Law ties U.S. hands on global disease fund

The United States will be forced to withhold $120 million from this year’s donation to the Global Fund to Fight AIDS, Tuberculosis and Malaria unless other donors can come up with twice that amount by the end of September, U.S. AIDS czar Randall Tobias said Wednesday.

By U.S. law, the American share of the fund can total no more than 33 percent of all contributions. But as of July 31, donations from other countries fell $243 million short of the amount required for a full U.S. grant of $547 million for the period.

Tobias said he would exercise his discretion to wait two months in hopes that the full grant could be made. Otherwise, the money would be used as part of the President’s Emergency Plan for AIDS Relief.

“We want to comply with the letter of the law but, at the same time, we are also doing everything we can do within the letter of the law to (encourage donation of) as much money to the Global Fund as we can,” Tobias said in a telephone news conference.

Tobias signaled the United States’ intentions in a letter to Dr. Richard Feachem, executive director of the fund, and in a telephone call with Feachem on Wednesday afternoon.

The Global Fund was created in 2001 with hopes that it could provide prevention and treatment services to impoverished developing countries, but its vision has far outpaced reality. Estimates by UNAIDS and other groups indicate that the fund requires a minimum of $10 billion per year to provide those services effectively, but donations have fallen far short of that goal.

For the 10 months ending July 31, contributions to the fund by foreign governments and foundations totaled $866 million, according to a U.S. audit, Tobias said. U.S. contributions during the period were the maximum $426 million – 33 percent of the total. For the United States to contribute the maximum $547 million budgeted, the rest of the world needed to contribute $1.11 billion.

Tobias is stretching the period for two months, in hopes of obtaining the additional funds so that the rest of the U.S. contribution can be made.

“Regardless of what happens, the $120 million will be used for HIV/AIDS,” Tobias said. “We would just like to make it available to the Global Fund.”

Tobias and the United States were heavily criticized at last month’s International AIDS Congress in Bangkok, Thailand, because of the perception that too little of the money in the Bush administration’s five-year, $15-billion AIDS Program is going to the Global Fund. The bulk of that money is being spent in bilateral programs with only about 20 heavily affected countries.

The primary focus of the criticism is that treatment funds in the President’s Emergency Plan for AIDS Relief can be used only for drugs that have been approved by the U.S. Food and Drug Administration. So far, that list includes only brand-name drugs and not the inexpensive copies produced in foreign countries – meaning that the number of people who can be treated is much lower than it would be if generic versions could be used.

Ranbaxy Laboratories Ltd. of India and Thailand’s Government Pharmaceuticals Organization have applied to the FDA for approval of their anti-AIDS drugs under the fast-track program, but approval has not yet been granted.