An AIDS Policy That Would Add Up
By Sebastian Mallaby
Monday, December 2, 2002; Page A21
This week Richard Feachem will make the rounds in Washington, trying to scare up money for his organization, the Global Fund to Fight AIDS, Tuberculosis & Malaria. He could not have picked a better moment. Because yesterday was AIDS day, and because President Bush is set to visit Africa, AIDS activists have been pressing the administration to engage a scourge that's equivalent to 1,000 Sept. 11's annually. For a variety of reasons, the administration looks unengaged. Feachem's visit is an opportunity to formulate a credible response.
First, consider why the administration is on the defensive. Last June Bush promised $500 million to fight mother-child transmission of the AIDS virus. Unfortunately, this was a substitute for a more generous Senate plan that the White House squashed. But then in August Bush vetoed the first tranche of the $500 million because he objected to other spending that came with it. To date, no money has been appropriated. In the 111 days since the Bush veto, an estimated 222,000 babies have been infected with HIV.
Last winter the Bush team revised its position on medicines for AIDS and other serious diseases. It signed a World Trade Organization declaration supporting poor countries' efforts to use cheap generic copies of patented drugs. On Friday, however, WTO efforts to fill in the fine print of that declaration foundered. A big reason was U.S. intransigence.
Last year Bush was the first among world leaders to pledge money to Feachem's global fund. State Department fact sheets continue to point out that the United States, which now has pledged $500 million, remains the fund's largest contributor. But this boasting sounds hollow. Britain, with an economy less than a sixth the size of America's, has pledged $215 million.
In proportional terms, it is roughly three times as generous.
So Bush lacks a serious AIDS strategy, which is not good for a president who'll be in Africa next month. What should he do then? Here's an answer that fits Bush's conservatism as well as the facts.
Bush should point out that the biggest obstacle in the AIDS battle is not actually a lack of money. It is that money can be hard to spend. During the past two years, the World Bank has pledged $550 million for AIDS projects in Africa and has more money on hand. Yet little of the pledged millions has reached people.
Ethiopia's press recently reported that its government had received $60 million from the World Bank more than a year ago, but had spent only $12 million of that. If this is typical, only about $100 million of the bank's $550 million has been put to work so far. It's quite likely that disbursements are even lower than that.
The Bush people, who love to talk about improving aid's effectiveness, should use these numbers to put their own stamp on the AIDS fight.
They should welcome Feachem and make much of the fact that his fund marks a new experiment in the aid business. Unlike the World Bank, the fund goes around the back of central governments, giving cash directly to local governments and nongovernmental organizations that have health projects on the ground. In the war on terrorism, you need rapid deployment. In the war against AIDS, you need rapid disbursement.
The Bush people should note that this experiment is under pressure.
Tanzania's finance minister has tried to get his paws on Global Fund to Fight AIDS dollars intended for another part of government; South Africa's central government has behaved similarly. The Bush administration should announce that it is watching carefully. Unless Ethiopia-type roadblocks can be exploded, there can never be victory against the virus. Therefore, governments that sabotage the global fund's efforts should expect no assistance from the bilateral U.S. aid program.
The administration could even ask Feachem to construct a table of recipient countries, ranked according to their speed of productive disbursement. Copies of this table then could be distributed in countries with governments that screw up.
All this should fit Bush's conservative philosophy. But now comes the compassionate part. Feachem reckons that his fund's rapid-disbursement mechanism needs $7 billion in new donor money during the next two years. The U.S. share would be $2 billion, and yet in the 2003 budget the administration is asking for only a tenth of that.
Should Bush be more generous? Of course he should. With 5 million new infections annually, the risk of entrusting money to Feachem's experiment is much less than the risk of missing an opportunity to back effective AIDS programs.
Indeed, why stop at $2 billion? What if Bush gave Feachem the whole $7 billion? In one bold move, he would silence all those European whines about cowboy unilateralism. Man, that would feel good. And maybe he could even turn around humanity's shameful failure to fight the AIDS pandemic. What legacy could top that?
© 2002 The Washington Post Company