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Date: Mon, 22 Apr 2002 21:41:20 -0500
From: Africa Action <[log in to unmask]>
To: [log in to unmask]
Subject: Africa: Global Health Fund Issues
Africa: Global Health Fund Issues
Date distributed (ymd): 020422
Document reposted by Africa Action
Africa Policy Electronic Distribution List: an information
service provided by AFRICA ACTION (incorporating the Africa
Policy Information Center, The Africa Fund, and the American
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+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +security/peace+ +health+
SUMMARY CONTENTS:
The board of the Global Fund to fight AIDS,Tuberculosis, and
Malaria (GFATM) is meeting in New York April 22 to April 24 to make
decisions on its first grants. The fund faces enormous challenges,
including pledges which only cover 7% of the estimated annual need
and the urgent necessity of providing funds for treatment as well
as prevention and care.
This e-mail posting contains excerpts from three recent documents
highlighting these issues, (1) an article by Tim France, Gorik
Ooms, and Bernard Rivers comparing pledges with the equitable
contribution each rich country should provide, (2) a letter from
Health Gap, Act-Up Paris, and the African Services Committee, and
(3) a letter from Medecins sans Frontieres. The full text of the
first article is available on the web sites indicated; the full
text of the two letters will be available in the web archive of
this posting, at http://www.africaaction.org/docs02/gf0204.htm
The web site of the Global Fund is http://www.globalfundatm.org
Also today, the World Health Organization released new guidelines
for treatment of HIV/AIDS, for the first time unambiguously
affirming the need for treatment in "poor" settings as well as in
rich countries, and endorsing the inclusion of antiretrovirals in
its essential medicines list. See
http://www.who.int/inf/en/pr-2002-28.html
+++++++++++++++++end profile++++++++++++++++++++++++++++++
THE GLOBAL FUND: WHICH COUNTRIES OWE HOW MUCH?
By Tim France, Gorik Ooms and Bernard Rivers (21 April 2002)
[excerpts only: for full article, including formatted table, see
http://www.hdnet.org and http://www.aidspan.org]
Nearly one year ago, the majority of the world's nations resolved
at `UNGASS', a major UN conference on AIDS, to increase annual
expenditure on the AIDS epidemic to $7-10 billion by 2005, with
much of this money to be raised and disbursed by a new global fund.
When the fund was eventually set up, its mandate was extended, and
it was named the Global Fund to Fight AIDS, Tuberculosis and
Malaria.
AIDS, an unprecedented and accelerating emergency, is already
having a devastating impact in Africa, with similar impacts
unfolding on other continents. Every day, 8,000 die, and 13,000
more become infected. Experts agree that reasonable expenditures
on prevention and treatment of AIDS, tuberculosis and malaria can
be of dramatic benefit not only to human health, but also to
economic development.
Thus far, efforts have been made to raise the money needed by the
Global Fund through ad hoc voluntary donations. These efforts have
failed. Governments have pledged a mere $1.8 billion.
Contributions from the private sector have been even more
disappointing, with not a single meaningful pledge since the Bill
& Melinda Gates Foundation offered $100 million ten months ago.
It's time for a new approach. The Global Fund needs to grow
rapidly to the point where it raises $10 billion a year.
Contributions to the Global Fund should be equitably shared among
the countries whose citizens live the most comfortable and
unthreatened lives. This means that the wealthiest countries, such
as the US, should contribute considerably more than they currently
do. But it also means that contributions should come from the
likes of Australia, Singapore, and the United Arab Emirates -
relatively wealthy countries that have not yet contributed a penny.
Part of the problem is that to date, nobody has proposed which
countries should give how much. The following table therefore
offers an `Equitable Contributions Framework' that can be used as
a starting point for working out an appropriate contribution level
for each country, and for measuring how well each country is doing
against that level.
