Health GAP Talking Paper
www.globaltreatmentaccess.org | www.healthgap.org

On October 9, 2002, the Global Fund released an estimate of its need for new funds in 2003 to fund the high quality proposals it had received from applicant countries to fund programs fighting AIDS, TB, and malaria. That figure was $3.6 billion (to be added to the $.65 billion previously promised, but not yet completely paid, by donors - total $4.25 billion). Two days later, against all logic and at the risk of hundred of thousands of lives, Richard Feachem cut that estimate of new funds to $2 billion. What happened to the $1.6 billion? Did the donor countries hold a gun to Feachem's head? Was there a donor revolt at the October 10-11 Board Meeting? No. In fact, the United Kingdom made a last minute request that the number of funding rounds in 2003 be reduced from three to two in order to give the Board more time to make policy decisions instead of funding decisions. Inexplicably, Feachem used this procedural request to undermine his own conservative estimate of need. Without provocation, he lopped $1.6 billion off his funding request and even had a powerpoint slide ready with the new figure. Was he planning this retreat from the beginning? Was there a behind-the-scenes deal with donors once again that Feachem would not embarrass them by asking them to fund the true level of need but instead to provide political cover for their let-them-die level of funding?

When asked to defend the funding decrease, the Fund's explanation seems to turn on the reduced number of funding cycles. However, this makes no sense whatsoever. First, there is no reason to believe that applicants won't simply put all of their demands in the two time slots instead of in three. Second, even the math doesn't work - one-third of $4.25 billion is not $1.6 billion, it's $1.4 billion, even assuming all of the funding in 2003 is completely for new proposals, which we know is not true. Third, and most important, the Fund is under pressure to produce measurable results, but can't do so unless it funds dramatic new initiatives instead of spotty pilot-project-type proposals. How could the world's funding czar for the battle against the world's worst pandemics miscalculate so badly? Is he up to leading the Fund?

Last June, shortly after his nomination as Executive Director of the Global Fund to Fight AIDS, TB, and Malaria, Richard Feachem expressed confidence that the United States government would adequately support the Global Fund and that he "wasn't worried about U.S. contributions." Since this statement came on the heels of the President Bush/Senator Frist bait-and-switch whereby $500 million earmarked for the Global Fund in 2003 as transformed to a five-year mother-to-child transmission prevention program only, treatment activists from around the world questioned Feachem leadership and urged him, publicly and privately, to become a champion for people living with HIV/AIDS instead of an apologist for stingy donor countries. Strike one.

Feachem and the Fund got a major boost at the XIV International AIDS Conference in Barcelona. Feachem appeared on the stage minutes after ACT UP, Health GAP and other treatment activists stormed the same podium and prevented Tommy Thompson, Secretary of the U.S. Department of Health and Human Services, from trying to explain away failed AIDS prevention policies in the U.S. and from excusing the U.S.'s continued indifference to the global AIDS pandemic. The same audience that cheered the protestors cheered Feachem after he said "The Global Fund is committed and I am committed and you are committed to raising many billions of dollars of additional resources, and getting these funds to those on the frontlines who are really making a difference. The Global Fund needs a massive increase in resources, and it needs it quickly."

Turning to specifics, Feachem promised to a 90-day plan to produce a credible estimate of year-by-year needs at the Global Fund - what it needed to raise and what it needed to spend each year. At the same time that the Global Fund was attempting to project its own budget needs, based primarily on applicant-driven proposals that were pouring in the second funding round, the World Health Organization and others were promising to refine a consensus figure on total global needs to fight AIDS, TB, and malaria, addressing questions of infrastructure as well as the provision of comprehensive prevention, treatment, and care programs. Early estimates from UNAIDS and WHO were that $9-13 billion was needed was needed for HIV/AIDS alone, without considering infrastructure, but those numbers continued to be crunched by Jeffrey Sachs and others to come up with credible country-by-country needs that would be more credible to skeptical donors.

Although the Fund figures were shrouded in secrecy, on the eve of the Global Fund board meeting this October, Richard Feachem unveiled a prospectus seeking a modest $4.25 billion to be spent in 2003, only $650 million of which was pledged, let alone on hand. The estimate for 2004 was an equally modest $4.6 billion, only $300 million of which was pledged. Treatment activists were worried about the conservative estimate of need, believing that bottom-up applicant demand had been suppressed by a history of neglect and by behind the scenes pressure from donor representatives on applicants' country coordinating mechanisms. Even more important, applicants believed that a "big-bang" approach was vastly superior to the "go-slow-but-produce-dramatic-results" Catch-22 being proposed by major donors including the U.S. However, in light of the WHO estimate of a global need of $6.5 billion for AIDS alone in 2003 (twice as much as the $3 billion spent globally in 2002) and in light of its projection of greatly increasing need and capacity to deliver AIDS programs in 2005 ($10 billion globally), activists were willing to give the Fund and Feachem the benefit of the doubt as long as he twisted donors' arms to complete the pledges already made and so long as he embarked on a major fund-raising tour using all available means to extract indispensable funds from reluctant donors.

So, the conservative estimate of need at the Global Fund was $3.6 billion in new funds for 2003. With millions of lives hanging in the balance, Richard Feachem shot the Fund in the foot by bidding against himself and unilaterally reducing the demand for 2003 by a whopping $1.6 billion. Strike two.

Unfortunately, this is not the World Series where a batter strikes out and gets a chance to redeem himself in later innings. The fight against AIDS is too critical to allow people in leadership positions to make major gaffs over and over again. Richard Feachem, get this straight. People living with HIV/AIDS need money for comprehensive prevention and care, and especially for treatment, now - not in some distant future. People dying in rural villages, townships, and informal settlements need an advocate, who puts their needs first, who stands up to donors publicly and privately, who asks for big-bang funding not crumbs from the table.

Fortunately, Richard Feachem is in a position to rectify his gross miscalculation. If there were credible figures supporting $3.6 billion on October 9, 2002, there are credible figure for $3.6 billion on November 6. It's time for Feachem to step up to the plate, forget the donor pressure, and hit a $l.6 billion dollar home run - nothing less than $3.6 billion new dollars in 2003.

Professor Brook K. Baker, Health GAP