Feb. 6, 2004

Speakers Debate U.S. Commitment To HIV/AIDS Pandemic

WASHINGTON - Amid reports that U.S. President George W. Bush's new budget plan significantly reduces his promised financing for the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria, U.S. Global AIDS Coordinator Randall Tobias yesterday reasserted the administration's commitment to battling the HIV/AIDS epidemic at an American Enterprise Institute conference.

Tobias likened the president's AIDS initiative to the Marshall Plan, highlighting that U.S. contributions to the Global Fund this year will double the pledges of all other nations combined.

In last year's State of the Union address, Bush pledged $15 billion dollars for the next five years under his Emergency Plan for AIDS Relief, dedicated to bringing resources to the most heavily afflicted HIV/AIDS regions - Africa and the Caribbean. The $15 billion also included $1 billion for the Global Fund. However, the Washington Post reported yesterday that under Bush's 2004 budget proposal, this year's spending for the fund would be slashed by 64 percent, from $550 million to $200 million.

"The U.S. needs more help from the rest of the world," Tobias said in a speech opening the conference, The Global Pandemic: AIDS in Africa, China, and Russia. According to Tobias, Bush critics are unfairly attacking his proposed budget adjustments, since the president plans to increase AIDS spending in other areas.

Tobias, former chief executive of the pharmaceutical giant Eli Lilly and Company, called for international cooperation and emphasized the need for the leaders of China, India and Russia to adequately acknowledge the HIV/AIDS crisis in their countries.

The scope of the HIV/AIDS pandemic is uncertain in these regions since the overwhelming number of cases remain largely undocumented. It has been Beijing's practice to lowball its HIV/AIDS figures against outside projections.

While a June 2002 report by the Joint U.N. Program on HIV/AIDS (UNAIDS) suggested that there are 1.5 million people infected with HIV in China, the Chinese government reported 1 million infections. The UNAIDS report further projected that by 2010, that number could explode to 10 million. The scenario is difficult to predict in China, India and Russia, where officials remain unresponsive and ambivalent about their nations' HIV/AIDS situation.

They cannot afford to remain so for long. Based on AEI researcher Nicholas Eberstadt's 2002 report The Future of AIDS, the economic toll of the disease will be costlier for China, India and Russia than all of sub-Saharan Africa. According to UNAIDS, 26.6 million of the world's 40 million HIV are found in sub-Saharan Africa alone. However, as the pandemic spreads to the strategically important Eurasian nations, the report paints an economic and security doomsday scenario for the rest of the world.

"Africa's AIDS catastrophe . has been remarkably muted outside the continent itself," Eberstadt wrote in his report. "The explanation for this awful dissonance lies in the region's marginal status in global economics and politics." In contrast, Eurasia is home to a large portion of the world's population. Its combined 2000 gross national product of $15 trillion exceeds that of the United States and Europe combined and it is home to four out of five of the world's strongest armies, Eberstadt wrote.

These high-risk nations need to arm themselves against the devastating spread of HIV/AIDS by developing their economic and political infrastructure, rooting out corruption and eradicating poverty, suggested Roger Bate, a visiting scholar at AEI.

Bate and AEI fellow and panel moderator James Glassman promoted the notion "wealth makes health." In other words, rich nations are better equipped to manage the AIDS crisis because they have better access to the latest medicine and a more reliable health care system. Based on Bate's research, the poorest African countries also have the highest number of HIV-infected people.

"Poverty . does not stem from a lack of natural resources or a surfeit of bad weather," Glassman wrote in a paper on the topic. "Poverty grows from bad political and economic systems, and Africa has those in abundance."

What Africa lacks are antiretroviral drugs, education and health care. The panelists agreed that while international assistance and free ARVs provide relief, it fails to bring much needed institutional development to these countries.

"Even if ARVs became free tomorrow, Africa would still have an AIDS crisis," argued Glassman, insisting that without building stable institutions, eradicating poverty and ridding governments of corruption, the AIDS crisis will continue to worsen in Africa.

Bate said the World Health Organization goal to get 3 million people in Africa on AIDS treatment by 2005 is highly unlikely to be realized.

While Tobias reasserted Bush's promise to provide the most effective drugs at the lowest available price, Glassman criticized such moves as anti-free market and discouraging the development of new drugs.

Bate found that since 1997 the number of AIDS medicines under development have decreased by 40 percent, as various smaller drug companies have walked away from developing AIDS medicines. He blames the World Trade Organization's August 2003 plan allowing poor nations facing an AIDS crisis to forego drug patent laws and import generic drugs.

"It's not that companies like Merck aren't investing in AIDS research, it's that smaller companies are walking away," Bate said. "These companies aren't spending money on AIDS research because they can't make money or recoup expenses," he said, adding that does not foresee drug companies making any profit in the current culture of weak patent protection.

Jeffrey Sturchio, Merck vice president of external affairs and human health in Europe, Middle East and Africa, described Merck and Co. Inc.'s incentive for partnering with the Gates Foundation and the Botswana government to donate $50 million for an AIDS program. "It is in our long-term interest to improve health care creating a market we can supply in the developing world," he said.

U.S. Secretary of Health and Human Services Tommy Thompson made it clear that protecting drug patent rights is a major U.S. priority. As the event's keynote speaker, he closed the event by saying, "The U.S. is very clear on this . we're going to protect intellectual property. We must encourage corporate responsibility to give drugs at a discount. But I don't want to stifle innovation of drugs in pharmaceutical companies. It's counter-productive."

Originally published in The U.N. Wire.