Global Fund director admits to $8bn shortfall

BMJ 2002; 325 doi: (Published 20 July 2002) Cite this as: BMJ 2002;325:121
  1. Alex Vass
  1. BMJ

    The Global Fund, which was set up to fight AIDS, tuberculosis, and malaria, needs a huge increase in resources and it needs it quickly, said its executive director, Dr Richard Feacham, speaking to delegates at the 14th international AIDS conference, held in Barcelona last week.

    He said the $1.8bn (£1.2bn; €1.8bn) secured by the fund this year was “nothing like enough, but it is a start.”

    The fund, which was set up in 2001, is widely expected to need $8bn to $10bn a year to meet the challenges of the three diseases.

    Former US president Bill Clinton, speaking at the close of the conference, said that wealthy nations should “figure out and pay their share.” He estimated that the United States owes the fund just under $2bn.

    Throughout the conference AIDS activists voiced criticisms of the US government and other governments for not committing more money to the fund.

    US health secretary Tommy Thompson was shouted down at the start of his address over his country's level of contribution. Backstage afterwards he told reporters that campaigners should vent their anger on the rest of the world.

    The United States has contributed $450m to the fund this year—25% of the total pledged. The United Kingdom gave $200m, and the Bill and Melinda Gates Foundation was the largest private contributor, pledging $100m.

    While the idea of the fund has been broadly welcomed, there is widespread doubt that it can secure the resources to live up to its expectations. Concerns have been expressed that some governments have put pressure on organisations not to apply to the fund.

    The first pledges to the fund this year totalled $1.6bn, to be spent over the next five years. Of this sum $616m has been committed immediately, for 58 projects in 38 countries. More than 60% of the funding is for Africa and nearly 70% for projects addressing HIV/AIDS. Importantly, prevention as well as treatment programmes are being funded.

    Delegates were told that the grants would double the number of people in developing countries receiving antiretroviral drugs, including a sixfold increase in the current provision in Africa. But with just 30000 people in Africa with access to antiretrovirals now, out of an estimated 28 million infected people, this increase is seen as a drop in the ocean.

    The importance of treatment was echoed in the closing speech, by former South African president Nelson Mandela.

    “We must find ways and means to make life saving treatment available to all who need it, regardless of whether they can pay or where they live,” he said. “Many people who suffer from HIV are not killed by the disease itself but by the stigma that surrounds it.”

    He added, “People must not be afraid of speaking out. When you keep quiet you are signing your own death warrant. The best thing to do is to be frank and say, ‘I have this disease.’”

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    Campaigners in Barcelona last week demand help for developing countries to tackle AIDS


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