WP-Editorial: Another $10 Billion

[Guest guest]

The Washington Post

June 2, 2006

Another $10 Billion (editorial)

The world has only begun to wake up to the AIDS challenge.

The generals in the global battle against HIV-AIDS are meeting at the United Nations this week, five years after another U.N. summit promised an intensified push against the crisis. The target of mobilizing $7 billion to $10 billion per year has been met: Last year low – and middle-income countries spent $2.5 billion of their own money and an additional $5.8 billion from donors on AIDS treatment and prevention and the care of orphans. But that money has bought less than expected. Rather than hitting the “three by five” target of getting medicines to 3 million people by 2005, the world has put only about 1.4 million people on treatment – a big improvement on the 240,000 who were receiving drugs in 2001 but still well less than half of the number who need medicines immediately. Equally, better-financed prevention efforts have succeeded in driving down infection rates among young adults, notably in Kenya, Uganda, Zimbabwe and Haiti. But last year there were 4.1 million new infections worldwide. The plague is still advancing.

The summiteers in New York therefore confront a daunting problem. The latest U.N. estimate, which may prove as optimistic as the last one, is that fighting the disease will soon require $20 billion to $23 billion a year, more than twice the current spending. What’s more, this is not a temporary commitment: Once people go on antiretroviral treatment, they need medicines for years; caring for orphans is also a long-term proposition. Assuming that some of the extra resources will be provided by middle-income countries, the rich world may need to reach into its taxpayers’ pockets for an extra $10 billion a year. Official development assistance, which has already jumped by more than two-thirds in real terms between 2000 and 2005, would have to grow by a tenth or so.

Moreover, the effect of that money will be limited unless the world expands its commitment to other development efforts. Donor-financed AIDS programs can suck nurses and doctors out of the rest of the health system, so an increase in AIDS spending requires a parallel increase in general health investment. AIDS flourishes in poor societies because illiteracy and penury make people vulnerable; success against the virus depends partly on broader progress. As President Kagame of Rwanda told The Post on Wednesday, there’s no use in giving someone antiretroviral drugs if he has no food.

The imperative to raise extra money for AIDS and other development objectives raises an institutional issue. To carry out its commitments of five years ago, the world created the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has raised and spent an impressive $5 billion; the question is whether this venture should be the vehicle for the next step-up in AIDS funding. The fund’s critics, notably the Bush administration, rightly say that it has suffered from poor management, that it has occasionally given money on the basis of poor grant proposals and that it has indulged grantees whose performance should have led to a suspension of disbursements. But rather than snipe at the fund, the critics should work to improve it. The fund’s structure provides a way of sharing the financial burden globally. The quality of its grants has recently gone up. And centralizing AIDS finance simplifies the administrative burden on stressed officials from poor countries. The fund’s entrepreneurial leader, Feachem, has announced that he will leave when his term expires this year. The priority should be to find a replacement who is pushy enough to raise extra money and savvy enough to solidify the institution’s management.