Health GAP Talking Paper
www.globaltreatmentaccess.org | www.healthgap.org
Bush's Five-Year MTCT plan
It is very hard to figure out what Bush is actually planning to do re his "bold new $500 million initiative" on mother-to-child transmission, since his speech was internally inconsistent (e.g., time frame = 14 months vs. five years; infrastructure exists vs. there's no infrastructure, etc.). However, trying to fit the pieces together, I think this is the AIDS score-card of the compassionate conservative as he heads to Alberta for G-7 meetings where rich governments will make bold pronouncement and clip their coupons on their investment in globalization:
$100 MILLION A YEAR FOR FIVE YEARS
The first $200 million is being taken from the current Senate/House emergency supplemental proposal, with $100 million being spent in fiscal 2002 and $100 million in fiscal 2003. How this will actually work is quite uncertain given that '02 emergency supplemental money is ordinarily earmarked to be spent by Sept. of 2002. (Maybe Enron's bookkeepers will help Bush spread the money over two years or maybe he'll have to give it to the Global Fund afterall.)
As the New York Times recognized, this result actually diverts money, $100 million, that was otherwise probably earmarked for the Global Fund. In addition, this part of the bold initiative came at the expense of an immediate $500 million dollars for MTCT being proposed in the Frist/Helms emergency fund amendment that Bush sabotaged on June 6-7, and at the expense of the even more comprehensive $700 million Senate proposal for 2002 that would have added dramatically to the Global Fund and other bilateral international initiatives.
Starting in fiscal 2004, Bush will seek an additional $300 million, presumably $100 million to be spent annually in 2004, 2005, 2006 (assuming five years in fact means five years).
HUGE MTCT, MINISCULE MTCT-PLUS, SOME INFRASTRUCTURE
The money is going to three purposes, with proportions yet unspecified, but with the outline quite clear:
1. The vast bulk of the money is going to voluntary counseling and testing, nevirapine therapy, and (maybe) formula. Although Boehringer-Ingelhem has previously offered free nevirapine, it's unclear whether Bush is now going to insure that BI gets paid - who knows. It sounds like Bush is going to tout formula, even though the trade-off between mortality based on bad water, diarrheal and respiratory infection, and reduced maternal antibodies and mortality based on transmission via breast milk is unclear, but probably tilting toward exclusive breastfeeding at this point. But, maybe Bush will get more money to formula makers as well.
2. A minuscule amount of money is going to MTCT plus in some form where the mother and fetus might receive ongoing ARV therapy during pregnancy. After childbirth, infants who are infected "might" receive ongoing ARVs as might their mothers and fathers if their stage of disease qualifies them for treatment (this according to Paul De Lay, director of the HIV?AIDS office at USAID). Query: does this mean stopping therapy for mothers who were receiving therapy other than delivery-based nevirapine?
This MTCT-plus program, to the extent it actually exists, is limited to countries and sites with sufficient medical infrastructure and expertise. In this regard, it is interesting to note that Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and one of Bush's key advisors on this policy, stated in interviews on June 19, that "in order to provide therapy for adults who are already infected for the period of time - essentially, indefinitely - you would need a health care infrastructure that just doesn't exist right now." He repeated this same "no-capacity" slander with respect to MTCT saying "part of the program is to actually provide comprehensive therapy to a certain proportion of the mothers - you can't do that if the infrastructure doesn't exist." I'm sure this information is a surprise to the international treatment and public health activists like Alan Berkman and David Hoos who are already in the process of delivering grants for MTCT-plus programs.
3. Because of this alleged total lack of capacity, an unidentified proportion of the money will go to build health care infrastructure and partnerships between African and U.S. hospitals. I assume this means that medical professionals and hospitals in the U.S. will receive at least some portion of this funding.
Having just returned from South Africa and having been there during the Constitutional Court case brought by the Treatment Action Campaign demanding a universal roll-out of a MTCT prevention program, I feel that it's certainly appropriate that MTCT prevention gets a boost from international donors. However, Health GAP, TAC and many others see the hypocracy of saving babies while their parents are left to die. When sophist politicians weep crocodile tears over innocent life and then rob children of their parents, leaving villages of AIDS orphans, the compassion of their conservativism is surely in question. When these same politicians deny that any medical infrastructure exists when existing public sector, NGO sector, and church mission sector health capacity goes unutilized because of lack of access to life-saving ARV's, these politicians wilfully misrepresent the facts.
Northeastern Universtiy School of Law
Boston, MA 02115
617-373-3217
b.baker@neu.edu
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