Advocates, Lawmakers Say U.S. Setting ‘Poor Example’ for Donations to Global AIDS Fund; Thompson to Testify in Senate on International AIDS Efforts

Donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria have fallen short of the $7 billion to $10 billion goal set by U.N. Secretary-General Kofi Annan last spring, and some advocates and lawmakers "blame" the Bush administration for the shortfall, saying "its pledge of $200 million this year sets a poor example for other countries," the New York Times reports. Sen. Richard Durbin (D-Ill.), who yesterday introduced legislation that would authorize an annual commitment to the fund of $1.2 billion, said that the administration's pledge, which so far is $500 million over two years, "just does not come close to meeting the need. It is a totally inadequate response to a problem that could literally overwhelm the world." According to one unnamed U.N. official, the United States is "really not setting the example that is required." He explained, "In everyone's mind, there is the juxtaposition with Afghanistan," which is receiving more money for rebuilding than the U.S. government is contributing to the fund. White House spokesperson Scott McClellan dismissed those charges, calling the United States a "global leader in the fight against AIDS" and noting that the country has pledged more than any other country (Stolberg, New York Times, 2/13).

Senate Committee Will Address Fund
United Nations and U.S. government officials will testify today and tomorrow before the Senate Foreign Relations Committee about the fund and how it plans to ensure compliance with the rigorous standards for obtaining a grant that it has already outlined. The Wall Street Journal reports that although most lawmakers are "convinced of the urgency of addressing" AIDS, TB and malaria -- which kill six million people a year -- they say they must be assured that the U.S. pledge "won't disappear down a global rathole of corruption and inefficiency" (Schoofs/Phillips, Wall Street Journal, 2/13). HHS Secretary Tommy Thompson will speak at today's hearing, where he is expected to renew the administration's support for the fund. "We will pursue new sources of financial support from governments and the private sector worldwide," Thompson said in a release, adding that the administration has "no intention of slackening" its efforts against HIV/AIDS (HHS release, 2/11). Some committee members are expected to question the size of the government's donation during this week's hearings, and others are expected to call for an increase in the amount pledged. Sen. John Kerry (D-Mass.) said that he and Sen. Bill Frist (R-Tenn.) are drawing up legislation to increase the U.S. contribution, but would not say by how much. Annan will also be in Washington today to meet privately with members of the committee to update them on the fund's progress and is expected to "make the case for more money" (New York Times, 2/13). A live kaisernetwork.org HealthCast of the hearing will be available online beginning at 11:00 a.m. ET this morning.

Tough Standards
The fund is expected to hold grant applicants to the "highest medical and financial standards" to assure that programs are effective and that donors are satisfied and do not withdraw their contributions, the Wall Street Journal reports. The applications will be reviewed on their "public health merits" and "fiscal safeguards" by a 17-member expert panel, and the first round of grants will be awarded in April. "We envision a level of fiscal accountability and a level of substantive accountability -- meaning results -- that's unheard of in international development assistance," an official with the Bush administration said. The accountability process will be modeled on WHO's Stop TB Partnership, an international health program that supplies TB medications to developing nations that has rejected many requests because monitoring plans were insufficient, and the Global Alliance for Vaccines and Immunization, which has also declined assistance requests or cancelled follow-up assistance because plans or results were inadequate. "Just because you need the money, we're not giving it to you unless you can show you can do something with it," Dr. Helene Gayle, an adviser to the Bill & Melinda Gates Foundation, one of GAVI's major partners, explained, adding that the approach is "very different from the way the U.N. has worked (in the past), which is almost an entitlement system." Such tight controls are necessary not only to control spending but also to ensure that drug treatment protocols are followed to lower the risk of patients developing resistant disease strains (Wall Street Journal, 2/13).