy group DATA. Paul Zeitz, executive director of the Global AIDS Alliance, said the United States' "go-it-alone" approach in setting up prevention and treatment programs is particularly problematic. "While recognizing the problem in 14 countries, they're actually making the problem worse by setting up a parallel program rather than working through existing partnerships that are already up and running," he said.