The Framework suggests that $1 billion a year should come from the
private sector, as a minimum to justify the label `public/private
partnership' and the two seats it has out of the 18 voting seats on
the Fund board. The remaining $9 billion a year should come, in
proportion to Gross Domestic Product (GDP), from the 48 countries
that have a `high' Human Development Index, or HDI. (The UN's HDI
measures the overall quality of life based on standard of living,
life expectancy, and literacy plus school-enrolment.)
The proposed contribution comes to 0.035% of GDP for each country.
Not one country has yet given at this level. ...
It is to the credit of countries like Uganda and Nigeria that, poor
as they are on a per capita basis, they have made
multi-million-dollar contributions to the Fund. And it is to the
shame of many of the 48 relatively wealthy countries that they have
contributed little or nothing, without even stating why.
The Global Fund represents a bold new approach. The Fund's leaders
say that it will be more fast-moving, participatory, transparent
and accountable than traditional channels. The Fund needs a chance
to prove itself. It would be a shame if it were to fail simply
because it did not receive the funding it needs to get properly
established and to respond to the most urgent and obvious needs.
The authors are:
* Dr. Tim France, Health & Development Networks (US EST +11 hours)
Thailand: Tel: +66 9 950 0685; Email: [log in to unmask]; Web:
http://www.hdnet.org
* Gorik Ooms, M,decins Sans FrontiSres (MSF) Luxembourg (US EST +7
hours) Mozambique: Tel: +258 82 311 075; Email:
[log in to unmask]; Web: http://www.msf.lu
* Bernard Rivers, Aidspan (US EST) USA (New York): Tel: +1 212 662
6800; Email: [log in to unmask]; Web: http://www.aidspan.org
================================
[display table in courier font to line up columns; better formatted
versions available on web sites indicated.]
Table: Equitable Contributions Framework for the Global Fund, based
on GDP (21 April 2002)
a) G7 "high Human Development Index" countries:
I | Suggested | Total pledge | Estimated | I
| "equitable | to GF thus far| portion of | I
| annual | ($m., and | total pledge | I
|contribution"| as % of Col 2)| that applies | I
| (US$m) | | to 2002 |
I--------------|-------------| ------ | -----| ---- |------ | I
United States: | 3,479 | 450 | (13%)| 250 | (7%) | I
Japan: | 1,646 | 200 | (12%)| 68 | (4%) | I
Germany: | 658 | 158 | (24%)| 35 | (5%) | I
United Kingdom:| 498 | 219 | (44%)| 67 | (13%) | I
France: | 453 | 151 | (33%)| 51 | (11%) | I
Italy: | 376 | 215 | (57%)| 73 | (19%) | I
Canada: | 243 | 100 | (41%)| 38 | (15%) |
I--------------|-------------| ------ | -----| ---- |------ | I
G7 total: | 7,352 | 1,493 | (20%)| 580 | (8%) |
b) Non-G7 "high Human Development Index" countries:
I | Suggested | Total pledge | Estimated | I
| "equitable | to GF thus far| portion of | I
| annual | ($m., and | total pledge | I
|contribution"| as % of Col 2)| that applies | I
| (US$m) | | to 2002 |
I--------------|-------------| ------ | -----| ---- |------ | I
Spain: | 195 | 58 | (29%)| 19 | (10%) | I
Netherlands: | 128 | 125 | (97%)| 42 | (32%) | I
Switzerland: | 85 | 10 | (12%)| 3 | (4%) | I
Belgium: | 81 | 19 | (24%)| 6 | (8%) | I
Sweden: | 80 | 58 | (73%)| 20 | (25%) | I
Austria: | 67 | 4 | (5%)| 1 | (2%) | I
Denmark: | 57 | 2 | (4%)| 1 | (1%) | I
Finland: | 42 | 2 | (4%)| 1 | (1%) | I
Greece: | 39 | 2 | (4%)| 1 | (1%) | I
Portugal: | 37 | 1 | (4%)| 0 | (1%) | I
Ireland: | 33 | 10 | (31%)| 3 | (10%) | I
Kuwait: | 10 | 1 | (10%)| 0 | (3%) | I
Luxembourg: | 7 | 3 | (41%)| 1 | (14%) | I
Others: | 1 to 161 | 0 | (0%) | 0 | (0%) |
I--------------|-------------| ------ | -----| ---- |------ | I
Non-G7 total: | 1,648 | 294 | (18%)| 99 | (6%) |
c) Totals from the above table
(i) Total for all 48 high HDI countries:
* Suggested "equitable annual contribution" to Global Fund:
