[Ip-health] Schoofs on Global Fund

[Asia Russell]

This article glosses over the small donation from the US and instead
addresses the high expectations of potential applicants among US actors
including Helene Gayle.
 
We all want results and we want scientific rigor in evaluating funding
requests. But how is the Fund going to be able to deliver the results the US
says it wants to see, with next to no resources to fund treatment access?

No amount of "strictness" in evaluating applications can fix the crisis
created by the refusal of the US to cough up the $1.3 billion or so in new
money that is needed.

Asia Russell 


-----------------------------------------------------------------------
Global Disease Fund to Be Strict For Better Chance to Get Results

Wall Street Journal - February 13, 2002
Mark Schoofs and Michael M. Phillips, Staff Reporters of The Wall Street
Journal 
------------------------------------------------------------------------
Poor and beset with the world's biggest tuberculosis epidemic, India seemed
a perfect candidate for free TB drugs offered through the World Health
Organization. But, over the past year, the WHO has turned down India's
request -- twice. 

People familiar with the situation say India couldn't convince the WHO that
it had a viable plan to bring more patients under directly observed therapy,
a method that achieves high cure rates by ensuring that TB patients take
their medicine properly.

And India isn't the only country that has had trouble making the grade. Of
the 25 nations that have applied for free TB drugs, only 16 have so far been
approved. 

It is that kind of tough love that the much grander Global Fund to Fight
AIDS, Tuberculosis, and Malaria plans to adopt as it writes its first checks
in the next two months. United Nations Secretary-General Kofi Annan called
for the creation of the Global Fund last April. Just two weeks ago, the
Global Fund issued its first request for project proposals, and Wednesday
and Thursday the Senate will hold hearings on the topic, including how the
fund plans to enforce its standards, with Mr. Annan himself briefing
senators apart from the hearings. Thursday's Senate hearing will include
testimony from Peter Piot, executive director of UNAIDS, who is sure to be
questioned about how the Global Fund will ensure its money is well spent.

Most top Bush administration officials and lawmakers no longer need to be
convinced of the urgency of addressing diseases that kill about six million
people a year. But U.S. officials do need to be convinced that their
two-year, $500 million proposed pledge for the Global Fund won't disappear
down a global rathole of corruption and inefficiency.

The organizers of the Global Fund know they must hold themselves to the
highest medical and financial standards or run the risk that the almost $2
billion pledged world-wide so far won't be replenished, let alone increased.
Worse, the remarkable international momentum built up over the past three
years to fight these sweeping epidemics could grind to a halt.

"There's a lot riding on this," says Sen. Bill Frist (R., Tenn.), the only
doctor in the Senate and a leading proponent of American aid to help stem
epidemics in poor nations.

WHO's Stop TB Partnership is just one of the international health programs
that impose tight standards and serve as models for the Global Fund. The
Global Alliance for Vaccines and Immunization, whose partners include WHO,
UNICEF, multinational drug companies and the Bill & Melinda Gates
Foundation, has rejected many countries whose applications are deemed
inadequate. Those whose are accepted must, in essence, sign a contract
saying how many additional children will be immunized using GAVI aid. If
countries don't reach that target, GAVI withholds additional cash and can
stop sending vaccines.

The Gates Foundation, through GAVI, pioneered aggressive accounting
practices in poor countries, including unannounced audits of programs
receiving assistance. The foundation donated $100 million to the Global
Fund, and a representative from the Gates Foundation, Helene Gayle, sits on
the Fund's board of directors. "Just because you need the money, we're not
giving it to you unless you can show you can do something with it," says Dr.
Gayle. "That's very different from the way the U.N. has worked [in the
past], which is almost an entitlement system."

Proposals to the Global Fund will be vetted by a 17-member panel of experts,
who will evaluate the public-health merits of the proposed projects as well
as their fiscal safeguards. "We envision a level of fiscal accountability
and a level of substantive accountability -- meaning results -- that's
unheard of in international development assistance," a Bush administration
official said. 

India's health secretary, J.A. Chowdury, couldn't be reached for comment,
and WHO officials won't discuss India's TB-aid application. They say,
however, that with U.N. help, India's TB program has improved enormously,
and the country is now on the verge of qualifying for free drugs.

Critics of the free-drug program argue that the U.N. underestimated the
effectiveness of India's TB program. But even those critics concede that the
U.N. stood firm. "Certainly it's an example of the U.N. saying no to a
powerful country," says one veteran TB expert with knowledge of the case.

The strict TB policy isn't designed just to persuade skeptical lawmakers in
rich countries to loosen the purse strings. If misused, TB drugs can create
resistant strains of the disease. While malaria and HIV also can mutate to
become resistant to drugs, tuberculosis programs have grown especially
vigilant against drug resistance. The strict WHO application process "is not
there to create barriers to assistance," says Diana Weil, a senior
public-health specialist at the World Bank and one of the experts who
reviews TB-aid applications. But, "because it's a fund that buys drugs ...
it is particularly important that it fit into a larger strategy."

The test of how well the Global Fund puts its lofty goals into practice
could come soon. Fund organizers plan to dole out the initial round of
grants in April, on the first anniversary of Mr. Annan's call for its
creation. 

The rush to show results, however, has drawn criticism of its own. The
request for proposals, issued at the end of January, gives would-be
recipients barely a month to draft their plans. But if the Global Fund had
allowed more time to prepare proposals, "we would have gotten criticism for
being too slow," says Anders Nordstrom, the Global Fund's acting executive
director. "We had to move now. People are dying."

-- Rachel Zimmerman contributed to this article.

Write to Mark Schoofs at mark.schoofs@wsj.com1 and Michael M. Phillips at
michael.phillips@wsj.com2



____________________
Asia Russell
asia@critpath.org
ACT UP Philadelphia
Health GAP Coalition

+1 215 474-9329 tel
+1 215 985-4492 fax
+1 267 475-2645 cell