Global Policy Forum

By Celia W. Dugger

A group of countries led by France plan to raise at least $300 million next year, mostly through taxes on airline tickets, to help pay for the treatment of children with AIDS, tuberculosis and malaria, a senior French official said yesterday.

In all, they say, the plan can help pay for the treatment of 100,000 children with AIDS, and another 100,000 people who have become resistant to antiretroviral AIDS drugs, as well as the treatment of 150,000 children with tuberculosis and 28 million with malaria."We would not permit thousands of children to die in the United States and France," said Jean Dussourd, a French official who is coordinating the project for President Jacques Chirac. "Why should we allow that in Asia and Africa?"

The new infusion of money was welcomed by public health experts, who said long-term financing through dedicated taxes was especially suited for the lifelong treatment of people with AIDS. Though France and the other donors have promised that the aid will be in addition to other poverty financing, some analysts, like Steven Radelet at the Center for Global Development in Washington, worry that the airline tax revenue will eventually supplant traditional sources of assistance from annual government budgets.

Other experts warned that the focus on the purchase of medicine and diagnostic tests did not deal with the most difficult obstacles to treatment in Africa: the extreme shortage of health workers and broken-down public health systems. "Any solution that addresses diagnostics and drugs but not the human resources crisis and the lack of political will in many African settings will not be comprehensive," said Dr. Mark W. Kline, a pediatrics professor at the Baylor College of Medicine in Houston, which is sponsoring 50 American pediatricians working in seven African countries.

Officials from France and the William J. Clinton Foundation say Unitaid's aim is not to single-handedly deliver AIDS drugs to children and other neglected groups, but to provide a reliable source of financing for the medicine and diagnostics and to free up other groups to focus on systemic problems in African public health. "We'll have a sustainable way to assure a supply of drugs and tests for the long term," said Ira Magaziner, who leads the Clinton Foundation's AIDS program. Buying in bulk, he said, would also allow Unitaid to negotiate significantly lower prices.

France is the dominant donor to Unitaid, providing $250 million of the $300 million for next year, all from an airline ticket tax it began collecting this summer. It is charging 4 euros, about $5, for every international economy ticket and 40 euros, about $51, for first-class ones. Britain is contributing about $25 million next year, drawn from its growing foreign aid budget, an amount that will rise to $76 million by 2010, British officials said.

A dozen more countries are actively considering contributing by imposing airline ticket taxes of their own, Mr. Dussourd said. The United States, which has its own ambitious global AIDS program, has rejected the idea of financing a health program with an airline tax.

The United Nations AIDS agency estimates that only about 80,000 of the 660,000 children who need antiretroviral drugs globally are getting them. Mr. Clinton said in an interview yesterday that the money from Unitaid means poor countries with high H.I.V. infection rates would not have to ask themselves, "Shall I save three 20-year-olds or two kids?"