Bush’s Nomination of Tobias as Global AIDS Coordinator Draws Mixed Reaction From AIDS Advocates

As expected, President Bush yesterday named Randall Tobias, former chair and CEO of drug maker Eli Lilly, as head of a new State Department office assigned to oversee the global AIDS initiative, the Indianapolis Star reports (Penner, Indianapolis Star, 7/3). U.S. officials from several government departments and agencies have been working since February to develop a global AIDS bureau in the State Department to oversee the initiative (HR 1298), which authorizes $3 billion a year over five years for HIV/AIDS programs in Africa and the Caribbean, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria. However, work has been delayed by the lack of a coordinator. As the global AIDS czar, Tobias would work under the secretary of state, and he would be able to distribute funds directly to nongovernmental organizations and transfer funds between government agencies. The position will carry the rank of ambassador (Kaiser Daily HIV/AIDS Report, 7/2).

Delivering Drugs
Bush said, "I have chosen a superb leader who knows a great deal about lifesaving medicines and who knows how to get results" (Indianapolis Star, 7/3). "Randy Tobias has a mandate directly from me to get our AIDS initiative up and running as soon as possible," Bush added (Bumiller, New York Times, 7/3). Bush also said that the administration would work with Tobias to "get help to the people who need it most by purchasing low-cost antiretroviral medications and other drugs that are needed to save lives." Bush added, "We will set up a broad and efficient network to deliver drugs to the furthest reaches of Africa, even by motorcycle or bicycle" (Epstein, San Francisco Chronicle, 7/3). Tobias said, "AIDS has already killed almost 20 million people in sub-Saharan Africa, where it is the number one cause of death. And without intervention, it will claim the lives of one-quarter of the population in the next decade," which is "nearly incomprehensible" (Washington Times, 7/3). Tobias added that he would meet his new position "with enthusiasm and with optimism" (New York Times, 7/3). The Senate Foreign Relations Committee, chaired by Sen. Richard Lugar (R-Ind.), will consider Tobias' nomination before it is debated on the Senate floor (Indianapolis Star, 7/3). Senate Majority Leader Bill Frist (R-Tenn.) said that Tobias' nomination should "move quickly" through the Senate (Washington Times, 7/3).

Drugs and ABCs
Some AIDS advocates are concerned that Tobias' link to the drug industry could "undercut th[e] goal" of making inexpensive antiretroviral drugs available to countries hardest-hit by the pandemic, the Chronicle reports (San Francisco Chronicle, 7/3). Nathan Geffen, national manager of South Africa's Treatment Action Campaign, said that Tobias' nomination "demonstrates incredible lack of tact and respect for people with HIV living in the developing world who frequently cannot access life-saving medicines," adding, "He's certainly not someone who's known for being at the forefront of AIDS" and his nomination has the "potential to be quite detrimental" (Indianapolis Star, 7/3). Family Research Council's vice president for government affairs Connie Mackey said, "We are concerned that Mr. Tobias does not have a proven track record of supporting the effective strategies to combat AIDS," adding, "The White House must ensure that Mr. Tobias follows the A-B-C model to combating AIDS." Michael Schwartz, vice president for government relations at Concerned Women for America, said, "CWA applauds Mr. Tobias for sharing the philosophies of this president and accepting the nomination to carry out this historic initiative to implement the Ugandan model" (Washington Times, 7/3). Dr. Joe McIlhaney, president and founder of the Medical Institute for Sexual Health and a member of the Presidential Advisory Council on HIV and AIDS, said that he has "no doubt" that Tobias will advocate the ABC model of AIDS prevention (Medical Institute for Sexual Health release, 7/2).

Management Experience
Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation, said that Tobias "needs to coordinate the efforts of all relevant federal agencies, work hard to avoid unnecessary bureaucracy, and move resources quickly into the field where they are urgently needed" (Riechmann, AP/Long Island Newsday, 7/2). He added that Tobias "does seem to [have] some management acumen and the ability to pull a lot of levers" (New York Times, 7/3). HHS Secretary Tommy Thompson said that Tobias will "bring a wealth of valuable experience to this mission, and his appointment signals once again the president's high commitment to fighting HIV/AIDS worldwide" (HHS release, 7/2). AIDS Healthcare Foundation President Michael Weinstein said, "Given the enormity of the stakes in terms of human life and the difficult waters he'll have to navigate, we wish Mr. Tobias well in this new role" (AHF release, 7/2).

Global AIDS Alliance Report
Paul Zeitz, executive director of the Global AIDS Alliance, said, "This decision [to nominate Tobias] is another troubling sign that the president may not be prepared to fulfill his pledge to take emergency action on AIDS. This raises serious questions of conflict of interest and the priorities of the White House. Both the people of Africa and the people of the United States will lose if the president's AIDS initiative fails to use the lowest-cost, generic medications" (San Francisco Chronicle, 7/3). GAA last week released a report examining the president's "unfulfilled promises" related to the AIDS pandemic (GAA release, 7/2). The report, titled "The Truth about President Bush's $15 Billion 'Emergency' AIDS Pledge... Is it all Spin and Broken Promises?," is a briefing note on the president's upcoming trip to Africa, which "should not be a victory lap around the continent; in fact, it is his last chance to deliver on his pledge" to fight AIDS in Africa, according to the report (GAA report, 7/2). Zeitz said, "We call on the Senate to carefully scrutinize this nomination. Senators from both sides of the aisle should fully investigate the continuing relationship between Mr. Tobias and the pharmaceutical industry" (GAA release, 7/2).

Looking to Africa
The Tobias announcement comes less than a week before Bush is scheduled to visit five African nations -- Senegal, South Africa, Botswana, Uganda and Nigeria -- to promote economic development and the fight against HIV/AIDS (Kaiser Daily HIV/AIDS Report, 7/2). During his trip, Bush will "stee[r] clear" of "hotspots" and instead visit countries that have already "made headway in democratic development," such as Uganda, which has also shown success in curbing HIV/AIDS, the Associated Press reports (Gedda, Associated Press, 7/3). Some advocates are concerned that Bush's Africa trip and the AIDS initiative could be a "premature ... credit ... for an effort [that] will move too slowly," Reuters reports (Richwine, Reuters, 7/2). Jeffrey Sachs, director of the Columbia University Earth Institute, said, "I don't think that this administration understands the magnitude of the calamity" of HIV/AIDS, tuberculosis and malaria in Africa. Sachs added that the administration is "cutting programs in other areas of health to make way for the meager first installment on the AIDS program. The president should take the opportunity of this trip to open his eyes and get a little education about the realities ... Africa faces" (Borst, Associated Press, 7/2). Jamie Drummond, executive director of DATA, said, "Whether this trip is ... a real change for Africa will be debated in [Washington] D.C." during the appropriations process. Drummond added that Congress should fulfill Bush's budget requests but that "the president needs to fight ... to make that happen" (Reuters, 7/2). The White House yesterday released a fact sheet detailing the President's "Emergency Plan for AIDS Relief" (White House fact sheet, 7/2).

A video excerpt of CNN's coverage of Bush's announcement is available online in RealPlayer.

NPR's "All Things Considered" yesterday reported on Tobias' nomination. The segment includes comments from Bush, Tobias, Zeitz and Africa Action Executive Director Salih Booker (Wilson, "All Things Considered," NPR, 7/2). The full segment is available online in RealPlayer.