Global Policy Forum

$1b Expected This Year Despite $7b-$10b Goal

By John Donnelly

Four weeks after it was launched, the most ambitious plan yet to combat the runaway global AIDS epidemic is making little headway. Rich nations are not coming up with the necessary funds, and international groups are politicking over control of the initiative. United Nations officials and global health experts predict that donors will contribute only about $1 billion by year's end to the Global AIDS and Health Fund announced by UN Secretary General Kofi Annan at an AIDS summit in Nigeria in late April. Annan said $7 billion to $10 billion in additional funds was needed.

Wary governments and organizations, including the European Union, not only want to continue their own funding programs, but also balk at putting millions of dollars into a fund based on what remains a jumble of ideas. The skepticism grew so great earlier this month that it appeared that the fund might collapse, say global health officials involved in the effort.

''The fate of the fund hung in the balance a little while,'' said Gordon Perkin, executive director of the global health program at the Bill & Melinda Gates Foundation, one of the leading donors to international health programs. ''There was concern about a big fund that governments wouldn't control themselves. But now I think the problems are being worked out.''

Annan has been hoping to announce the framework of the fund, as well as several substantial donations, at next month's UN special session on AIDS. But while he may be able to outline much of the fund's governance, substantial donations are less certain.

So far, the only contribution has been the Bush administration's $200 million, which was criticized by AIDS activists as too small but is being used by UN officials to try to encourage donations by other governments. HIV-AIDS now infects more than 36 million people around the world, about 70 percent of them in Africa.

''The $200 million from the US probably means up to $1 billion in total new resources this year, figuring that other countries will give about $600 million and private donors another $200 million,'' Mark Malloch Brown, administrator of the UN Development Program, said in an interview. But that would be ''way short'' of Annan's goal, he said.

For now, Annan has other, more pressing problems. Several UN officials, speaking on condition of anonymity, said turf battles have broken out among UN organizations and the World Bank. The World Health Organization has staked a claim to lead on technical issues, UNICEF and UNDP are also pressing for leadership roles, and World Bank officials have lobbied US congressmen and the Treasury Department for a major say in how funds are spent.

The emerging plan is to create a public-private board similar to that used by the Global Alliance for Vaccines and Immunization. Many at the UN, including Brown, say they hope that developing countries will set the agenda by proposing initiatives for consideration. But hundreds of details remain unresolved.

''It's fair to describe it as a work in progress,'' Deputy Secretary General Louise Frechette said in an interview yesterday. Donors have responded slowly, because ''they probably want to know a little more about how this fund will function before making firm commitments for money,'' said Frechette, who is leading the effort to create the fund. ''My sense is there is very, very strong support around the world.''

Behind closed doors, several officials from wealthy countries are trying to shape the fund. One idea is to limit the World Bank's role to that of a check writer, because of past troubles with the bank's bureaucracy, UN officials said. The struggle to control the fund has raised questions about the future role of UNAIDS, the only UN agency focused on a single disease. ''UNAIDS is a question mark right now,'' said one health official, speaking on condition of anonymity. ''It was formed because the WHO used to be such a disaster. With WHO back on the rails, it's a different dynamic.''

But Frechette insisted that ''the need for UNAIDS will continue with or without a fund.'' ''It is a source of advice and support for governments,'' he said.

There are also questions about how the money will be spent and who will monitor spending. Some of the funds will go toward purchasing AIDS drugs to treat those infected in Africa, Frechette said. But he added that the size of the fund will determine the extent of treatment efforts.

Others said the fund would grow eventually. ''One billion dollars is not the end point; this is a starting point of a long process,'' said Nils Daulaire, head of the Global Health Council, an advocacy group based in Washington and Vermont.

Laura L. Efros, who was senior adviser for international health at the National Economic Council under the Clinton administration, said difficult questions will arise soon if the fund does not approach Annan's goal.

Without $7 billion to $10 billion a year, ''the question is whether you provide AZT drugs and nevirapine to pregnant women'' to prevent infection of the fetus, Efros said. ''Unless Gates comes through in a big way, and he has done remarkable things in the past, I don't know how they are going to reach the $7 billion.''

Perkin, of the Gates Foundation, said the foundation was ''not convinced throwing money into the pot is the best use of our dollars.'' France and Japan also have remained quiet. Britain, Canada, Italy, and some Scandinavian countries are expected to contribute. The Bush administration may put in additional money later, officials say.

Efros said that she believed that ''an order of magnitude more is needed to fight AIDS.'' But, she said, ''it might be a poor idea now to put much money into a fund that does not yet exist.''

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