US$9,000 million * Total pledge to Global Fund thus far: US$1,788
million * Estimated portion of total pledge that applies to 2002:
US$679 million
(ii) Total for all non-'high HDI' countries that have
donated**:
* Suggested "equitable annual contribution" to Global Fund: $0 *
Total pledge to Global Fund thus far: US$33 million * Estimated
portion of total pledge that applies to 2002: US$11 million
(iii) Total for private sector (foundations and corporations) ***:
* Suggested "equitable annual contribution" to Global Fund:
US$1,000 million * Total pledge to Global Fund thus far: US$101
million * Estimated portion of total pledge that applies to 2002:
US$34 million
(iv) Grand total
* Suggested "equitable annual contribution" to Global Fund:
US$10,000 million * Total pledge to Global Fund thus far: US$1,922
million * Estimated portion of total pledge that applies to 2002:
US$725 million
The final column is based on private sources plus our own
estimates, because the information is not published. We understand
that total pledges are: 2002=$725m., 2003=$487m., 2004=$132m.,
2005=$67m., 2006=$27m., plus $484m. for which the year(s) are not
specified. ...
================================
Accompanying note to readers and editors
The above article was written by three people who work with
non-governmental organizations (NGOs) in three different
continents. They `met' electronically through their active
involvement in the Break-the-Silence (BTS) dedicated e-mail
discussion forum, which has over 3,000 members worldwide. BTS
serves to support civil society participation in international
debates on HIV/AIDS and other health-related issues. Since October
2001, BTS discussions have mainly focused on the Global Fund.
Financial contributions to the Fund have decreased significantly in
recent months, and are far below the originally intended level.
The first funding requests for grants from the Fund, in March 2002,
were already for far more money than the Fund can currently provide
in any sustained way. ...
The article, written in response to that frustration, proposes the
establishment of an `Equitable Contributions Framework' to serve as
a guide to appropriate contribution levels to the Fund.
If you or your organization are encouraging contributions to the
Fund from your own country, you can use the Framework to highlight
your country's appropriate contribution, its total pledges already
made, its apparent pledge for 2002, and the consequent shortfall.
To join the BTS forum, send an e-mail message to:
[log in to unmask]
To read previous BTS postings on the Global Fund process, go to:
http://archives.healthdev.net/bts
*****************************************************************
Health GAP (Global Access Project), Philadelphia, USA
Act Up-Paris, France
African Services Committee New York City, USA
18 April 2002
[excerpts only: full text will be available on web archive of this
posting at http://www.africaaction.org/docs02/gf0204.htm]
To all Members, Board of Directors, the Global Fund to fight AIDS,
Tuberculosis, and Malaria (GFATM):
...
Summary:
We insist on a concerted effort on the part of this Board to
correct and redress the devastating cumulative impact of years of
indifference to untreated HIV/AIDS in developing countries, where
95% of people with HIV/AIDS live.
The Board must emerge with a clear statement prioritizing massive
scale-up and implementation of antiretroviral treatment programs in
developing countries.
The acute need for more money for the GFATM must not be reserved
for internal, hushed Board discussion. On the contrary, the
desperate need for more resources must be publicly emphasized by
the Board. Bona fide demand for funding-especially funding for
programs that include antiretroviral treatment, on the scale
necessary for substantial impact-tremendously outpaces the funds
available to the Board for spending for the first and subsequent
tranches of 2002. ...
