Health GAP Talking Paper
www.globaltreatmentaccess.org | www.healthgap.org
SEN. FRIST'S BAIT AND SWITCH AND THE BUSH UNFUND
Two contradictory forces are at operation in the early history of the Global Fund to Fight AIDS, TB, and Malaria. One the one hand, AIDS treatment activists, public health specialists, human rights advocates, and multilateral leaders have championed the creation of a lean, mean, and efficient multilateral funding mechanism that pools and leverages donor resources to provide maximum bang for the buck in the battle against the pandemic diseases that undermine development, social well-being, and even security in developing countries. These pro-Global Fund forces, in the short period of a year, have established operational protocols, gathered technical resources, and solicited and awarded money to the first batch of applications. By giving first priority to countrywide and regional proposals, by drawing on the best scientific expertise, and by keeping bureaucracy and overhead to a minimum, the Fund has launched a strong, though not perfect, response to the deepening public health crisis in developing countries.
Opposing these pro-Global Fund forces is a loose but powerful array of governmental and institutional players, most notable the Bush White House. From the beginning the Bush Administration has worked hard to set sights low and to undermine and demean the institutional competence of the Global Fund. In the earliest days of the administration, through his proxy Colin Powell, President Bush set the bar for Global AIDS at $200 million a year, a 10% solution at best. Although scientific estimates put the annual cost of providing prevention, treatment, and care for people living with AIDS alone at $6 to $9 billion dollars (assuming greatly reduced drug prices for anti-retrovirals) and although the U.S. fair share based on the size of its GDP would be approximately $2.5 billion a year, the Bush administration has persisted in its lowball funding to the Global Fund, though it has modestly increased bilateral funding through USAID and elsewhere. At the same time that the Administration has starved the Fund of desperately needed resources and thereby encouraged other donors to offer chump change, it has quietly set out to challenge the competence of the Fund even before it got started. It did so by referring constantly to "inefficient" United Nations structures, even though the Global Fund is not a UN institution, and by bad-mouthing the Fund's anticipated "bloated bureaucracy," even though the Fund was planned to be remarkably lean by governmental standards.
Bush also set out to undercut the mission of the Fund, particularly its plan to deliver meaningful levels of treatment for people living with HIV/AIDS. In addition to referencing the comparative cost efficiencies of treating TB and malaria (with cheap but increasingly ineffective medicines), the Administration consistently championed the cost-efficiency of prevention versus treatment. Although several figures in the Administration started to pay some lip service to the mantra of a "balanced program of prevention, treatment, and care," other members of the Administration went to great lengths to describe the inability of Africans to "tell time" and thus be able to comply with complex ARV treatment regimes (Andrew Natsios) and to exaggerate the extent of medical incapacity and lack of medical infrastructure in Africa. Disregarding evidence of unused medical capacity in the private, NGO, and church mission sector and ignoring prospects for a rapid expansion of capacity if funding were provided, the Administration sliced treatment "utilization" estimates from the billions to the hundreds of millions as a cover for its fiscal starvation strategy. When countries applying to the Fund planned bold treatment plans, especially Malawi, but others as well, the donor countries, including the U.S., strong-armed country coordinating mechanisms to dramatically reduce their funding requests.
Instead of responding to 40 millions lives at risk, the Administration, especially USAID, continue to tout the benefits of individual behavioral prevention strategies, especially abstinence. In a bow to the religious right and with the effect to perpetuating racial myths about Africa sexuality, the Bush administration has not only taken treatment of the table, but it has also focused on moralistic, culturally insensitive message blaming people who have contracted AIDS for a blameless disease.
It is against this background that we must judge the Administration's role in undercutting the Global Fund, once again, in the most recent budget battle. Although billions and billions of dollars could be allocated for homeland defense in the Supplemental Emergency Appropriation bill for 2002, including a billion dollars for bio-terrorism alone (death count from anthrax six and stagnant), the Bush administration could not stomach the prospect of a half billion dollars for the Global Fund (body count, 8000 dead from AIDS a day, 6000 from tuberculosis, and 3,000 from malaria). Apparently, these lives, mostly African, are not worth saving.
When confronted in May with Congressional proposals of $700 million and/or $500 million extra "emergency" appropriations for Global AIDS, much of it earmarked for the Global Fund, the Bush Administration plotted an endgame strategy. It would use Paul O'Neil's trip to Africa to highlight again, compassionate conservatives' empathy for babies born with HIV. It would expropriate Sen. Jesse Helms' conversion to mother-to-child transmission prevention. And it would defeat the larger Durbin/Specter $700 million dollar funding proposal before it pulled the rug out from under the even more modest $500 million in the Frist/Helms supplemental appropriations bill.
Charmed by the prospect of voting favorably on a $500 million proposal, the Senate narrowly defeated the bill for $700 million 46-49 on June 7. Then, having held the $500 million bait out long enough, Bush "prevailed" on Sen. Frist, who has Vice Presidential aspirations, to reduce his bill by 80%, all the way down to $100 million only the switch was completed. This $100 million switch doubled the Administrations emergency appropriation for global AIDS to $200 million, but limited expenditures to mother-to-child transmission, leaving millions upon millions of youths, mothers, and men in a death queue.
The mainstream press reports that the Bush Administration came to the table late in the game to try to preserve some press for the President when he announces an extremely modest mother-to-child-transmission prevention program in advance of the upcoming G-8 meetings. And, indeed, there may have been some last minute scrambling. But there is a deep context for Bush undercutting of the Global Fund. This unfunding-the-fund is consistent with Bushs prior policy and with the Administrations long-term U.S. foreign policy objectives of talking about partnerships while practicing big stick diplomacy.
President Bush would rather get 10 minutes of favorable publicity for his MTCT "initiative," then cooperate with Congressional leaders other international donors to scale up a massively more appropriate response to the worst human rights and public health dilemma of our generation an AIDS scourge that presently infects 28.1 million Africans. Shame on Sen. Frist, a doctor, for his bait-and-switch complicity. Shame on the "compassionate" President for his stunning cynicism.
JUNE 27, 2002
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