Behind closed doors at the UN and in Western capitals, government and corporate officials are arguing over the size and governance of a fund that is going to be the primary international response to the greatest public health pandemic since the Black Death. Virtually alone among world leaders, UN Secretary General Kofi Annan has recognized the severity of the AIDS crisis. While pushing developing-country governments to confront the disease openly and devote more money to HIV/AIDS and healthcare in general, he has called on the rich countries to allocate $7 billion to $10 billion annually to a global fund to address infectious diseases--primarily HIV/AIDS, malaria and tuberculosis--in developing countries.
But an eloquent plea from the Secretary General guarantees neither that the rich countries will provide the needed resources nor that the fund will be structured wisely. The opaque and ad hoc process by which the fund is being negotiated into existence--with a swirl of rumors, whispers and back-room intrigue driving the process forward--makes the final outcome uncertain.
The fund will be high on the agenda at both the UN General Assembly special session on AIDS and a meeting of the G-8--the rich countries' club--in Genoa, Italy, in July. UNAIDS executive director Peter Piot says the fund should be operational by the end of the year.
Among the key questions likely to be resolved or nearly resolved by July:
[sections] How much money will be in the fund? The United States was first to announce its contribution: $200 million for the fund's first year (a level of funding that, if maintained for ten years, would represent less than two-tenths of 1 percent of the Bush tax cut). In its rush to be first, the United States set the donor bar low. Most observers now expect the fund to begin operations with about $1 billion or less per year.
[sections] How will the fund be governed? It seems clear that donors will exert a decisive role on the fund's governing board, and it's probable that the fund will be independent of, although allied with, the United Nations. Whether and to what extent developing-country governments, nongovernmental groups and people with HIV/AIDS will participate in fund governance remains up for grabs. The fund is likely to be housed at the World Bank, though it's uncertain whether the bank will gain substantial influence over policy or whether the bank's role will be primarily administrative.
[sections] Will drug companies be permitted a role in governance of the fund? Activists are aghast at the prospect that the very same brand-name drug companies that have maintained super-high prices for antiretroviral drugs, and drugs to treat opportunistic infections, might serve on the fund's governing board. But amid the rush to develop the fund as a "public-private" partnership and mindless recitation of the mantra that the multinational firms must be "part of the solution," it now appears likely that the drug companies will have a role in fund governance. …