1. Prioritizing antiretroviral treatment-redressing the crisis in
HIV medicines access
HIV treatment access is a human rights and public health necessity.
As a new, non-duplicative mechanism that includes funding HIV
treatment programs among its objectives, the GFATM at its launch
was seen as the best hope for sustainable, accelerated scale-up and
implementation of antiretroviral treatment programs in developing
countries.
However, applicants and potential applicants have received mixed
messages from the board and from bilateral donors regarding
proposals that include funding requests for antiretroviral
treatment. When the historical exclusion of treatment was coupled
with donor pressure to scale back the size and scope of proposals
at the Country Coordinating Mechanism (CCM) level, many countries
chose to submit proposals with very modest treatment components,
that under-represented the capacity of a country to deliver
medicines for AIDS, tuberculosis, and malaria treatment. ...
If the GFATM is to take up its task of remedying the disparity in
HIV treatment access, the Board must clarify through a public
communication that viable antiretroviral treatment programs are
feasible, fundable, are a required aspect of a comprehensive,
effective response to the AIDS pandemic. Funding requests
containing components for AIDS treatment must not be downgraded in
consideration because of relative higher cost.
The direct and measurable impact of treatment access on morbidity
and mortality, as well as its spillover benefits to HIV prevention
efforts, are outcomes necessary to demonstrate for donors the value
and impact of GFATM funded interventions. The most dramatic
outcomes possible with the scarce resources available will be
produced by funding discrete sectors with antiretroviral treatment,
effectively delivered.
The Board should encourage exactly such applications, and commit
all available resources on hand.
2. Patents and the procurement of medicines by the GFATM
Commitment to the procurement of lowest possible cost, quality
medicines-including quality generic drugs-must be communicated by
Board members.
Generic competition has been shown to be the most powerful tool in
exerting downward pressure on drug prices. The procurement of
quality generic versions of HIV medicines will increase
life-extending treatment access by extending finite resources as
efficiently as possible.
In most developing countries, there is little viable market for
pharmaceuticals. Given the decimation of adult populations in some
countries due to untreated HIV disease, the interest of brand name
pharmaceutical companies in guarding patent monopolies and
concomitant high prices must not determine the policy of the Board
regarding health commodities procurement. ...
*****************************************************************
Medecins Sans Frontieres (MSF)
OPEN LETTER TO MEMBERS OF THE BOARD OF DIRECTORS AND TECHNICAL
REVIEW PANEL OF THE GLOBAL FUND TO FIGHT ADS, TUBERCULOSIS AND
MALARIA
18 April 2002
Original version with footnotes and malaria report referenced
available upon request from: [log in to unmask]
[excerpts only: full text will be available on web archive of this
posting at http://www.africaaction.org/docs02/gf0204.htm]
...
Treatment: a medical and ethical imperative
As a medical humanitarian organization, MSF believes that the
Global Fund must provide financing for treatment programmes for
HIV/AIDS, TB, and malaria. This is an ethical imperative. It is now
widely accepted that treatment and prevention are mutually
dependent and synergistic; that one reinforces and strengthens the
other, and that prevention-whether through condom distribution,
bednets, or general health education-has failed to control these
three diseases alone. We know this firsthand from our experience in
the field. We are therefore encouraged by the news that proposals
that include well-designed treatment interventions will be eligible
for funding.
However, the Fund has failed to clearly spell out the critical need
for addressing treatment as part of a comprehensive approach to
controlling HIV/AIDS, TB or malaria ...We are deeply concerned that
patients already living with HIV/AIDS, TB, or malaria will be
written off despite pronouncements of support for treatment
programmes that would extend or save their lives because donors and
some in the international health community traditionally favour
prevention at the expense of treatment ...
