In another signal that the global
battle against AIDS is falling apart
for lack of money, the Global Fund
to Fight AIDS, Tuberculosis and
Malaria failed on Tuesday to reach
even its lowest “austerity level”
fund-raising target of $13 billion —
the amount it had said it needed
just to keep putting patients on
treatment at current rates.
Three-year pledges from 40
countries attending a two-day
conference held in Manhattan
amounted to $11.7 billion. The
pledges were announced at the
United Nations. The fund had hoped
to raise $20 billion to catch up with
the growing epidemic.
No one now on treatment will be
cut off, said Dr. Michel Kazatchkine,
the fund ’s executive director, but
the targets for the next few years
must be lowered.
He said that he “deeply
appreciates” the amount raised, but
that “we need to recognize that it’s
not enough to meet expected
demand and will lead to difficult
decisions in the next three years.”
He could not, he said, estimate
exactly how many deaths would
result.
The fund pays for AIDS drugs for
almost three million patients now,
and still might be able to reach four
million by 2013. It had hoped to
reach five million or more.
It supports about half of the world’s
poor who are getting treatment.
The President ’s Emergency Plan for
AIDS Relief, or Pepfar, started under
the administration of President
George W. Bush, pays for the other
half.
An estimated 33 million people are
infected worldwide, a number that
grows by a million people a year
after adding new infections and
subtracting deaths.
Of that number, about 14 million
are already so sick that, under
World Health Organization
guidelines, they should be on drugs.
It looks increasingly likely that that
number will outpace the number
getting drugs.
The United States pledged $4 billion,
which is a nearly 40 percent
increase over its previous
contribution. It is by far the most
generous donor, and most countries
raised their contributions by less.
France, Canada and Norway went
up by 20 percent, Japan by 28
percent. Britain, Sweden and the
Netherlands could not commit
because of budget cycles, but were
expected to be in that ballpark;
Italy and Spain gave nothing. South
Africa, which has the world ’s worst
AIDS epidemic, made a token
contribution of $2 million. Russia
and China gave $60 million and $14
million respectively, far less than
fund officials had hoped. To reach
the fund ’s $20 billion goal, all
countries would have had to
roughly double their giving.
AIDS activists vented open
frustration, both with the overall
result and the American
contribution.
“This is a modest course correction,
not what we were hoping for in
terms of U.S. leadership, ” said Dr.
Paul Zeitz, executive director of the
Global AIDS Alliance, an advocacy
group that had lobbied the
administration for a $6 billion
contribution. “This took the other
donors off the hook. Everyone
could aim low. ”
By not reaching a decision earlier,
he complained, the United States
dithered away its leverage over
other countries.
Under American law, the United
States can contribute only one-third
of the fund. If it had told other
donors privately weeks ago that it
intended a 40 percent increase,
they would have been under
pressure to match that, both to
avoid sounding cheap, and because
the United States cannot pay unless
its donation is matched 2 to 1.
Dr. Eric Goosby, the global AIDS
coordinator, said the intra-
administration debate about how
much to pledge was “robust” and
went on right up until Tuesday
morning.
“We’re proud of the pledge,” Dr.
Goosby said in a telephone
interview. Getting the United States,
which has a one-year budget cycle,
to commit to a three-year pledge
was “swimming upstream,”
especially in such a weak economy.
The battles against malaria and
tuberculosis will also suffer, but the
effect on AIDS is easier to measure.
Malaria waxes and wanes with hot
weather and local spraying. The TB
epidemic echoes the AIDS epidemic
because so many people have
both, but TB can be cured in six
months, which shrinks case counts
rapidly.
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