Public Health & Health Systems

A not so warm welcome

US President George W Bush received a less than warm welcome from AIDS activists and health experts worldwide when he set foot on South African shores. Amid all the talking and photo opportunities critics questioned when Bush would make the money available he had promised earlier in the year or whether he would try to ‘€œspin’€ his way out of meeting his commitments.

US president George Bush’€™s African tour which kicks off next week will no doubt involve lots of sturdy flesh pressing, posing for hundreds of photographs, lining up for traditional African dancing and of course the obligatory visit to a game farm somewhere in between.

But many view the visit of the leader of the most powerful country in the world to this continent where millions are dying of preventable diseases, with enormous cynicism.

One such fierce critic when it comes to the issue of US development aid (or lack thereof) is Professor Jeffrey Sachs, special advisor to United Nations Secretary-General Koffi Anan.

According to Sachs; ‘€œthe Bush administration, besides spin, has done nothing for years. President Bush may not notice, but he will be walking into a continent of mass deaths’€ he said during a press conference with African media.

Sachs, who is also Director of Columbia University’€™s Earth Institute, says it is clear than Bush is intent on taking a victory lap for his announcement on January 28 this year promising US $15-billion for an emergency plan for AIDS relief. His pledge was specific to the AIDS epidemic and not other diseases.

Activists and pressure groups now accuse Bush of reneging on that promise.

In a speech that sounded at times more like a sermon, Bush declared that the funds would go towards ‘€œa work of mercy’€ and that the US would ‘€œlead the world in sparing innocent people from a plague of nature’€.

Indications are that this pledge remains unfulfilled.

In May 2003, Bush signed an AIDS, TB and Malaria spending authorisation bill in a widely covered State Department ceremony, that specified U$3-billion in spending for the 2004 financial year, when in fact the actual level of funds provided are likely to closely track his own budget of U$1,55-billion.

Also, Bush includes funding for research programs as well as for US programs to fight TB and Malaria in the overall figure. Without this funding the total programme cost would be U$13,112-billion over five years, not U$15-billion.

This figure shrinks to U$12,862   (Just U$1,55-billion for 2004) once all non-AIDS and research spending is subtracted.

‘€œThere is no serious policy programme in the Bush administration. Five million Africans have died of AIDS. Five million Africans have died of Malaria and between three and four million Africans have died of TB. Still there has been no response,’€ says Sachs.

Bush has also proposed that the bulk of new funding in his budget go to AIDS programmes in 14 of the hardest hit countries, but he is providing it via slow-paced US agencies with high administrative overheads.

Six months after announcing his ‘€œemergency plan’€, Bush has appointed Randall ‘€œRandy’€ Tobias as head of his AIDS program. But questions remain around the appointment of Tobias, who is the recently-retired CEO of the US pharmaceutical giant Eli Lilly, a corporation with close ties to the Republican Party and the Bush Administration.

Eli Lilly is also a top Republican party donor, contributing more than U$1,5-million to Republican campaigns during the 2002 election cycle, and spending U$234,000 in mailings to shareholders on behalf of Bush’s campaign in 2000.

That aside, treatment activists are adamant that the purchase of lowest cost medicines, including generics, is a must.

The heads of state of every other nation in the world agreed at the World Trade Organisation that public health and access to medicines for all takes precedence over drug company monopolies.

But the question is now which side will Tobias be on.

Bush’s five-year AIDS plan has also come under attack for sidestepping the UN’€™s Global Fund to Fight AIDS, Tuberculosis and Malaria, a multilateral program that is already operating and functional.

The Global Fund is facing an immediate fiscal shortfall of $700 million in 2003 alone, because the US and other donors have not committed their fair share. Activists have also criticised the fact that the White House has still not released clinical or programmatic details about the Bush AIDS Plan.

‘€œ1.5 million people have died of AIDS since Bush’s announcement, and instead of a plan, the White House makes a political appointment,’€ says Brook Baker of HealthGAP in the US.

‘€œThe clock is ticking – a detailed plan setting out how the White House expects to achieve the clinical goals of its AIDS program is long overdue.’€

Bush’s trade agenda has also focused on increasing patent rights for drug companies, even in poor countries, where patent monopolies result in higher cost and decreased access.

In Nigeria and Uganda the US has pressured local officials to enact national patent policies that exceed the strict rules of the WTO and would restrict countries’ rights to break patent monopolies to reduce medicines cost.

Sachs holds out no hopes for the Bush visit leading to any meaningful spin offs for the continent. ‘€œI can’€™t see any serious development assistance coming from his visit. He will be more interested in the photo opportunities, paying attention to terrorism and talking about the oil resources off the West Coast of Africa.’€

Amid all the spin, one fact is certain. Once the Bush entourage has completed its victory lap around Africa and the drums have fallen silent, several hundred Africans would have died of raging diseases that affordable drugs could have cured.

About the author

Anso Thom