It is vital to improve treatment interventions, not expand use of
ineffective treatments
It is of vital importance that the Global Fund be used to support
improvement of treatment interventions, and that it does not
inadvertently facilitate the expanded use of ineffective
treatments. Yet the Fund has not taken a clear stand on the need to
make ARVs, second line TB treatments, or new, more effective
anti-malarials available (at the lowest possible cost). For
instance, in the case of malaria treatment, it would be wrong to
support programmes that continue to use treatments in areas where
they have lost their effectiveness due to resistance on the basis
that they are inexpensive. Where resistance to traditional
first-line treatments-especially chloroquine and
sulfadoxine-pyrimethamine (SP)-is high, malaria treatment must
include not only traditional antimalarials, but also
artemisinin-based combination therapy (ACT), as per the
recommendations of the world's leading malaria experts convened by
WHO in April 2001, and the February 2002 statement of Roll Back
Malaria on Malaria and Resistance. ...
... MSF recently released a report about changing malaria treatment
protocols in Africa where resistance to first-line drugs is high
(please see the enclosed report entitled "Changing National Malaria
Treatment Protocols: What Is the Cost and Who Will Pay?"). The
central concern of the paper is with the growing rates of
resistance to chloroquine and SP in Africa, namely in Kenya,
Rwanda, Tanzania, Uganda, and Burundi, and the possibility that
these countries, which are ready to change their national malaria
treatment protocols, will, possibly for financial reasons, settle
on a sub-optimal "mid-term" protocol (e.g. amodiaquine + SP) rather
than the clearly more effective choice of ACT. ...
Purchasing drugs at the lowest possible cost is essential
We are deeply concerned about the sort of technical advice being
given to potential recipient countries-by donor governments, the
World Health Organisation, and others-in relation to purchases of
medicines. Specifically, we are outraged that countries have
apparently been advised that they will only be able to purchase
patented drugs for their programmes. In the proposal to the Global
Fund from Malawi, for example, it clearly states the following:
"At present, we are assuming that the Global Fund will only finance
patented drugs. This is in line with consultations with WHO and the
donor community and initial documents from the Technical Support
Secretariat. If however, Global Fund rules permit the use of
generic drugs, the proposal and programme budget will be amended to
reflect this."
To ensure that international funding mechanisms, including the
Global Fund, offer treatment to the highest number of people
possible, it is essential that funds be available for bulk
purchases of medicines and medical technologies at the lowest
possible cost, through international tender. ...
We therefore call on all members of the Board, whether individually
and/or collectively, to issue a clearly articulated public
statement during the Board meeting indicating that the Global Fund
explicitly supports purchases of lowest cost drugs, whether generic
or brand-name, and the use of TRIPS-legal safeguards to override
patents when they constitute a barrier to access. The Global Fund
should also clearly specify that these measures are fully compliant
with TRIPS and in keeping with the spirit and letter of the Doha
Declaration. ...
These principles related to procurement of drugs and diagnostics
are crucial because prices of medicines and other essential health
care goods will have a profound impact on the reach and
effectiveness of the Global Fund. Antiretroviral drugs for the
treatment of HIV/AIDS provide a good illustration: ...Using the
lowest cost suppliers will increase by as much as three times the
number of patients who can be treated with the same amount of
money, and will allow for greater investments in other important
components of care and prevention. We know this firsthand from our
experience in the field in our ARV demonstration projects. ...
More funds desperately needed
... To date, the Fund has received funding requests totaling
US$5 billion over five years, and yet the total amount of
multi-year financing pledged is merely US$1.9 billion and the
amount of funding available for disbursement in the first funding
cycle is approximately US$200 million. This falls drastically short
of the needs and will be a major disappointment for all of those
who have placed great hope in the ability of the Fund to reduce the
death rates from these three treatable diseases. We call on you as
members of the Board to take whatever steps necessary to ensure
that donors immediately allocate additional resources to the Global
Fund and other financing mechanisms to fight these three diseases.
...
Sincerely,
Bernard P,coul, MD, MPH Director,
MSF Access to Essential Medicines Campaign
************************************************************
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